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NASA NTRSDate not supplied

Earth-Independent Medical Operations (EIMO) Concept of Operations

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

Earth Independent Medical Operations↗
NASA NTRSDate not supplied

Impact, A Tool Suite for Crew Health and Performance System Trade Analyses and Decision to Support - Transition to Operations

Mission planners, systems engineers, and clinicians that support crew health and performance face very difficult choices on upcoming exploration missions. Given that there will be a heavily constrained mass and volume allocation for a medical system on these missions, what medical capability should be manifested to minimize both medical risk and mission risk? Given that not all promising research and technology proposals can be funded, how can proposals be prioritized so that those funded research investments produce the maximum benefit in reducing overall medical risk? The Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) project seeks to answer these kinds of questions and others to support upcoming exploration missions. IMPACT enables risk-informed and evidence-based trade space analysis for future space vehicles, missions, and systems. This presentation will discuss the long-term HRP and ExMC vision for the larger ecosystem of tools, which include an updated medical database, consisting of an Evidence Library for medical conditions and a medical item database (MedID) for medical resources, dynamic Probabilistic Risk Assessment (PRA) capabilities, System Modeling Language (SysML) models, and contextual data visualizations of output data. IMPACT is the result of a multi-center collaborative effort. The trade space analyses performed by IMPACT can directly inform mission, vehicle, and habitat development by quantifying medical risk, given a design reference mission, crew attributes and a set of medical capabilities. This presentation will update the audience on the development status of the IMPACT tool suite as it comes out of its System Acceptance Review (SAR) and nears Transition to Operations (TTO). It will review IMPACT’s constituent parts, briefly discuss typical outputs, and outline the plans for transitioning to operations, currently scheduled for later in FY24. Recent development successes on the IMPACT project include the integration of the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) v2.0 to accommodate segmented missions with multiple carriers and medical systems, full onboarding of the IMPACT Medical Database (IMPACT-MD), clustering medical resources and skills into medical capabilities and mutually-dependent bundles, verification of IMPACT-MD, and the ability to perform trade analyses on different medical sets, different design reference missions (DRM), with different crew complements and extra-vehicular activity (EVA) schedules.

IMPACT↗
NASA NTRS2023

Progressively Enabling Earth Independent Medical Operations (EIMO)

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

Jay Lemery↗
NASA NTRSDate not supplied

Progressively Enabling Earth Independent Medical Operations (EIMO)

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

John Lemery↗
NASA NTRS2023

Earth Independent Medical Operations (EIMO) Training Technical Interchange Meeting, 26th October 2023: Background and Summary of Discussion

On 26th October 2023, ExMC convened a panel of Subject Matter Experts (SMEs) from NASA, broadly representing Headquarters, the Human Research Program, Medical Operations, the Human Health and Performance Directorate at JSC, the Health and Medical Technical Authority, the Flight Operations Directorate, and representation from other Centers including: Ames Research Center (ARC), and Glenn Research Center (GRC). Representatives from the Canadian Space Agency also participated in this TIM. In addition, SMEs from industry included representation from the following entities: Axiom Space, Space Exploration Technologies Corporation, Level Ex, Shiny Box Interactive. Additional SMEs from academia included: University of Houston, Touro University, Weill Cornell Medical College and the Translational Research Institute for Space Health at Baylor College of Medicine. This group of stakeholders discussed the training issues related to facilitating EIMO. Sub-topics for this discussion included the following: - Pre-launch medical curriculum development - Ground-based training on medical hardware - Dental health - Behavioral health - Telemedicine - Just-in-time training - Simulation-based training (extended reality)

CMO Training↗
NASA NTRSDate not supplied

IMPACT, A Tool Suite for Crew Health and Performance System Trade Analyses and Decision Support- Transition to Operations

Mission planners, systems engineers, and clinicians that support crew health and performance face very difficult choices on upcoming exploration missions. Given that there will be a heavily constrained mass and volume allocation for a medical system on these missions, what medical capability should be manifested to minimize both medical risk and mission risk? Given that not all promising research and technology proposals can be funded, how can proposals be prioritized so that those funded research investments produce the maximum benefit in reducing overall medical risk? The Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) project seeks to answer these kinds of questions and others to support upcoming exploration missions. IMPACT enables risk-informed and evidence-based trade space analysis for future space vehicles, missions, and systems. This presentation will discuss the long-term HRP and ExMC vision for the larger ecosystem of tools, which include an updated medical database, consisting of an Evidence Library for medical conditions and a medical item database (MedID) for medical resources, dynamic Probabilistic Risk Assessment (PRA) capabilities, System Modeling Language (SysML) models, and contextual data visualizations of output data. IMPACT is the result of a multi-center collaborative effort. The trade space analyses performed by IMPACT can directly inform mission, vehicle, and habitat development by quantifying medical risk, given a design reference mission, crew attributes and a set of medical capabilities. This presentation will update the audience on the development status of the IMPACT tool suite as it comes out of its System Acceptance Review (SAR) and nears Transition to Operations (TTO). It will review IMPACT’s constituent parts, briefly discuss typical outputs, and outline the plans for transitioning to operations, currently scheduled for later in FY24. Recent development successes on the IMPACT project include the integration of the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) v2.0 to accommodate segmented missions with multiple carriers and medical systems, full onboarding of the IMPACT Medical Database (IMPACT-MD), clustering medical resources and skills into medical capabilities and mutually-dependent bundles, verification of IMPACT-MD, and the ability to perform trade analyses on different medical sets, different design reference missions (DRM), with different crew complements and extra-vehicular activity (EVA) schedules.

IMPACT↗
NASA NTRS2024

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

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

Earth Independent Medical Operations↗
NASA NTRSDate not supplied

Exploration Atmosphere Demonstration of A Multi-Functional Integrated Medical Device (Tempus Pro)

INTRODUCTION The Exploration Medical Capability (ExMC) element within the Human Research Program and the Exploration Medical Integrated Product Team (XMIPT) within the Mars Campaign Office seek to advance medical system design and risk-informed decision-making for exploration missions. This includes assessment of candidate devices and their compatibility within a variety of increasingly Earth-independent medical scenarios. The Tempus Pro (Remote Diagnostic Technologies, Ltd., Philips Corp., Farnborough, UK) is a commercial-off-the-shelf (COTS), multi-functional integrated medical device capable of vital signs monitoring, with built-in procedure support (iAssist), patient record and telemedicine communication features, and medical imaging (e.g., camera, laryngoscope, ultrasound) that meets multiple exploration medical capability needs. One of several hypobaric atmospheres being considered for exploration vehicles is 8.2 psi with 34% oxygen. To assess the useability of the Tempus Pro in such environments by individuals without formal medical training, the unit was tested in May and June of 2023 at the Johnson Space Center 20-Foot Exploration Atmosphere Chamber in conjunction with the Exploration Atmospheres-2 (EA-2) study. TECHNOLOGY DEMONSTRATION Eight subjects in the EA-2 study were assigned roles as the caregiver or patient – or both in the case of a self-exam – and caregivers were asked to place sensors for 3-Lead ECG, non-invasive blood pressure (NIBP), pulse oximetry (SpO2), and temperature using Tempus Pro’s iAssist. Depending on the procedure, additional tasks included an oropharyngeal exam of the throat with the laryngoscope and capturing ultrasound images of a cardiac subxiphoid view or of the user’s choice from a pre-specified list. Scenarios ranged from remote-guided to fully autonomous operations and surveyed the effectiveness of support, amount of support desired, and importance of support by type (e.g., written crew procedures, iAssist and device guidance, remote console guidance, etc.). Feedback from the subjects and the support personnel was also gathered to inform future designs for training and support and to determine what operations are plausible given different levels of each. An unweighted NASA task load index (TLX) was used to profile the demands of using the device, however the sample size does not support statistics. The research was exploratory in nature and qualitative information was the main goal. Calibration checks on the Tempus Pro were conducted before and after chamber testing to ensure the device was in useable condition. RESULTS All subjects performed their tasks successfully and found the Tempus Pro easy to use with the support provided. The calibration checks outside the chamber showed that the Tempus Pro remained unchanged and measurements inside the chamber were within normal values. Caregivers taking the NASA TLX reported mean scores ≤ 41/100 showing the tasks to be undemanding and less demanding with repeated use (~20/100). Novice users were able to easily connect sensors and take vital signs with the guidance from Tempus Pro’s iAssist feature. For more complex tasks, such as the oropharyngeal exam and ultrasound image acquisition, guidance beyond iAssist was needed, primarily from a supporting physician. Feedback on the importance of support types varied by person and scenario but greater than 50% of the support used by each was non-native to the device. Overall opinions were positive, but the ultrasound users expressed a lack of confidence in their results and 3 out of 4 desired more time, training, or support. Subjects found the sensors to be comfortable and comparable to prior experiences with such devices, except for the blood pressure cuff, which squeezed too tightly for uncomfortably long periods. Many observations provoked discussion, especially regarding ultrasound, that will aide decisions about future demonstrations.

R. S. Miller↗
NASA NTRS2024

Risk of Bone Fracture due to Spaceflight-induced Changes to Bone

The Human Research Program (HRP) is taking a biomechanical approach to assessing subsequent fracture risk in active astronauts as a consequence of spaceflight exposure. Triennial testing of active and retired astronauts continues as Space Medicine monitors for a premature diagnosis of primary osteoporosis, which is associated with age-related bone loss and skeletal fragility. This updated 2023 Fracture Evidence Report has expanded the description of skeletal changes to capture the full effects of spaceflight on bone: • Recent analysis of fractures from health records of the full astronaut cohort, suggests an increased incidence rate of hip and spine fractures in astronauts following longer spaceflight duration flights compared to incident rates found in shorter duration flights. • Routine preflight-to-postflight surveillance by DXA (dual-energy x-ray absorptiometry) does not provide the full detection of loss and recovery in the long-duration (LD) astronaut nor the full recovery of hip trabecular bone. • The inclusion of hip quantitative computed tomography (QCT) in flight studies delineates effects of spaceflight, of countermeasures, and of post-flight recovery on cortical and trabecular bone parameters—some of which are verified predictors of hip fracture in the aged. • QCT detects and compares the distinct countermeasure effects of the pharmaceutical alendronate and of resistive exercise (on the Advanced Resistive Exercise Device, ARED) in specific cortical and trabecular bone sub-regions during spaceflight. • A published comparison of QCT-determined loss rates of hip trabecular bone in LD astronauts compared to terrestrial cohorts suggest that accelerated loss rates in trabecular volumetric BMD (vBMD) during spaceflight might be analogous to skeletal effects of accelerated loss rates in females due to menopause, potentially leading to disruptions in trabecular microarchitecture. • A dataset of finite element (FE) estimates of hip bone strength in aging terrestrial cohorts (spanning astronaut age-range) provides comparative context for changes in the FE of hip bone strength in LD astronauts, including comparison (force unit of newton) to percentiles (50th, 75th, and 100th) of sex-matched aged humans with hip fractures. • Risk of fracture, due to the mechanical overloading of bones, is being updated with IMPACT, the next-generation tool suite for probabilistic risk assessment (PRA) for exploration missions being created by the Exploration and Medical Capability Element (ExMC) at NASA. IMPACT is currently in development and will not be included in this 2024 update. The risk for fracture necessitates understanding the relationship between applied loads to bone and the biomechanical competence of bone. The Risk for Early Onset Osteoporosis focuses on the weakened condition of bone (including development of new technologies, measurements of novel skeletal attributes, translation of multiple measures to an index of bone fragility, and interpretations of data used to reflect a weakened bone), while the Risk for Fracture assesses factors that influence the probability an astronaut would encounter applied loads exceeding the biomechanical competence of bones, resulting in fracture. This Evidence Report combines the research gaps and tasks associated with both risks.

Fracture↗
NASA NTRS2024

Crew Health and Performance Integrated Data Architecture (CHP-IDA) TechPort May 2024

Future exploration missions to Mars will have increased need for crew autonomy. Crew Health & Performance (CHP) related data on the ISS is currently, manually downlinked and in disparate locations, which limits crew autonomy for future missions. The CHP-IDA project is developing a backend data system platform that grants the ability to seamlessly collect, store, process, and display CHP-related data for exploration missions. This platform allows for integration of data and advanced analytics that offer crew and ground teams better insight into the crew’s health and performance. It also enables applications that can improve the crew’s ability to provide more autonomous medical care during exploration missions. Data will be collected automatically to reduce crew and ground team time and effort and will synchronize across all in-mission vehicles, habitats, and ground as communication delay permits. The Human Research Program’s (HRP) Medical Data Architecture (MDA) project focused on this backend data architecture but for medical data only. The CHP-IDA project, a joint effort between HRP’s Exploration Medical Capability (ExMC) element and the Exploration Medical Integrated Product Team (XMIPT), expands this capability to all relevant CHP-related data. The additional inputs from nutrition, environment, exercise, radiation, and any other relevant sources will give more insight into crew’s health and performance. Currently, the Human Systems Engineering and Integration Division at Johnson Space Center (JSC) is designing the system. The team completed a system requirements review (SRR) in FY22 and now the focus is on core software development, testbed buildup, and use case scenario demonstration. An end-to-end demonstration with multiple data sources across CHP domains is schedule for the end of FY24 where all three focus areas will be displayed. Following this ground demo, the software will be completed, tested, and validated for flight.

Courtney M Schkurko↗
NASA NTRSDate not supplied

Artificial Intelligence (AI) Methods for Augmenting the IMPACT Tool Evidence Library

Development of the Evidence Library for use with the IMPACT probability risk assessment tool took several years and involved a staggering amount of effort from a multi-disciplinary team. A very significant amount of the labor effort to collect, assess and finalize the Clinical Finding Form (CliFF) for each of the 119 medical conditions was provided by physician subject matter experts from the Exploration Medical Capability (ExMC) Element Clinical and Science Team. Many AI tools such as ChatGPT are excellent at summarizing large amounts of information and the current project was initiated to determine how such tools might streamline laborious processes, e.g., review and summarization of many scientific research publications, to execute key steps more efficiently in the process of developing CliFFs. The process for collecting the evidence which is found in the CliFFs is well documented in the Evidence Library Methods document (ELM; HRP-48036*). Using ELM and the CliFF development instructions as a guideline, a team of developers is leveraging Microsoft Azure AI tools and services along with open-source frameworks, to construct an AI-assisted automated pipeline. This pipeline is designed to search, retrieve, and process the necessary data sources, and ultimately help generate the final version of a CliFF. Currently, the large language model evaluates the relevance of each source material to spaceflights, either as direct evidence or as an analog. Additionally, the model assists in extracting keywords and generating brief summaries to enhance augmented retrieval and search processes in later stages of CliFF development. Once the data is ready, the model can perform semantic search and retrieval, generating and extracting valuable information for the CliFF. For instance, it can handle epidemiological statistical data, such as incidence rates and the likelihood of best or worst-case scenarios. The steps that required reading and summarizing articles were viewed as providing the greatest return on investment since large language models are very efficient and accurate in summarizing large amounts of text. Since labor effort to complete the original CliFF was not recorded with sufficient granularity, comparisons with an AI tool-generated CliFF will provide merely an approximation of time saved. Upon completion of the process, the CliFF for the medical condition “appendicitis” generated with the support of AI-based methods will serve as a proof-of-concept and will be compared to the original appendicitis CliFF to determine if use of the tools resulted in content and conclusory similarity. Based upon the results from face validation of the two CliFFs, modifications to the process will be made if necessary and additional condition CliFFs will be evaluated. Ultimately, CliFFs for the entire set of medical conditions will be created with the assistance of AI tools. Depending on the cost savings realized, CliFFs for additional medical conditions can be created to expand the Evidence Library. Future direction includes specifying the characteristics of the reviewer (prompting the AI tools to generate output assuming the reviewer is a sub-specialist physician, or nurse or EMT/medic) to determine if the effects on AI-generated output are different based on knowledge, skills and abilities. *Exploration Medical Capability Evidence Library Methods, HRP-48036 Rev A, July 2022.

Ali Al↗
NASA NTRSDate not supplied

Artificial Intelligence (AI) Methods for Automating the Impact Tool Evidence Library

INTRODUCTION: The development of the Evidence Library for use with the IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) probability risk assessment tool involved a multilayered, time intensive process of data collection and analysis by subject matter experts from the Exploration Medical Capability (ExMC) Element Clinical and Science Team to produce clinical findings forms (CliFFs) for 120 medical conditions. Artificial Intelligence Large Language Models (LLMs) can be leveraged to facilitate this process, thus reducing labor and time. TOPIC: CliFFs contain information about medical conditions as they pertain to spaceflight. This includes condition definitions, incidence data, crew task impairment estimates caused by conditions, treatment protocols and references to literature used for gathering condition evidence. Guided by the Evidence Library Methods document and the CliFF development instructions, a team has leveraged Microsoft Azure AI services and open-source documentation to construct an AI-assisted automated pipeline for CliFF development. This process is designed to search, retrieve, and evaluate the applicable data, and ultimately generate a completed CliFF. The LLM evaluates the relevance of each of the source materials to spaceflight, either as direct evidence or as an analog. The model extracts keywords and generates brief summaries to enhance search and retrieval in later stages of CliFF development. For instance, it can calculate epidemiological statistical data, such as incidence rates and the likelihood of best or worst-case scenarios. APPLICATION: Large Language Models (LLMs) can efficiently summarize large amounts of text. Leveraging this technology will automate data retrieval and evidence gathering for medical databases, like the IMPACT tool, by aiding in the labor-intensive process of analyzing large bodies of literature and organizing it into a formatted document like a CliFF. This added efficiency will enable expeditious expansion of the Evidence Library with additional medical conditions and update previous CLiFFs as new technology becomes available.

Ali Al↗
NASA NTRSDate not supplied

Custom Integration of Multiple Medical Functionalities

INTRODUCTION: Previous spaceflight experience and results from probabilistic risk assessment of spaceflight medical risk have highlighted the need for vital sign measurements, medical scopes, and clinical imaging tools for managing medical conditions during spaceflight. The Human Research Program’s Exploration Medical Capability (ExMC) Element and the Mars Campaign Office’s Exploration Medical Integrated Product Team (XMIPT) have performed ground-based evaluations of two Commercial-off-the-Shelf (COTS) Multi-functional Integrated Medical (MIM) devices, which integrate various medical capabilities together in one device. The key findings from these evaluations are presented in a complementary presentation, leaving this presentation to focus on forward recommendations for customized integration of multiple medical functionalities. KEY COMPONENTS: The key features of a custom integration of multiple medical functionalities includes devices and capabilities that optimally reduce medical risk. The COTS MIM devices incorporated functionality for best supporting Earth-based, emergency, pre-hospital care. Our custom integration will use probabilistic risk assessment tools, such as the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT), to determine the optimal functionality to include based on medical risk minimization. An additional feature of custom integration includes the ability to adapt to different requirements within different vehicles and/or missions. The COTS MIM devices store data in patient specific records, however, the format of the records is not modifiable, and data are not easily transferred from the MIM device to a central data architecture outside of the manufacturer’s established system. Our concept for custom integration will use devices that have an open application programming interface, which can easily connect to independent data architectures and third-party visualization software. The ultrasound capabilities included within the COTS MIM devices did not satisfy many of the Artemis Research and Operations Working Group’s ultrasound functional needs, and therefore, incorporation of higher quality ultrasound capabilities within a customized integration will be beneficial. The COTS MIM devices included minimal procedural guidance and clinical decision support tools. Supplemental tools of this type would need to be supplied along with the COTS MIM devices if they were to be used operationally, so another advantage of customization is the ability to integrate these support tools along with the medical functionality, for a more streamlined user experience. CONCLUSION: Investigation of a customized integration of medical functionality provides a method for further understanding the needs of a long-term exploration spaceflight medical system. The crew members of these exploration missions will need to operate more and more independently from Earth-based ground support. Therefore, having an optimized, streamlined medical system, which contains the functionality and supporting information needed, while remaining within mission and vehicle constraints, will help to maintain crew health and performance, which is necessary for achieving high levels of mission success.

B E Lewandowski↗
NASA NTRSDate not supplied

Preliminary Design of an 'Autonomous Medical Response Agent' Interface Prototype for Long Duration Spaceflight

Major challenges for astronauts in future long-duration exploration missions (LDEMs) will be that crewmembers are not expected to be medical professionals, may be under high workload and stress, are facing physiological challenges caused by spaceflight, and will have limited, delayed voice communications with medical support from Earth. An autonomous medical response agent (AMRA) is envisioned to help astronauts address medical complaints, develop a differential diagnosis, and guide self-treatment until a healthy state is restored. AMRA develops a process of personalized diagnosis and treatment through a Bayesian predictive control system that recommends therapeutic control actions including diagnostic tests and treatments to crewmembers (Menon, 2020). The Human Computer Interaction (HCI) lab from NASA Ames Research Center’s Human Systems Integration Division (Code TH) has collaborated with Nahlia Inc in human-centered design augmentation research for AMRA. The project, titled Design of ‘Autonomous Medical Response Agent Interface Prototype for Long Duration Spaceflight, has been funded by the Translational Research Institute for Space Health (TRISH) and introduces an interactive user-interface prototype that guides astronauts through self-diagnosis, treatment, and rehabilitation while communicating with remote specialists in ground support (most notably a patient’s flight surgeon). Our project develops the interaction design for the crewmember using AMRA through user research, iterative design, and usability testing to evaluate the user interface and workflow designed. The interface design deliverable for this project, titled AMRA Aggregate Information Display (AMRA AID) is an integrated information display system for comprehensive autonomous medical guidance, diagnosis, and treatment of in-flight medical conditions experienced by crewmembers. AMRA AID demonstrates how we might ensure crew autonomy, increase the crew’s medical capabilities, and decrease cognitive burden within a front-end user interface. AMRA AID refrains from relying on input from ground or mission control for self-treatment of medical issues—though ground awareness and communication with ground is maintained as a means of ensuring trust between mission control and crew. AMRA AID demonstrates how the crew’s on-board medical system might integrate with information from vehicle monitoring and crew schedule, without assuming causal relationships. AMRA AID’s comprehensive view enables efficient information access for both crew and ground support, reducing cognitive burden in the event of an unplanned or emergency medical incident and enabling informed analytical decisions to be made based on both crew and vehicle health. Human-centered design augmentation advanced within the prototype included: enhanced workflow and treatment guidance for two medical scenarios for a non-specialist user base with various levels of medical training, interaction design which considered speech (conversational user interface) elements and on-screen interactions to be developed in future iterations of the project, communication design and functional requirements relevant to self-care versus caring for another astronaut, as well as user testing of the prototype with an international space medical community. This project arrives at critical findings regarding usability needs, communication requirements, and integrated information requirements for a future technology interface functioning to increase confidence between ground support and LDEM crewmembers.

TRISH↗
NASA NTRS2023

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

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

ExMC↗
NASA NTRS2023

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

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

ExMC↗