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Man-Machine Interaction Design and Analysis System (MIDAS): Memory Representation and Procedural Implications for Airborne Communication Modalities

The Man-Machine Interaction Design and Analysis System (MIDAS) has been under development for the past ten years through a joint US Army and NASA cooperative agreement. MIDAS represents multiple human operators and selected perceptual, cognitive, and physical functions of those operators as they interact with simulated systems. MIDAS has been used as an integrated predictive framework for the investigation of human/machine systems, particularly in situations with high demands on the operators. Specific examples include: nuclear power plant crew simulation, military helicopter flight crew response, and police force emergency dispatch. In recent applications to airborne systems development, MIDAS has demonstrated an ability to predict flight crew decision-making and procedural behavior when interacting with automated flight management systems and Air Traffic Control. In this paper we describe two enhancements to MIDAS. The first involves the addition of working memory in the form of an articulatory buffer for verbal communication protocols and a visuo-spatial buffer for communications via digital datalink. The second enhancement is a representation of multiple operators working as a team. This enhanced model was used to predict the performance of human flight crews and their level of compliance with commercial aviation communication procedures. We show how the data produced by MIDAS compares with flight crew performance data from full mission simulations. Finally, we discuss the use of these features to study communications issues connected with aircraft-based separation assurance.

Corker, Kevin M.↗

Training - Behavioral and motivational solutions?

Psychological factors which govern interpersonal activities in the cockpit are examined. It is suggested that crew members should be selected based on personality characteristics required for the position and that training does not cause long lasting personality changes, it only teaches and improves task performance skills. The effects of mindlessness as defined by Langer (1978) and the attribution theory of Jones and Nisbett (1971) on flight deck communications and cockpit management are described. The needs for a new system of training crew members, with emphasis on strategies that induce cognitive processes and awareness, and for field investigations of pilots are discussed.

Helmreich, Robert L.↗

The Current State and Future of the Former Central Nervous System Risk Managed by Space Radiation Element Part of NASA’s Human Research Program

Historically, the Space Radiation Element, as part of the NASA Human Research Program, was responsible for the scientific strategy and funding of research focused on characterizing and mitigating the effects of space radiation exposure on the central nervous system (CNS). During the past few years, there have been two major changes that have affected the management of the science associated with the CNS risk. The first major change was the integration of several related risks: CNS (C), behavioral medicine (B), and sensorimotor (S) to be managed as an integrated effort called CBS. CBS was formed to accelerate research on combined spaceflight stressors, specifically space radiation, microgravity, isolation, and confinement. CBS was managed by Human Factors and Behavioral Performance (HFBP) with support and inputs from Space Radiation as well as Human Health Countermeasures. Secondly, and more recently, the CNS risk was absorbed by the behavioral medicine risk currently also held by HFPB. As a result, the gaps associated with CNS were removed and aspects of them are represented in the BMED gaps (link). However, due to recent changes in element leadership, budget, and timeline, extensive restructuring of CBS is in progress. In addition, in an effort to harmonize datasets to be used in modeling efforts, an Animal Standardization TIM was held in June 2021 to standardize the type of behavioral and cognitive tasks as well as experimental set-ups used in animal models of future funded research. This presentation is an effort to communicate with the radiation research community concerning the strategy, management, and future of the former central nervous system risk and the role of the Space Radiation Element.

Janice A Zawaski↗

Hazard alerting and situational awareness in advanced air transport cockpits

Advances in avionics and display technology have significantly changed the cockpit environment in current 'glass cockpit' aircraft. Recent developments in display technology, on-board processing, data storage, and datalinked communications are likely to further alter the environment in second and third generation 'glass cockpit' aircraft. The interaction of advanced cockpit technology with human cognitive performance has been a major area of activity within the MIT Aeronautical Systems Laboratory. This paper presents an overview of the MIT Advanced Cockpit Simulation Facility. Several recent research projects are briefly reviewed and the most important results are summarized.

Hansman, R. John↗

Developing a Hybrid Spacesuit Simulator as a Research Tool for Assessing Extravehicular Activity Relevant Workload

Conducting human tests in a pressurized spacesuit is limited by availability, cost, and manpower; however, pressurized spacesuits are not always needed depending on the objectives of testing, including the development and testing of new informatics capabilities. The Human Physiology, Performance, Protection & Operations Laboratory (H-3PO) at NASA is developing a Hybrid Spacesuit Simulator (HS3) to support testing and characterization of human performance during analog planetary exploration extravehicular activities (EVAs). The goal of HS3 is to create a low-cost, modular, and unpressurized spacesuit simulator as a research tool that provides relevant physical and cognitive workload approximations with EVA-like immersion. HS3 consists of a soft outer suit, thermal control, gloves, boots, helmet, and integrated bioinformatics and communications. Baseline HS3 assessments were performed during 3-hour EVA simulations in two different subjects (DEMO1 and DEMO2) that included traverses at variable resistances and geological sampling activities. Liquid cooling garment (LCG) temperature, mean skin temperature, heart rate, motion capture, and metabolic rate were collected during each 3-hour simulated EVA. During DEMO1 and DEMO2, baseline metabolic rates at rest were 836 ± 327 BTU/hr and 869 ± 207 BTU/hr and increased to 2124 ± 548 BTU/hr and 2269 ± 559 BTU/hr, respectively, during 500m traverse. Average inlet LCG temperatures were 29.57 ± 6.62 °C and 25.63 ± 6.48 °C for DEMO1 and DEMO2 with increased outlet LCG temperatures of 33.53 ± 6.62 °C and 29.21 ± 4.79 °C, respectively. Overall, HS3 will enable future studies to characterize EVA tasks, human performance, and test future EVA capabilities in analog test environments without the need for pressurized suited environments.

Monica Hew↗

Developing A Hybrid Spacesuit Simulator as A Research Tool for Assessing Extravehicular Activity Relevant Workload

Conducting human tests in a pressurized spacesuit is limited by availability, cost, and manpower; however, pressurized spacesuits are not always needed depending on the objectives of testing, including the development and testing of new informatics capabilities. The Human Physiology, Performance, Protection & Operations Laboratory (H-3PO) at NASA is developing a Hybrid Spacesuit Simulator (HS3) to support testing and characterization of human performance during analog planetary exploration extravehicular activities (EVAs). The goal of HS3 is to create a low-cost, modular, and unpressurized spacesuit simulator as a research tool that provides relevant physical and cognitive workload approximations with EVA-like immersion. HS3 consists of a soft outer suit, thermal control, gloves, boots, helmet, and integrated bioinformatics and communications. Baseline HS3 assessments were performed during 3-hour EVA simulations in two different subjects (DEMO1 and DEMO2) that included traverses at variable resistances and geological sampling activities. Liquid cooling garment (LCG) temperature, mean skin temperature, heart rate, motion capture, and metabolic rate were collected during each 3-hour simulated EVA. During DEMO1 and DEMO2, baseline metabolic rates at rest were 836 ± 327 BTU/hr and 869 ± 207 BTU/hr and increased to 2124 ± 548 BTU/hr and 2269 ± 559 BTU/hr, respectively, during 500m traverse. Average inlet LCG temperatures were 29.57 ± 6.62 °C and 25.63 ± 6.48 °C for DEMO1 and DEMO2 with increased outlet LCG temperatures of 33.53 ± 6.62 °C and 29.21 ± 4.79 °C, respectively. Overall, HS3 will enable future studies to characterize EVA tasks, human performance, and test future EVA capabilities in analog test environments without the need for pressurized suited environments.

Suit simulator↗

Assessments of Physiology and Cognition in Hybrid-Reality Environments (APACHE)

NASA is planning to return to the Moon in the mid-2020s as a stepping stone to Mars missions in the 2030s. Spacewalks, or extravehicular activities (EVAs), performed on the Moon and Mars will differ in a variety of ways from those that have been performed in decades past. NASA has identified multiple risks to human health and performance associated with a crewed mission to Mars, especially those associated with exploration EVAs which are expected to be a primary mission activity. Crew may be expected to conduct up to 24 hours of EVA per person per week, where the likelihood of injury and/or mental mistakes are increased compared to ground-based training or current microgravity EVAs and the consequences of which can be catastrophic. Current test environments for exploration EVA research and technology development are large, costly facilities that are limited in their availability or capabilities. Spacesuit testing in a reduced gravity environment such as NASA’s Neutral Buoyancy Laboratory, while a good representation of the crew’s physical workload during exploration EVAs, typically has small datasets and is difficult to integrate physiological sensors or other types of crew performance measures. Meanwhile, scientific field-based testing such as NASA’s Desert Research and Technology Studies offers an operationally relevant environment for exploration EVAs, particularly for cognitive workload, but is also limited by small datasets, lack of a pressurized spacesuit, and obtrusive measures. The limitations of current analogs for exploration EVAs identify a need for a new test environment that can approximate both the physical and cognitive demands associated with exploration EVAs to enable rapid, controlled, and repeatable evaluations of human health and performance risks of exploration missions. In response, the Human Physiology, Performance, Protection, and Operations Laboratory (H-3PO) at NASA Johnson Space Center has developed a hybrid reality exploration EVA analog named the Assessments of Physiology And Cognition in Hybrid-reality Environments (APACHE) to address these limitations using a combination of virtual, physical, and hybrid reality techniques. The APACHE facility resides at NASA Johnson Space Center and serves as a large “sandbox” for EVA research and simulation. At its center is a roughly 15x20ft space surrounded by a 14” tall sandbox partially filled with lunar regolith simulant to emulate the physical feeling of walking on a planetary surface and to allow for simulated geology operations. Nearby, a curved passive treadmill (Skillmill Connect, Technogym, Fairfield, NJ) and an omnidirectional treadmill (Infinadeck, Infinadeck, Rocklin, CA) are included to enable exploration of these large virtual environments while also imposing the physical demands, representative timelines, and cognitive burdens required to navigate and traverse these distances during exploration EVA. A 6DOF motion platform is used to simulate rover operations and supports various human performance evaluations and associated risks. Lastly, APACHE can support two extravehicular (EV) crewmembers working in tandem. A computer workstation is located nearby and also supports an intravehicular (IV) crewmember as part of a full mission simulation. The IV crewmember has direct video and audio communication with the EV crew in VR to provide operational and procedural support. The software used in APACHE was created by the JSC Engineering Directorate, in partnership with Buendea, powered by a custom Unreal Engine 5 (UE5.3, Epic Games) project. APACHE currently utilizes the HTC Vive Pro Eye in a wireless configuration for VR simulations. There are two virtual environments that subjects can explore within APACHE, a Lunar and Martian surface. The virtual Lunar surface was created from LIDAR data of the Lunar South Pole to create roughly 16 sq km of explorable terrain. The virtual Martian surface contains roughly 400 sq km of explorable terrain derived from Mars Reconnaissance Orbiter LIDAR data of the Jezero Crater. The immersion and related cognitive burdens of conducting a planetary EVA is simulated through a series of EVA-relevant tasks performed in the VR environment, using these high-fidelity visual representations. Additionally, APACHE includes biosensor driven informatics, such as real-time heart rate monitoring and/or derived values from model simulations, for active monitoring by the EV crew and added cognitive demand. A “Wizard of Oz” control panel enables test operators to activate contingency events such as simulated spacesuit malfunctions, loss of communications, and/or limited visibility. Embedded performance measures such as accuracy, completeness, and execution time have been developed for various exploration tasks to objectively quantify crew performance during an EVA and compare impacts to performance when different environmental stressors, both physical and cognitive, are added to or removed from the simulation. Additionally, validated cognitive and operational performance measures such as the Digit Symbol Substitution Task have been recreated and embedded in VR for direct and relatively unobtrusive measurement of motor perception. The APACHE environment currently supports multiple research studies at NASA. Examples include the CHAPEA project, a series of simulated year-long missions on Mars by a 4-person crew; and the CO2 Contingency Walk Back Study, an investigation of elevated CO2 exposure on crew performance during a contingency EVA scenario. APACHE also provides a test environment to support the development of the Crew State and Risk Model, which is a collection of individualized, mathematical models of crew physical and cognitive state; and the Personalized EVA Informatics and Decision Support system, an operational tool for flight controllers, and eventually a self-reliant Martian crew, to make biomedically-informed decisions in real-time to optimize the EVA planning and execution with respect to crew health and performance. Some technical challenges associated with developing the APACHE environment, as well as current limitations, include VR limitless natural walking with a hybrid spacesuit simulator, optimizing performance for wireless PC VR streaming while maintaining a high degree of visual fidelity, and the integration of various physiological (metabolic masks) and psychometric (eye tracking) sensors with the VR headset.

Human Performance↗

Impasse-driven tutoring for reactive skill acquisition

We are interested in developing effective performance-oriented training for the operation of systems that are used for monitor and control purposes. We have focused on one such system, the communications Link Monitor and Control (LMC) system used in NASA's Deep Space Network (DSN), which is a worldwide system for navigating, tracking and communicating with unmanned interplanetary spacecraft. The tasks in this domain are procedural in nature and require reactive, goal-oriented skills; we have previously described a cognitive model for problem solving that accounts for both novice and expert levels of behavior as well as how skill is acquired. Our cognitive modeling work in this task domain led us to make a number of predictions about tutoring that have influenced the design of the system described in this paper.

Hill, Randall W., Jr.↗

Impasse-Driven Tutoring for Reactive Skill Acquisition

We are interested in developing effective performance-oriented training for the operation of systems that are used for monitor and control purposes. We have focused on one such system, the communications Link Monitor and Control (LMC) system used in NASA's Deep Space Network (DSN), which is a worldwide system for navigating, tracking and communicating with unmanned interplanetary spacecraft. The tasks in this domain are procedural in nature and require reactive, goal-oriented skills; we have previously described a cognitive model for problem solving that accounts for both novice and expert levels of behavior as well as how skill is acquired [Hill and Johnson, 1993]. Our cognitive modeling work in this task domain led us to make a number of predictions about tutoring that have influenced the design of the system described in this paper.

Johnson, W. Lewis↗

Cockpit weather graphics using mobile satellite communications

Many new companies are pushing state-of-the-art technology to bring a revolution in the cockpits of General Aviation (GA) aircraft. The vision, according to Dr. Bruce Holmes - the Assistant Director for Aeronautics at National Aeronautics and Space Administration's (NASA) Langley Research Center, is to provide such an advanced flight control system that the motor and cognitive skills you use to drive a car would be very similar to the ones you would use to fly an airplane. We at ViGYAN, Inc., are currently developing a system called the Pilot Weather Advisor (PWxA), which would be a part of such an advanced technology flight management system. The PWxA provides graphical depictions of weather information in the cockpit of aircraft in near real-time, through the use of broadcast satellite communications. The purpose of this system is to improve the safety and utility of GA aircraft operations. Considerable effort is being extended for research in the design of graphical weather systems, notably the works of Scanlon and Dash. The concept of providing pilots with graphical depictions of weather conditions, overlaid on geographical and navigational maps, is extremely powerful.

Seth, Shashi↗

Ada and knowledge-based systems: A prototype combining the best of both worlds

A software architecture is described which facilitates the construction of distributed expert systems using Ada and selected knowledge based systems. This architecture was utilized in the development of a Knowledge-based Maintenance Expert System (KNOMES) prototype for the Space Station Mobile Service Center (MSC). The KNOMES prototype monitors a simulated data stream from MSC sensors and built-in test equipment. It detects anomalies in the data and performs diagnosis to determine the cause. The software architecture which supports the KNOMES prototype allows for the monitoring and diagnosis tasks to be performed concurrently. The basic concept of this software architecture is named ACTOR (Ada Cognitive Task ORganization Scheme). An individual ACTOR is a modular software unit which contains both standard data processing and artificial intelligence components. A generic ACTOR module contains Ada packages for communicating with other ACTORs and accessing various data sources. The knowledge based component of an ACTOR determines the role it will play in a system. In this prototype, an ACTOR will monitor the MSC data stream.

Brauer, David C.↗

Assessing and Promoting Functional Resilience in Flight Crews During Exploration Missions

NASA plans to send humans to Mars in about 20 years. The NASA Human Research Program supports research to mitigate the major risks to human health and performance on extended missions. However, there will undoubtedly be unforeseen events on any mission of this nature - thus mitigation of known risks alone is not sufficient to ensure optimal crew health and performance. Research should be directed not only to mitigating known risks, but also to providing crews with the tools to assess and enhance resilience, as a group and individually. We can draw on ideas from complexity theory and network theory to assess crew and individual resilience. The entire crew or the individual crewmember can be viewed as a complex system that is composed of subsystems (individual crewmembers or physiological subsystems), and the interactions between subsystems are of crucial importance for overall health and performance. An understanding of the structure of the interactions can provide important information even in the absence of complete information on the component subsystems. This is critical in human spaceflight, since insufficient flight opportunities exist to elucidate the details of each subsystem. Enabled by recent advances in noninvasive measurement of physiological and behavioral parameters, subsystem monitoring can be implemented within a mission and also during preflight training to establish baseline values and ranges. Coupled with appropriate mathematical modeling, this can provide real-time assessment of health and function, and detect early indications of imminent breakdown. Since the interconnected web of physiological systems (and crewmembers) can be interpreted as a network in mathematical terms, we can draw on recent work that relates the structure of such networks to their resilience (ability to self-organize in the face of perturbation). There are many parameters and interactions to choose from. Normal variability is an established characteristic of a healthy physiological response. Healthy coupling has been investigated less extensively, but there are cases in which too tight or too loose coupling can be problematic. This might be in inter-individual behaviors, such as sleep cycles, coordination of work and meal times, and coupled motions during communication. Less apparent are couplings of physiological systems, nevertheless examples abound of coupled systems which might be monitored: cardio-respiratory rhythms; circadian rhythms, body temperature, and sleep; stress markers and cognition, sleep, and performance; profiles of biochemical markers related to immune function and nutritional status; sensorimotor aspects such as motion sickness, ataxia, reaction time, and manual control. Tools for resilience are then the means to measure and analyze these parameters, incorporate them into appropriate models of normal variability and interconnectedness, and recognize when parameters or their couplings are outside of normal limits. What to do when a problem is identified depends on its nature. Changes can be made to crew procedures, work pacing, interpersonal interactions, sleep cycles, meal timing and content, as guided by the model. Use and continued development of these methods could not only provide tools for resilience, but also meaningful autonomous work for the crew on an extended flight.

Shelhamer, Mark↗

Monitoring Human Performance on Future Deep Space Missions Abstract

NASA and the commercial spacecraft community are working diligently to put the first woman on the moon in the 2024 timeframe. At the same time, NASA researchers are thinking about how to solve the even larger challenges that future deep space missions will bring. Space travel itself is difficult, but astronauts on deep space missions will face obstacles and unknowns never before experienced. In addition to the altered gravity and hostile/closed environment of a spacecraft, deep space crews will face increased radiation, isolation, and distance from Earth. During Extravehicular Activity (EVA, or “spacewalk”) operations, crew will experience increased physical and cognitive workload due to extended types, frequencies and durations of tasks performed on exploration missions in partial gravity environments. All of these stressors will impact crew physical and mental health and performance in difficult-to-anticipate ways. Crew autonomy may be one of the biggest challenges faced. Communication delays and blackouts will occur, and in those situations, the crew may not have access to the Mission Control Center (MCC). They may be forced to be solely dependent on each other and the available information onboard to stay alive, healthy, and achieve the mission. The only conceivable way to meet the challenges of Earth independence is to enable the crew to monitor their own health and performance -- preferably unobtrusively as they perform their duties. Technologies and techniques must be developed to aid the crew in these assessments. A deep space mission is expected to have relatively short periods of high cognitive demand, stress, and fatigue, alongside potentially long periods of cognitive underload during the transit, where boredom, loneliness, and depression can set in. Both ends of this spectrum are dangerous. Crew must be made aware when their task performance drops significantly, when their cognitive workload is too high, when they have lost situation awareness, or when they are too stressed or too fatigued to perform well. They must be able to identify these risks, and then mitigate them with countermeasures available onboard. A number of self-monitoring technologies are presently being explored by NASA to advance crew state determination capabilities. These range from real-time, physiological workload and situation awareness assessments, to crew health measurements determining physical and mental fitness for duty, to task performance metrics such as suit resource expenditures. For EVA tasks during surface exploration missions, biomedical information such as metabolic rate may be provided to crewmembers for situational awareness related to task performance efficiency. In addition, translation distances, hydration, nutrition, inspired CO2 exposure and other consumables usage rates may be useful input metrics for modeling individualized performance during tasks to inform crew or provide estimates of work efficiency. Oculomotor metrics such as gaze dwell time, pupilometry, and eye tracking collected in advanced helmet mounted displays could potentially be used to characterize crew situation awareness. This paper highlights some of these projects, and provides broader discussion about the need for advanced monitoring and smart technologies, as NASA takes the leap into the next generation of space exploration.

Kritina Holden↗

The Cosmic Radiation Symphony: Soundtrack for a Journey to Mars

Space radiation (SR) is a constant threat to astronauts who journey away from the Earth’s protective magnetosphere. Galactic cosmic rays (GCR) are atomic nuclei from remnants of supernovae and are omnipresent in outer space. These ionized particles travel close to the speed of light and when they traverse biological material,they leave behind a path of damage. Another space radiation threat is from our sun when solar particle events (SPEs), or bursts of energetic protons,occur. Exposure to space radiation can lead to cancer, cardiovascular disease,immune dysfunction, and cognitive and behavioral decrements. Yet humans cannot see, smell, taste, hear,or feel radiation, making it less tangible than other health threats and much more difficult to describe.This is an important gap in risk communication that the Space Radiation Element is working to close within NASA’s Human Research Program. Music and art are powerful means of communicating human emotions and feelings and are effective and creative ways to convey other types of information. In this work, the sonification process was used to transcribe or translate the physical nature of the SR environment on a 3-year mission to Mars into sound, a format perceptible to the human ear. A visual representation for the journey was also developed so the audience can both hear and envision the chronic presence of GCR and the acute and large bursts of energy present in SPEs. Data for this project were derived from the Radiation Assessment Detector on the NASA Curiosity Rover during its outbound cruise to Mars and on the Martian surface, as well as from models of the space radiation environment behind spacecraft shielding. Our data-driven audiovisual composition was realized using custom programmed digital signal processing and graphic design in the programming languages Pure Data and Processing. The data sonification was contextualized in time and space by calculating and visualizing the location of the spacecraft in relation to the other planets during the Mars mission. The finished work is a unique and powerful means of communicating the presence and risk of space radiation, accessible by people of all ages and scientific backgrounds

Richard Snow↗

Clinical Decision Support - Concepts of Operation

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

clinical decision support↗

Clinical Decision Support - Concepts of Operation

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

clinical decision support↗

CLINICAL DECISION SUPPORT: PATH TO FUNCTIONAL REQUIREMENTS

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, all of which demand greater crew autonomy. Specifically, as the communication delays intensify the further we explore space, the unqualified need for Earth-independent medical operations focused on autonomous diagnosis, treatment and prevention will be key to mission continuation and success. To augment the requisite knowledge, skills and abilities (KSAs) of a time-constrained crew operating under stressful conditions, combatting fatigue, and facing a potential medical crisis, a robust clinical decision support system (CDSS) is a probable solution that would facilitate, guide and inform Earth-independent medical operations, while assisting crewmembers through various clinical presentations. The Exploration Medical Capability (ExMC) Element of the Human Research Program (HRP) is expanding the boundaries of space medical systems to advance the care of astronauts on future exploration missions beyond low Earth orbit. ExMC is actively identifying and testing next-generation medical care and crew health maintenance technologies. The Clinical Decision Support (CDS) project addresses gap Medical-701 within the Inflight Medical Conditions risk: “Enhance medical capabilities within an exploration medical system.” Though mass, volume, and power will face increasing constraints, the projected computational capabilities of spacecraft systems will increase exponentially as information technology continues to advance this decade and beyond. Hence, data, software and computational resources will play an essential and synergistic role in maintaining crew health, wellness and performance in deep space missions. The focus of the CDS project is to develop recommended requirements for an in-vehicle CDSS that acts as a ‘virtual assistant’ for delivering optimal health, performance and medical care during exploration missions. The CDSS is envisioned as an integrated, software-based tool deployed on a laptop computer or handheld device. The CDSS will assist the crew and ground support when interacting with knowledge/databases (e.g. records, pharmacy, schedule), instrumentation (e.g. imaging, physiological monitoring devices), and habitat (e.g. wellness system, task performance system) and vehicle systems (e.g. environmental system, communication system). In addition, the human interface will employ a context-based approach that accounts for the crew’s situation. Thus, extraneous and clinically/operationally non-relevant information are reduced to avoid an increase in cognitive load. The framework of an ideal spaceflight CDSS is to include core and advanced analytical features that incorporate work from collaborators yet maintain a flexible platform for integrating new technology in the future. In fiscal year 2021 (FY21), the CDS project identified requirements through two primary mechanisms: (i) the development of software implementation prototypes and (ii) the application of systems engineering processes. The CDS project developed and tested a series of increasingly complex system prototypes that were based on use cases derived from the CDSS concept of operations (ConOps). These software implementations yielded insights on CDSS functionality as well as lessons learned that provided the initial requirements for CDSS capability. By applying a systems engineering (SE) approach, medical scenarios provided in the ConOps and the use cases for software implementation underwent functional decomposition to identify CDSS functionality. Also, systems-based modeling language (SysML) tools such as activity diagrams were developed from the same ConOps and use cases to identify CDSS functionality. The lessons learned from software implementation defined both specific requirements and broad areas of requirements. Within these defined broad requirement areas, further analysis of the SE products identified specific capability that resulted in the final functional requirements. In summary, the software prototypes, functional decomposition of the ConOps and use cases, and SysML diagrams provided the basis for the CDSS requirements developed in FY21. In the upcoming year, these requirements will be refined for their final ExMC baseline review in latter FY22.

clinical decision support↗

Clinical Decision Support: Path to Functional Requirements

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, all of which demand greater crew autonomy. Specifically, as the communication delays intensify the further we explore space, the unqualified need for Earth-independent medical operations focused on autonomous diagnosis, treatment and prevention will be key to mission continuation and success. To augment the requisite knowledge, skills and abilities (KSAs) of a time-constrained crew operating under stressful conditions, combatting fatigue, and facing a potential medical crisis, a robust clinical decision support system (CDSS) is a probable solution that would facilitate, guide and inform Earth-independent medical operations, while assisting crewmembers through various clinical presentations. The Exploration Medical Capability (ExMC) Element of the Human Research Program (HRP) is expanding the boundaries of space medical systems to advance the care of astronauts on future exploration missions beyond low Earth orbit. ExMC is actively identifying and testing next-generation medical care and crew health maintenance technologies. The Clinical Decision Support (CDS) project addresses gap Medical-701 within the Inflight Medical Conditions risk: “Enhance medical capabilities within an exploration medical system.” Though mass, volume, and power will face increasing constraints, the projected computational capabilities of spacecraft systems will increase exponentially as information technology continues to advance this decade and beyond. Hence, data, software and computational resources will play an essential and synergistic role in maintaining crew health, wellness and performance in deep space missions. The focus of the CDS project is to develop recommended requirements for an in-vehicle CDSS that acts as a ‘virtual assistant’ for delivering optimal health, performance and medical care during exploration missions. The CDSS is envisioned as an integrated, software-based tool deployed on a laptop computer or handheld device. The CDSS will assist the crew and ground support when interacting with knowledge/databases (e.g. records, pharmacy, schedule), instrumentation (e.g. imaging, physiological monitoring devices), and habitat (e.g. wellness system, task performance system) and vehicle systems (e.g. environmental system, communication system). In addition, the human interface will employ a context-based approach that accounts for the crew’s situation. Thus, extraneous and clinically/operationally non-relevant information are reduced to avoid an increase in cognitive load. The framework of an ideal spaceflight CDSS is to include core and advanced analytical features that incorporate work from collaborators yet maintain a flexible platform for integrating new technology in the future. In fiscal year 2021 (FY21), the CDS project identified requirements through two primary mechanisms: (i) the development of software implementation prototypes and (ii) the application of systems engineering processes. The CDS project developed and tested a series of increasingly complex system prototypes that were based on use cases derived from the CDSS concept of operations (ConOps). These software implementations yielded insights on CDSS functionality as well as lessons learned that provided the initial requirements for CDSS capability. By applying a systems engineering (SE) approach, medical scenarios provided in the ConOps and the use cases for software implementation underwent functional decomposition to identify CDSS functionality. Also, systems-based modeling language (SysML) tools such as activity diagrams were developed from the same ConOps and use cases to identify CDSS functionality. The lessons learned from software implementation defined both specific requirements and broad areas of requirements. Within these defined broad requirement areas, further analysis of the SE products identified specific capability that resulted in the final functional requirements. In summary, the software prototypes, functional decomposition of the ConOps and use cases, and SysML diagrams provided the basis for the CDSS requirements developed in FY21. In the upcoming year, these requirements will be refined for their final ExMC baseline review in latter FY22.

Clinical decision support↗