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NASA NTRS1991

A telemedicine health care delivery system

The Interactive Telemedicine Systems (ITS) system was specifically developed to address the ever widening gap between our medical care expertise and our medical care delivery system. The frustrating reality is that as our knowledge of how to diagnose and treat medical conditions has continued to advance, the system to deliver that care has remained in an embryonic stage. This has resulted in millions of people being denied their most basic health care needs. Telemedicine utilizes an interactive video system integrated with biomedical telemetry that allows a physician at a base station specialty medical complex or teaching hospital to examine and treat a patient at multiple satellite locations, such as rural hospitals, ambulatory health centers, correctional institutions, facilities caring for the elderly, community hospital emergency departments, or international health facilities. Based on the interactive nature of the system design, the consulting physician at the base station can do a complete history and physical examination, as if the patient at the satellite site was sitting in the physician's office. This system is described.

Sanders, Jay H.↗
NASA NTRSDate not supplied

Summary of Technical Interchange Meetings (TIMs) Designed to Enable Earth Independent Medical Operations (EIMO)

The Exploration Medical Capability Element (ExMC) in NASA’s Human Research Program hosted a series of TIMs in 2023-2024 designed to stimulate discussion around specific topics with the goal of enabling EIMO. In context of the thematic constituent elements of EIMO, namely pre-mission planning, acute/emergent/prolonged medical decision making, supply/resource management and task load management, subject matter experts from industry, academia and government (NASA and other Agencies) provided valuable and actionable guidance and recommendations. Earth-based medical experts will remain indispensable for pre-mission planning, however, management of acute/emergent medical contingencies will require a gradual transition of medical care and decision making from terrestrial to space-based assets to enable support of astronaut health and performance and reduce overall mission risk. Key to achieving these enhancements is providing an integrated data system platform capable of utilizing multiple data streams in concert with a variety of on-board databases and passive monitoring of video and wearable sensors to enable a multi-modal, agentic AI-based clinical decision support system (CDSS) to support crew medical officer (CMO) medical decision-making. The EIMO series of TIMs (I-V) have proven to be instructive and portend a significant paradigm shift will be necessary to maintain crew health and performance on exploration class missions. Importantly, since the expected paradigm shift will be significantly different from the methods of operation that have been employed for the majority of missions from the inception of human spaceflight to date, any proposed methods must be deployed in the setting of ongoing operations early and be “tested, reviewed and practiced” while reliable back-up is available to facilitate an Enterprise-wide level of comfort and acceptance. Serious constraints on data transmission coupled with a large and expanding universe of on-board medical informatics data streams will necessitate implementation of a CDSS to supplant the current reliance on support provided by ground-based SMEs. Establishment of trust in the system by CMO/crew and the ground-based medical support team will be essential. Co-development of a CDSS with industry partners will assure that state of the art tools can be employed, and industry efficiencies can be leveraged. Training regimens, materials and tools must evolve to be responsive (just-in-time training) and facilitate autonomous execution of procedures. Proficiency metrics should be established and be based on validated competencies or milestones as opposed to a prescribed number of training hours. Training should be prioritized for broad, translatable skills that have universal application across a variety of medical conditions. Repetition was deemed to be the key to achieving proficiency and emphasis should lie in procedural training which is known to extinguish more rapidly than diagnostic skills. Advanced tools, e.g., extended reality, can provide more realistic and effective training. Use of advanced probabilistic risk assessment tools will be essential to optimize the medical system capability while carefully balancing risk relative to mass/power/volume limitations. Importance of factoring use-life of medical supplies and maintaining awareness of redundancy and opportunity to re-purpose under off nominal situations was emphasized. Consideration of adopting optimized performance standards vs. “good-enough” performance thresholds is warranted. The use of legacy systems as opposed to creating new systems may be preferable. Managing task load and associated cognitive load will be essential to maintain operational safety and behavioral health. ExMC aspires to create a shared EIMO paradigm and strategic vision for advancing medical system design through novel technologies, training, protocols, and support capabilities, built upon the spirit of successful strategies and innovations over the past six decades of space medicine operations.

Jay Lemery↗
NASA NTRS2010

NASA-Navy Telemedicine: Autogenic Feedback Training Exercises for Motion Sickness

Airsickness is the most significant medical condition affecting naval aviation training. A 2001 study showed that airsickness was reported in 81% of naval aviation students and was associated with 82% of below average flight scores. The cost to a single training air-wing was over $150,000 annually for fuel and maintenance costs alone. Resistent cases are sent to the Naval Aerospace Medical Institute (NAMI) for evaluation and desensitization in the self-paced airsickness desensitization (SPAD) program. This approach is 75% successful, but can take up to 8 weeks at a significant travel cost. NASA Ames Research Center's Autogenic Feedback Training Exercises (AFTE) uses physiological and biofeedback training for motion sickness prevention. It has a remote capability that has been used from Moffett Field, CA to Atlanta, GA . AFTE is administered in twelve (30-minute) training sessions. The success rate for the NASA AFTE program has been over 85%. Methods: Implementation Phases: Phase I: Transfer NASA AFTE to NAMI; NASA will remotely train aviation students at NAMI. Phase II: NAMI-centered AFTE application with NASA oversight. Phase III: NAMI-centered AFTE to remotely train at various Navy sites. Phase IV: NAMI to offer Tri-service application and examine research opportunities. Results: 1. Use available telemedicine connectivity between NAMI and NASA. 2. Save over $2,000 per student trained. 3. Reduce aviation training attrition. 4. Provide standardization of multi-location motion sickness training. 5. Future tri-service initiatives. 6. Data to NASA and Navy for QA and research opportunities.

Acromite, Michael T.↗
NASA NTRS2008

Medical Grade Water Generation for Intravenous Fluid Production on Exploration Missions

This document describes the intravenous (IV) fluids requirements for medical care during NASA s future Exploration class missions. It further discusses potential methods for generating such fluids and the challenges associated with different fluid generation technologies. The current Exploration baseline mission profiles are introduced, potential medical conditions described and evaluated for fluidic needs, and operational issues assessed. Conclusions on the fluid volume requirements are presented, and the feasibility of various fluid generation options are discussed. A separate report will document a more complete trade study on the options to provide the required fluids.At the time this document was developed, NASA had not yet determined requirements for medical care during Exploration missions. As a result, this study was based on the current requirements for care onboard the International Space Station (ISS). While we expect that medical requirements will be different for Exploration missions, this document will provide a useful baseline for not only developing hardware to generate medical water for injection (WFI), but as a foundation for meeting future requirements. As a final note, we expect WFI requirements for Exploration will be higher than for ISS care, and system capacity may well need to be higher than currently specified.

Niederhaus, Charles E.↗
NASA NTRS2023

Flight Surgeon Survey Results Review: Long-Duration Artemis Medical System ConOps

Background: The Artemis Mission Functional Medical Concept of Operation (ConOp) is an operational document that describes the functional medical capabilities and concept of operations for early Artemis missions of around 30 days duration. It is currently under revision for longer missions (180+ days), aiming to build a foundational diagnostic and treatment capabilities list considering mission parameters, crew selection and training, and mass/volume constraints. An interview of NASA operational flight surgeons was completed to start the revision of the medical ConOp. Methods: In the survey, 20 experienced NASA flight surgeons responded to 57 standardized questions covering 17 categories, 22 questions of which were covered in this analysis including 4 categories: Cardiovascular, Catastrophic Situations, Pulmonary, and Respiratory/O2 Support. These results were categorized into recommendations and observations. The recommendations were used to objectively quantify the responses to look for consensus, differences and uncertainty among responses. The observations remain important but were not included in this review. Analysis: Regarding questions related to changes in medical conditions treated for long-duration missions, percentage of “No Change” responses varied from 20% to 75%. In the “Change” treatment plan responses, a variety of recommendations were made, which were further made into graphics for better illustration. Additionally, recommendations on capability questions in multiple systems were visualized altogether in one product. Discussion: This work demonstrates the importance of collaboration and thorough analysis amongst experienced NASA flight surgeons for helping establish medical systems and contributing to the likelihood of mission success during Artemis long-duration missions. Through this review, we were able to identify some positive attributes as well as areas for improvement, which will facilitate further discussions.

Andrew Bushong↗
NASA NTRS2011

Exploration Medical Capability - Technology Watch

The objectives of the Technology Watch process are to identify emerging, high-impact technologies that augment current ExMC development efforts, and to work with academia, industry, and other government agencies to accelerate the development of medical care and research capabilities for the mitigation of potential health issues that could occur during space exploration missions. The establishment of collaborations with these entities is beneficial to technology development, assessment and/or insertion. Such collaborations also further NASA s goal to provide a safe and healthy environment for human exploration. The Tech Watch project addresses requirements and capabilities identified by knowledge and technology gaps that are derived from a discrete set of medical conditions that are most likely to occur on exploration missions. These gaps are addressed through technology readiness level assessments, market surveys, collaborations and distributed innovation opportunities. Ultimately, these gaps need to be closed with respect to exploration missions, and may be achieved through technology development projects. Information management is a key aspect to this process where Tech Watch related meetings, research articles, collaborations and partnerships are tracked by the HRP s Exploration Medical Capabilities (ExMC) Element. In 2011, ExMC will be introducing the Tech Watch external website and evidence wiki that will provide access to ExMC technology and knowledge gaps, technology needs and requirements documents.

Krihak, Michael↗
NASA NTRS2014

Effects of Long Duration Spaceflight on Venous and Arterial Compliance

The visual impairment and intracranial pressure syndrome (VIIP) is a newly described space flight-associated medical condition made up of a constellation of symptoms affecting at least 34% of American astronauts who have flown International Space Station (ISS) missions. VIIP is defined primarily by visual acuity deficits and anatomical changes to eye structures, and is thought to be related to elevated intracranial pressure secondary to space flightinduced cephalad fluid shifts. Loss of visual acuity could be a significant threat to crew health and performance and may be suggestive of other adaptations with implications for years post-flight. Our primary objective is to determine whether vascular compliance is altered by space flight and whether such adaptations are related to the incidence of VIIP. In particular, we will measure ocular parameters and vascular compliance in vessels of the head and neck in astronauts who have no space flight experience, in astronauts before, during, and after space flight, and in bed rest subjects with conditions similar to space flight. Additionally, we will analyze astronaut data from the Lifetime Surveillance of Astronaut Health (LSAH) archive to determine which factors might be predictive of the development of VIIP. The project will be conducted in four separate but related parts. To understand the baseline condition of astronauts without any prior space flight experience, we will study 10 astronauts who have never flown in space by performing a comprehensive evaluation of the vasculature of the head, neck and eyes. Hemodynamic data (stroke volume and blood pressure), ocular (tonometry and ocular ultrasound), venous and arterial parameters will be acquired across a range of tilt angles (20, 10, 0, -10, -20 degrees). Vessels to be studied include the temporal, jugular, and vertebral veins and the cerebral, carotid and vertebral arteries. Ophthalmic data from the annual physical will be obtained through data sharing. To examine the relation between vascular compliance in the head and neck and the development of VIIP after a long duration space flight, we will study 10 astronauts before, during, and after long-duration ISS missions. Pre- and post-flight testing will be identical to that described above. During flight, images of the same vessels of interest will be obtained for later analysis. Ophthalmic data including VIIP scores will be obtained through data sharing from medically-required tests. To investigate the effects of age and elevated sodium intake, two potential contributors to VIIP, we will study 24 men (in two age groups: 25-35 and 45-55) during a 14 day 6deg head-down bed rest, a well-accepted analog of space flight. Standard NASA bed rest conditions will be maintained except for dietary sodium. Sodium intake will be similar to that of ISS astronauts, which is higher than consumed in previous bed rest studies. Pre- and post-bed rest testing procedures will be identical to the testing protocol described above for astronauts. Ophthalmic testing (optical coherence tomography, fundoscopy, and tonometry) will be conducted on the same day that vascular compliance measures are obtained. To identify parameters that may relate to an increase in an astronaut's susceptibility to developing VIIP, we will use data mining techniques to evaluate astronaut data obtained from the LSAH. Medical history, family history, space flight history and its related exposures, and history of high performance jet aircraft exposure will be examined for their potential relationship to ocular data. We hypothesize that the cephalad fluid shift induced by space flight will result in structural and functional adaptations in head and neck vessels leading to decreased vascular compliance and related to the development of VIIP symptoms. Further, although VIIP has not been observed in previous bed rest studies, we hypothesize that an elevated sodium intake will increase the incidence of VIIP symptoms in this space flight analog. Finally, we hypothesize that data mining analyses will reveal relationships between health history, previous exposures (including space flight and high performance aircraft), and the development of VIIP in the astronaut population.

Ribeiro, L. C.↗
NASA NTRS2016

Sensitivity Analysis of the Integrated Medical Model for ISS Programs

Sensitivity analysis estimates the relative contribution of the uncertainty in input values to the uncertainty of model outputs. Partial Rank Correlation Coefficient (PRCC) and Standardized Rank Regression Coefficient (SRRC) are methods of conducting sensitivity analysis on nonlinear simulation models like the Integrated Medical Model (IMM). The PRCC method estimates the sensitivity using partial correlation of the ranks of the generated input values to each generated output value. The partial part is so named because adjustments are made for the linear effects of all the other input values in the calculation of correlation between a particular input and each output. In SRRC, standardized regression-based coefficients measure the sensitivity of each input, adjusted for all the other inputs, on each output. Because the relative ranking of each of the inputs and outputs is used, as opposed to the values themselves, both methods accommodate the nonlinear relationship of the underlying model. As part of the IMM v4.0 validation study, simulations are available that predict 33 person-missions on ISS and 111 person-missions on STS. These simulated data predictions feed the sensitivity analysis procedures. The inputs to the sensitivity procedures include the number occurrences of each of the one hundred IMM medical conditions generated over the simulations and the associated IMM outputs: total quality time lost (QTL), number of evacuations (EVAC), and number of loss of crew lives (LOCL). The IMM team will report the results of using PRCC and SRRC on IMM v4.0 predictions of the ISS and STS missions created as part of the external validation study. Tornado plots will assist in the visualization of the condition-related input sensitivities to each of the main outcomes. The outcomes of this sensitivity analysis will drive review focus by identifying conditions where changes in uncertainty could drive changes in overall model output uncertainty. These efforts are an integral part of the overall verification, validation, and credibility review of IMM v4.0.

medical equipment↗
NASA NTRS1994

Microcapsules and Methods for Making

This invention relates to methods for forming multi-lamellar microcapsules of both hydrophilic and hydrophobic immiscible liquid phases using several polymer/solvent systems. Liquid-Liquid diffusion and spontaneous emulsification are controlled by properly timed sequence exposures of immiscible phases in aqueous vehicles dispersed in hydrocarbon solvents containing small quantities of oil, co-surfactants, and glycerides. Water-in-oil and oil-in-water microcapsules are formed containing selected combinations of several types of drugs, co-encapsulated within fluid compartments inside the microcapsule. Commercial applications of the process and the resultant product relate to drug therapy for treating medical conditions such as cancer, circulatory conditions, and other conditions in which pharmaceuticals are advantageously targeted to specific organs, or delivered in combination with other pharmaceuticals. Small microcapsules may be delivered intravenously to diseased organs or clotted vessels. The use of multiple drugs within the same microcapsule structure provides advantages for applications such as chemoembolization treatments and may be used to deliver both chemotherapeutic drugs, against tumor cells, and an immuno-adjuvant or immunological stimulant to enhance the patient's immune response. Active forms of urokinase and other enzymes may be delivered without dilution to the local site of an embolism for dissolving the embolism. Thus, the invention has several potentially valuable commercial applications related to pharmaceutical and medical applications.

Morrison, Dennis R.↗
NASA NTRS2009

Human Research Program (HRP) Exploration Medical Capability (ExMC) Standing Review Panel (SRP)

The SRP believes strongly that regularly performed in-flight crew assessments are needed in order to identify a change in health status before a medical condition becomes clinically apparent. It is this early recognition in change that constitutes the foundation of the "occupational health model" expounded in the HRP Requirements Document as a key component of the HRP risk mitigation strategy that will enable its objective of "prevention and mitigation of human health and performance risks". A regular crew status examination of physiological and clinical performance is needed. This can be accomplished through instrumented monitoring of routine embedded tasks. The SRP recommends addition of a new gap to address this action under Category 3.0 Mitigate the Risk. This new gap is closely associated with Task 4.19 which addresses the lack of adequate biomedical monitoring capabilities for performing periodic clinical status evaluations and contingency medical monitoring. A corollary to these gaps is the critical emphasis on preventive medicine, not only during pre- and post-flight phases of a mission as is the current practice, but continued into the in-flight phases of exploration class missions.

Cintron, Nitza↗
NASA NTRSDate not supplied

CHP-PRA: Sensorimotor Countermeasures Proof of Concept

The capabilities included in Crew Health and Performance (CHP) systems are designed to keep the crew healthy, happy, and productive. In doing so, the CHP system allows reductions in human related risks to be realized. All human missions, though particularly future Artemis and Mars missions, have constraints on the mass and volume allocated to the CHP system. Thus, trades must be made on how to best buy down risk while still meeting other requirements. Understanding how different CHP capabilities influence medical, performance, and long-term health risks is key to making informed choices among these trades. To address this, an integrated CHP Probabilistic Risk Assessment (PRA) model is being developed. Much like how IMPACT is designed to allow medical resource trades informed by medical risks, CHP PRA will enable analogous trades in human system risks across all CHP functions and capabilities. There are 29 Human System Risk Board (HSRB) risk areas to consider for model implementation. This effort focused solely on the implementation of countermeasures associated with sensorimotor risk. The framework and lessons learned from this proof of concept will benefit the implementation of other risks and countermeasures. Astronauts experience sensorimotor changes when entering or exiting a microgravity environment. While most sensorimotor issues are resolved within a few days, they pose a serious risk to crew health and performance during the adaptation period. This adaptation period aligns with gravity transitions and key mission phases where the crew members may be required to complete challenging tasks ideally with an undisturbed sensorimotor system. Countermeasures such as training or pharmaceuticals can be used to mitigate risk. This effort began by identifying physiological changes to the sensorimotor system that could lead to functional performance decrements or medical conditions and potential countermeasures, so that the overall effect of sensorimotor disturbance on human risk could be captured. We then selected example countermeasures, mapped relationships between countermeasures and outcomes, and used results from existing sensorimotor investigations to define the relationship between a sensorimotor countermeasure and subsequent performance of a sensorimotor-affected task. Specifically, using shuttle landing performance data, we compared the use or absence of inflight training capabilities to yield a relative performance change that can be applied to the prediction of the risk associated with manual control performance in future missions, as depicted in the figure. This sensorimotor proof of concept demonstrates how HRP research information can be transformed into quantifiable relationships to describe changes in HSRB medical and performance risks.

Caroline R Austin↗
NASA NTRS2014

Portable Intravenous Fluid Production Device For Ground Use Project

Several medical conditions require the administration of intravenous (IV) fluids,but limitations of mass, volume, shelf-life, transportation, and local resources can restrict the availability of these important fluids. Such limitations are expected in long-duration space exploration missions and in remote or austere places on Earth. This design uses regular drinking water that is pumped through two filters to produce, in minutes, sterile, ultrapure water that meets the stringent quality standards of the United States Pharmacopeia for Water for Injection (Total Bacteria, Conductivity, Endo - toxins, Total Organic Carbon). The device weighs 2.2 lb (1 kg) and is 10 in. long, 5 in. wide, and 3 in. high (≈25, 13, and 7.5 cm, respectively) in its storage configuration. This handheld device produces one liter of medical-grade water in 21 minutes. Total production capacity for this innovation is expected to be in the hundreds of liters. The device contains one battery powered electric mini-pump. Alternatively, a manually powered pump can be attached and used. Drinking water enters the device from a source water bag, flows through two filters, and final sterile production water exits into a sealed, medical-grade collection bag. The collection bag contains pre-placed crystalline salts to mix with product water to form isotonic intravenous medical solutions. Alternatively, a hypertonic salt solution can be injected into a filled bag. The filled collection bag is detached from the device and is ready for use or storage. This device currently contains one collection bag, but a manifold of several pre-attached bags or replacement of single collection bags under sterile needle technique is possible for the production of multiple liters. The entire system will be flushed, sealed, and radiation-sterilized. Operation of the device is easy and requires minimal training. Drinking water is placed into the collection bag. Inline stopcock flow valves at the source and collection bags are opened, and the mini-pump is turned on by a switch to begin fluid flow. When the collection bag is completely filled with the medical- grade water, the pump can be turned off. The pump is designed so it cannot pump air, and overfilling of the collection bag with fluid is avoided by placing an equal amount of water in the source bag. Backflow is avoided by inline check valves. The filled collection bag is disconnected from its tubing and is ready for use. The source bag can be refilled for production of multiple liters, or the source bag can be replaced with an input tube that can be placed in a larger potable water source if the device is attended. The device functions in all orientations independent of any gravity fields. In addition to creating IV fluids, the device produces medical-grade water, which can be used for mixing with medications for injection, reconstituting freeze-dried blood products for injection, or for wound hydration or irrigation. Potential worldwide use is expected with medical activities in environments that have limited resources, storage, or resupply such as in military field operations, humanitarian relief efforts, submarines, commercial cruise ships, etc.

Technology Portfolio System↗
NASA NTRS2024

IVGen Mini Techport May 2024

Intravenous (IV) fluids are an important treatment modality for multiple medical conditions that have the potential to occur during Mars missions and that may lead to adverse crew health and mission outcomes without appropriate treatment. However, carrying sufficient volumes of IV fluids with adequate shelf life to support such missions is currently not feasible due to anticipated mass and volume constraints of future vehicles and the relatively short shelf-life of terrestrial IV fluids. The goal of the IntraVenous Fluid Generation for Exploration Missions, Miniaturized, (IVGen Mini) project is to develop a low mass and volume IV fluid generation device that can produce IV fluids in situ and that reduces the need to launch and store large quantities of IV fluids. It builds on the original IVGEN system developed by the Human Research Program’s Exploration Medical Capability Element that successfully demonstrated the capability to produce in-situ IV fluids aboard the ISS in 2010 using an ISS potable water source. Flight demonstration objectives for this system included purification via packed bed resin, bubble removal, sterilization, passive mixing in microgravity, and United States Pharmacopeia (USP) tested compliance. The project will culminate in a flight technical demonstration on the ISS in 2025/2026.

Courtney M Schkurko↗
NASA NTRS1992

Review of performance, medical, and operational data on pilot aging issues

An extensive review of the literature and studies relating to performance, medical, operational, and legal data regarding pilot aging issues was performed in order to determine what evidence there is, if any, to support mandatory pilot retirement. Popular misconceptions about aging, including the failure to distinguish between the normal aging process and disease processes that occur more frequently in older individuals, continue to contribute to much of the misunderstanding and controversy that surround this issue. Results: Review of medical data related to the pilot aging issue indicate that recent improvement in medical diagnostics and treatment technology have made it possible to identify to a high degree individuals who are at risk for developing sudden incapacitating illness and for treating those with disqualifying medical conditions. Performance studies revealed that after controlling for the presence of disease states, older pilots are able to perform as well as younger pilots on many performance tasks. Review of accident data showed that older, healthy pilots do not have higher accident rates than younger pilots, and indeeed, evidence suggests that older pilots have an advantage in the cockpit due to higher experience levels. The Man-Machine-Mission-Environment interface of factors can be managed through structured, supervised, and enhanced operations, maintenance, flight reviews, and safety procedures in order to ensure safe and productive operations by reducing the margin of error and by increasing the margin of safety. Conclusions: There is no evidence indicating any specific age as an arbitrary cut-off point for pilots to perform their fight duties. A combination of regular medical screening, performance evaluation, enhanced operational maintenance, and safety procedures can most effectively ensure a safe pilot population than can a mandatory retirement policy based on arbitrary age restrictions.

Stoklosa, J. H.↗
NASA NTRS2012

Hydrostatic Hyperbaric Chamber Ventilation System

The hydrostatic hyperbaric chamber (HHC) represents the merger of several technologies in development for NASA aerospace applications, harnessed to directly benefit global health. NASA has significant experience developing composite hyperbaric chambers for a variety of applications. NASA also has researched the application of water-filled vessels to increase tolerance of acceleration forces. The combination of these two applications has resulted in the hydrostatic chamber, which has been conceived as a safe, affordable means of making hyperbaric oxygen therapy (HBOT) available in the developing world for the treatment of a variety of medical conditions. Specifically, HBOT is highly-desired as a possibly curative treatment for Buruli Ulcer, an infectious condition that afflicts children in sub-Saharan Africa. HBOT is simply too expensive and too dangerous to implement in the developing world using standard equipment. The HHC technology changes the paradigm. The HHC differs from standard hyperbaric chambers in that the majority of its volume is filled with water which is pressurized by oxygen being supplied in the portion of the chamber containing the patient s head. This greatly reduces the amount of oxygen required to sustain a hyperbaric atmosphere, thereby making the system more safe and economical to operate. An effort was taken to develop an HHC system to apply HBOT to children that is simple and robust enough to support transport, assembly, maintenance and operation in developing countries. This paper details the concept for an HHC ventilation and pressurization system to provide controlled pressurization and adequate washout of carbon dioxide while the subject is enclosed in the confined space during the administration of the medical treatment. The concept took into consideration operational complexity, safety to the patient and operating personnel, and physiological considerations. The simple schematic, comprised of easily acquired commercial hardware, supports sustainability.

Sarguisingh, Miriam J.↗
DOE OSTI2020

Development and validation of a 30-day mortality index based on pre-existing medical administrative data from 13,323 COVID-19 patients: The Veterans Health Administration COVID-19 (VACO) Index

Background Available COVID-19 mortality indices are limited to acute inpatient data. Using nationwide medical administrative data available prior to SARS-CoV-2 infection from the US Veterans Health Administration (VA), we developed the VA COVID-19 (VACO) 30-day mortality index and validated the index in two independent, prospective samples. Methods and findings We reviewed SARS-CoV-2 testing results within the VA between February 8 and August 18, 2020. The sample was split into a development cohort (test positive between March 2 and April 15, 2020), an early validation cohort (test positive between April 16 and May 18, 2020), and a late validation cohort (test positive between May 19 and July 19, 2020). Our logistic regression model in the development cohort considered demographics (age, sex, race/ethnicity), and pre-existing medical conditions and the Charlson Comorbidity Index (CCI) derived from ICD-10 diagnosis codes. Weights were fixed to create the VACO Index that was then validated by comparing area under receiver operating characteristic curves (AUC) in the early and late validation cohorts and among important validation cohort subgroups defined by sex, race/ethnicity, and geographic region. We also evaluated calibration curves and the range of predictions generated within age categories. 13,323 individuals tested positive for SARS-CoV-2 (median age: 63 years; 91% male; 42% non-Hispanic Black). We observed 480/3,681 (13%) deaths in development, 253/2,151 (12%) deaths in the early validation cohort, and 403/7,491 (5%) deaths in the late validation cohort. Age, multimorbidity described with CCI, and a history of myocardial infarction or peripheral vascular disease were independently associated with mortality–no other individual comorbid diagnosis provided additional information. The VACO Index discriminated mortality in development (AUC = 0.79, 95% CI: 0.77–0.81), and in early (AUC = 0.81 95% CI: 0.78–0.83) and late (AUC = 0.84, 95% CI: 0.78–0.86) validation. The VACO Index allows personalized estimates of 30-day mortality after COVID-19 infection. For example, among those aged 60–64 years, overall mortality was estimated at 9% (95% CI: 6–11%). The Index further discriminated risk in this age stratum from 4% (95% CI: 3–7%) to 21% (95% CI: 12–31%), depending on sex and comorbid disease. Conclusion Prior to infection, demographics and comorbid conditions can discriminate COVID-19 mortality risk overall and within age strata. The VACO Index reproducibly identified individuals at substantial risk of COVID-19 mortality who might consider continuing social distancing, despite relaxed state and local guidelines.

60 APPLIED LIFE SCIENCES↗
NASA NTRS2012

Portable Intravenous Fluid Production Device for Ground Use

There are several medical conditions that require intravenous (IV) fluids. Limitations of mass, volume, storage space, shelf-life, transportation, and local resources can restrict the availability of such important fluids. These limitations are expected in long-duration space exploration missions and in remote or austere environments on Earth. Current IV fluid production requires large factory-based processes. Easy, portable, on-site production of IV fluids can eliminate these limitations. Based on experience gained in developing a device for spaceflight, a ground-use device was developed. This design uses regular drinking water that is pumped through two filters to produce, in minutes, sterile, ultrapure water that meets the stringent quality standards of the United States Pharmacopeia for Water for Injection (Total Bacteria, Conductivity, Endotoxins, Total Organic Carbon). The device weighs 2.2 lb (1 kg) and is 10 in. long, 5 in. wide, and 3 in. high (.25, 13, and 7.5 cm, respectively) in its storage configuration. This handheld device produces one liter of medical-grade water in 21 minutes. Total production capacity for this innovation is expected to be in the hundreds of liters.

Scarpa, Philip J.↗
NASA NTRS2010

Cognitive Assessment During Long-Duration Space Flight

The Space Flight Cognitive Assessment Tool for Windows (WinSCAT) is a computer-based, self-administered battery of five cognitive assessment tests developed for medical operations at NASA's Johnson Space Center in Houston, Texas. WinSCAT is a medical requirement for U.S. long-duration astronauts and has been implemented with U.S. astronauts from one NASA/Mir mission (NASA-7 mission) and all expeditions to date on the International Space Station (ISS). Its purpose is to provide ISS crew surgeons with an objective clinical tool after an unexpected traumatic event, a medical condition, or the cumulative effects of space flight that could negatively affect an astronaut's cognitive status and threaten mission success. WinSCAT was recently updated to add network capability to support a 6-person crew on the station support computers. Additionally, WinSCAT Version 2.0.28 has increased difficulty of items in Mathematics, increased number of items in Match-to-Sample, incorporates a moving rather than a fixed baseline, and implements stricter interpretation rules. ISS performance data were assessed to compare initial to modified interpretation rules for detecting potential changes in cognitive functioning during space flight. WinSCAT tests are routinely taken monthly during an ISS mission. Performance data from these ISS missions do not indicate significant cognitive decrements due to microgravity/space flight alone but have shown decrements. Applying the newly derived rules to ISS data results in a number of off-nominal performances at various times during and after flight.. Correlation to actual events is needed, but possible explanations for off-nominal performances could include actual physical factors such as toxic exposure, medication effects, or fatigue; emotional factors including stress from the mission or life events; or failure to exert adequate effort on the tests.

Seaton, Kimberly↗