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Dr. Steven S. Saliterman developed his Dynacath Critical Care Patient Simulator as a training system for medical personnel involved in critical care management and hemodynamic monitoring. The system incorporates NASA simulation technology and allows hospitals and medical manufacturers to conduct training away from the patient's bedside. Dr. Saliterman was formerly employed by Ames Research Center and Johnson Space Center.
Exercise countermeasures are the most commonly utilized approach for maintaining the health and performance of astronauts during spaceflight missions. However, International Space Station (ISS) exercise countermeasure hardware reliability and prescriptions are not at a point of departure to support exploration-class missions. The JSC Exercise Countermeasures Project (ECP) plans to use ISS as a research and hardware evaluation platform to define and validate improved exercise hardware, prescriptions, and monitoring strategies to support crewmember operations on the Moon and Mars. The ECP will partner with JSC's Space Medicine Division to standardize elements of ISS exercise prescriptions to better understand their efficacy and to propose modified prescriptions for implementation that may be used in the crew exploration vehicle and/or lunar habitat. In addition, evaluations of the ISS treadmill harness will be conducted to define and improve fit and function, and assess the next generation medical monitoring devices such as the portable unit for metabolic analysis and the muscle atrophy research and exercise system for completion of periodic fitness evaluations during lunar and Mars travel. Finally, biomechanical data from ISS crew exercise sessions will be obtained to better understand loading and restraint systems, and identify the physiologic requirements during ISS extravehicular activities that may be analogous to extended excursions from the lunar habitat. It is essential to optimize exercise prescriptions, hardware, and monitoring strategies for exploration initiatives using ISS as a platform before the planned retirement of the Shuttle in 2010 and the declining NASA emphasis on ISS to maximize knowledge before embarking on travel to the Moon and Mars.
In order to cultivate healthy bacteria in bioreactors, Kennedy Space Center awarded SBIR funding to Needham Heights, Massachusetts-based Polestar Technologies Inc. to develop sensors that could monitor oxygen levels. The result is a sensor now widely used by pharmaceutical companies and medical research universities. Other sensors have also been developed, and in 2013 alone the company increased its workforce by 50 percent.
A critical component of the DNA Medicine Institute's Reusable Handheld Electrolyte and Lab Technology for Humans (rHEALTH) sensor are nanoscale test strips, or nanostrips, that enable multiplexed blood analysis. Nanostrips are conceptually similar to the standard urinalysis test strip, but the strips are shrunk down a billionfold to the microscale. Each nanostrip can have several sensor pads that fluoresce in response to different targets in a sample. The strips carry identification tags that permit differentiation of a specific panel from hundreds of other nanostrip panels during a single measurement session. In Phase I of the project, the company fabricated, tested, and demonstrated functional parathyroid hormone and vitamin D nanostrips for bone metabolism, and thrombin aptamer and immunoglobulin G antibody nanostrips. In Phase II, numerous nanostrips were developed to address key space flight-based medical needs: assessment of bone metabolism, immune response, cardiac status, liver metabolism, and lipid profiles. This unique approach holds genuine promise for space-based portable biodiagnostics and for point-of-care (POC) health monitoring and diagnostics here on Earth.
There is ample evidence to suggest that space flight leads to immune system dysregulation, however the nature of the phenomenon as it equilibrates over longer flights has not been determined. This dysregulation may be a result of microgravity, confinement, physiological stress, radiation, environment or other mission-associated factors. The clinical risk (if any) for exploration-class space flight is unknown, but may include increased incidence of infection, allergy, hypersensitivity, hematological malignancy or altered wound healing. The objective of this Supplemental Medical Objective (SMO) is to determine the status of the immune system, physiological stress and latent viral reactivation (a clinical outcome that can be measured) during both short and long-duration spaceflight. In addition, this study will develop and validate an immune monitoring strategy consistent with operational flight requirements and constraints. Pre-mission, in-flight and post-flight blood and saliva samples will be obtained from participating crewmembers. Assays included peripheral immunophenotype, T cell function, cytokine profiles (RNA, intracellular, secreted), viral-specific immunity, latent viral reactivation (EBV, CMV, VZV), and stress hormone measurements. This study is currently ongoing. To date, 10 short duration and 5 long-duration crewmembers have completed the study. Technically, the study is progressing well. In-flight blood samples are being collected, and returned for analysis, including functional assays that require live cells. For all in-flight samples to date, sample viability has been acceptable. Preliminary data (n = 4/7; long/short duration, respectively) indicate that distribution of most peripheral leukocyte subsets is largely unaltered during flight. Exceptions include elevated T cells, reduced B/NK cells, increased memory T cells and increased central memory CD8+ T cells. General T cell function, early blastogenesis response to mitogenic stimulation, is markedly reduced in-flight. In-vivo cytokine production profiles are altered, with in-flight dysregulation observed in the Th1/Th2/Treg equilibrium. EBV specific T cell levels are increased during flight, whereas their function is reduced. VZV reactivation was observed inflight and several days post flight with highest levels measured later during long-duration flight. The shedding of CMV in the urine was detected of 4/5 long duration and 4/7 short duration crewmembers. Plasma cortisol was not elevated during flight. Further data will be required to validate the initial observations.
The Automatic Particle Fallout Monitor (APFM) is an automated instrument that assesses real-time particle contamination levels in a facility by directly imaging, sizing, and counting contamination particles. It allows personnel to respond to particle contamination before it becomes a major problem. For NASA, the APFM improves the ability to mitigate, avoid, and explain mission-compromising incidents of contamination occurring during payload processing, launch vehicle ground processing, and potentially, during flight operations. Commercial applications are in semiconductor processing and electronics fabrication, as well as aerospace, aeronautical, and medical industries. The product could also be used to measure the air quality of hotels, apartment complexes, and corporate buildings. IDEA sold and delivered its first four units to the United Space Alliance for the Space Shuttle Program at Kennedy. NASA used the APFM in the Kennedy Space Station Processing Facility to monitor contamination levels during the assembly of International Space Station components.
The applications to medicine of various results from space exploration are examined. Improvements have been made in the management of cardiovascular disease, in particular the use of the ultrasonic scanner to image arteries in three dimensions, the use of excimer lasers to disrupt arterial plaques in coronary blood vessels, and the use of advanced electrodes for cardiac monitoring. A bone stiffness analyzer has helped to diagnose osteoporosis and aid in its treatment. An automated light microscope system is used for chromosome analysis, and an X-ray image intensifier called Lixiscope is used in emergency medical care. An advanced portable defibrillator has been developed for the heart, and an insulin delivery system has been derived from space microminiaturization techniques.
There is ample evidence to suggest that space flight leads to immune system dysregulation. This may be a result of microgravity, confinement, physiological stress, radiation, environment or other mission-associated factors. The clinical risk (if any) from prolonged immune dysregulation during exploration-class space flight has not yet been determined, but may include increased incidence of infection, allergy, hypersensitivity, hematological malignancy or altered wound healing. Each of the clinical events resulting from immune dysfunction has the potential to impact mission critical objectives during exploration-class missions. To date, precious little in-flight immune data has been generated to assess this phenomenon. The majority of recent flight immune studies have been post-flight assessments, which may not accurately reflect the in-flight status of immunity as it resolves over prolonged flight. There are no procedures currently in place to monitor immune function or its effect on crew health. The objective of this Supplemental Medical Objective (SMO) is to develop and validate an immune monitoring strategy consistent with operational flight requirements and constraints. This SMO will assess immunity, latent viral reactivation and physiological stress during both short and long duration flights. Upon completion, it is expected that any clinical risks resulting from the adverse effects of space flight on the human immune system will have been determined. In addition, a flight-compatible immune monitoring strategy will have been developed with which countermeasures validation could be performed. This study will determine, to the best level allowed by current technology, the in-flight status of crewmembers' immune systems. The in-flight samples will allow a distinction between legitimate in-flight alterations and the physiological stresses of landing and readaptation which are believed to alter R+0 assessments. The overall status of the immune system during flight (activation, deficiency, dysregulation) and the response of the immune system to specific latent virus reactivation (known to occur during space flight) will be thoroughly assessed. The first in-flight activity for integrated immunity very recently occurred during the STS-120 Space Shuttle mission. The protocols functioned well from a technical perspective, and accurate in-flight data was obtained from 1 Shuttle and 2 ISS crewmembers. Crew participation rates for the study continue to be robust.
In photo above, the electrocardiogram of a hospitalized patient is being transmitted by telemetry. Widely employed in space operations, telemetry is a process wherein instrument data is converted to electrical signals and sent to a receiver where the signals are reconverted to usable information. In this instance, heart readings are picked up by the electrode attached to the patient's body and delivered by wire to the small box shown, which is a telemetry transmitter. The signals are relayed wirelessly to the console in the background, which converts them to EKG data. The data is displayed visually and recorded on a printout; at the same time, it is transmitted to a central control station (upper photo) where a nurse can monitor the condition of several patients simultaneously. The Patient Monitoring System was developed by SCI Systems, Inc., Huntsville, Alabama, in conjunction with Abbott Medical Electronics, Houston, Texas. In developing the system, SCI drew upon its extensive experience as a NASA contractor. The company applied telemetry technology developed for the Saturn launch vehicle and the Apollo spacecraft; instrumentation technology developed for heart, blood pressure and sleep monitoring of astronauts aboard NASA's Skylab long duration space station; and communications technology developed for the Space Shuttle.
The major efforts of the Stanford Biomedical Applications Team Program at the Stanford University School of Medicine for the period from October 1, 1975 to September 31, 1976 are covered. A completed EMG biotelemetry system which monitors the physiological signals of man and animals in space related research is discussed. The results of a pilot study involving lower body negative pressure testing in cardiac patients has been completed as well as the design and construction of a new leg negative pressure unit for evaluating heart patients. This technology utilizes vacuum chambers to stress the cardiovascular system during space flight. Laboratory tests of an intracranial pressure transducer, have been conducted. Extremely stable long term data using capacative pressure sensors has lead to the order of commercially manufactured monitoring systems base. Projects involving commercialization are: flexible medical electrodes, an echocardioscope, a miniature biotelemetry system, and an on-line ventricular contour detector.
Microbial monitoring of spacecraft environments provides key information in the assessment of infectious disease risk to the crew. Monitoring aboard the Mir space station and International Space Station (ISS) has provided a tremendous informational baseline to aid in determining the types and concentrations of microorganisms during a mission. Still, current microbial monitoring hardware utilizes culture-based methodology which may not detect many medically significant organisms, such as Legionella pneumophila. We hypothesize that evaluation of the ISS environment using non-culture-based technologies would reveal microorganisms not previously reported in spacecraft, allowing for a more complete health assessment. To achieve this goal, a spaceflight experiment, operationally designated as SWAB, was designed to evaluate the DNA from environmental samples collected from ISS and vehicles destined for ISS. Results from initial samples indicate that the sample collection and return procedures were successful. Analysis of these samples using denaturing gradient gel electrophoresis and targeted PCR primers for fungal contaminants is underway. The current results of SWAB and their implication for in-flight molecular analysis of environmental samples will be discussed.
International Space Station (ISS) astronauts receive supervised physical training pre-flight, utilize exercise countermeasures in-flight, and participate in a structured reconditioning program post-flight. Despite recent advances in exercise hardware and prescribed exercise countermeasures, ISS crewmembers are still found to have variable levels of deconditioning post-flight. This presentation provides an overview of the astronaut medical certification requirements, pre-flight physical training, in-flight exercise countermeasures, and the post-flight reconditioning program. Astronauts must meet medical certification requirements on selection, annually, and prior to ISS missions. In addition, extensive physical fitness testing and standardized medical assessments are performed on long duration crewmembers pre-flight. Limited physical fitness assessments and medical examinations are performed in-flight to develop exercise countermeasure prescriptions, ensure that the crewmembers are physically capable of performing mission tasks, and monitor astronaut health. Upon mission completion, long duration astronauts must re-adapt to the 1 G environment, and be certified as fit to return to space flight training and active duty. A structured, supervised postflight reconditioning program has been developed to prevent injuries, facilitate re-adaptation to the 1 G environment, and subsequently return astronauts to training and space flight. The NASA reconditioning program is implemented by the Astronaut Strength, Conditioning, and Rehabilitation (ASCR) team and supervised by NASA flight surgeons. This program has evolved over the past 10 years of the International Space Station (ISS) program and has been successful in ensuring that long duration astronauts safely re-adapt to the 1 g environment and return to active duty. Lessons learned from this approach to managing deconditioning can be applied to terrestrial medicine and future exploration space flight missions.
Management guidelines were created to screen and manage asymptomatic renal stones in U.S. astronauts. The true risk for renal stone formation in astronauts due to the space flight environment is unknown. Proper management of this condition is crucial to mitigate health and mission risks. The NASA Flight Medicine Clinic electronic medical record and the Lifetime Surveillance of Astronaut Health databases were reviewed. An extensive review of the literature and current aeromedical standards for the monitoring and management of renal stones was also done. This work was used to develop a screening and management protocol for renal stones in astronauts that is relevant to the spaceflight operational environment. In the proposed guidelines all astronauts receive a yearly screening and post-flight renal ultrasound using a novel ultrasound protocol. The ultrasound protocol uses a combination of factors, including: size, position, shadow, twinkle and dispersion properties to confirm the presence of a renal calcification. For mission-assigned astronauts, any positive ultrasound study is followed by a low-dose renal computed tomography scan and urologic consult. Other specific guidelines were also created. A small asymptomatic renal stone within the renal collecting system may become symptomatic at any time, and therefore affect launch and flight schedules, or cause incapacitation during a mission. Astronauts in need of definitive care can be evacuated from the International Space Station, but for deep space missions evacuation is impossible. The new screening and management algorithm has been implemented and the initial round of screening ultrasounds is under way. Data from these exams will better define the incidence of renal stones in U.S. astronauts, and will be used to inform risk mitigation for both short and long duration spaceflights.
Management guidelines were created to screen and manage asymptomatic renal stones in U.S. astronauts. The true risk for renal stone formation in astronauts due to the space flight environment is unknown. Proper management of this condition is crucial to mitigate health and mission risks. The NASA Flight Medicine Clinic electronic medical record and the Lifetime Surveillance of Astronaut Health databases were reviewed. An extensive review of the literature and current aeromedical standards for the monitoring and management of renal stones was also done. This work was used to develop a screening and management protocol for renal stones in astronauts that is relevant to the spaceflight operational environment. In the proposed guidelines all astronauts receive a yearly screening and post-flight renal ultrasound using a novel ultrasound protocol. The ultrasound protocol uses a combination of factors, including: size, position, shadow, twinkle and dispersion properties to confirm the presence of a renal calcification. For mission-assigned astronauts, any positive ultrasound study is followed by a low-dose renal computed tomography scan and urologic consult. Other specific guidelines were also created. A small asymptomatic renal stone within the renal collecting system may become symptomatic at any time, and therefore affect launch and flight schedules, or cause incapacitation during a mission. Astronauts in need of definitive care can be evacuated from the International Space Station, but for deep space missions evacuation is impossible. The new screening and management algorithm has been implemented and the initial round of screening ultrasounds is under way. Data from these exams will better define the incidence of renal stones in U.S. astronauts, and will be used to inform risk mitigation for both short and long duration spaceflights.
In space, there is a need to monitor astronauts' vital signs and assess their readiness to perform specific tasks during a mission. Currently, NASA does not have the capability to noninvasively monitor crew for extended periods of time. The Canadian Space Agency is working with the Psychophysiology Lab at NASA ARC to determine if the Astroskin could be used as a solution to this problem. Astroskin, a commercially available garment with built-in biosensors, can be comfortably worn under clothing or a spacesuit and relay information to the crewman's own mobile device. Data can also be sent wirelessly to the on-board Exploration Medical System. To determine if Astroskin meets requirements for health monitoring, it must first be validated in spaceflight analog environments. In the current study Astroskin data will be compared to traditional biomedical instrument measures of electrocardiography (ECG), respiration rate, and systolic blood pressure. The data will be recorded during Autogenic Feedback Training Exercise (AFTE), which is a type of physiological self-regulation training designed for astronauts. The data will also be recorded during simulations of the Orion spacecraft re-entry. The results to date suggest that Astroskin is a suitable ambulatory monitoring system that allows astronauts to self-diagnose and self-regulate adverse autonomic nervous system responses to sustained exposure to microgravity of spaceflight.
It will be the responsibility of the long-duration space flight crew to take the actions necessary to maintain their health and well-being and to cope with medical emergencies without direct assistance from support personnel, including maintaining mental health and managing physiological and psychological changes that may impair decision making and performance. The Behavior and Performance Integrated Product Team at Johnson Space Center, working, within the Space Medicine, Monitoring, and Countermeasures Program, has identified critical questions pertaining to long-duration space crew behavioral health, psychological adaptation, human factors and habitability, and sleep and circadian rhythms. Among the projects addressing these questions are: the development of tools to assess cognitive functions during space missions; the development of a model of psychological adaptation in isolated and confined environments; tools and methods for selecting individuals and teams well-suited for long-duration missions; identification of mission-critical tasks and performance evaluation; and measures of sleep quality and correlation to mission performance.
Individualized health monitoring can now incorporate a precision medicine approach, profiling multiple molecular and physiological measures of health (generalized omics) longitudinally to enable the timely diagnosis and treatment of disease. Such measurements can include blood chemistries, gene expression data, metabolite measurements, and digital device data. We will present our work on extending such an approach to monitoring individual astronaut health for deep space missions. We have developed and implemented novel algorithms to monitor and detect physiolgical state departures from individualized healthy astronaut baselines , utilizing and biologically annotating generalized omics. Our new methods can detect baseline deviations across omics corresponding to potentially adverse medical events. Events pointing to changes in individual health are then compared across individuals to identify common responses and detect changes affecting multiple crewmembers. We show the utility of our methods in detecting temporal health changes across subjects using retrospective Earth and astronaut mission data (metabolite and immune marker data across multiple missions), in order for this technique t o be applicable for future missions.
One of the primary challenges to interplanetary human travel is mitigation of radiation expo-sure. As fast transit with LENR driven or conventional nuclear electric (NEP) or thermal propulsion (NTP) may be imminent, time and level of radiation exposure composingALARA (As Low as Rea-sonably Achievable) must be ascertained rapidly and precisely. Since acute physiological effects are difficult to detect, and chronic effects on crew health are delayed and potentially trans-generational, improved detection technologies will be game-changing and an essential element of the crew health monitoring and environmental protection toolkit.Secondary Galactic Cosmic Ray (GCR) induced neutrons are an additional hazard.