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NASA NTRS2014

Fatigue‐Related Countermeasures for Long‐Duration Exploration Missions

The NASA Human Research Program's (HRP) Behavioral Health and Performance Element (BHP) supports and conducts research to mitigate deleterious outcomes related to fatigue, sleep loss, circadian desynchronization, and work overload. Objective evidence indicates that within the context of the International Space Station (ISS), sleep is reduced and there is circadian misalignment. Despite chronic sleep loss and high workloads; however, astronauts successfully complete their missions. Contributing to their success is not only the tremendous skills and capabilities of each astronaut, but also the collaborative team efforts amongst the crew, between flight and ground crews, and through real‐time care provided by medical personnel. It is anticipated that risks to human health and performance will increase in the context of exploration missions, where crewmembers will venture to deep space for extended durations and in small vehicles with limited communication with home. Hence, fatigue‐related countermeasures are being developed and/or validated that include unobtrusive monitoring technologies to detect fatigue‐related performance decrements, environmental countermeasures, and sleep education and training for flight and ground crews. Given that fatigue is an issue in current ISS missions, the BHP works collaboratively with Space Medicine operations to collect data in the operational environment, to validate fatigue-related countermeasures, and provide evidence‐based mitigations. Our presentation will summarize fatigue‐related operational research that is underway through NASA's BHP in partnership with its operational counterparts. Efforts include studies evaluating the effects of hypnotics, lighting protocols as countermeasures for circadian entrainment, and investigations involving education and training. This presentation will further identify, based on flight and terrestrial evidence, additional sleep and circadian countermeasures that may still be needed to support exploration missions. Lessons learned from transitioning research deliverables into ISS operations will also be discussed.

Whitmire, A.↗
NASA NTRS2018

Differences in Pre and Post Vascular Patterning Within Retinas from ISS Crew Members and Head-Down Tilt (HDT) Subjects by VESGEN Analysis

Accelerated research by NASA has investigated the significant risks incurred during long-duration missions in microgravity for Space Flight-Associated Neuro-ocular Syndrome (SANS, formerly known as Visual Impairments associated with Increased Intracranial Pressure, VIIP) [1]. For our study, NASA's VESsel GENeration Analysis (VESGEN) was used to investigate the role of retinal blood vessels in the etiology of SANS/VIIP. The response of retinal vessels to microgravity was evaluated in astronaut crew members pre and post flight to the International Space Station (ISS), and compared to the response of retinal vessels in healthy volunteers to 6deg head-down tilt during 70 days of bed rest (HDTBR). For the study, we are testing the hypothesis that long-term cephalad fluid shifts resulting in ocular and visual impairments are necessarily mediated in part by retinal blood vessels, and therefore are accompanied by structural adaptations of the vessels. METHODS: Vascular patterns in the retinas of crew members and HDTBR subjects extracted from 30deg infrared (IR) Heidelberg Spectralis images collected pre/postflight and pre/post HDTBR, respectively, were analyzed by VESGEN (patent pending). VESGEN is a mature, automated software developed as a research discovery tool for progressive vascular diseases in the retina and other tissues. The multi-parametric VESGEN analysis generates maps of branching arterial and venous trees quantified by parameters such as the fractal dimension (Df, a modern measure of vascular space-filling capacity), vessel diameters, and densities of vessel length and number classified into specific branching generations according to vascular physiological branching rules. The retrospective study approved by NASA's Institutional Review Board included the analysis of bilateral retinas in eight ISS crew members monitored by routine occupational surveillance and six HDTBR subjects (NASA FARU Campaign 11, for example). The VESGEN analysis was conducted in a blinded fashion, with IR retinal images masked to the subject's identity, ophthalmic and clinical characteristics, and to the temporal sequence of image collection. To complete our study, VESGEN results will be analyzed statistically and correlated with other ophthalmic and medical findings. RESULTS: Preliminary results for changes in the pre to post status of vascular patterning in the retinas of crew members and HDTBR subjects are interestingly opposite. By Df and other vascular branching measures, the space-filling capacity of arterial and venous trees decreased in the majority of crew members (11/16 retinas). In contrast, vascular densities increased in HDTBR subjects by the same parameters (6/10 retinas). To conclude the study, biostatistics and medical analyses will be conducted to quantify and draw conclusions about how the changes associated with flight compare to those associated with HDTBR. CONCLUSIONS: Vascular densities appeared to decrease in the retinas of ISS crew members and increase in HDTBR subjects. Differences in arterial and venous response to cephalad fluid shifts induced by ISS and HDTBR may have resulted from a long-duration conditioning phenomenon (for example, 6-month ISS missions compared to 70 days HDTBR), or the presence of gravity in HDTBR compared to microgravity on the ISS. In addition, increased and decreased vessel diameters for Crew Members and HDTBR, respectively, are subject to limits of im

Vascular↗
NASA NTRS2009

Life Science Research in Outer Space: New Platform Technologies for Low-Cost, Autonomous Small Satellite Missions

We develop integrated instruments and platforms suitable for economical, frequent space access for autonomous life science experiments and processes in outer space. The technologies represented by three of our recent free-flyer small-satellite missions are the basis of a rapidly growing toolbox of miniaturized biologically/biochemically-oriented instrumentation now enabling a new generation of in-situ space experiments. Autonomous small satellites (~ 1 50 kg) are less expensive to develop and build than fullsize spacecraft and not subject to the comparatively high costs and scheduling challenges of human-tended experimentation on the International Space Station, Space Shuttle, and comparable platforms. A growing number of commercial, government, military, and civilian space launches now carry small secondary science payloads at far lower cost than dedicated missions; the number of opportunities is particularly large for so-called cube-sat and multicube satellites in the 1 10 kg range. The recent explosion in nano-, micro-, and miniature technologies, spanning fields from telecommunications to materials to bio/chemical analysis, enables development of remarkably capable autonomous miniaturized instruments to accomplish remote biological experimentation. High-throughput drug discovery, point-of-care medical diagnostics, and genetic analysis are applications driving rapid progress in autonomous bioanalytical technology. Three of our recent missions exemplify the development of miniaturized analytical payload instrumentation: GeneSat-1 (launched: December 2006), PharmaSat (launched: May 2009), and O/OREOS (organism/organics exposure to orbital stresses; scheduled launch: May 2010). We will highlight the overall architecture and integration of fluidic, optical, sensor, thermal, and electronic technologies and subsystems to support and monitor the growth of microorganisms in culture in these small autonomous space satellites, including real-time tracking of their culture density, gene expression, and metabolic activity while in the space environment. Flight data and results will be presented from GeneSat-1, which tracked gene expression levels of GFP-labeled E. coli and from PharmaSat, which monitored the dose dependency of an antifungal agent against S. cerevisiae. The O/OREOS SESLO instrument, which will study the effects of radiation and microgravity upon the viability and growth characteristics of B. subtilis and the halophile Halorubrum chaoviatoris for periods of 0 - 6 months in space, will be described as well. The ongoing expansion of the small satellite toolbox of biological technologies will be summarized.

Ricco, Antonio J.↗
NASA NTRS2015

Laser Spectroscopy Multi-Gas Monitor: Results of Technology Demonstration on ISS

Tunable diode laser spectroscopy (TDLS) is an up and coming trace and major gas monitoring technology with unmatched selectivity, range and stability. The technology demonstration of the 4 gas Multi-Gas Monitor (MGM), reported at the 2014 ICES conference, operated continuously on the International Space Station (ISS) for nearly a year. The MGM is designed to measure oxygen, carbon dioxide, ammonia and water vapor in ambient cabin air in a low power, relatively compact device. While on board, the MGM experienced a number of challenges, unplanned and planned, including a test of the ammonia channel using a commercial medical ammonia inhalant. Data from the unit was downlinked once per week and compared with other analytical resources on board, notably the Major Constituent Analyzer (MCA), a magnetic sector mass spectrometer. MGM spent the majority of the time installed in the Nanoracks Frame 2 payload facility in front breathing mode (sampling the ambient environment of the Japanese Experiment Module), but was also used to analyze recirculated rack air. The capability of the MGM to be operated in portable mode (via internal rechargeable lithium ion polymer batteries or by plugging into any Express Rack 28VDC connector) was a part of the usability demonstration. Results to date show unprecedented stability and accuracy of the MGM vs. the MCA for oxygen and carbon dioxide. The ammonia challenge (approx. 75 ppm) was successful as well, showing very rapid response time in both directions. Work on an expansion of capability in a next generation MGM has just begun. Combustion products and hydrazine are being added to the measurable target analytes. An 8 to 10 gas monitor (aka Gas Tricorder 1.0) is envisioned for use on ISS, Orion and Exploration missions.

Mudgett, Paul D.↗
NASA NTRS2017

Beyond DNA Sequencing in Space: Current and Future Omics Capabilities of the Biomolecule Sequencer Payload

Why do we need a DNA sequencer to support the human exploration of space? (A) Operational environmental monitoring; (1) Identification of contaminating microbes, (2) Infectious disease diagnosis, (3) Reduce down mass (sample return for environmental monitoring, crew health, etc.). (B) Research; (1) Human, (2) Animal, (3) Microbes/Cell lines, (4) Plant. (C) Med Ops; (1) Response to countermeasures, (2) Radiation, (3) Real-time analysis can influence medical intervention. (C) Support astrobiology science investigations; (1) Technology superiorly suited to in situ nucleic acid-based life detection, (2) Functional testing for integration into robotics for extraplanetary exploration mission.

Wallace, Sarah↗
NASA NTRS2000

Design and Testing of a 2-Hour Oxygen Prebreathe Protocol for Space Walks from the International Space Station

To develop and test a 2-hour prebreathe protocol for performing extravehicular activities (EVAs) from the International Space Station (ISS). Combinations of adynamia (non-walking), prebreathe exercise, and space suit donning options (10.2 vs. 14.7 psi) were evaluated, against timeline and consumable contraints to develop an operational 2- hour prebreathe protocol. Prospective accept/reject criteria were defined for decompression sickness (DCS) and venous gas emboli (VGE) from analysis of historical DCS data, combined with risk management of DCS under ISS mission circumstances. Maximum operational DCS levels were defined based on protecting for EVA capability with two crew-members at 95% confidence, throughout ISS lifetime (within the constraints of NASA DCS disposition policy JPG 1800.3). The accept/reject limits were adjusted for greater safety based on analysis of related medical factors. Monte-Carlo simulation was performed to design a closed sequential, multi-center human trial. Protocols were tested with 4 different prebreathe exercises (Phases I-IV), prior to exposure to 4.3 psi for 4 hrs. Subject selection, Doppler monitoring for VGE, test termination criteria, and DCS definitions were standardized. Phase I: upper and lower body exercises using dual-cycle ergometry (75% VO2 max for 10 min). Phase II: ergometry plus 24 min of light exercise (simulating space-suit preparations). Phase III: same 24 min of light exercise but no ergometry, and Phase IV: 56 min of light exercise without ergometry. A prebreathe procedure was accepted if, at 95% confidence, the incidence of DCS was less than 15% (with no Type II DCS), and Grade IV VGE was less than 20%.

Gernhardt, Michael L.↗
NASA NTRS2006

Moving from Bilateral to Multilateral Medical Operations

When the ISS Integrated Medical Group moved to a multilateral configuration for the ASTROLAB mission, several challenges were encountered and overcome that allowed for a streamlined operational experience. Dating back to the early 1990s, the European Space Agency (ESA) has sent flight surgeon and Biomedical Engineering (BME) personnel to NASA-JSC and Russia to train for space flight operational support. This training was tailored towards the needs of particular Shuttle/Soyuz missions, and more generally for eventual ISS support. With the announcement of the ASTROLAB mission, NASA and ESA personnel worked together to develop a detailed training template for ESA BMEs to ensure successful support of the mission from the European Astronaut Center (EAC). This training included the deployment of ESA BMEs to JSC, as well as the development of a rotation of ISS-certified NASA BMEs to the EAC. In addition to training, NASA, ESA, and the Russian Federal Space Agency (FSA) worked together preflight to develop multilateral flight control support concepts and implementation plans. This resulted in flight control support schedules, operational rules of engagement, and the delineation of responsibilities. NASA also assisted ESA with the development and deployment of workstation displays to allow the ESA medical flight control team to monitor ISS telemetry from the EAC. The goal of this presentation is to provide details of the preflight preparation and in-flight support of the ASTROLAB mission by the ESA, NASA, and FSA medical support teams. In addition, it will identify lessons learned that will be implemented for future multilateral endeavors.

Roden, S.↗
NASA NTRS2009

Operations to Research: Communication of Lessons Learned

This presentation explores ways to build upon previous spaceflight experience and communicate this knowledge to prepare for future exploration. An operational approach is highlighted, focusing on selection and retention standards (disease screening and obtaining medical histories); pre-, in-, and post-flight monitoring (establishing degrees of bone loss, skeletal muscle loss, cardiovascular deconditioning, medical conditions, etc.); prevention, mitigation, or treatment (in-flight countermeasures); and, reconditioning, recovery, and reassignment (post-flight training regimen, return to pre-flight baseline and flight assignment). Experiences and lessons learned from the Apollo, Skylab, Shuttle, Shuttle-Mir, International Space Station, and Orion missions are outlined.

Fogarty, Jennifer↗
NASA NTRS2013

Spinoff 2012

Topics covered include: Water Treatment Technologies Inspire Healthy Beverages; Dietary Formulas Fortify Antioxidant Supplements; Rovers Pave the Way for Hospital Robots; Dry Electrodes Facilitate Remote Health Monitoring; Telescope Innovations Improve Speed, Accuracy of Eye Surgery; Superconductors Enable Lower Cost MRI Systems; Anti-Icing Formulas Prevent Train Delays; Shuttle Repair Tools Automate Vehicle Maintenance; Pressure-Sensitive Paints Advance Rotorcraft Design Testing; Speech Recognition Interfaces Improve Flight Safety; Polymers Advance Heat Management Materials for Vehicles; Wireless Sensors Pinpoint Rotorcraft Troubles; Ultrasonic Detectors Safely Identify Dangerous, Costly Leaks; Detectors Ensure Function, Safety of Aircraft Wiring; Emergency Systems Save Tens of Thousands of Lives; Oxygen Assessments Ensure Safer Medical Devices; Collaborative Platforms Aid Emergency Decision Making; Space-Inspired Trailers Encourage Exploration on Earth; Ultra-Thin Coatings Beautify Art; Spacesuit Materials Add Comfort to Undergarments; Gigapixel Images Connect Sports Teams with Fans; Satellite Maps Deliver More Realistic Gaming; Elemental Scanning Devices Authenticate Works of Art; Microradiometers Reveal Ocean Health, Climate Change; Sensors Enable Plants to Text Message Farmers; Efficient Cells Cut the Cost of Solar Power; Shuttle Topography Data Inform Solar Power Analysis; Photocatalytic Solutions Create Self-Cleaning Surfaces; Concentrators Enhance Solar Power Systems; Innovative Coatings Potentially Lower Facility Maintenance Costs; Simulation Packages Expand Aircraft Design Options; Web Solutions Inspire Cloud Computing Software; Behavior Prediction Tools Strengthen Nanoelectronics; Power Converters Secure Electronics in Harsh Environments; Diagnostics Tools Identify Faults Prior to Failure; Archiving Innovations Preserve Essential Historical Records; Meter Designs Reduce Operation Costs for Industry; Commercial Platforms Allow Affordable Space Research; Fiber Optics Deliver Real-Time Structural Monitoring; Camera Systems Rapidly Scan Large Structures; Terahertz Lasers Reveal Information for 3D Images; Thin Films Protect Electronics from Heat and Radiation; Interferometers Sharpen Measurements for Better Telescopes; and Vision Systems Illuminate Industrial Processes.

Source record↗
NASA NTRS2012

Surface, Water, and Air Biocharacterization (SWAB) Flight Experiment

The determination of risk from infectious disease during spaceflight missions is composed of several factors including both the concentration and characteristics of the microorganisms to which the crew are exposed. Thus, having a good understanding of the microbial ecology aboard spacecraft provides the necessary information to mitigate health risks to the crew. While preventive measures are taken to minimize the presence of pathogens on spacecraft, medically significant organisms have been isolated from both the Mir and International Space Station (ISS). Historically, the method for isolation and identification of microorganisms from spacecraft environmental samples depended upon their growth on culture media. Unfortunately, only a fraction of the organisms may grow on a specific culture medium, potentially omitting those microorganisms whose nutritional and physical requirements for growth are not met. To address this bias in our understanding of the ISS environment, the Surface, Water, and Air Biocharacterization (SWAB) Flight Experiment was designed to investigate and develop monitoring technology to provide better microbial characterization. For the SWAB flight experiment, we hypothesized that environmental analysis using non-culture-based technologies would reveal microorganisms, allergens, and microbial toxins not previously reported in spacecraft, allowing for a more complete health assessment. Key findings during this experiment included: a) Generally, advanced molecular techniques were able to reveal a few organisms not recovered using culture-based methods; however, there is no indication that current monitoring is "missing" any medically significant bacteria or fungi. b) Molecular techniques have tremendous potential for microbial monitoring, however, sample preparation and data analysis present challenges for spaceflight hardware. c) Analytical results indicate that some molecular techniques, such as denaturing gradient gel electrophoresis (DGGE), can be much less sensitive than culture-based methods. d) More sensitive molecular techniques, such as quantitative polymerase chain reaction (QPCR), were able to identify viral DNA from ISS environments, suggesting potential transfer of the organism between crewmembers. In addition, the hardware selected for this experiment represented advances for next-generation sample collection. The advanced nature of this collection hardware was noted, when the Sartorius MD8 Air Port air sampler from the SWAB experiment remained on board ISS at the request of JAXA investigators, who intend to use it in completion of their microbial ecology experiment.

Castro, V. A.↗
NASA NTRS1990

Earth benefits from space life sciences

Contributions of space exploration which are widely recognized are those dealing with the impact of space technology on public health and medical services in both urban and remote rural areas. Telecommunications, image enhancement, 3-dimensional image reconstructions, miniaturization, automation, and data analysis, have transformed the delivery of medical care and have brought about a new impetus to the field of biomedicine. Many areas of medical care and biological research have been affected. These include technological breakthroughs in such areas as: (1) diagnosis, treatment, and prevention of cardiovascular diseases, (2) new approaches to the understanding of osteoporosis, (3) early detection of genetic birth defects, (4) emergency medical care, and (5) treatment of chronic metabolic disorders. These are but a few examples where technology originally developed to support space medicine or space research has been applied to solving medical and health care delivery problems on Earth.

NASA Center HQS↗
NASA NTRS2003

Pulsed Phase Lock Loop Device for Monitoring Intracranial Pressure During Space Flight

We have developed an ultrasonic device to monitor ICP waveforms non-invasively from cranial diameter oscillations using a NASA-developed pulsed phase lock loop (PPLL) technique. The purpose of this study was to attempt to validate the PPLL device for reliable recordings of ICP waveforms and analysis of ICP dynamics in vivo. METHODS: PPLL outputs were recorded in patients during invasive ICP monitoring at UCSD Medical Center (n=10). RESULTS: An averaged linear regression coefficient between ICP and PPLL waveform data during one cardiac cycle in all patients is 0.88 +/- 0.02 (mean +/- SE). Coherence function analysis indicated that ICP and PPLL waveforms have high correlation in the lst, 2nd, and 3rd harmonic waves associated with a cardiac cycle. CONCLUSIONS: PPLL outputs represent ICP waveforms in both frequency and time domains. PPLL technology enables in vivo evaluation of ICP dynamics non-invasively, and can acquire continuous ICP waveforms during spaceflight because of compactness and non-invasive nature.

Ueno, Toshiaki↗
NASA NTRS2007

Medical Significance of Microorganisms in Spacecraft Environment

Microorganisms can spoil food supplies, contaminate drinking water, release noxious volatile compounds, initiate allergic responses, contaminate the environment, and cause infectious diseases. International acceptability limits have been established for bacterial and fungal contaminants in air and on surfaces, and environmental monitoring is conducted to ensure compliance. Allowable levels of microorganism in water and food have also been established. Environmental monitoring of the space shuttle, the Mir, and the ISS have allowed for some general conclusions. Generally, the bacteria found in air and on interior surfaces are largely of human origin such as Staphylococcus spp., Micrococcus spp. Common environmental genera such as Bacillus spp. are the most commonly isolated bacteria from all spacecraft. Yeast species associated with humans such as Candida spp. are commonly found. Aspergillus spp., Penicillium spp., and Cladosporium spp. are the most commonly isolated filamentous fungi. Microbial levels in the environment differ significantly depending upon humidity levels, condensate accumulation, and availability of carbon sources. However, human "normal flora" of bacteria and fungi can result in serious, life-threatening diseases if human immunity is compromised. Disease incidence is expected to increase as mission duration increases.

Pierson, Duane L.↗
NASA NTRS1991

A coated-wire ion-selective electrode for ionic calcium measurements

A coated-wire ion-selective electrode for measuring ionic calcium was developed, in collaboration with Teknektron Sensor Development Corporation (TSDC). This coated wire electrode sensor makes use of advanced, ion-responsive polyvinyl chloride (PVC) membrane technology, whereby the electroactive agent is incorporated into a polymeric film. The technology greatly simplifies conventional ion-selective electrode measurement technology, and is envisioned to be used for real-time measurement of physiological and environment ionic constituents, initially calcium. A primary target biomedical application is the real-time measurement of urinary and blood calcium changes during extended exposure to microgravity, during prolonged hospital or fracture immobilization, and for osteoporosis research. Potential advanced life support applications include monitoring of calcium and other ions, heavy metals, and related parameters in closed-loop water processing and management systems. This technology provides a much simplified ionic calcium measurement capability, suitable for both automated in-vitro, in-vivo, and in-situ measurement applications, which should be of great interest to the medical, scientific, chemical, and space life sciences communities.

Hines, John W.↗
NASA NTRS1998

Breaking the Wavelength Barrier

Under an SBIR (Small Business Innovative Research) contract with Goddard Space Flight Center, Focused Research, Inc. and New Focus, Inc., developed a single mode tunable diode laser from 1.9 to 4.0 microns. As an offshoot from this work, they were able to introduce a 2.0 micron diode laser into their commercial product line. These lasers are useful in trace gas detection, environmental monitoring, seeding of lidar systems, and medical diagnostic experiments.

Source record↗
NASA NTRS2011

Improvements to the Ionizing Radiation Risk Assessment Program for NASA Astronauts

To perform dosimetry and risk assessment, NASA collects astronaut ionizing radiation exposure data from space flight, medical imaging and therapy, aviation training activities and prior occupational exposure histories. Career risk of exposure induced death (REID) from radiation is limited to 3 percent at a 95 percent confidence level. The Radiation Health Office at Johnson Space Center (JSC) is implementing a program to integrate the gathering, storage, analysis and reporting of astronaut ionizing radiation dose and risk data and records. This work has several motivations, including more efficient analyses and greater flexibility in testing and adopting new methods for evaluating risks. The foundation for these improvements is a set of software tools called the Astronaut Radiation Exposure Analysis System (AREAS). AREAS is a series of MATLAB(Registered TradeMark)-based dose and risk analysis modules that interface with an enterprise level SQL Server database by means of a secure web service. It communicates with other JSC medical and space weather databases to maintain data integrity and consistency across systems. AREAS is part of a larger NASA Space Medicine effort, the Mission Medical Integration Strategy, with the goal of collecting accurate, high-quality and detailed astronaut health data, and then securely, timely and reliably presenting it to medical support personnel. The modular approach to the AREAS design accommodates past, current, and future sources of data from active and passive detectors, space radiation transport algorithms, computational phantoms and cancer risk models. Revisions of the cancer risk model, new radiation detection equipment and improved anthropomorphic computational phantoms can be incorporated. Notable hardware updates include the Radiation Environment Monitor (which uses Medipix technology to report real-time, on-board dosimetry measurements), an updated Tissue-Equivalent Proportional Counter, and the Southwest Research Institute Radiation Assessment Detector. Also, the University of Florida hybrid phantoms, which are flexible in morphometry and positioning, are being explored as alternatives to the current NASA computational phantoms.

Semones, E. J.↗
NASA NTRS1977

Ergonomics technology

Major areas of research and development in ergonomics technology for space environments are discussed. Attention is given to possible applications of the technology developed by NASA in industrial settings. A group of mass spectrometers for gas analysis capable of fully automatic operation has been developed for atmosphere control on spacecraft; a version for industrial use has been constructed. Advances have been made in personal cooling technology, remote monitoring of medical information, and aerosol particle control. Experience gained by NASA during the design and development of portable life support units has recently been applied to improve breathing equipment used by fire fighters.

Jones, W. L.↗
NASA NTRS2005

GO/NO-GO - When is medical hazard mitigation acceptable for launch?

Medical support of spaceflight missions is composed of complex tasks and decisions that dedicated to maintaining the health and performance of the crew and the completion of mission objectives. Spacecraft represent one of the most complex vehicles built by humans, and are built to very rigorous design specifications. In the course of a Flight Readiness Review (FRR) or a mission itself, the flight surgeon must be able to understand the impact of hazards and risks that may not be completely mitigated by design alone. Some hazards are not mitigated because they are never actually identified. When a hazard is identified, it must be reduced or waivered. Hazards that cannot be designed out of the vehicle or mission, are usually mitigated through other means to bring the residual risk to an acceptable level. This is possible in most engineered systems because failure modes are usually predictable and analysis can include taking these systems to failure. Medical support of space missions is complicated by the inability of flight surgeons to provide "exact" hazard and risk numbers to the NASA engineering community. Taking humans to failure is not an option. Furthermore, medical dogma is mostly comprised of "medical prevention" strategies that mitigate risk by examining the behaviour of a cohort of humans similar to astronauts. Unfortunately, this approach does not lend itself well for predicting the effect of a hazard in the unique environment of space. This presentation will discuss how Medical Operations uses an evidence-based approach to decide if hazard mitigation strategies are adequate to reduce mission risk to acceptable levels. Case studies to be discussed will include: 1. Risk of electrocution risk during EVA 2. Risk of cardiac event risk during long and short duration missions 3. Degraded cabin environmental monitoring on the ISS. Learning Objectives 1.) The audience will understand the challenges of mitigating medical risk caused by nominal and off-nominal mission events. 2.) The audience will understand the process by which medical hazards are identified and mitigated before launch. 3.) The audience will understand the roles and responsibilities of all the other flight control positions in participating in the process of reducing hazards and reducing medical risk to an acceptable level.

Hamilton, Douglas R.↗