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NASA NTRSDate not supplied

Spaceflight Medical Evacuation Risk Assessment Principles - A Qualitative Investigation

BACKGROUND Future human space exploration beyond Low Earth Orbit (LEO) will require innovative solutions in many areas, primarily those that provide direct medical support to crew on long-duration missions and optimize their health and performance. The associated challenges therein will be numerous, including but not necessarily limited to extended one-way or "asynchronous" communication delays, minimal to non-existent resupply, and a prolonged transit time to "definitive care" ranging from 3-days to 9-months. At the same time, long-duration exploration spacecraft and crew will face restrictions on mass, power, volume, and data far more significant than that seen in current LEO settings. Given these limitations, medical risk assessment is of primary importance, especially evaluating the implications of a medical evacuation of an ill or injured crewmember. Such evacuations are complicated, potentially dangerous, and well may be impossible in certain phases of the mission. Regardless, such issues must be weighed against the risks of the injured crew remaining aboard a spacecraft with limited medical resources. OBJECTIVE This qualitative study drew from the experiences of subject matter experts (SMEs) in spaceflight and appropriate analog environments (i.e., military, disaster, and extreme environment fields) to identify unique principles common amongst medical evacuation considerations helpful in informing future risk assessment tools. Appropriate analog environments included austere operational settings where multiple factors (weather, logistics/limited resupply, denied/extreme environments, and patient condition) resulted in a limited ability to provide definitive local medical care. The fundamental principles in question revolved around scenarios where evacuation became a complicating yet necessary consideration and where life-threatening medical concerns had to be weighed against critical mission objective(s). The primary authors collected semi-structured data gathered through in-depth interviews with 16 subject matter experts (SMEs). Interview questions investigated how these SMEs consider and weigh the attendant risks present in medical evacuation scenarios. Among the critical questions posed were those that sought to understand how the SME balanced the challenges and requirements of medical evacuation (or keeping an injured patient "on-site" aka: "prolonged field care") against the evacuation operation's risks on impacting overarching mission success. The team analyzed interview transcripts for common themes and principles using the qualitative methods of thematic analysis based on consensus, co-occurrence, and comparison. As a result, nine primary risk consideration themes and nine contributing factor themes emerged, all of which will ideally inform future medical evacuation decision-making tools and operational decision-making for exploration class missions. Specific aims for this study included: 1. Identification of common principles used to assess risks and benefits of medical evacuations in extreme environments 2. Identification of common points of friction or complication and challenges in extreme environment evacuations

A T Almand↗

NASA NTRS2018

Ultra Long-Lived Autonomous Air Quality Sensing

Wagner, Raymond S.↗

NASA NTRSDate not supplied

Ultra Long-Lived, Self-Surveying Autonomous Air Quality Sensing

Environmental sensing will be key to autonomous vehicle operation and crew health monitoring in tended/untended long-duration habitats for Human Space Exploration in deep space. Small wireless sensors, based on Radio Frequency Identification (RFID) technology, can provide unprecedented capacity to monitor crew/habitat health. We develop a next-generation, path-to-flight wireless air quality sensor capable of operating for years on a small coin-cell battery without crewmember intervention. Initial steps are taken to integrate a self-surveying capability under development as a NASA Small Business Innovative Research (SBIR) project, though final integration was prevented due to COVID-19 center closure.

Raymond S Wagner↗

NASA NTRS2016

Risk of Adverse Health Outcomes & Decrements in Performance due to Inflight Medical Conditions: ExMC Pharmacy Research Plan

The Exploration Medical Capabilities (ExMC) Element of NASA's Human Research Program is charged with identifying medical capabilities that can address the challenges of prevention, diagnosis, and treatment of disease and injuries that could occur during exploration missions beyond Earth's orbit. Faced with the obstacle of access to in-flight medical care, and limitations of vehicle space, time, and communications; it is necessary to prioritize what medical consumables are manifested for the flight, and which medical conditions are addressed. Studies of astronaut health establish the incidence of common and high risk medical conditions that require medical intervention during long-duration exploration missions. In 2000, the Institute of Medicine (IOM) convened a committee of experts, Committee on Creating a Vision for Space Medicine during Travel beyond Earth Orbit, to examine the issues surrounding astronaut health and safety for long duration space missions. Two themes run throughout the committee's final report: (1) that not enough is known about the risks to human health during long-duration missions beyond Earth's orbit or about what can effectively mitigate those risks to enable humans to travel and work safely in the environment of deep space and (2) that everything reasonable should be done to gain the necessary information before humans are sent on missions of space exploration (IOM, 2001). Although several spaceflight focused pharmaceutical research studies have been conducted, few have provided sufficient data regarding medication usage or potency changes during spaceflight. The Du pharmaceutical stability study assessed medications flown on space shuttles to and from the International Space Station (ISS) from 2006 until 2008; of which some medications were still viable beyond their expiration dates (Du et al, 2011). However, as with many spaceflight studies, the small 'n' associated with this study limits the ability to draw strong conclusions from it. Dr. Wotring and others have recently published articles containing information regarding medication usage, indications, and efficacy gleaned from spaceflight records (Wotring et al, 2015, 2016; Barger et al, 2014; Basner and Dinges, 2014). Although some conclusions can be drawn from these studies, the inability to fully quantify medication usage, indications, side effects, and effectiveness, limits insight as to which medications should be prioritized for further research.

Antonsen, Erik↗

NASA NTRS2014

2014 SRP Integration Transcript

HRP's mission is to reduce the risks to human health and performance during long-duration spaceflight. The HRP Integrated Research Plan (IRP) contains the research plans for the 32 risks that require research to characterize and mitigate. From its inception the "integrate" aspect of the IRP has denoted the integrated nature of risks to human health and performance. Even though each risk in the IRP has its own research plan and is tracked separately, the interrelated nature of health and performance requires that they be addressed in an integrative or holistic fashion so that the connectedness of physiological systems within the human body and the integrated response to spaceflight can be addressed. Common characteristics of the spaceflight environment include altered gravity, atmospheres, and light/dark cycles; space radiation; isolation; noise; and periods of high or low workload. Long-term exposure to this unique environment produces a suite of physiological effects such as stress; vision, neurocognitive, and anthropometric changes; circadian misalignment; fluid shifts; cardiovascular deconditioning; immune dysregulation; and altered nutritional requirements. Expanding cross-disciplinary integrative approaches that synthesize concepts or data from two or more disciplines would improve the identification and characterization risk factors, and enable the development of countermeasures relevant to multiple risks. Cross-disciplinary approaches might also help to illuminate problem areas that may arise when a countermeasure adversely impacts risks other than those which it was developed to mitigate, or to identify groupings of physiological changes that are likely to occur that may impact the overall risk posture. In 2014 HRP embarked on a pilot study that combined four SRPs (and 12 HRP risks) - Behavioral Health, Sensorimotor, Cardiovascular, and Bone/Muscle - specifically to discuss cross-disciplinary integration. The points outlined below were suggested to seed the discussion, within the bounding constraint that research plans must be feasible and relevant to the HRP mission. While these were suggested starting points, the overall guiding principle was to allow free discussion from panel members on any aspect of integrated research that they felt was important, Existing cross-disciplinary integration as documented in the IRP (HRR), Existing or needed integration already identified by HRP, but not yet well defined within the IRP, Areas of integration that are missing.

Steinberg, Susan↗

NASA NTRS2011

Bone Density Following Three Years of Recovery from Long-Duration Space Flight

It is well recognized that bone mineral density [BMD] at load-bearing sites of the hip and spine sustain significant loss during space flight, estimated at approximately 0.5-1.0% per month. However, the long-term effects on bone health following return from long-duration space flight remain unclear. It is unknown whether BMD for men recovers beyond 1 year following return from space to what would be predicted or if deficits persist. Using our previously created prediction models, we compared the observed BMD of male US crew following 3 years since returning from longduration space flight with what would be predicted if they had not been exposed to microgravity.

Amin, Shreyasee↗

NASA NTRS2007

Foods for a Mission to Mars: Investigations of Low-Dose Gamma Radiation Effects

Food must be safe, nutritious, and acceptable throughout a long duration mission to maintain the health, well-being, and productivity of the astronauts. In addition to a developing a stable pre-packaged food supply, research is required to better understand the ability to convert edible biomass into safe, nutritious, and acceptable food products in a closed system with many restrictions (mass, volume, power, crew time, etc.). An understanding of how storage conditions encountered in a long-term space mission, such as elevated radiation, will impact food quality is also needed. The focus of this project was to contribute to the development of the highest quality food system possible for the duration of a mission, considering shelf-stable extended shelf-life foods, bulk ingredients, and crops to be grown in space. The impacts of space-relevant radiation doses on food, bulk ingredient, and select candidate crop quality and antioxidant capacity were determined. Interestingly, increasing gamma-radiation doses (0 to 1000 Gy) did not always increase dose-related effects in foods. Intermediate radiation doses (10 to 800Gy) often had significantly larger impact on the stability of bulk ingredient oils than higher (1000Gy) radiation doses. Overall, most food, ingredient, and crop systems investigated showed no significant differences between control samples and those treated with 3 Gy of gamma radiation (the upper limit estimated for a mission to Mars). However, this does not mean that all foods will be stable for 3-5 years, nor does it mean that foods are stable to space radiation comprising more than gamma rays.

Gandolph, J.↗

NASA NTRS2014

Rodent Research Development for Long Duration Studies on the International Space Station

Rodent research in space is needed to advance our understanding of the health risks,consequences and possible countermeasures to protect crew during future, long duration missions. TheAnimal Enclosure Module (AEM) was designed originally to support habitation of rats and mice onrelatively short duration, Shuttle missions (<19 days). The AEM was flown previously on 27 SpaceShuttle missions, and recently was modified extensively to support future long duration space biology andbiomedical research on the International Space Station (ISS). In consultation with a Science WorkingGroup comprised of veterinarians and investigators experienced in rodent spaceflight experimentation inspace, the Rodent Habitat project team at Ames Research Center modified existing hardware, developednew hardware, operations, and science activities, and performed a series of ground-based operational andscience habitat verification tests in preparation for the first validation flight.

long duration studies↗

NASA NTRS2005

Exploration-Related Research on ISS: Connecting Science Results to Future Missions

In January, 2004, the U.S. President announced The Vision for Space Exploration, and charged the National Aeronautics and Space Administration (NASA) with using the International Space Station (ISS) for research and technology targeted at supporting U.S. space exploration goals. This paper describes: What we have learned from the first four years of research on ISS relative to the exploration mission; The on-going research being conducted in this regard; and Our current understanding of the major exploration mission risks that the ISS can be used to address. Specifically, we discuss research carried out on the ISS to determine the mechanisms by which human health is affected on long-duration missions, and to develop countermeasures to protect humans from the space environment. These bioastronautics experiments are key enablers of future long duration human exploration missions. We also discuss how targeted technological developments can enable mission design trade studies. We discuss the relationship between the ultimate number of human test subjects available on the ISS to the quality and quantity of scientific insight that can be used to reduce health risks to future explorers. We discuss the results of NASA's efforts over the past year to realign the ISS research programs to support a product-driven portfolio that is directed towards reducing the major risks of exploration missions. The fundamental challenge to science on ISS is completing experiments that answer key questions in time to shape design decisions for future exploration. In this context, exploration relevant research must do more than be conceptually connected to design decisions - it must become a part of the mission design process.

Rhatigan, Jennifer L.↗

NASA NTRS2005

Bone Markers, Calcium Metabolism, and Calcium Kinetics During Extended-Duration Space Flight on the Mir Space Station

Bone loss is a current limitation for long-term space exploration. Bone markers, calcitropic hormones, and calcium kinetics of crew members on space missions of 4-6 months were evaluated. Spaceflight-induced bone loss was associated with increased bone resorption and decreased calcium absorption. INTRODUCTION: Bone loss is a significant concern for the health of astronauts on long-duration missions. Defining the time course and mechanism of these changes will aid in developing means to counteract these losses during space flight and will have relevance for other clinical situations that impair weight-bearing activity. MATERIALS AND METHODS: We report here results from two studies conducted during the Shuttle-Mir Science Program. Study 1 was an evaluation of bone and calcium biochemical markers of 13 subjects before and after long-duration (4-6 months) space missions. In study 2, stable calcium isotopes were used to evaluate calcium metabolism in six subjects before, during, and after flight. Relationships between measures of bone turnover, biochemical markers, and calcium kinetics were examined. RESULTS: Pre- and postflight study results confirmed that, after landing, bone resorption was increased, as indicated by increases in urinary calcium (p < 0.05) and collagen cross-links (N-telopeptide, pyridinoline, and deoxypyridinoline were all increased >55% above preflight levels, p < 0.001). Parathyroid hormone and vitamin D metabolites were unchanged at landing. Biochemical markers of bone formation were unchanged at landing, but 2-3 weeks later, both bone-specific alkaline phosphatase and osteocalcin were significantly (p < 0.01) increased above preflight levels. In studies conducted during flight, bone resorption markers were also significantly higher than before flight. The calcium kinetic data also validated that bone resorption was increased during flight compared with preflight values (668 +/- 130 versus 427 +/- 153 mg/day; p < 0.001) and clearly documented that true intestinal calcium absorption was significantly lower during flight compared with preflight values (233 +/- 87 versus 460 +/- 47 mg/day; p < 0.01). Weightlessness had a detrimental effect on the balance in bone turnover such that the daily difference in calcium retention during flight compared with preflight values approached 300 mg/day (-234 +/- 102 versus 63 +/- 75 mg/day; p < 0.01). CONCLUSIONS: These bone marker and calcium kinetic studies indicated that the bone loss that occurs during space flight is a consequence of increased bone resorption and decreased intestinal calcium absorption.

Bone and Bones/metabolism/pathology↗

NASA NTRS2013

The "Programmatics" of the ISS Crewmembers' Twelve Month Mission

The mission duration for crewmembers' stay on the International Space Station (ISS) has historically been approximately six months, consistent with the service life of the Soyuz spacecraft that delivers and returns the crewmembers previous. Exploration missions beyond low Earth orbit are expected to require crew durations of a year or more. The ISS Partners have agreed to begin building an experience base of longer crew durations, and have selected two crewmembers to serve on ISS for approximately twelve months, beginning in the Spring of 2015. The preparations for the one NASA and one Roscosmos crewmember require many new considerations for the ISS Program and its Partnership - "programmatic" considerations that are separate from crew health concerns. Since the long-duration crew's Soyuz will need to be replaced halfway through their stay, crew rotation, handover and the Soyuz docking port plan are affected. There is also an opportunity for two short-duration crewmembers to fly during the Soyuz exchange. It is desirable to minimize additional training required of the prime and backup crewmembers; normal crew rotations have a Soyuz crew train as the backup crew, then train as the prime crew. Ground teams will adjust their traditional support to ISS crewmembers, including communication of long-term plans, onboard training, and logistics support. The lessons learned during the preparation and execution of the 12-month mission will support improvements in future ISS long-duration missions and exploration missions.

Hasbrook, Pete↗

NASA NTRS2017

Integrating Bioregenerative Foods into the Exploration Spaceflight Food System

Food, the nutrition it provides, and the eating experiences surrounding it, are central to performance, health, and psychosocial wellbeing on long duration spaceflight missions. Exploration missions will require a spaceflight food system that is safe, nutritious, and acceptable for up to five years, possibly without cold storage. Many of the processed and packaged spaceflight foods currently used on the International Space Station will not retain acceptable quality or required levels of key nutrients under these conditions. The addition of bioregenerative produce to exploration missions may become an important countermeasure to the nutritional gaps and a resource to support psychosocial health. Bioregenerative produce will be central to establishment of Earth-independence as exploration extends deeper into space. However, bioregenerative foods introduce food safety and scarcity risks that must be eliminated prior to crew reliance on these systems. The pathway to Earth independence will require small-scale integration and validation prior to large scale bioregenerative dependence. Near term exploration missions offer the opportunity to establish small scale supplemental salad crop and fruit systems and validate infrastructure reliability, nutritional potential, and the psychosocial benefits necessary to promote further bioregenerative integration.

Douglas, Grace L.↗

NASA NTRS2016

Proteomic Assessment of Fluid Shifts and Association with Visual Impairment and Intracranial Pressure in Twin Astronauts

BACKGROUND: Astronauts participating in long duration space missions are at an increased risk of physiological disruptions. The development of visual impairment and intracranial pressure (VIIP) syndrome is one of the leading health concerns for crew members on long-duration space missions; microgravity-induced fluid shifts and chronic elevated cabin CO2 may be contributing factors. By studying physiological and molecular changes in one identical twin during his 1-year ISS mission and his ground-based co-twin, this work extends a current NASA-funded investigation to assess space flight induced "Fluid Shifts" in association with the development of VIIP. This twin study uniquely integrates physiological and -omic signatures to further our understanding of the molecular mechanisms underlying space flight-induced VIIP. We are: (i) conducting longitudinal proteomic assessments of plasma to identify fluid regulation-related molecular pathways altered by long-term space flight; and (ii) integrating physiological and proteomic data with genomic data to understand the genomic mechanism by which these proteomic signatures are regulated. PURPOSE: We are exploring proteomic signatures and genomic mechanisms underlying space flight-induced VIIP symptoms with the future goal of developing early biomarkers to detect and monitor the progression of VIIP. This study is first to employ a male monozygous twin pair to systematically determine the impact of fluid distribution in microgravity, integrating a comprehensive set of structural and functional measures with proteomic, metabolomic and genomic data. This project has a broader impact on Earth-based clinical areas, such as traumatic brain injury-induced elevations of intracranial pressure, hydrocephalus, and glaucoma. HYPOTHESIS: We predict that the space-flown twin will experience a space flight-induced alteration in proteins and peptides related to fluid balance, fluid control and brain injury as compared to his pre-flight protein/peptide signatures. Conversely, the trajectory of these protein signatures will remain relatively constant in his ground based co-twin. METHODS: We are using proteomic and standard immunoelectrophoresis techniques to delineate the change in protein signatures throughout the course of a long duration space flight in relation to the development of VIIP. We are also applying a novel cell-based metaboloic organ system assay ("Organs on a Plate") to address how these circulating biomarkers affect physiological processes at the cellular and organ level which could result in VIIP symptoms. These molecular data will be correlated with physiological measures (eg. extra and intracellular fluid volume, vascular filling/flow patterns, MRI, and Optic Coherence Tomography. DISCUSSION: Pre- and in-flight data collection is in progress for the space-flown twin, and similar data have been obtained from the ground-based twin. Biosamples will be batch processed when received from ISS after the conclusion of the 1-year mission. Omic and Physiological measures from the twin astronauts will be compared to similar data being collected on twin subjects who participated in simulated microgravity study. bed rest study.

Rana, Brinda K.↗

NASA NTRS2016

Computational Modeling of Space Physiology

The Digital Astronaut Project (DAP), within NASAs Human Research Program, develops and implements computational modeling for use in the mitigation of human health and performance risks associated with long duration spaceflight. Over the past decade, DAP developed models to provide insights into space flight related changes to the central nervous system, cardiovascular system and the musculoskeletal system. Examples of the models and their applications include biomechanical models applied to advanced exercise device development, bone fracture risk quantification for mission planning, accident investigation, bone health standards development, and occupant protection. The International Space Station (ISS), in its role as a testing ground for long duration spaceflight, has been an important platform for obtaining human spaceflight data. DAP has used preflight, in-flight and post-flight data from short and long duration astronauts for computational model development and validation. Examples include preflight and post-flight bone mineral density data, muscle cross-sectional area, and muscle strength measurements. Results from computational modeling supplement space physiology research by informing experimental design. Using these computational models, DAP personnel can easily identify both important factors associated with a phenomenon and areas where data are lacking. This presentation will provide examples of DAP computational models, the data used in model development and validation, and applications of the model.

simulation↗

NASA NTRS2012

Space Radiation Cancer Risks and Uncertainities for Different Mission Time Periods

Space radiation consists of solar particle events (SPEs), comprised largely of medium energy protons (less than several hundred MeV); and galactic cosmic ray (GCR), which includes high energy protons and high charge and energy (HZE) nuclei. For long duration missions, space radiation presents significant health risks including cancer mortality. Probabilistic risk assessment (PRA) is essential for radiation protection of crews on long term space missions outside of the protection of the Earth s magnetic field and for optimization of mission planning and costs. For the assessment of organ dosimetric quantities and cancer risks, the particle spectra at each critical body organs must be characterized. In implementing a PRA approach, a statistical model of SPE fluence was developed, because the individual SPE occurrences themselves are random in nature while the frequency distribution of SPEs depends strongly upon the phase within the solar activity cycle. Spectral variability of SPEs was also examined, because the detailed energy spectra of protons are important especially at high energy levels for assessing the cancer risk associated with energetic particles for large events. An overall cumulative probability of a GCR environment for a specified mission period was estimated for the temporal characterization of the GCR environment represented by the deceleration potential (theta). Finally, this probabilistic approach to space radiation cancer risk was coupled with a model of the radiobiological factors and uncertainties in projecting cancer risks. Probabilities of fatal cancer risk and 95% confidence intervals will be reported for various periods of space missions.

Kim,Myung-Hee Y.↗

NASA NTRS2017

VESsel GENeration Analysis (VESGEN): Innovative Vascular Mappings for Astronaut Exploration Health Risks and Human Terrestrial Medicine

Currently, astronauts face significant health risks in future long-duration exploration missions such as colonizing the Moon and traveling to Mars. Numerous risks include greatly increased radiation exposures beyond the low earth orbit (LEO) of the ISS, and visual and ocular impairments in response to microgravity environments. The cardiovascular system is a key mediator in human physiological responses to radiation and microgravity. Moreover, blood vessels are necessarily involved in the progression and treatment of vascular-dependent terrestrial diseases such as cancer, coronary vessel disease, wound-healing, reproductive disorders, and diabetes. NASA developed an innovative, globally requested beta-level software, VESsel GENeration Analysis (VESGEN) to map and quantify vascular remodeling for application to astronaut and terrestrial health challenges. VESGEN mappings of branching vascular trees and networks are based on a weighted multi-parametric analysis derived from vascular physiological branching rules. Complex vascular branching patterns are determined by biological signaling mechanisms together with the fluid mechanics of multi-phase laminar blood flow.

astronaut↗

NASA NTRS2013

Long Duration Head-down Tilt Bed Rest Studies: Safety Considerations Regarding Vision Health

No abstract available

Cromwell, R. L.↗

NASA NTRS2014

Pulmonary and Systemic Immune Response to Chronic Lunar Dust Inhalation

Background: Due to millennia of meteorite impact with virtually no erosive effects, the surface of the Moon is covered by a layer of ultra‐fine, reactive Lunar dust. Very little is known regarding the toxicity of Lunar dust on human physiology. Given the size and electrostatic characteristics of Lunar dust, countermeasures to ensure non‐exposure of astronauts will be difficult. To ensure astronaut safety during any future prolonged Lunar missions, it is necessary to establish the effect of chronic pulmonary Lunar dust exposure on all physiological systems. Methods: This study assessed the toxicity of airborne lunar dust exposure in rats on pulmonary and system immune system parameters. Rats were exposed to 0, 20.8, or 60.8 mg/m3 of lunar dust (6h/d; 5d/wk) for up to 13 weeks. Sacrifices occurred after exposure durations of 1day, 7 days, 4 weeks and 13 weeks post‐exposure, when both blood and lung lavage fluid were collected for analysis. Lavage and blood assays included leukocyte distribution by flow cytometry, electron/fluorescent microscopy, and cytokine concentration. Cytokine production profiles following mitogenic stimulation were performed on whole blood only. Results: Untreated lavage fluid was comprised primarily of pulmonary macrophages. Lunar dust inhalation resulted in an influx of neutrophils and lymphocytes. Although the percentage of lymphocytes increased, the T cell CD4:CD8 ratio was unchanged. Cytokine analysis of the lavage fluid showed increased levels of IL‐1b and TNFa. These alterations generally persisted through the 13 week sampling. Blood analysis showed few systemic effects from the lunar dust inhalation. By week 4, the peripheral granulocyte percentage was elevated in the treated rats. Plasma cytokine levels were unchanged in all treated rats compared to controls. Peripheral blood analysis showed an increased granulocyte percentage and altered cytokine production profiles consisting of increased in IL‐1b and IL‐6, and decreased IL‐2 production. Conclusion: Lunar dust inhalation results in significant lung inflammation, and some systemic effects, that does not resolve through 13 weeks. Lunar dust may therefore represent a crew health risk during sortie or long‐duration Lunar missions.

Crucian, Brian↗