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NASA NTRS2016

Exploration Laboratory Analysis

The Exploration Laboratory Analysis (ELA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the availability of inflight laboratory analysis instrumentation has been identified as an essential capability for manned exploration missions. Since a single, compact space-ready laboratory analysis capability to perform all exploration clinical measurements is not commercially available, the ELA project objective is to demonstrate the feasibility of emerging operational and analytical capability as a biomedical diagnostics precursor to long duration manned exploration missions. The initial step towards ground and flight demonstrations in fiscal year (FY) 2015 was the downselection of platform technologies for demonstrations in the space environment. The technologies selected included two Small Business Innovation Research (SBIR) performers: DNA Medicine Institute's rHEALTH X and Intelligent Optical System's lateral flow assays combined with Holomic's smartphone analyzer. The selection of these technologies were based on their compact size, breadth of analytical capability and favorable ability to process fluids in a space environment, among several factors. These two technologies will be advanced to meet ground and flight demonstration success criteria and requirements. The technology demonstrations and metrics for success will be finalized in FY16. Also, the downselected performers will continue the technology development phase towards meeting prototype deliverables in either late 2016 or 2017.

In-Flight laboratory↗
NASA NTRSDate not supplied

Implementation of a SysML Model-Based Concept of Operations for Level of Care IV: Long-Duration Lunar Orbital and Surface Operations

One goal of the Human Research Program (HRP) Exploration Medical Capability (ExMC) Element Systems Engineering (SE) team is to define the technical system needed to support crew medical system capabilities for future exploration missions, including orbital and surface operations for long duration lunar missions. This is accomplished through the development of a Medical System Foundation, which communicates medical system requirements, capabilities, conditions, and resources that define a starting point for a medical system that meets the specification for design reference missions and associated Levels of Care (as defined by NASA-STD-3001). The starting point for creating this Medical System Foundation Model is the development of a Concept of Operations (ConOps) that describes the operation of the system from the point of view of the users. It includes a comprehensive and thoroughly vetted list of the users, their specific needs, the goals of the system, key assumptions about the system, and definitions of the system’s operational environments. The use case scenarios included in the ConOps illustrate required medical system capabilities for Level of Care IV and enable the ExMC SE team to develop integrated medical system requirements and identify capabilities required to meet those requirements. For this “Long Duration” Medical System Foundation development effort, ExMC replaced the traditional document-based ConOps with a model-based ConOps using model-based systems engineering. This approach has several advantages, including the facilitation of more efficient understanding of the material through information-dense images with less opportunity for misinterpretation than text alone, the roll-out of changes to the ConOps to stakeholders in real-time as they are approved, and the consolidation of all salient information into one centralized location. This discussion will focus on both how the model represents the ConOps content and how the SE team utilized lessons learned in an agile environment to improve the way this information was created and presented to stakeholders.

M Kaetzer↗
NASA NTRSDate not supplied

Implementation of a SysML Model-Based Concept of Operations for Level of Care IV: Long-Duration Lunar Orbital and Surface Operations

One goal of the Human Research Program (HRP) Exploration Medical Capability (ExMC) Element Systems Engineering (SE) team is to define the technical system needed to support crew medical system capabilities for future exploration missions, including orbital and surface operations for long duration lunar missions. This is accomplished through the development of a Medical System Foundation, which communicates medical system requirements, capabilities, conditions, and resources that define a starting point for a medical system that meets the specification for design reference missions and associated Levels of Care (as defined by NASA-STD-3001). The starting point for creating this Medical System Foundation Model is the development of a Concept of Operations (ConOps) that describes the operation of the system from the point of view of the users. It includes a comprehensive and thoroughly vetted list of the users, their specific needs, the goals of the system, key assumptions about the system, and definitions of the system’s operational environments. The use case scenarios included in the ConOps illustrate required medical system capabilities for Level of Care IV and enable the ExMC SE team to develop integrated medical system requirements and identify capabilities required to meet those requirements. For this “Long Duration” Medical System Foundation development effort, ExMC replaced the traditional document-based ConOps with a model-based ConOps using model-based systems engineering. This approach has several advantages, including the facilitation of more efficient understanding of the material through information-dense images with less opportunity for misinterpretation than text alone, the roll-out of changes to the ConOps to stakeholders in real-time as they are approved, and the consolidation of all salient information into one centralized location. This discussion will focus on both how the model represents the ConOps content and how the SE team utilized lessons learned in an agile environment to improve the way this information was created and presented to stakeholders.

Mary Susan Kaetzer↗
NASA NTRS2016

Exploration Laboratory Analysis

The Exploration Laboratory Analysis (ELA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the availability of inflight laboratory analysis instrumentation has been identified as an essential capability for manned exploration missions. Since a single, compact space-ready laboratory analysis capability to perform all exploration clinical measurements is not commercially available, the ELA project objective is to demonstrate the feasibility of emerging operational and analytical capability as a biomedical diagnostics precursor to long duration manned exploration missions. The initial step towards ground and flight demonstrations in fiscal year (FY) 2015 was the down selection of platform technologies for demonstrations in the space environment. The technologies selected included two Small Business Innovation Research (SBIR) performers: DNA Medicine Institutes rHEALTH X and Intelligent Optical Systems later flow assays combined with Holomics smartphone analyzer. The selection of these technologies were based on their compact size, breadth of analytical capability and favorable ability to process fluids in a space environment, among several factors. These two technologies will be advanced to meet ground and flight demonstration success criteria and requirements that will be finalized in FY16. Also, the down selected performers will continue the technology development phase towards meeting prototype deliverables in either late 2016 or 2017.

Laboratory analysis↗
NASA NTRSDate not supplied

Developing a Medical System Concept of Operations for Level of Care IV: Long-Duration Lunar Orbital and Surface Operations

A goal of the Human Research Program (HRP) Exploration Medical Capability (ExMC) Element Systems Engineering (SE) team is to define the technical system needed to support crew medical system capabilities for future exploration missions, including a mission with lunar orbital and long duration surface operations. The medical system concept of operations (ConOps) is the starting point of creating a foundation for a medical system that meets Level of Care IV requirements, as defined by NASA’s space flight human-system standards. This ConOps illustrates how NASA can provide a Level of Care IV medical system for crews within the various cis-lunar orbit and lunar surface habitat environments. The use case scenarios included in this ConOps illustrate required medical system capabilities for Level of Care IV and enable the ExMC SE team to develop integrated medical system requirements and identify capabilities required to meet those requirements. This discussion will focus on how this concept of operations was constructed – by utilizing the lessons learned from ExMC’s existing Short-Duration Lunar Orbit Medical System Concept of Operations, by employing Model-Based Systems Engineering, and by collaborating with stakeholders in order to ensure the necessary assumptions were made.

M. Kaetzer↗
NASA NTRS2014

NASA Laboratory Analysis for Manned Exploration Missions

The Exploration Laboratory Analysis (ELA) project supports the Exploration Medical Capability Element under the NASA Human Research Program. ELA instrumentation is identified as an essential capability for future exploration missions to diagnose and treat evidence-based medical conditions. However, mission architecture limits the medical equipment, consumables, and procedures that will be available to treat medical conditions during human exploration missions. Allocated resources such as mass, power, volume, and crew time must be used efficiently to optimize the delivery of in-flight medical care. Although commercial instruments can provide the blood and urine based measurements required for exploration missions, these commercial-off-the-shelf devices are prohibitive for deployment in the space environment. The objective of the ELA project is to close the technology gap of current minimally invasive laboratory capabilities and analytical measurements in a manner that the mission architecture constraints impose on exploration missions. Besides micro gravity and radiation tolerances, other principal issues that generally fail to meet NASA requirements include excessive mass, volume, power and consumables, and nominal reagent shelf-life. Though manned exploration missions will not occur for nearly a decade, NASA has already taken strides towards meeting the development of ELA medical diagnostics by developing mission requirements and concepts of operations that are coupled with strategic investments and partnerships towards meeting these challenges. This paper focuses on the remote environment, its challenges, biomedical diagnostics requirements and candidate technologies that may lead to successful blood-urine chemistry and biomolecular measurements in future space exploration missions.

Laboratory Analysis↗
NASA NTRS2016

Conceptual Drivers for an Exploration Medical System

Interplanetary spaceflight, such as NASA's proposed three-year mission to Mars, provides unique and novel challenges when compared with human spaceflight to date. Extended distance and multi-year missions introduce new elements of operational complexity and additional risk. These elements include: inability to resupply medications and consumables, inability to evacuate injured or ill crew, uncharted psychosocial conditions, and communication delays that create a requirement for some level of autonomous medical capability. Because of these unique challenges, the approaches used in prior programs have limited application to a Mars mission. On a Mars mission, resource limitations will significantly constrain available medical capabilities, and require a paradigm shift in the approach to medical system design and risk mitigation for crew health. To respond to this need for a new paradigm, the Exploration Medical Capability (ExMC) Element is assessing each Mars mission phase-transit, surface stay, rendezvous, extravehicular activity, and return-to identify and prioritize medical needs for the journey beyond low Earth orbit (LEO). ExMC is addressing both planned medical operations, and unplanned contingency medical operations that meld clinical needs and research needs into a single system. This assessment is being used to derive a gap analysis and studies to support meaningful medical capabilities trades. These trades, in turn, allow the exploration medical system design to proceed from both a mission centric and ethics-based approach, and to manage the risks associated with the medical limitations inherent in an exploration class mission. This paper outlines the conceptual drivers used to derive medical system and vehicle needs from an integrated vision of how medical care will be provided within this paradigm. Keywords: (Max 6 keywords: exploration, medicine, spaceflight, Mars, research, NASA)

Antonsen, Erik↗
NASA NTRSDate not supplied

Medical Database Accomplishments and Lessons Learned - 2021

The Medical Database (MD) is a virtual repository consisting of two software components: the Medical Item Database (MedID) and the Evidence Library (EL). MedID consists of engineering data and associated information for specific medical resource items (e.g., pharmaceutical, medical devices, and supporting components), while the EL is a tool which provides all of the medical evidence necessary. The Medical Database will serve as the single “source of truth” for the Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool suite for both medical evidence and medical resource engineering data. It will be used in conjunction with the IMPACT tool suite to inform research prioritizations and perform systematic trade study evaluations using probabilistic risk assessment and simulated human spaceflight missions to aid stakeholders in making informed decisions during Pre-Phase-A planning of human spaceflight missions. The IMPACT project is conducted under the Exploration Medical Capability (ExMC) element of the Human Research Program (HRP), within NASA’s Human Exploration and Operations Mission Directorate. Over the past year, the MedID software has been successfully merged with the Evidence Library into one cohesive Medical Database with two independent user interface experiences for modifying either clinical evidence or resource engineering data. As MD has evolved substantially over the past year, a number of challenges have been encountered and overcome along the way. A number of ‘lessons learned’ and practical/logistical realizations have emerged which will be detailed in the forthcoming Medical Database presentation.

Exploration Medical Capability↗
NASA NTRS2017

Medical Optimization Network for Space Telemedicine Resources

INTRODUCTION: Long-duration missions beyond low Earth orbit introduce new constraints to the space medical system such as the inability to evacuate to Earth, communication delays, and limitations in clinical skillsets. NASA recognizes the need to improve capabilities for autonomous care on such missions. As the medical system is developed, it is important to have an ability to evaluate the trade space of what resources will be most important. The Medical Optimization Network for Space Telemedicine Resources was developed for this reason, and is now a system to gauge the relative importance of medical resources in addressing medical conditions. METHODS: A list of medical conditions of potential concern for an exploration mission was referenced from the Integrated Medical Model, a probabilistic model designed to quantify in-flight medical risk. The diagnostic and treatment modalities required to address best and worst-case scenarios of each medical condition, at the terrestrial standard of care, were entered into a database. This list included tangible assets (e.g. medications) and intangible assets (e.g. clinical skills to perform a procedure). A team of physicians working within the Exploration Medical Capability Element of NASA's Human Research Program ranked each of the items listed according to its criticality. Data was then obtained from the IMM for the probability of occurrence of the medical conditions, including a breakdown of best case and worst case, during a Mars reference mission. The probability of occurrence information and criticality for each resource were taken into account during analytics performed using Tableau software. RESULTS: A database and weighting system to evaluate all the diagnostic and treatment modalities was created by combining the probability of condition occurrence data with the criticalities assigned by the physician team. DISCUSSION: Exploration Medical Capabilities research at NASA is focused on providing a medical system to support crew medical needs in the context of a Mars mission. MONSTR is a novel approach to performing a quantitative risk analysis that will assess the relative value of individual resources needed for the diagnosis and treatment of various medical conditions. It will provide the operational and research communities at NASA with information to support informed decisions regarding areas of research investment, future crew training, and medical supplies manifested as part of the exploration medical system.

Shah, R. V.↗
NASA NTRSDate not supplied

Presenting Model-Based Systems Engineering Information to Non-Modelers

NASA’s Human Research Program’s (HRP) Exploration Medical Capability (ExMC) Element adopted Systems Engineering (SE) principles and Model Based Systems Engineering (MBSE) tools to capture the system functions, system architecture, requirements, interfaces, and clinical capabilities for a future exploration medical system. There are many different stakeholders who may use the information in the model: systems engineers, requirement engineers, clinicians (doctors, nurses, and pharmacists), scientists, and program managers. Many of these individuals do not have access to MBSE modeling toolsor have never used these tools. Many of these individuals (clinicians, scientists, even program managers)may have no experience with SE in general let alone interpreting a systems model. The challenge faced by ExMC was how to present the content in the model to non-modelers in a way they could understand with limited to no training in MBSE or the Systems Modeling Language (SysML) without using the modeling tool. Therefore, from the model, ExMC created an HTML report that is accessible to anyone with a browser. When creating the HTML report, the ExMC SE team talked to stakeholders and received their feedback on what content they wanted and how to display this content. Factoring in feedback, the report arranges the content in a way that not only directs readers through the SE process taken to derive the requirements, but also helps them to understand the fundamental steps in an SE approach. The report includes links to source information (i.e., NASA documentation that describes levels of care) and other SE deliverables (e.g., Concept of Operations). These links were provided to aid in the understanding of how the team created this content through a methodical SE approach. This paper outlines the process used to develop the model, the data chosen to share with stakeholders, many of the model elements used in the report, the review process stakeholders followed, the comments received from the stakeholders, and the lessons ExMC learned through producing this HTML report.

Jeff Cohen↗
NASA NTRSDate not supplied

Presenting Model-Based Systems Engineering Information to Non-Modelers

NASA’s Human Research Program’s (HRP) Exploration Medical Capability (ExMC) Element adopted Systems Engineering (SE) principles and Model Based Systems Engineering (MBSE) tools to capture the system functions, system architecture, requirements, interfaces, and clinical capabilities for a future exploration medical system. There are many different stakeholders who may use the information in the model: systems engineers, clinicians (physicians, nurses, and pharmacists), scientists, and program managers. Many of these individuals do not have access to MBSE modeling tools or have never used these tools. Many of these individuals (clinicians, scientists, even program managers) may have no experience with SE in general let alone interpreting a systems model. The challenge faced by ExMC was how to present the content in the model to non-modelers in a way they could understand with limited to no training in MBSE or the Systems Modeling Language (SysML) without using the modeling tool. Therefore, from the model, ExMC created an HTML report that is accessible to anyone with a browser. When creating the HTML report, the ExMC SE team talked to stakeholders and received their feedback on what content they wanted and how to display this content. Factoring in feedback, the report arranges the content in a way that not only directs readers through the SE process taken to derive the requirements, but also helps them to understand the fundamental steps in an SE approach. The report includes links to source information (i.e., NASA documentation that describes levels of care) and other SE deliverables (e.g., Concept of Operations). These links were provided to aid in the understanding of how the team created this content through a methodical SE approach. This paper outlines the process used to develop the model, the data chosen to share with stakeholders, many of the model elements used in the report, the review process stakeholders followed, the comments received from the stakeholders, and the lessons ExMC learned through producing this HTML report.1Trade names and trademarks are used in this report for identification only. Their usage does not constitute an official endorsement, either expressed or implied, by the National Aeronautics and Space Administration.

Jeffrey R. Cohen↗
NASA NTRSDate not supplied

How ExMC Communicates a System Model to Non-Modelers

NASA’s Human Research Program (HRP) Exploration Medical Capability (ExMC) Element adopted Systems Engineering (SE) principles and Model Based Systems Engineering (MBSE) tools to capture the system functions, system architecture, requirements, interfaces, and clinical capabilities for a future exploration medical system. There are many different stakeholders who may use the information in the model: systems engineers, clinicians (physicians, nurses, and pharmacists), scientists, and mission planners. Many of these stakeholders have neither access to MBSE modeling tools nor experience with SE modeling techniques. The challenge faced by ExMC SE team was how to present the content in the model to non-modelers in a way they would understand the content with limited training in MBSE and without using the modeling tool. ExMC SE team created a Hypertext Markup Language (HTML) report that shows key model content and is accessible to anyone with a browser. When creating the HTML report, the ExMC SE received stakeholder feedback on what content they wanted and how to display this content. Incorporating this feedback, the report arranges the content in a way that directs readers through the SE process taken to derive the requirements and helps them to understand the fundamental steps in an SE approach. The report includes links to source information (e.g., NASA documentation that describes levels of care) and other SE products (e.g., Concept of Operations). These links were provided to aid in the understanding of how the team created this content through a methodical SE approach. This presentation outlines the process used to develop the model, the data chosen to share with stakeholders, many of the model elements used in the report, the review process stakeholders followed, the comments received from the stakeholders, and the lessons ExMC learned through producing this HTML report.

J. Cohen↗
NASA NTRSDate not supplied

Presenting Model-Based Systems Engineering Information to Non-Modelers

NASA’s Human Research Program’s (HRP) Exploration Medical Capability (ExMC) Element adopted Systems Engineering (SE) principles and Model Based Systems Engineering (MBSE) tools to capture the system functions, system architecture, requirements, interfaces, and clinical capabilities for a future exploration medical system. There are many different stakeholders who may use the information in the model: systems engineers, clinicians (physicians, nurses, and pharmacists), scientists, and program managers. Many of these individuals do not have access to MBSE modeling tools or have never used these tools. Many of these individuals (clinicians, scientists, even program managers) may have no experience with SE in general let alone interpreting a systems model. The challenge faced by ExMC was how to present the content in the model to non-modelers in a way they could understand with limited to no training in MBSE or the Systems Modeling Language (SysML) without using the modeling tool. Therefore, from the model, ExMC created an HTML report that is accessible to anyone with a browser. When creating the HTML report, the ExMC SE team talked to stakeholders and received their feedback on what content they wanted and how to display this content. Factoring in feedback, the report arranges the content in a way that not only directs readers through the SE process taken to derive the requirements, but also helps them to understand the fundamental steps in an SE approach. The report includes links to source information (i.e., NASA documentation that describes levels of care) and other SE deliverables (e.g., Concept of Operations). These links were provided to aid in the understanding of how the team created this content through methodical SE approach. This paper outlines the process used to develop the model, the data chosen to share with stakeholders, many of the model elements used in the report, the review process stakeholders followed, the comments received from the stakeholders, and the lessons ExMC learned through producing this HTML report.

Jeffrey R. Cohen↗
NASA NTRSDate not supplied

Custom Integration of Multiple Medical Functionalities

INTRODUCTION: Previous spaceflight experience and results from probabilistic risk assessment of spaceflight medical risk have highlighted the need for vital sign measurements, medical scopes, and clinical imaging tools for managing medical conditions during spaceflight. The Human Research Program’s Exploration Medical Capability (ExMC) Element and the Mars Campaign Office’s Exploration Medical Integrated Product Team (XMIPT) have performed ground-based evaluations of two Commercial-off-the-Shelf (COTS) Multi-functional Integrated Medical (MIM) devices, which integrate various medical capabilities together in one device. The key findings from these evaluations are presented in a complementary presentation, leaving this presentation to focus on forward recommendations for customized integration of multiple medical functionalities. KEY COMPONENTS: The key features of a custom integration of multiple medical functionalities includes devices and capabilities that optimally reduce medical risk. The COTS MIM devices incorporated functionality for best supporting Earth-based, emergency, pre-hospital care. Our custom integration will use probabilistic risk assessment tools, such as the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT), to determine the optimal functionality to include based on medical risk minimization. An additional feature of custom integration includes the ability to adapt to different requirements within different vehicles and/or missions. The COTS MIM devices store data in patient specific records, however, the format of the records is not modifiable, and data are not easily transferred from the MIM device to a central data architecture outside of the manufacturer’s established system. Our concept for custom integration will use devices that have an open application programming interface, which can easily connect to independent data architectures and third-party visualization software. The ultrasound capabilities included within the COTS MIM devices did not satisfy many of the Artemis Research and Operations Working Group’s ultrasound functional needs, and therefore, incorporation of higher quality ultrasound capabilities within a customized integration will be beneficial. The COTS MIM devices included minimal procedural guidance and clinical decision support tools. Supplemental tools of this type would need to be supplied along with the COTS MIM devices if they were to be used operationally, so another advantage of customization is the ability to integrate these support tools along with the medical functionality, for a more streamlined user experience. CONCLUSION: Investigation of a customized integration of medical functionality provides a method for further understanding the needs of a long-term exploration spaceflight medical system. The crew members of these exploration missions will need to operate more and more independently from Earth-based ground support. Therefore, having an optimized, streamlined medical system, which contains the functionality and supporting information needed, while remaining within mission and vehicle constraints, will help to maintain crew health and performance, which is necessary for achieving high levels of mission success.

B E Lewandowski↗
NASA NTRSDate not supplied

Artificial Intelligence (AI) Methods for Augmenting the IMPACT Tool Evidence Library

Development of the Evidence Library for use with the IMPACT probability risk assessment tool took several years and involved a staggering amount of effort from a multi-disciplinary team. A very significant amount of the labor effort to collect, assess and finalize the Clinical Finding Form (CliFF) for each of the 119 medical conditions was provided by physician subject matter experts from the Exploration Medical Capability (ExMC) Element Clinical and Science Team. Many AI tools such as ChatGPT are excellent at summarizing large amounts of information and the current project was initiated to determine how such tools might streamline laborious processes, e.g., review and summarization of many scientific research publications, to execute key steps more efficiently in the process of developing CliFFs. The process for collecting the evidence which is found in the CliFFs is well documented in the Evidence Library Methods document (ELM; HRP-48036*). Using ELM and the CliFF development instructions as a guideline, a team of developers is leveraging Microsoft Azure AI tools and services along with open-source frameworks, to construct an AI-assisted automated pipeline. This pipeline is designed to search, retrieve, and process the necessary data sources, and ultimately help generate the final version of a CliFF. Currently, the large language model evaluates the relevance of each source material to spaceflights, either as direct evidence or as an analog. Additionally, the model assists in extracting keywords and generating brief summaries to enhance augmented retrieval and search processes in later stages of CliFF development. Once the data is ready, the model can perform semantic search and retrieval, generating and extracting valuable information for the CliFF. For instance, it can handle epidemiological statistical data, such as incidence rates and the likelihood of best or worst-case scenarios. The steps that required reading and summarizing articles were viewed as providing the greatest return on investment since large language models are very efficient and accurate in summarizing large amounts of text. Since labor effort to complete the original CliFF was not recorded with sufficient granularity, comparisons with an AI tool-generated CliFF will provide merely an approximation of time saved. Upon completion of the process, the CliFF for the medical condition “appendicitis” generated with the support of AI-based methods will serve as a proof-of-concept and will be compared to the original appendicitis CliFF to determine if use of the tools resulted in content and conclusory similarity. Based upon the results from face validation of the two CliFFs, modifications to the process will be made if necessary and additional condition CliFFs will be evaluated. Ultimately, CliFFs for the entire set of medical conditions will be created with the assistance of AI tools. Depending on the cost savings realized, CliFFs for additional medical conditions can be created to expand the Evidence Library. Future direction includes specifying the characteristics of the reviewer (prompting the AI tools to generate output assuming the reviewer is a sub-specialist physician, or nurse or EMT/medic) to determine if the effects on AI-generated output are different based on knowledge, skills and abilities. *Exploration Medical Capability Evidence Library Methods, HRP-48036 Rev A, July 2022.

Ali Al↗
NASA NTRS2023

Identifying and Closing Medical Capability Gaps for Human Spaceflight Missions Beyond Low Earth Orbit

BACKGROUND: Features of human space missions beyond low Earth orbit such as increasing distance from Earth, lack of real-time communication, and limited or no evacuation or resupply capability are expected to drive an increase in medical risk and require crews to operate in an increasingly autonomous fashion. A diverse set of stakeholders at NASA are seeking to fund the development of concepts of operations, medical requirements, and medical capabilities for such missions. However, a systematic approach to identification of current medical capability gaps and a strategic framework to gap closure is needed. OVERVIEW: The Exploration Medical Integrated Product Team (XMIPT) has developed a list of nine high-level medical capability gaps and associated activities required for gap closure. The list was derived based on inputs from subject matter experts at NASA including flight surgeons, other clinical providers, as well as operational and research communities regarding medical capabilities required to support human missions to the Moon and the Mars surface. Responses were reviewed and distilled to identify common themes across capabilities. To ensure alignment with established human system risks, the gap list was further refined based on inputs from NASA’s Human System Risk Board. Relevant medical gap closure activities outside of those funded by the XMIPT were identified through solicitation of inputs from Elements of NASA’s Human Research Program (particularly Exploration Medical Capability), the broader medical operations community, and other stakeholders. This medical capability gap list is reviewed and updated regularly as new information becomes available or new stakeholders are identified. DISCUSSION: The medical capability gap list has matured to include a large group of NASA stakeholders and development activities. This has enabled articulation of priorities to funding entities and programmatic stakeholders, while serving as an accessible resource summarizing gap closure activities, relevant programmatic infusion points, and opportunities for collaboration between stakeholders. This presentation will provide an overview of the nine NASA medical capability gaps and their associated gap closure activities.

Moriah Thompson↗