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Applications of telemedicine in the United States space program

Since the beginning of human space flight, NASA has been placing humans in extreme and remote environments. There are many challenges in maintaining humans in outer space, including the provision of life-support systems, radiation shielding, and countermeasures for minimizing the effect of microgravity. Because astronauts are selected for their health, among other factors, disease and illness are minimized. However, it is still of great importance to have appropriate medical care systems in place to address illness and injury should they occur. With the exception of the Apollo program, exploration of space has been limited to missions that are within several hundred miles of the surface of the Earth. At the drawn of the 21st century and the new millennium, human exploration will be focused on operation of the International Space Station (ISS) and preparation for human missions to Mars. These missions will present inherent risks to human health, and, therefore, appropriate plans must be established to address these challenges and risks. Crews of long-duration missions must become more independent from ground controllers. New systems, protocols, and procedures are currently being perfected. Application of emerging technologies in information systems and telecommunications will be critical to inflight medical care. Application of these technologies through telemedicine will provide crew members access to information, noninvasive procedures for assessing health status, and guidance through the integration of sensors, holography, decision-support systems, and virtual environments. These technologies will also serve as a basis to enhance training and medical education. The design of medical care for space flight should lead to a redesign of the practice of medicine on Earth.

Review, Tutorial

Flight Systems Integration and Test

Topics to be Covered in this presentation are: (1) Integration and Test (I&T) Planning (2) Integration and Test Flows (3) Overview of Typical Mission I&T (4) Supporting Elements (5) Lessons-Learned and Helpful Hints (6) I&T Mishaps and Failures (7) The Lighter Side of I&T and (8) Small-Group Activity. This presentation highlights a typical NASA "in-house" I&T program (1) For flight systems that are developed by NASA at a space flight center (like GSFC) (2) Requirements well-defined: qualification/acceptance, documentation, configuration management. (3) Factors: precedents, human flight, risk-aversion ("failure-phobia"), taxpayer dollars, jobs and (4) Some differences among NASA centers, but generally a resource-intensive process

Wright, Michael R.

Psychological Selection of NASA Astronauts for International Space Station Missions

During the relatively short-duration Space Shuffle missions, a psychological support program for the astronauts has not been required. Such missions primarily require providing occasional communication with family members by means of audio, video or e-mail, and some diversions such as CD players. During the NASA-Mir Program, conducted from March 1995 through June 1998, mission duration increased to 4-6 months. As a result of these changes it was necessary for NASA to establish an operational Human Behavior and Performance Group (HBPG) to develop and implement a comprehensive program of psychological support. The Mir experience provided the opportunity to develop and implement a psychological support program for long-duration space missions. Many factors influence the support program, including individual preferences, mission duration, and environmental factors such as habitable and personal areas. Lessons learned from the Mir experience are being applied to improve the ISS psychological support program plan. This presentation will address which includes various preflight, in-flight, and post-flight support activities and tools that NASA's HBPG will provide to astronauts and their families for ISS missions.

VanderArk, Steve

Supplemental final environmental impact statement for advanced solid rocket motor testing at Stennis Space Center

Since the Final Environmental Impact Statement (FEIS) and Record of Decision on the FEIS describing the potential impacts to human health and the environment associated with the program, three factors have caused NASA to initiate additional studies regarding these issues. These factors are: (1) The U.S. Army Corps of Engineers and the Environmental Protection Agency (EPA) agreed to use the same comprehensive procedures to identify and delineate wetlands; (2) EPA has given NASA further guidance on how best to simulate the exhaust plume from the Advanced Solid Rocket Motor (ASRM) testing through computer modeling, enabling more realistic analysis of emission impacts; and (3) public concerns have been raised concerning short and long term impacts on human health and the environment from ASRM testing.

Source record

An Earthling to an Astronaut: Medical Challenges

Humans can travel safely into space in low Earth orbit (LEO) or to near-Earth objects if several medical, physiological, environmental, and human factors issues risks are mitigated. Research must be performed in order to set standards in these four areas, and current NASA standards are contained in the Space Flight Human System Standards volumes 1 and 2, and crew medical certification standards. These three sets of standards drive all of the clinical, biomedical research and environmental technology development for the NASA human space flight program. These standards also drive the identification of specific risks to crew health and safety, and we currently manage 65 human system risks within the human space flight program. Each risk has a specific program of research, technology development, and development of operational procedures to mitigate the risks. Some of the more important risks tat will be discussed in this talk include exposure to radiation, behavioral health due to confinement in a closed cabin, physiological changes such as loss of bone, muscle and exercise capability, reduction in immune system capability, environmental threats of maintaining an adequate atmosphere and water for drinking, avoidance of toxic or infectious material, protection of hearing, and human factors issues of equipment and task design. A nutritious and varied food supply must also be provided. All of these risks will be discussed and current strategies for mitigating these risks for long-duration human space flight. In mitigating these 65 human system risks, novel approaches to problem solving must be employed to find the most appropriate research and technology based applications. Some risk mitigations are developed internally to NASA while others are found through research grants, technology procurements, and more recently open innovation techniques to seek solutions from the global technical community. Examples and results will be presented from all of these approaches including the more recent use of prizes to stimulate innovation.

Davis, Jeffrey R.

Capability Considerations for Enhancing Safety on Long Duration Crewed Missions: Insights from a Technical Interchange Meeting on Autonomous Crew Operations

As future flight crews on long duration deep space missions are expected to operate more autonomously, considerations must be given to onboard capabilities and human-computer teaming that will fortify the safety net traditionally provided by the Mission Control Center. In August 2018, the Human Factors and Behavioral Performance Element of NASA's Human Research Program convened a Technical Interchange Meeting (TIM) on Autonomous Crew Operations at NASA Ames Research Center to address how intelligent technologies can be utilized to augment crew capabilities to support real-time anomaly response. In this paper, we highlight three topic areas discussed at the TIM that have direct implications for future crew anomaly response capabilities: smart structures, cognitive assistants, and manpower.

autonomous crew operations

The human role in space. Volume 3: Generalizations on human roles in space

The human role in space was studied. The role and the degree of direct involvement of humans that will be required in future space missions, was investigated. Valid criteria for allocating functional activities between humans and machines were established. The technology requirements, ecnomics, and benefits of the human presence in space were examined. Factors which affect crew productivity include: internal architecture; crew support; crew activities; LVA systems; IVA/EVA interfaces; and remote systems management. The accomplished work is reported and the data and analyses from which the study results are derived are included. The results provide information and guidelines to enable NASA program managers and decision makers to establish, early in the design process, the most cost effective design approach for future space programs, through the optimal application of unique human skills and capabilities in space.

Source record

High resolution magnetic resonance imaging of the calcaneus: age-related changes in trabecular structure and comparison with dual X-ray absorptiometry measurements

A high-resolution magnetic resonance imaging (MRI) protocol, together with specialized image processing techniques, was applied to the quantitative measurement of age-related changes in calcaneal trabecular structure. The reproducibility of the technique was assessed and the annual rates of change for several trabecular structure parameters were measured. The MR-derived trabecular parameters were compared with calcaneal bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA) in the same subjects. Sagittal MR images were acquired at 1.5 T in 23 healthy women (mean age: 49.3 +/- 16.6 [SD]), using a three-dimensional gradient echo sequence. Image analysis procedures included internal gray-scale calibration, bone and marrow segmentation, and run-length methods. Three trabecular structure parameters, apparent bone volume (ABV/TV), intercept thickness (I.Th), and intercept separation (I.Sp) were calculated from the MR images. The short- and long-term precision errors (mean %CV) of these measured parameters were in the ranges 1-2% and 3-6%, respectively. Linear regression of the trabecular structure parameters vs. age showed significant correlation: ABV/TV (r2 = 33.7%, P < 0.0037), I.Th (r2 = 26.6%, P < 0.0118), I.Sp (r2 = 28.9%, P < 0.0081). These trends with age were also expressed as annual rates of change: ABV/TV (-0.52%/year), I.Th (-0.33%/year), and I.Sp (0.59%/year). Linear regression analysis also showed significant correlation between the MR-derived trabecular structure parameters and calcaneal BMD values. Although a larger group of subjects is needed to better define the age-related changes in trabecular structure parameters and their relation to BMD, these preliminary results demonstrate that high-resolution MRI may potentially be useful for the quantitative assessment of trabecular structure.

NASA Discipline Number 26-10

The Transition from Spacecraft Development Ot Flight Operation: Human Factor Considerations

In the field of aeronautics and astronautics, a paradigm shift has been witnessed by those in academia, research and development, and private industry. Long development life cycles and the budgets to support such programs and projects has given way to aggressive task schedules and leaner resources to draw from all the while challenging assigned individuals to create and produce improved products of processes. however, this "faster, better, cheaper" concept cannot merely be applied to the design, development, and test of complex systems such as earth-orbiting of interplanetary robotic spacecraft. Full advantage is not possible without due consideration and application to mission operations planning and flight operations, Equally as important as the flight system, the mission operations system consisting of qualified personnel, ground hardware and software tools, and verified and validated operational processes, should also be regarded as a complex system requiring personnel to draw upon formal education, training, related experiences, and heuristic reasoning in engineering an effective and efficient system. Unquestionably, qualified personnel are the most important elements of a mission operations system. This paper examines the experiences of the Deep Space I Project, the first in a series of new technology in-flight validation missions sponsored by the United States National Aeronautics and Space Administration (NASA), specifically, in developing a subsystems analysis and technology validation team comprised of former spacecraft development personnel. Human factor considerations are investigated from initial concept/vision formulation; through operational process development; personnel test and training; to initial uplink product development and test support. Emphasis has been placed on challenges and applied or recommended solutions, so as to provide opportunities for future programs and projects to address and disposition potential issues and concerns as early as possible to reap the benefits associated with learning from other's past experiences.

Basilio, Ralph R.

Sex differences and deep space stressors: effects of 5-ion gcrsim, simulated microgravityand social isolation on immune function, brain, and behavior in mice

This project is testing the hypothesis that Ionizing Radiation (IR), microgravity and social isolation combine synergistically to trigger an oxidative stress response that alters immune homeostasis, brain structure/function, and neurobehavioral/cognitive performance. Specific Aims for this project are to: (1) Determine dose-response curves for acute ‘Five-Ion GCR Simulation’ exposure for immune, brain and performance responses in crew age-matched adult male and female mice; (2) Determine effects of acute ‘Five-Ion GCR Simulation’ exposure singly and in combination with simulated microgravity and social isolation, on immune, brain and performance responses in crew age-matched male and female mice mimicking deep space missions; and (3) Determine efficacy of the dietary antioxidant, Nicotinamide Mononucleotide (NMN), a key intermediate in nicotinamide adenine dinucleotide (NAD+) biosynthesis. Here we report findings from our studies of mature (24-week-old) male and female mice exposed to simulated 5-Ion GCRsim (0, 5, 15, or 50cGy) at the NASA Space Radiation Laboratory (NSRL) followed by combinatorial exposures to 15cGy, simulated microgravity via head-down tilt (hindlimb unloading) and social isolation. Immune, brain and behavioral (sensorimotor, risk-taking & cognitive) measures were acquired at ‘Acute’ (IR+24hrs, IR+72hrs), ‘Intermediate’ (IR+14 days) and ‘Delayed’ (IR+28 to IR+124 days) to inform biological responses anticipated during a transit to Mars. This project addresses NASA’s efforts to characterize risks and identify appropriate countermeasures in both women and men in anticipation of future deep space missions. Ensuring crew health and performance during extended transits necessitates that sensorimotor and cognitive abilities remain strong to avoid potentially catastrophic health and safety outcomes. Supported by the NASA Human Research Program (HRP) Human Factors Behavioral Performance Element Grant 18 18FLAG 2 0028.

behavioral sciences

Technology for Future NASA Missions: Civil Space Technology Initiative (CSTI) and Pathfinder

Information is presented in viewgraph form on a number of related topics. Information is given on orbit transfer vehicles, spacecraft instruments, spaceborne experiments, university/industry programs, spacecraft propulsion, life support systems, cryogenics, spacecraft power supplies, human factors engineering, spacecraft construction materials, aeroassist, aerobraking and aerothermodynamics.

Source record

Oxidative Stress and the Neuroconsequences of Spaceflight Environment - Immune Dysregulation and Antioxidant Dietary Countermeasure Efficacy

In this project, we will test the hypothesis that Ionizing Radiation (IR), microgravity and social isolation combine synergistically to trigger an oxidative stress response that alters immune homeostasis, brain structure and function, and neurobehavioral and cognitive performance. Specific Aims for this project are: (1) Determine dose-response curves for acute ‘Five-Ion GCR Simulation’ exposure for immune, brain and performance responses in crew age-matched adult male and female mice; (2) Determine effects of acute ‘Five-Ion GCR Simulation’ exposure singly and in combination with simulated microgravity and social isolation, on immune, brain and performance responses in crew age-matched male and female mice mimicking deep space missions; and (3) Determine efficacy of the dietary antioxidant, Nicotinamide Mononucleotide (NMN), a key intermediate in nicotinamide adenine dinucleotide (NAD+) biosynthesis. The project relies on established and highly translatable ground-based mouse models and assays with IR exposures to be performed at the NASA Space Radiation Laboratory (NSRL). The experimental approach will provide definitive data on the timing and mechanisms involved in the oxidative stress response, immune and brain changes, and ensuing functional (behavioral/cognitive) impairments expected during human transit to Mars. This project will identify potential biomarkers for, and mechanisms underlying, structural and functional changes in the immune and nervous systems leading to behavioral/cognitive performance deficits, and its potential application to develop effective countermeasures to mitigate negative health effects of long duration space habitation. The project will address NASA’s efforts to rapidly advance the characterization of risks and identify appropriate countermeasures in anticipation of future deep space missions. Ensuring crew health and performance during extended transits necessitates that sensorimotor and cognitive abilities remain strong to avoid potentially catastrophic health and safety outcomes. Further, despite historically low numbers of female astronauts, the two most recent NASA Astronaut Corps class selections, comprised of ~50% women as compared to men, signal the need to understand how sex differences affect physiological adaptation and health in the space environment. Here, we will determine how key features of the deep space environment may interact to increase risk to crewmembers by negatively impacting health and performance, and identify and develop strategies to characterize and mitigate the potential risks via countermeasures. Supported by the NASA Human Research Program (HRP) Human Factors Behavioral Performance Element Grant 18-18FLAG_2-0028.

radiation

Human interactions during Shuttle/Mir space missions

To improve the interpersonal climate of crewmembers involved with long-duration space missions, it is important to understand the factors affecting their interactions with each other and with members of mission control. This paper will present findings from a recently completed NASA-funded study during the Shuttle/Mir program which evaluated in-group/out-group displacement of negative emotions; changes in tension, cohesion, and leader support over time; and cultural differences. In-flight data were collected from 5 astronauts, 8 cosmonauts, and 42 American and 16 Russian mission control personnel who signed informed consent. Subjects completed a weekly questionnaire that assessed their mood and perception of their work group's interpersonal climate using questions from well-known, standardized measures (Profile of Mood States, Group and Work Environment Scales) and a critical incident log. There was strong evidence for the displacement of tension and dysphoric emotions from crewmembers to mission control personnel and from mission control personnel to management. There was a perceived decrease in commander support during the 2nd half of the missions, and for American crewmembers a novelty effect was found on several subscales during the first few months on-orbit. There were a number of differences between American and Russian responses which suggested that the former were less happy with their interpersonal environment than the latter. Mission control personnel reported more tension and dysphoria than crewmembers, although both groups scored better than other work groups on Earth. Nearly all reported critical incidents came from ground subjects, with Americans and Russians showing important differences in response frequencies.

Non-NASA Center

Musculoskeletal adaptations to weightlessness and development of effective countermeasures

A Research Roundtable, organized by the American College of Sports Medicine with sponsorship from the National Aeronautics and Space Administration, met in November 1995 to define research strategies for effective exercise countermeasures to weightlessness. Exercise was considered both independently of, and in conjunction with, other therapeutic modalities (e.g., pharmacological nutritional, hormonal, and growth-related factors) that could prevent or minimize the structural and functional deficits involving skeletal muscle and bone in response to chronic exposure to weightlessness, as well as return to Earth baseline function if a degree of loss is inevitable. Musculoskeletal deficits and countermeasures are described with respect to: 1) muscle and connective tissue atrophy and localized bone loss, 2) reductions in motor performance, 3) potential proneness to injury of hard and soft tissues, and 4) probable interaction between muscle atrophy and cardiovascular alterations that contribute to the postural hypotension observed immediately upon return from space flight. In spite of a variety of countermeasure protocols utilized previously involving largely endurance types of exercise, there is presently no activity-specific countermeasure(s) that adequately prevent or reduce musculoskeletal deficiencies. It seems apparent that countermeasure exercises that have a greater resistance element, as compared to endurance activities, may prove beneficial to the musculoskeletal system. Many questions remain for scientific investigation to identify efficacious countermeasure protocols, which will be imperative with the emerging era of long-term space flight.

Non-NASA Center

Safe Human Expeditions Beyond Low Earth Orbit (LEO)

The NASA Engineering and Safety Center (NESC) conducted an interdisciplinary study and workshop focusing on capabilities needed for crew health and safety on long-duration deep space expeditions in support of the Artemis Program and missions to Mars. The study focused on integration among four disciplines: 1) space weather monitoring and forecasting, 2) shielding technologies, 3) human health research, and 4) human factors engineering tools. An integrated risk assessment was performed to inform characteristics of mission architecture and capabilities needed for safe, long-duration human expeditions beyond low Earth orbit. This report contains the outcome of the NESC assessment.

Low Earth Orbit

Fluid flow releases fibroblast growth factor-2 from human aortic smooth muscle cells

This study tested the hypothesis that fluid shear stress regulates the release of fibroblast growth factor (FGF)-2 from human aortic smooth muscle cells. FGF-2 is a potent mitogen that is involved in the response to vascular injury and is expressed in a wide variety of cell types. FGF-2 is found in the cytoplasm of cells and outside cells, where it associates with extracellular proteoglycans. To test the hypothesis that shear stress regulates FGF-2 release, cells were exposed to flow, and FGF-2 amounts were measured from the conditioned medium, pericellular fraction (extracted by heparin treatment), and cell lysate. Results from the present study show that after 15 minutes of shear stress at 25 dyne/cm(2) in a parallel-plate flow system, a small but significant fraction (17%) of the total FGF-2 was released from human aortic smooth muscle cells. FGF-2 levels in the circulating medium increased 10-fold over medium from static controls (P<0.01). A 50% increase in FGF-2 content versus control (P<0.01) was found in the pericellular fraction (extracted by heparin treatment). Furthermore, a significant decrease in FGF-2 was detected in the cell lysate, indicating that FGF-2 was released from inside the cell. Cell permeability studies with fluorescent dextran were performed to examine whether transient membrane disruption caused FGF-2 release. Flow cytometry detected a 50% increase in mean fluorescence of cells exposed to 25 dyne/cm(2) versus control cells. This indicates that the observed FGF-2 release from human aortic smooth muscle cells is likely due to transient membrane disruption on initiation of flow.

Non-NASA Center

Human Research Program Requirements Document (Revision C)

The purpose of this document is to define, document, and allocate the Human Research Program (HRP) requirements to the HRP Program Elements. It establishes the flow-down of requirements from Exploration Systems Mission Directorate (ESMD) and Office of the Chief Health and Medical Officer (OCHMO) to the various Program Elements of the HRP to ensure that human research and technology countermeasure investments are made to insure the delivery of countermeasures and technologies that satisfy ESMD's and OCHMO's exploration mission requirements. Requirements driving the HRP work and deliverables are derived from the exploration architecture, as well as Agency standards regarding the maintenance of human health and performance. Agency human health and performance standards will define acceptable risk for each type and duration of exploration mission. It is critical to have the best available scientific and clinical evidence in setting and validating these standards. In addition, it is imperative that the best available evidence on preventing and mitigating human health and performance risks is incorporated into exploration mission and vehicle designs. These elements form the basis of the HRP research and technology development requirements and highlight the importance of HRP investments in enabling NASA's exploration missions. This PRD defines the requirements of the HRP which is comprised of the following major Program Elements: Behavioral Health and Performance (BHP), Exploration Medical Capability (ExMC), Human Health Countermeasures (HHC), ISS Medical Project (ISSMP), Space Human Factors and Habitability (SHFH), and Space Radiation (SR).

Vargas, Paul R.

A Tool for the Automated Collection of Space Utilization Data: Three Dimensional Space Utilization Monitor

Space Human Factors and Habitability (SHFH) Element within the Human Research Program (HRP) and the Behavioral Health and Performance (BHP) Element are conducting research regarding Net Habitable Volume (NHV), the internal volume within a spacecraft or habitat that is available to crew for required activities, as well as layout and accommodations within the volume. NASA needs methods to unobtrusively collect NHV data without impacting crew time. Data required includes metrics such as location and orientation of crew, volume used to complete tasks, internal translation paths, flow of work, and task completion times. In less constrained environments methods exist yet many are obtrusive and require significant post-processing. Examplesused in terrestrial settings include infrared (IR) retro-reflective marker based motion capture, GPS sensor tracking, inertial tracking, and multi-camera methods Due to constraints of space operations many such methods are infeasible. Inertial tracking systems typically rely upon a gravity vector to normalize sensor readings,and traditional IR systems are large and require extensive calibration. However, multiple technologies have not been applied to space operations for these purposes. Two of these include: 3D Radio Frequency Identification Real-Time Localization Systems (3D RFID-RTLS) Depth imaging systems which allow for 3D motion capture and volumetric scanning (such as those using IR-depth cameras like the Microsoft Kinect or Light Detection and Ranging / Light-Radar systems, referred to as LIDAR)

Vos, Gordon A.