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NASA NTRSDate not supplied

Countermeasures for Mitigation of Sensorimotor Decrements Following Head-Down Bed Rest

BACKGROUND Astronauts experience postflight disturbances in postural and locomotor control due to sensorimotor adaptations during spaceflight. These alterations may have adverse consequences if a rapid egress is required after landing. Although exercise is partially effective for mitigating cardiovascular and muscular deconditioning, additional countermeasures are needed to further preserve sensorimotor function for exploration missions. We have identified proprioceptive training and electrical muscle stimulation (EMS) as promising in-flight countermeasures. Since prolonged head down bed rest (HDBR) is a spaceflight analog for body unloading and causes postural and locomotor control decrements that parallel those observed after spaceflight, it can be used to facilitate the development of these countermeasures. METHODS This study will determine the effects of proprioceptive training and EMS on functional task performance and sensorimotor function following 60 days of 6° HDBR. Subjects will be randomly assigned to one of four groups: 1)an EMS arm, 2) a proprioceptive training arm, 3) an exercise plus proprioceptive training arm, and 4) a control arm. The EMS countermeasure will include daily bilateral stimulation of selected bilateral lower extremity muscles (30 minutes per session). Proprioceptive training will be performed three days per week (20 minutes per session) consisting of body-loaded postural tasks in the horizontal position on an air bearing sled. Exercise training will mimic current protocols used on the International Space Station, but treadmill aerobic exercise will be replaced with additional cycling aerobic exercise. Primary outcome measures will include pre and post HDBR functional tests that are representative of high priority exploration mission tasks and require high demand for dynamic control of postural stability. Additional measures will be used to identify the key physiological factors contributing to countermeasure benefits. Given the constrained samples size, a Bayesian modelling approach will be used to quantify the probability that there is an effect of a given magnitude. HARDWARE AND PROTOCOL DEVELOPMENT Proprioceptive countermeasure design enhancements continued as part of the Mars Campaign Office (MCO) Crew Health and Performance (CHP) Crew Health Countermeasures (CHC). The primary goals of this work were to assemble a portable version of the countermeasure system that can be used at the :envihab facility, expand the software feedback system’s capabilities, and develop an actuator loading system that mimics what could be used on the International Space Station. In addition, one major piece of exercise hardware used in previous HDBR studies, the Horizontal Squat Device, was reassembled and restored to full functionality. Human-in-the-loop pilot testing is ongoing, prior to shipping both devices to the :envihab HDBR facility. Evaluations are also underway for the best EMS device technologies and specific methods. Finally, assessment techniques are being translated for administration in the horizontal position (e.g., leg dexterity and foot sole skin sensitivity). Our current goals are to refine the countermeasure training and assessment techniques and integrate protocols across multiple modalities. RELEVANCE The deliverable from this project will be proof-of-concept sensorimotor countermeasure designs for functional task performance with full assessment of efficacy in a spaceflight analog. If one or more countermeasures are effective, they will be translated for validation with the suite of operationally implemented in-flight countermeasures. ACKNOWLEDGEMENT This work is supported by NASA’s Human Research Program Human Health Countermeasures Element and by the Canadian Space Agency (L. Bent).

T R Macaulay↗
NASA NTRS2014

How HRP Research Results Contribute to Human Space Exploration Risk Mitigation

In addition to the scientific value of publications derived from research, results from Human Research Program (HRP) research also support HRP’s goals of mitigating crew health and performance risks in space flight. Research results are used to build the evidence base characterizing crew health and performance risks, to support risk research plan development, to inform crew health and performance standards, and to provide technologies to programs for meeting those standards and optimizing crew health and performance in space. This talk will describe examples of how research results support these efforts. For example, HRP research results are used to revise or even create new standards for human space flight, which have been established to protect crew health and performance during flight, and prevent negative long-term health consequences due to space flight. These standards are based on the best available clinical and scientific evidence, as well as operational experience from previous space flight missions, and are reviewed as new evidence emerges. Research results are also used to update the HRP evidence base, which is comprised of a set of reports that provide a current record of the state of knowledge from research and operations for each of the defined human health and performance risks for future NASA exploration missions. A discussion of the role of evidence within the HRP architecture will also be presented. The scope of HRP research results extends well beyond publications, as they are used in several capacities to support HRP deliverables and, ultimately, the advancement of human space exploration beyond low-Earth orbit.

Lumpkins, S. B.↗
NASA NTRS2014

How HRP Research Results Contribute to Human Space Exploration Risk Mitigation

In addition to the scientific value of publications derived from research, results from Human Research Program (HRP) research also support HRP's goals of mitigating crew health and performance risks in space flight. Research results are used to build the evidence base characterizing crew health and performance risks, to support risk research plan development, to inform crew health and performance standards, and to provide technologies to programs for meeting those standards and optimizing crew health and performance in space. This talk will describe examples of how research results support these efforts. For example, HRP research results are used to revise or even create new standards for human space flight, which have been established to protect crew health and performance during flight, and prevent negative long-term health consequences due to space flight. These standards are based on the best available clinical and scientific evidence, as well as operational experience from previous space flight missions, and are reviewed as new evidence emerges. Research results are also used to update the HRP evidence base, which is comprised of a set of reports that provide a current record of the state of knowledge from research and operations for each of the defined human health and performance risks for future NASA exploration missions. A discussion of the role of evidence within the HRP architecture will also be presented. The scope of HRP research results extends well beyond publications, as they are used in several capacities to support HRP deliverables and, ultimately, the advancement of human space exploration beyond low-Earth orbit.

Lumpkins, Sarah↗
NASA NTRSDate not supplied

Clinical Decision Support - Concepts of Operation

We are entering a new era in space exploration to return to the moon and explore Mars. Crew members operating independently during long duration space exploration missions will require a clinical decision support system (CDSS) to increase autonomy by augmenting their knowledge, skills and abilities in different scenarios. Significant changes to in-flight and habitat medical care due to constraints on mass, volume, power, crew time and medical evacuation capabilities are needed to increase crew autonomy and self-reliance in decision making and task performance. The Exploration Medical Capability (ExMC) Element of the Human Research Program (HRP) pushes the boundary of space medical systems to advance the care of astronauts on future exploration missions beyond low Earth orbit by identifying and testing next-generation medical care and crew health maintenance technologies. Clinical decision support (CDS) presents knowledge and data in a context aware manner to augment a crew members’ knowledge, skills and abilities during the process of observation, orientation, decisions and action. A comprehensive crew health and performance CDSS is required to augment crew capability and will be used in different scenarios for several reasons. In general, the CDSS’s role is to assist the crew in prevention, detection, diagnosis and treatment of crew health and performance related conditions that may arise in exploration spaceflight. For example, CDSS would assist a high acuity scenario such as a heart attack by supplying clear instructions, vital signs and treatment reminders. A lower severity scenario such as kidney stone risk could interface to vehicle systems and display more complex predictive data during a diagnosis. A CDSS needs to contribute to successful missions by maintaining a high performing crew who can potentially exhibit countless medical conditions related to derangements from the space environment (sleep, cognition, nutrition and exercise) as well as conditions intrinsic to humans anywhere. While supporting the crew’s ability to make sound clinical decisions is desirable in any mission, it is essential for exploration missions with significant communication delays, no evacuation capability, and extended exposure to the flight environment. Such missions correspond with medical Level of Care V (LOC V), the highest level specified in NASA-STD-3001. The project focuses on CDS implementation research to derive requirements for LOC V, where the need for increased autonomy results in new practices and the inclusion of non-clinical data, such as vehicle environmental measures and physical exercise results, from other human and vehicle domains and advanced analytics. The CDS project describes how the CDSS is intended to be used by defining concepts of operations (ConOps). The process to derive ConOps focuses on increased autonomy that reduces the likelihood and consequences of accepted medical conditions. These crew health and performance inputs are grouped by common datasets and analysis models. Use cases are derived to research new clinical scenarios, architectural development and workflows. Implementation research is conducted with protypes to inform assumptions and derive requirements. The project also establishes how externally developed analysis and approaches can be added to expand a clinical decision support system and thus highlight how a comprehensive system can be globally developed with collaborators. This presentation will cover example scenarios from the CDS ConOps and the method to derive them. One example scenario will be CDSS alerting an increased kidney stone risk during a mission, with diagnosis and treatment options provided during the intervention.

clinical decision support↗
NASA NTRSDate not supplied

Clinical Decision Support - Concepts of Operation

We are entering a new era in space exploration to return to the moon and explore Mars. Crew members operating independently during long duration space exploration missions will require a clinical decision support system (CDSS) to increase autonomy by augmenting their knowledge, skills and abilities in different scenarios. Significant changes to in-flight and habitat medical care due to constraints on mass, volume, power, crew time and medical evacuation capabilities are needed to increase crew autonomy and self-reliance in decision making and task performance. The Exploration Medical Capability (ExMC) Element of the Human Research Program (HRP) pushes the boundary of space medical systems to advance the care of astronauts on future exploration missions beyond low Earth orbit by identifying and testing next-generation medical care and crew health maintenance technologies. Clinical decision support (CDS) presents knowledge and data in a context aware manner to augment a crew members’ knowledge, skills and abilities during the process of observation, orientation, decisions and action. A comprehensive crew health and performance CDSS is required to augment crew capability and will be used in different scenarios for several reasons. In general, the CDSS’s role is to assist the crew in prevention, detection, diagnosis and treatment of crew health and performance related conditions that may arise in exploration spaceflight. For example, CDSS would assist a high acuity scenario such as a heart attack by supplying clear instructions, vital signs and treatment reminders. A lower severity scenario such as kidney stone risk could interface to vehicle systems and display more complex predictive data during a diagnosis. A CDSS needs to contribute to successful missions by maintaining a high performing crew who can potentially exhibit countless medical conditions related to derangements from the space environment (sleep, cognition, nutrition and exercise) as well as conditions intrinsic to humans anywhere. While supporting the crew’s ability to make sound clinical decisions is desirable in any mission, it is essential for exploration missions with significant communication delays, no evacuation capability, and extended exposure to the flight environment. Such missions correspond with medical Level of Care V (LOC V), the highest level specified in NASA-STD-3001. The project focuses on CDS implementation research to derive requirements for LOC V, where the need for increased autonomy results in new practices and the inclusion of non-clinical data, such as vehicle environmental measures and physical exercise results, from other human and vehicle domains and advanced analytics. The CDS project describes how the CDSS is intended to be used by defining concepts of operations (ConOps). The process to derive ConOps focuses on increased autonomy that reduces the likelihood and consequences of accepted medical conditions. These crew health and performance inputs are grouped by common datasets and analysis models. Use cases are derived to research new clinical scenarios, architectural development and workflows. Implementation research is conducted with protypes to inform assumptions and derive requirements. The project also establishes how externally developed analysis and approaches can be added to expand a clinical decision support system and thus highlight how a comprehensive system can be globally developed with collaborators. This presentation will cover example scenarios from the CDS ConOps and the method to derive them. One example scenario will be CDSS alerting an increased kidney stone risk during a mission, with diagnosis and treatment options provided during the intervention.

clinical decision support↗
NASA NTRS2023

Intravenous Fluid Generation Mini (IVGEN Mini) Summary and Related Research

This paper assists the ongoing effort to support NASA Glenn’s mission and its Human Research Program (HRP) core competency by investigating a technology demonstration to mitigate human health and performance risks during space exploration. Crew health and performance are critical to successful human exploration beyond low Earth orbit. Four hundred forty-two medical conditions have been identified and may present and require treatment during long-duration space exploration missions. One hundred fifteen out of four hundred forty-two identified medical conditions would require medical fluid treatment, generating a need for an on-demand or continuous supply of medical fluid. Intravenous Fluid Generation Mini (IVGEN Mini) is a technology demonstration designed to demonstrate a water purification and pharmaceutical mixing system that can make intravenous (IV) fluid in microgravity and builds on the success of the original Intravenous Fluid Generation for Exploration Missions (IVGEN) experiment, which flew on the ISS in March 2010. IVGEN Mini seeks to increase the Technology Readiness Level (TRL) and the overall function of the original IVGEN experiment to reduce the dependence of a needed medical consumable and streamline the size of the device and process to generate IV fluid IVGEN Mini is funded by the Advanced Exploration Systems (AES) directorate via the Exploration Medical Integrated Product Team (XMIPT) as a part of their mission to advance exploration medical technologies to benefit the overall health and safety of crews for beyond low Earth orbit space missions. This paper discusses a collection of related research topics such as microgravity fluid mixing and studying past efforts of IV fluid usage in extreme environments to aid IVGEN Mini project scientists in developing the IVGEN Mini technology.

iv generation↗
NASA NTRSDate not supplied

Proof-of-Concept for a Long-Term Health Metric to Quantify End of Mission Health Status in Astronauts

NASA has long used Probabilistic Risk Assessment (PRA) when high-stakes decisions need to be made about complex systems. For spaceflight medical risk, the Human Research Program’s Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) is a significant step towards robustly quantifying the risk to crew health during exploration missions. However, there remains a significant gap in the ability to comprehensively characterize and assess risk across the disparate functionalities and capabilities which comprise the entire Crew Health and Performance (CHP) system. To fill this gap, the Crew Health and Performance – Probabilistic Risk Assessment (CHP-PRA) project aims to perform risk characterization for the CHP system by assessing performance risk in addition to medical risk. This effort also includes quantifying Long-Term Health (LTH) risk in addition to in-mission risk outcomes within the CHP-PRA results. LTH risk encompasses the timeframe from immediately post-flight, through the rest of an astronaut’s career, through retirement, and until death. A proof-of-concept LTH risk metric is based on medical condition end-state, as defined by the Evidence Library, capturing the spaceflight specific medical impacts persisting into post-flight[1]. Condition outcomes in the Evidence Library progress through three Clinical Phases (CP): the diagnostic phase (CP1), the treatment/convalescent phase (CP2), and the end-state phase (CP3) which represents the detrimental effects of the condition after the crew member has recovered to the maximal extent. Each CP has an associated Task Impairment (TI), defined as the degree of crew incapacity due to experiencing the condition, and is quantified with a 0-1 range. Conditions with an associated CP3 (e.g. Sepsis, Traumatic Hypovolemic Shock, Sudden Cardiac Arrest, etc.) typically have serious consequences that can cause an astronaut to be fully or partially debilitated throughout the remainder of the mission. Consequently, the Cumulative CP3 TI End-of-Mission Health Status Metric is developed by CHP-PRA to quantify the cumulative effects of all conditions which progressed to the CP3 state throughout the entirety of the mission. Hence, this End-of-Mission Health Status Metric attempts to serve as an indicator of an astronaut’s health state at the time of landing. The severity of the lingering effects of in-mission medical events are dependent on mission activities and the level of available in-mission medical care. This allows the associated cumulative TI metric to be used in comparison with the crew’s end of mission health status for different levels of in-mission resources. This presentation provides the strategy for using CP3 as an LTH metric component, as well as a proof-of-concept demonstration of LTH risk characterization using this component.

long term health↗
NASA NTRSDate not supplied

Clinical Decision Support - Overview and Update

We are entering a new era in space exploration to return to the moon and explore Mars. These ambitious goals will require significant changes to in-flight and habitat medical care due to constraints on mass, volume, power, crew time and medical evacuation capabilities. These constraints make it absolutely necessary to develop transformative solutions using new technologies. The Exploration Medical Capability (ExMC) Element of the Human Research Program (HRP) pushes the boundary of space medical systems to advance the care of astronauts on future exploration missions beyond low Earth orbit by identifying and testing next-generation medical care and crew health maintenance technologies. The Clinical Decision Support (CDS) project addresses the gap Medical-701 within the Inflight Medical Conditions risk: Enhance medical capabilities within an exploration medical system. For long-duration, deep space missions, computational and data resources will play an important role in maintaining crew health, wellness and performance where the crew will need to be more self-reliant. The aim of the CDS project is to develop and provide recommended requirements for an in-vehicle CDSS that acts as an assistant for delivering optimal health and performance and medical care during exploration missions. The CDSS is envisioned as a software-based tool that will augment a crewmembers’ knowledge, skills and abilities to assist in decision-making and crew health and performance (CHP) management thus increasing CHP systems capabilities. The human interface will be context aware and lessen the cognitive load to assimilate and use information as well as combine large disparate data sets in such a manner that provides the crew with actionable insight to decisions related to crew medical, health and performance management. Crew autonomy will be provided through a CDS that presents knowledge and data in a context aware manner to augment a crew members’ knowledge, skills and abilities during the process of observation, orientation, decisions and action. The CDS project addresses the need for crew members to operate independently during long duration space exploration missions that require medical Levels of Care (LoC) V, the highest level specified by NASA-STD-3001 and described in more detail by the ExMC interpretation of LoC document (NASA/TM-2017-219290), where significant changes to in-flight and habitat medical care necessitate increasing crew autonomy in decision making and task performance. The CDS project will develop and test a series of iterative and increasingly more complex system prototypes. These annual demonstrations of the data system integration with the crew health and performance domain will inform exploration medical system requirements for an on-board Clinical Decision Support System (CDSS) through a series of use cases that guide CDS prototype functionality. CDS concepts are based on ExMC Concept of Operations documents (presented separately) and will highlight architecture extensibility to other more complex analyses and tests using core crew health and performance integrated data management, processing and visualization capabilities. This approach also establishes how externally developed analyses and approaches could be added to expand a clinical decision support system and thus highlight how a comprehensive system can be commercially and/or globally developed. The CDS project will build upon the concept of an integrated data management approach based on the Medical Data Architecture (MDA) project to more fully address challenges associated with in-flight and habitat medical, health and performance care due to constraints on mass, volume, power, crew time and medical evacuation capabilities required for medical LoC V. These requirements will be derived through systems engineering approaches and software prototype developments over the course of the multi-year CDS project to address crew health and performance decision-making and task performance, often autonomously executed by the crew, in a manner that is consistent with the appropriate medical level of care for the mission. This presentation will provide an overview of the vision for the CDS project and highlight the initial accomplishments in project planning, implementation and requirements identification in fiscal year 2020.

clinical decision support system↗
NASA NTRSDate not supplied

Clinical Decision Support - Concepts of Operation

We are entering a new era in space exploration to return to the moon and explore Mars. These ambitious goals will require significant changes to in-flight and habitat medical care due to constraints on mass, volume, power, crew time and medical evacuation capabilities. These constraints make it absolutely necessary to develop transformative solutions using new technologies. The Exploration Medical Capability (ExMC) Element of the Human Research Program (HRP) pushes the boundary of space medical systems to advance the care of astronauts on future exploration missions beyond low Earth orbit by identifying and testing next-generation medical care and crew health maintenance technologies. The Clinical Decision Support (CDS) project addresses the gap Medical-701 within the Inflight Medical Conditions risk: Enhance medical capabilities within an exploration medical system. For long-duration, deep space missions, computational and data resources will play an important role in maintaining crew health, wellness and performance where the crew will need to be more self-reliant. The aim of the CDS project is to develop and provide recommended requirements for an in-vehicle CDSS that acts as an assistant for delivering optimal health and performance and medical care during exploration missions. The CDSS is envisioned as a software-based tool that will augment a crewmembers’ knowledge, skills and abilities to assist in decision-making and crew health and performance (CHP) management thus increasing CHP systems capabilities. The human interface will be context aware and lessen the cognitive load to assimilate and use information as well as combine large disparate data sets in such a manner that provides the crew with actionable insight to decisions related to crew medical, health and performance management. Crew autonomy will be provided through a CDS that presents knowledge and data in a context aware manner to augment a crew members’ knowledge, skills and abilities during the process of observation, orientation, decisions and action. The CDS project addresses the need for crew members to operate independently during long duration space exploration missions that require medical Levels of Care (LoC) V, the highest level specified by NASA-STD-3001 and described in more detail by the ExMC interpretation of LoC document (NASA/TM-2017-219290), where significant changes to in-flight and habitat medical care necessitate increasing crew autonomy in decision making and task performance. The CDS project will develop and test a series of iterative and increasingly more complex system prototypes. These annual demonstrations of the data system integration with the crew health and performance domain will inform exploration medical system requirements for an on-board Clinical Decision Support System (CDSS) through a series of use cases that guide CDS prototype functionality. CDS concepts are based on ExMC Concept of Operations documents (presented separately) and will highlight architecture extensibility to other more complex analyses and tests using core crew health and performance integrated data management, processing and visualization capabilities. This approach also establishes how externally developed analyses and approaches could be added to expand a clinical decision support system and thus highlight how a comprehensive system can be commercially and/or globally developed. The CDS project will build upon the concept of an integrated data management approach based on the Medical Data Architecture (MDA) project to more fully address challenges associated with in-flight and habitat medical, health and performance care due to constraints on mass, volume, power, crew time and medical evacuation capabilities required for medical LoC V. These requirements will be derived through systems engineering approaches and software prototype developments over the course of the multi-year CDS project to address crew health and performance decision-making and task performance, often autonomously executed by the crew, in a manner that is consistent with the appropriate medical level of care for the mission. This presentation will provide an overview of the vision for the CDS project and highlight the initial accomplishments in project planning, implementation and requirements identification in fiscal year 2020.

clinical decision support↗
NASA NTRSDate not supplied

Datascope to Enable Earth Independent Medical Operations (EIMO)

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

Medical operations↗
NASA NTRS2015

Addressing Human System Risks to Future Space Exploration

NASA is contemplating future human exploration missions to destinations beyond low Earth orbit, including the Moon, deep-space asteroids, and Mars. While we have learned much about protecting crew health and performance during orbital space flight over the past half-century, the challenges of these future missions far exceed those within our current experience base. To ensure success in these missions, we have developed a Human System Risk Board (HSRB) to identify, quantify, and develop mitigation plans for the extraordinary risks associated with each potential mission scenario. The HSRB comprises research, technology, and operations experts in medicine, physiology, psychology, human factors, radiation, toxicology, microbiology, pharmacology, and food sciences. Methods: Owing to the wide range of potential mission characteristics, we first identified the hazards to human health and performance common to all exploration missions: altered gravity, isolation/confinement, increased radiation, distance from Earth, and hostile/closed environment. Each hazard leads to a set of risks to crew health and/or performance. For example the radiation hazard leads to risks of acute radiation syndrome, central nervous system dysfunction, soft tissue degeneration, and carcinogenesis. Some of these risks (e.g., acute radiation syndrome) could affect crew health or performance during the mission, while others (e.g., carcinogenesis) would more likely affect the crewmember well after the mission ends. We next defined a set of design reference missions (DRM) that would span the range of exploration missions currently under consideration. In addition to standard (6-month) and long-duration (1-year) missions in low Earth orbit (LEO), these DRM include deep space sortie missions of 1 month duration, lunar orbital and landing missions of 1 year duration, deep space journey and asteroid landing missions of 1 year duration, and Mars orbital and landing missions of 3 years duration. We then assessed the likelihood and consequences of each risk against each DRM, using three levels of likelihood (Low: less than or equal to 0.1%; Medium: 0.1%–1.0%; High: greater than or equal to 1.0%) and four levels of consequence ranging from Very Low (temporary or insignificant) to High (death, loss of mission, or significant reduction to length or quality of life). Quantitative evidence from clinical, operational, and research sources were used whenever available. Qualitative evidence was used when quantitative evidence was unavailable. Expert opinion was used whenever insufficient evidence was available. Results: A set of 30 risks emerged that will require further mitigation efforts before being accepted by the Agency. The likelihood by consequence risk assessment process provided a means of prioritizing among the risks identified. For each of the high priority risks, a plan was developed to perform research, technology, or standards development thought necessary to provide suitable reduction of likelihood or consequence to allow agency acceptance. Conclusion: The HSRB process has successfully identified a complete set of risks to human space travelers on planned exploration missions based on the best evidence available today. Risk mitigation plans have been established for the highest priority risks. Each risk will be reassessed annually to track the progress of our risk mitigation efforts.

Paloski, W. H.↗
NASA NTRSDate not supplied

CHP-PRA: Sensorimotor Countermeasures Proof of Concept

The capabilities included in Crew Health and Performance (CHP) systems are designed to keep the crew healthy, happy, and productive. In doing so, the CHP system allows reductions in human related risks to be realized. All human missions, though particularly future Artemis and Mars missions, have constraints on the mass and volume allocated to the CHP system. Thus, trades must be made on how to best buy down risk while still meeting other requirements. Understanding how different CHP capabilities influence medical, performance, and long-term health risks is key to making informed choices among these trades. To address this, an integrated CHP Probabilistic Risk Assessment (PRA) model is being developed. Much like how IMPACT is designed to allow medical resource trades informed by medical risks, CHP PRA will enable analogous trades in human system risks across all CHP functions and capabilities. There are 29 Human System Risk Board (HSRB) risk areas to consider for model implementation. This effort focused solely on the implementation of countermeasures associated with sensorimotor risk. The framework and lessons learned from this proof of concept will benefit the implementation of other risks and countermeasures. Astronauts experience sensorimotor changes when entering or exiting a microgravity environment. While most sensorimotor issues are resolved within a few days, they pose a serious risk to crew health and performance during the adaptation period. This adaptation period aligns with gravity transitions and key mission phases where the crew members may be required to complete challenging tasks ideally with an undisturbed sensorimotor system. Countermeasures such as training or pharmaceuticals can be used to mitigate risk. This effort began by identifying physiological changes to the sensorimotor system that could lead to functional performance decrements or medical conditions and potential countermeasures, so that the overall effect of sensorimotor disturbance on human risk could be captured. We then selected example countermeasures, mapped relationships between countermeasures and outcomes, and used results from existing sensorimotor investigations to define the relationship between a sensorimotor countermeasure and subsequent performance of a sensorimotor-affected task. Specifically, using shuttle landing performance data, we compared the use or absence of inflight training capabilities to yield a relative performance change that can be applied to the prediction of the risk associated with manual control performance in future missions, as depicted in the figure. This sensorimotor proof of concept demonstrates how HRP research information can be transformed into quantifiable relationships to describe changes in HSRB medical and performance risks.

Caroline R Austin↗
NASA NTRS2018

Exploration Medical System Technical Architecture Overview

The Exploration Medical Capability (ExMC) Element Systems Engineering (SE) goals include defining the technical system needed to support medical capabilities for a Mars exploration mission. A draft medical system architecture was developed based on stakeholder needs, system goals, and system behaviors, as captured in an ExMC concept of operations document and a system model. This talk will discuss a high-level view of the medical system, as part of a larger crew health and performance system, both of which will support crew during Deep Space Transport missions. Other mission components, such as the flight system, ground system, caregiver, and patient, will be discussed as aspects of the context because the medical system will have important interactions with each. Additionally, important interactions with other aspects of the crew health and performance system are anticipated, such as health & wellness, mission task performance support, and environmental protection. This talk will highlight areas in which we are working with other disciplines to understand these interactions.

Cerro, J.↗
NASA NTRS2009

Microbial Risk Assessment

Historically, microbiological spaceflight requirements have been established in a subjective manner based upon expert opinion of both environmental and clinical monitoring results and the incidence of disease. The limited amount of data, especially from long-duration missions, has created very conservative requirements based primarily on the concentration of microorganisms. Periodic reevaluations of new data from later missions have allowed some relaxation of these stringent requirements. However, the requirements remain very conservative and subjective in nature, and the risk of crew illness due to infectious microorganisms is not well defined. The use of modeling techniques for microbial risk has been applied in the food and potable water industries and has exceptional potential for spaceflight applications. From a productivity standpoint, this type of modeling can (1) decrease unnecessary costs and resource usage and (2) prevent inadequate or inappropriate data for health assessment. In addition, a quantitative model has several advantages for risk management and communication. By identifying the variable components of the model and the knowledge associated with each component, this type of modeling can: (1) Systematically identify and close knowledge gaps, (2) Systematically identify acceptable and unacceptable risks, (3) Improve communication with stakeholders as to the reasons for resource use, and (4) Facilitate external scientific approval of the NASA requirements. The modeling of microbial risk involves the evaluation of several key factors including hazard identification, crew exposure assessment, dose-response assessment, and risk characterization. Many of these factors are similar to conditions found on Earth; however, the spaceflight environment is very specialized as the inhabitants live in a small, semi-closed environment that is often dependent on regenerative life support systems. To further complicate modeling efforts, microbial dose-response characteristics may be affected by a potentially dysfunctional crew immune system during a mission. In addition, microbial virulence has been shown to change under certain conditions during spaceflight, further complicating dose-response characterization. An initial study of the applicability of microbial risk assessment techniques was performed using Crew Health Care System (CHeCS) operational data from the International Space Station potable water systems. The risk of infection from potable water was selected as the flight systems and microbial ecology are well defined. This initial study confirmed the feasibility of using microbial risk assessment modeling for spaceflight systems. While no immediate threat was detected, the study identified several medically significant microorganisms that could pose a health risk if uncontrolled. The study also identified several specific knowledge gaps in making a risk assessment and noted that filling these knowledge gaps is essential as the risk estimates may change by orders of magnitude depending on the answers. The current phase of the microbial risk assessment studies focuses on the dose-response relationship of specific infectious agents, focusing on Salmonella enterica Typhimurium, Pseudomonas spp., and Escherichia coli, as their evaluation will provide a better baseline for determining the overall hazard characterization. The organisms were chosen as they either have been isolated on spacecraft or have an identified route of infection during a mission. The characterization will utilize dose-response models selected either from the peer-reviewed literature and/or by using statistical approaches. Development of these modeling and risk assessment techniques will help to optimize flight requirements and to protect the safety, health, and performance of the crew.

Ott, C. M.↗
NASA NTRSDate not supplied

Conclusions of A Mini Technical Interchange Meeting on New Cross Risk Integration Projects Managed By the NASA Space Radiation Element

To enable deep space exploration and sustained human presence in space, the NASA Human Research Program’s (HRP) Space Radiation Element (SRE) funds research to characterize and mitigate adverse health outcomes from exposure to space radiation. Recently, the Space Radiation Element was tasked with supporting multiple HRP Elements with innovative and enabling projects to inform risk characterization, facilitate mitigation activities, and support crew health and performance. These projects, such as precision health initiative, NASA Omics Archive (NOA) and human sample repositories, are agnostic to any HRP Element, hence the name, Cross Risk Integration Projects (CRIP). CRIP serves three broad purposes: Services: Generate samples/data or manage the receipt, inventory, archive and ultimate redistribution of biospecimens created in HRP-funded spaceflight and analog research activities – includes NASA Omics Archive (NOA) project and various human and animal sample repositories. Method Development: Identify and evaluate, new-to-NASA research or analysis methods or techniques – includes TRRaC (Translational Radiation Research and Countermeasures) Project. Enabling Capabilities: Demonstrate real world application by adapting, adopting and/or developing capabilities to benefit crew health & performance and improve risk – includes Precision Health Initiative (Pharmacogenomics) and advanced biological systems and engineered tissue microsystems initiative (tissue chips, organ-on-a-chip). To identify new technologies, future work, and solicitations, the SRE organizes themed sessions at annual HRP Investigators’ Workshops (IWS). These technical interchange meetings (TIMs) provide a venue for the scientific community to present ongoing work and engage in open discussion, limitations of current approaches, and incorporation of novel experimental strategies and other innovative techniques. Here a summary and lessons learned from the SRE-sponsored mini-TIM titled “Space Radiation Cross Risk Integrations Projects” at HRP IWS 2024 will be communicated. The 90-min TIM had 6 speakers who presented impressive novel ideas and work This poster presents the outcomes of the session along with proposed future workshops and other SRE initiatives.

Janapriya Saha↗
NASA NTRS2013

Apollo Medical Operations Project: Recommendations for EVA and Lunar Surface Operations

The potential risk of injury to crewmembers is inherent in aggressive surface activities, whether they be Moon-, Mars-, or asteroid-based. In December 2005, the Space Medicine Division at JSC requested a study to identify Apollo mission issues that had an impact to crew health or performance or both. This talk focused on the Apollo EVA suit and lunar surface operations concerning crew health and performance. There were roughly 20 recommendations from this study of Apollo for improving these two areas for future exploration missions, a few of which were incorporated into the Human Systems Integration Requirements (HSIR). Dr. Richard Scheuring covered these topics along with some of the analog work that has been done regarding surface operations and medical contingencies.

Scheuring, R. A.↗
NASA NTRS2005

Operational behavioral health and performance resources for international space station crews and families

The Behavioral Health and Performance Section (BHP) at NASA Johnson Space Center provides direct and indirect psychological services to the International Space Station (ISS) astronauts and their families. Beginning with the NASA-Mir Program, services available to the crews and families have gradually expanded as experience is gained in long-duration flight. Enhancements to the overall BHP program have been shaped by crewmembers' personal preferences, family requests, specific events during the missions, programmatic requirements, and other lessons learned. The BHP program focuses its work on four areas: operational psychology, behavioral medicine, human-to-system interface, and sleep and circadian. Within these areas of focus are psychological and psychiatric screening for astronaut selection as well as many resources that are available to the crewmembers, families, and other groups such as crew surgeon and various levels of management within NASA. Services include: preflight, in flight, and postflight preparation; training and support; resources from a Family Support Office; in-flight monitoring; clinical care for astronauts and their families; and expertise in the workload and work/rest scheduling of crews on the ISS. Each of the four operational areas is summarized, as are future directions for the BHP program.

Space Flight↗
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↗