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Dermatitis During Spaceflight Associated With HSV-1 Reactivation- A Case Study

Human alpha herpesviruses herpes simplex virus (HSV-1 or -2) and varicella zoster virus (VZV) establish latency in various cranial nerve ganglia, and often reactivate in response to stress-associated immune system dysregulation. Reactivation of Epstein Barr Virus (EBV), VZV, HSV-1 and Cytomegalovirus (CMV) is typically asymptomatic during spaceflight, though live/infectious virus has been recovered and the shedding rate increases with mission duration. The risk of clinical disease, therefore, may increase for astronauts assigned to extended missions (>180 days). Here, we report for the first time, a case of HSV-1 skin rash (dermatitis) occurring during a long duration spaceflight. The astronaut reported persistent dermatitis during flight, which was treated onboard with oral antihistamines and topical/oral steroids. No HSV-1 DNA was detected in 6-month pre-mission saliva samples, but on flight day 82, a saliva and rash swab both yielded 4.8 copies/ng DNA and 5.3×104 copies/ng DNA, respectively. Post-mission saliva samples continued to have high infectious HSV-1 load (1.67×107 copies/ng DNA). HSV-1 from both rash and saliva samples had 99.4% genotype homology. Additional physiological monitoring, including stress biomarkers (cortisol, dehydroepiandrosterone (DHEA), and salivary amylase), immune markers (adaptive regulatory and inflammatory plasma cytokines) and biochemical profile markers including vitamin/mineral status and bone metabolism are also presented for this case. These data highlight an atypical presentation of HSV-1 during spaceflight and underscore the importance of viral screening during clinical evaluations of in-flight dermatitis, to determine viral etiology and guide treatment.

Herpes, Viral Reactivation, Spaceflight, Dermatiti↗

Comparison of Acoustic Models and Trajectory Generation Methods for an Acoustically-Aware Aircraft

This paper presents a comparison of trajectory generation methodologies using acoustic source noise models of different fidelity for motion planning for an acoustically-aware aircraft subject to constraints on the vehicle dynamic performance, mission, and acoustic footprint of the vehicle at a set of (three-dimensional) observer locations. The performance of a pre-mission Bézier curve-based planner and a (near) real-time stochastic model predictive control planner are compared. Additionally, a comparison is made between the motion planning performance using a lower-fidelity acoustic model based on propeller tip Mach number and omni-directional sound power radiation, and a hemisphere-based higher-fidelity acoustic model. It is demonstrated that the asymmetry in hemisphere-based acoustic model can be exploited for improved flight path planning and trajectory-tracking performance in the presence of acoustic constraints.

Kasey A Ackerman↗

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

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

ExMC↗

Enabling Human Space Exploration Missions Through Progressively Earth Independent Medical Operations (EIMO)

Goal: Current Space Medicine operations depend on terrestrial support to manage medical events. As astronauts travel to destinations such as the Moon, Mars, and beyond, distance will substantially limit this support and require increasing medical autonomy from the crew. This paper defines Earth Independent Medical Operations (EIMO) and identifies key elements of a conceptual EIMO system. Methods: The NASA Human Research Program Exploration Medical Capability Element held a 2-day conference at Johnson Space Center in Houston, TX with NASA experts representing all aspects of Space Medicine. Results: EIMO will be a process enabling progressively resilient deep space exploration systems and crews to reduce risk and increase mission success. Terrestrial assets will continue to provide pre-mission screening, planning, health maintenance, and prevention, while onboard medical care will increasingly be the purview of the crew. Conclusions: This paper defines and describes the key components of EIMO.

ExMC↗

Lunar Instrument Data Integration Into the Virtual Reality Mission Simulation System for Decision Communication and Situational Awareness

In situ resource utilization (ISRU) technologies are a key advancement required to make human habitation on the Moon and Mars viable. The upcoming Volatiles Investigating Polar Exploration Rover (VIPER) mission will provide crucial correlations between volatiles and lunar geology to understand the water content available for ISRU on the moon. The mission will require the coordination of multi-disciplinary teams across the country making real time decisions based on rover instrument data. The virtual reality Mission Simulation System (vMSS) is a virtual reality platform designed at MIT by the Resource Exploration and Science of our Cosmic Environment (RESOURCE) team to provide teams with a collaboration interface for planetary missions like VIPER. Herein we determine the integration pathway for analog based datasets that are examples of VIPER's two main instruments, the near-infrared volatile spectrometer subsystem (NIRVSS) and the neutron spectrometer subsystem (NSS), into vMSS to provide the most valuable visualization tools. Focusing on improving situational awareness, decision making, reducing task load and incorporating comments from scientists working previous analogs and on the current VIPER mission, we recommend critical elements to implement into vMSS and the best approaches for data visualization. We present a review of relevant analogs and state of the art mission software. We have developed a design concept and path to flight of analysed instrument data integrated with data maps that allow for virtual manipulation and annotation between non-co-located team members. We focus on pre-mission mapping of a priori data for improved situational awareness, layering of analysed instrument data, correlative mapping and interactive capabilities for in-mission decision making, as well as archiving and annotation tools for post-mission analysis. Finally, we lay out the roadmap for the future development of immersive sample site visualization capabilities and the use of integrated instrument data in vMSS with automated temporal and geospatial planning.

Cody Alison Paige↗

Earth-Independent Medical Operations (EIMO) Concept of Operations

Compared to the current paradigm for crew health in low-Earth orbit and Lunar missions that rely on constant communication with Mission Control, there is an anticipated shift in medical operations for deep-space exploration missions. This shift stems from mission constraints imposed by the considerable distance from Earth, which include resource limitations due to a lack of resupply, mass, power, volume, and data limitations, challenges imposed by communication latency and the inability to evacuate in case of emergencies. To transition towards a more self-reliant medical approach, a comprehensive strategy is essential to progressively enable crew autonomy and mitigate mission success risks in the challenging environment of space. This transformative shift is collectively referred to as "Earth-Independent Medical Operations" (EIMO), signifying the gradual transfer of medical care and decision-making from terrestrial resources to space-based assets. This transition is aimed at bolstering astronaut health and performance while simultaneously reducing the overall risks associated with space missions. The constraints related to EIMO necessitate an integrated development of medical systems, featuring interoperability with mission planning, vehicle design, spacesuit design, and data architecture. This integration is vital in establishing a robust medical infrastructure that not only supports the well-being of astronauts but also ensures the success of the mission as a whole. The Human Research Program (HRP) Exploration Medical Capability (ExMC) Element has developed a model-based Concept of Operations (ConOps) outlining an initial vision for EIMO. Within this ConOps, a comprehensive view is presented, encompassing stakeholder needs, system objectives, and system goals associated with EIMO. Additionally, it provides illustrative examples of the various activities (scenarios) for which the system will be employed during missions. The selection of these activities has been meticulous, aiming to encompass a wide spectrum of medical conditions, including those falling under different risk categories, such as low-likelihood-low-consequence, low-likelihood-high-consequence, and high-likelihood-low-consequence. The selection of these activities (scenarios) effectively encompasses the wide range of medical events situated within an assumed probability-consequence bell curve. In each scenario, at least one of the five main EIMO components identified is captured. Those EIMO components are: Pre-mission Planning, Acute and Emergent Management Decision Making, Prolonged Medical Management Decision Making, Supplies and Resource Management, and Task Load Management. The ConOps was developed by a multidisciplinary team consisting of systems engineers, scientists, and clinicians across NASA and aims to serve as an initial recommendation to gradually and safely enabling crew autonomy for Mars missions and beyond.

Earth Independent Medical Operations↗

Earth Independent Medical Operations (EIMO) Datascope: Challenges and Potential Solutions

Data flows and storage/retrieval capacity are severely constrained during missions in space and challenges will become even greater during exploration class missions. There is a need for an artificial intelligence (AI)-based clinical decision support system (CDSS) to monitor and analyze data to provide real-time consultative support for crew medical officer (CMO) decision-making. EIMO is defined as the gradual transition of medical care and decision making from terrestrial to space-based assets, enabling support of astronaut health and performance and reducing overall mission risk. While a hallmark of this paradigm shift from low-earth orbit is that on-board care will increasingly become the responsibility of the astronauts for primary management and decision making, terrestrial assets will continue to be paramount in pre-mission screening and planning, as well as prevention, health maintenance and long-term care contingencies. New capabilities and systems that enable progressively more robust and resilient systems and crews will be necessary to reduce risk and increase probability of deep space exploration mission success. An aspiration for EIMO is to develop AI-enhanced solutions for analysis of crew health & performance data and to facilitate clinical decision support for autonomous medical operations. A “system of systems” approach is envisioned whereby EIMO will deploy AI-supported natural language processing and machine learning (ML) techniques to utilize embedded reference databases and real-time data streams [input vectors] from multiple data sources. Constituent input vectors may include environmental controls, countermeasures data, behavioral data, physiologic wearables, point-of-care laboratory tests, personalized medical records, inventory trade space risk assessments, COTS medical databases, and ground support inputs. An ideal AI capability would possess trained fusion algorithms to cross reference input vectors with medical ‘knowledge’ [cultivated database] to stratify relevant data streams for predictive and actionable capabilities. In addition, EIMO will feature mobility, in that it can be accessed and can push/pull data within and between multiple vehicles/habitats. Large amounts and variable sources of data can be leveraged to diagnose, inform treatment strategies, and potentially predict medical events and performance decrements. Inclusion of advanced training tools using extended reality will enable increasingly autonomous medical care to aid a CMO when ground support is unavailable or time-delayed beyond required action window, e.g., emergent medical situations. EIMO CDSS would require very large datasets to train pre-flight and significant amounts of data are needed to support ML via in-flight CDSS operations. An additional challenge will be to find sufficient data to train a model relevant to astronaut demographics. The rapid, accelerating evolution of this field creates a propitious solution space to leverage multi-modal AI through public-private partnership(s). The status of multi-modal AI systems today would preclude their use for long duration missions as they remain unreliable and are subject to “digital hallucinations” and other errors that could pose operational risk. A federated labs structure is being considered to test and optimize data flow from the multiple input vectors leading to field testing in suitable ground/flight analogs. Critical to the success of an EIMO CDSS will be integration and interoperability and success will be defined by a system that can serve as an in-flight medical consult for the CMO providing critical support during medical contingencies. Benefits to terrestrial medicine may be significant as an outflow of the EIMO medical system, particularly for remote areas and communities lacking significant infrastructure, personnel and resources.

J Lemery↗

Progressively Enabling Earth Independent Medical Operations (EIMO)

This panel presents the findings from a series of Technical Interchange Meetings (TIMs) hosted by the Exploration Medical Capability Element (ExMC) in NASA’s Human Research Program. The topics for the TIMs were derived from a 2-day conference of senior leaders and subject matters experts that collectively outlined a multi-faceted strategy designed to optimize crew health and performance through an increasingly autonomous medical approach. The first abstract in this panel outlines the scope of issues related to data collection, usage, transmission and computing capacity to facilitate EIMO. The second presentation provides an overview of the challenges in developing curricula and advanced training tools to baseline knowledge, skills and abilities (KSA), verify clinical competency and assure retention during prolonged durations inherent in exploration-class missions. An overview of the complicated medical supply and resource chain necessary to facilitate EIMO is provided in the third presentation of this panel. The final presentation in this EIMO panel surveys the breadth and depth of demands on cognitive load expected to be experienced by crew on an exploration mission and proposes strategies to mitigate the prospect of cognitive overload through methods to shift task load from the crew to multi-modal artificial intelligence based medical support systems. Taken together, these presentations summarize the challenges to be expected and potential solution spaces to be explored and developed to progressively enable increasing autonomous medical operations to support crewed missions beyond low earth orbit. Through EIMO focused pre-mission planning, integrated data architecture design, innovative training development and AI-assisted task load management, the gradual transition of medical care and decision making from terrestrial to space-based assets enabling support of astronaut health and performance and reducing overall mission risk is achievable.

Jay Lemery↗

Progressively Enabling Earth Independent Medical Operations (EIMO)

This panel presents the findings from a series of Technical Interchange Meetings (TIMs) hosted by the Exploration Medical Capability Element (ExMC) in NASA’s Human Research Program. The topics for the TIMs were derived from a 2-day conference of senior leaders and subject matters experts that collectively outlined a multi-faceted strategy designed to optimize crew health and performance through an increasingly autonomous medical approach. The first abstract in this panel outlines the scope of issues related to data collection, usage, transmission and computing capacity to facilitate EIMO. The second presentation provides an overview of the challenges in developing curricula and advanced training tools to baseline knowledge, skills and abilities (KSA), verify clinical competency and assure retention during prolonged durations inherent in exploration-class missions. An overview of the complicated medical supply and resource chain necessary to facilitate EIMO is provided in the third presentation of this panel. The final presentation in this EIMO panel surveys the breadth and depth of demands on cognitive load expected to be experienced by crew on an exploration mission and proposes strategies to mitigate the prospect of cognitive overload through methods to shift task load from the crew to multi-modal artificial intelligence based medical support systems. Taken together, these presentations summarize the challenges to be expected and potential solution spaces to be explored and developed to progressively enable increasing autonomous medical operations to support crewed missions beyond low earth orbit. Through EIMO focused pre-mission planning, integrated data architecture design, innovative training development and AI-assisted task load management, the gradual transition of medical care and decision making from terrestrial to space-based assets enabling support of astronaut health and performance and reducing overall mission risk is achievable.

John Lemery↗

Supply and Resource Management to Progressively Enable EIMO

BACKGROUND: Current medical operations in Low Earth Orbit (LEO) allow for real-time audio-video communication with a flight surgeon at mission control, resupply, and medical evacuation to earth on the order of hours. As mission profiles change from LEO to the Moon, Mars, and beyond, medical risk as a contribution to overall mission risk is anticipated to rise substantially. Concurrently, due to the distance, the medical systems on board vehicles proposed for these mission types are expected to have reduced mass and volume allocation. Together, astronaut crews will be at a higher risk of major medical events, be required to perform a broader set of tasks, and have substantially reduced resources and support to do so. Earth Independent Medical Operations (EIMO) aims to identify and fill the gaps present in this progressively changing paradigm. OVERVIEW: Medical supplies, resources, and skills are central to spaceflight medical systems. Vehicles used for non-LEO missions are anticipated to be smaller and thus the medical system will also need to have reduced mass, volume, and power. Medical resources are another form of consumable and may need resupply or pre-deployment to meet crew needs. One particular concern is the degradation of medications which become less efficacious and potentially toxic with time, particularly given environmental conditions such as temperature, humidity, oxygen, and radiation which have not yet been fully studied. Supply and resource management in LEO is dependent on resupply, however the supply chain of transporting equipment does not yet have a clear infrastructure for missions beyond LEO. DISCUSSION: EIMO is intended to systemically identify and fill these gaps with forward-looking solutions. In mission monitoring of resources with technology like RFID, improving medical resource longevity, targeted resupply and careful pre-mission planning will be central to facilitate crew health and performance. One approach to optimizing resources is the Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool, which uses probabilistic risk assessment (PRA) to quantitatively predict medical risk and identify resources and skills that mitigate this risk. This evidence based, quantitative analysis prediction tool and several other approaches to meeting the challenge of supply and resource management are discussed.

Arian Anderson↗

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↗

Earth Independent Medical Operations (EIMO)

Inherent in interplanetary space travel are unprecedented challenges that could threaten mission success and negatively impact crew health and performance. Return to definitive care is essentially untenable and resources will be constrained with practically no re-supply capability. Access to ground-based medical expertise will be significantly delayed under nominal conditions with exacerbation during conjunction or prolonged dust storms. Taken together, these challenges necessitate the development of a progressively autonomous medical operational support system to assist the crew medical officer (CMO). While support from ground based medical experts will remain indispensable for pre-mission planning, the approach to management of acute/emergent medical contingencies will require a gradual transition of medical care and decision making from terrestrial to space-based assets, enabling support of astronaut health and performance and reducing overall mission risk. To progressively enable EIMO, a series of meetings were convened with subject matter experts from within NASA, academia and industry to facilitate mapping of the path to support autonomous medical operations. Topics explored in these meetings included the scope of data (storage capacity, usage, transmission rate and bandwidth, computing capacity), CMO training, supply and resource management and task load balance. Recommendations from these meetings will inform the EIMO Concept of Operations and definition of the associated requirements culminating in updates to the NASA 3001 standards. The EIMO project team will work with stakeholders to conceptualize a clinical decision support system (CDSS) to assist the CMO in response to medical contingencies when terrestrial support is delayed or otherwise unavailable. The CDSS will be a system of systems that will utilize data from numerous input vectors. Successful deployment of the CDSS will facilitate medical decision making while decreasing the cognitive load leading to an improvement in task load balancing. Additional benefits of the envisioned CDSS include assistance with inventory management, locating resources, storage/retrieval of medical records, highlighting trends in recorded data, in addition to providing a consult for diagnosis and treatment. More advanced features might include passive monitoring to identify early warning signs of behavioral or medical anomalies to possibly pre-empt onset of conditions that would compromise crew health and performance.

Benjamin Easter↗

Earth Independent Medical Operations (EIMO) Datascope: Challenges and Potential Solutions

Data flows and storage/retrieval capacity are severely constrained during missions in space and challenges will become even greater during exploration class missions. There is a need for an artificial intelligence (AI)-based clinical decision support system (CDSS) to monitor and analyze data to provide real-time consultative support for crew medical officer (CMO) decision-making. EIMO is defined as the gradual transition of medical care and decision making from terrestrial to space-based assets, enabling support of astronaut health and performance and reducing overall mission risk. While a hallmark of this paradigm shift from low-earth orbit is that on-board care will increasingly become the responsibility of the astronauts for primary management and decision making, terrestrial assets will continue to be paramount in pre-mission screening and planning, as well as prevention, health maintenance and long-term care contingencies. New capabilities and systems that enable progressively more robust and resilient systems and crews will be necessary to reduce risk and increase probability of deep space exploration mission success. An aspiration for EIMO is to develop AI-enhanced solutions for analysis of crew health & performance data and to facilitate clinical decision support for autonomous medical operations. A “system of systems” approach is envisioned whereby EIMO will deploy AI-supported natural language processing and machine learning (ML) techniques to utilize embedded reference databases and real-time data streams [input vectors] from multiple data sources. Constituent input vectors may include environmental controls, countermeasures data, behavioral data, physiologic wearables, point-of-care laboratory tests, personalized medical records, inventory trade space risk assessments, COTS medical databases, and ground support inputs. An ideal AI capability would possess trained fusion algorithms to cross reference input vectors with medical ‘knowledge’ [cultivated database] to stratify relevant data streams for predictive and actionable capabilities. In addition, EIMO will feature mobility, in that it can be accessed and can push/pull data within and between multiple vehicles/habitats. Large amounts and variable sources of data can be leveraged to diagnose, inform treatment strategies, and potentially predict medical events and performance decrements. Inclusion of advanced training tools using extended reality will enable increasingly autonomous medical care to aid a CMO when ground support is unavailable or time-delayed beyond required action window, e.g., emergent medical situations. EIMO CDSS would require very large datasets to train pre-flight and significant amounts of data are needed to support ML via in-flight CDSS operations. An additional challenge will be to find sufficient data to train a model relevant to astronaut demographics. The rapid, accelerating evolution of this field creates a propitious solution space to leverage multi-modal AI through public-private partnership(s). The status of multi-modal AI systems today would preclude their use for long duration missions as they remain unreliable and are subject to “digital hallucinations” and other errors that could pose operational risk. A federated labs structure is being considered to test and optimize data flow from the multiple input vectors leading to field testing in suitable ground/flight analogs. Critical to the success of an EIMO CDSS will be integration and interoperability and success will be defined by a system that can serve as an in-flight medical consult for the CMO providing critical support during medical contingencies. Benefits to terrestrial medicine may be significant as an outflow of the EIMO medical system, particularly for remote areas and communities lacking significant infrastructure, personnel and resources.

Medical Operations↗

Earth-Independent Medical Operations (EIMO) Concept of Operations (ConOps)

Compared to the current paradigm for crew health in low-Earth orbit and Lunar missions that rely on constant communication with Mission Control, there is an anticipated shift in medical operations for deep-space exploration missions. This shift stems from mission constraints imposed by the considerable distance from Earth, which include resource limitations due to a lack of resupply, mass, power, volume, and data limitations, challenges imposed by communication latency and the inability to evacuate in case of emergencies. To transition towards a more self-reliant medical approach, a comprehensive strategy is essential to progressively enable crew autonomy and mitigate mission success risks in the challenging environment of space. This transformative shift is collectively referred to as "Earth-Independent Medical Operations" (EIMO), signifying the gradual transfer of medical care and decision-making from terrestrial resources to space-based assets. This transition is aimed at bolstering astronaut health and performance while simultaneously reducing the overall risks associated with space missions. The constraints related to EIMO necessitate an integrated development of medical systems, featuring interoperability with mission planning, vehicle design, spacesuit design, and data architecture. This integration is vital in establishing a robust medical infrastructure that not only supports the well-being of astronauts but also ensures the success of the mission as a whole. The Human Research Program (HRP) Exploration Medical Capability (ExMC) Element has developed a model-based Concept of Operations (ConOps) outlining an initial vision for EIMO. Within this ConOps, a comprehensive view is presented, encompassing stakeholder needs, system objectives, and system goals associated with EIMO. Additionally, it provides illustrative examples of the various activities (scenarios) for which the system will be employed during missions. The selection of these activities has been meticulous, aiming to encompass a wide spectrum of medical conditions, including those falling under different risk categories, such as low-likelihood-low-consequence, low-likelihood-high-consequence, and high-likelihood-low-consequence. The selection of these activities (scenarios) effectively encompasses the wide range of medical events situated within an assumed probability-consequence bell curve. In each scenario, at least one of the five main EIMO components identified is captured. Those EIMO components are: Pre-mission Planning, Acute and Emergent Management Decision Making, Prolonged Medical Management Decision Making, Supplies and Resource Management, and Task Load Management. The ConOps was developed by a multidisciplinary team consisting of systems engineers, scientists, and clinicians across NASA and aims to serve as an initial recommendation to gradually and safely enabling crew autonomy for Mars missions and beyond.

Earth Independent Medical Operations↗

Earth Independent Medical Operations [EIMO] Definition Workshop

As the vanguard of human spaceflight increasingly transitions from one of low Earth orbit (LEO) to Lunar and subsequently Martian missions, there is a commensurate imperative for Earth-based medical authority to transition to space-based assets for the continued assurance of optimal astronaut health and performance. The transition to Earth Independent Medical Operations (EIMO) will be a process that enables progressively resilient systems and crews to reduce risk and enhance wellness and overall mission success for deep space exploration. Terrestrial assets will continue to be paramount in pre-mission screening, planning, maintenance, and prevention. Yet on-board care, response to unexpected medical events, and management of communication delays and dropouts will increasingly become the purview of the crew for primary management.

John Lemery↗

Seeing the Future of Spaceflight: Applications of Extended Reality (XR) Technologies

INTRODUCTION Advances in Earth Independent Medical Operations (EIMO) focused capabilities will be crucial for completing successful beyond low-earth-orbit (LEO) missions, where traditional Earth-based medical support and near real-time communication are limited, intermittent, or absent. In such restricted or limited communication environments, emerging extended reality (ER or XR) technologies may play a vital role in ensuring crew health and safety. Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR) are common terms used to describe technologies that "generate or modify" while “extended reality” (ER or XR) is often used as an umbrella term for these technologies. This review explores how such cutting-edge “extended reality” information delivery systems are currently applied across various disciplines within NASA. The review focuses on their capabilities, limitations, and prospective future applications as they pertain to Earth-Independent Medical Operations and its components of pre-mission planning, medical decision making, resource management, and task load management. METHODS/DESIGN The review began with a literature search to identify relevant disciplines (e.g., medical education, austere environments) where XR technologies have been studied to highlight areas where evidence is lacking. Previous and current NASA XR projects and applications, as well as commercial partnerships, such as those with Small Business Innovation Research (SBIR), were identified. Discussions with technical experts involved in the design, development, and application of these technologies allowed for classification based on their respective spaceflight applications. RESULTS AND CONCLUSION This review highlights current and emerging XR technologies that have been developed, tested, and implemented both terrestrially and in spaceflight by NASA, its international partners, the U.S. Armed Forces, and various relevant commercial entities. While these novel information delivery systems vary in their respective technology readiness levels (TRL), they have the potential to be implemented on Earth, in LEO, and during deep space exploration. These systems have the potential for impacting and optimizing many aspects of EIMO.

Yevgeniy Zhivotovskiy↗

Private Astronaut Post-Mission Debrief Interviews Study

BACKGROUND The commercialization of space will increasingly include individuals that are not rigorously-selected, highly-trained professional astronauts. Private astronaut missions (PAMs), such as Axiom-1 in 2022, will continue to travel to the International Space Station in the coming years, but the risk of integrating private astronauts with NASA astronauts has not been clearly quantified nor mitigated. An earlier internal NASA operations assessment, which consisted of a comprehensive literature review and interviews of current NASA experts, found that PAMs are likely to increase the risk to NASA astronauts during integrated missions (Landon, Whiting, Russell, Schorn, Passmore, & Roma, 2022). There are ongoing efforts at NASA to mitigate concerns from a medical, psychological, and technical perspective. NASA experts are working closely with PAM providers to offer recommendations and best practices beyond the limits of requirements to ensure crew health and safety. However, efforts are siloed between groups to some extent, and with the rate of PAMs likely to increase, a more comprehensive and integrated process is needed to reduce the burden on NASA resources. AIMS The purpose of this project is to understand private astronauts’ motivations for journeying to space, their pre-mission preparation period, and their experiences in space. Data will be collected via private astronaut post-mission debrief interviews. This data will inform training needs and in-mission support needed for missions that include private astronauts; the preparation NASA astronauts and mission support personnel will need to work with these integrated crews; and gaps in knowledge to guide research and countermeasure development. Our study aims to (1) Characterize risks posed by commercialization and private astronaut crew integration in spaceflight operations, as it relates to Team, Human Systems Integration Architecture (HSIA), and Behavioral Medicine (BMed) Risks, (2) Recommend potential countermeasures and identify gaps in current research. Countermeasures may be related to crew selection and composition, training, crew support systems (e.g., medical/psychological support, support from Mission Control, on-board resources), and habitability and human factors design. METHOD The BHP Lab will conduct 30-minute interviews with up to eight (8) private astronaut mission (PAM) astronauts (e.g., Axiom) and spaceflight participants (e.g., SFPs or “free flyers” on Polaris Dawn) per year from 2024-2030 to discuss knowledge gaps and needs related to selection and assessment, crew composition, training, crew support systems (e.g., medical/psychological support, support from Mission Control, onboard resources), and habitability and human factors design, which may influence the risk to NASA astronauts. Interviews will then be coded using thematic analysis and interpreted with the assistance of lexical analysis software (e.g., LIWC). As of the end of 2024, we have collected data from one PAM crew. At the conclusion of data collection in 2030, a final report will be prepared integrating all data collected by 2031. SUMMARY Post-return interviews of private astronauts are being conducted to understand their experiences and inform training and countermeasures to ensure the safety of all who journey to the ISS.

Private Astronaut Missions↗