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NASA NTRS2015

NASA Astronaut Occupational Surveillance Program and Lifetime Surveillance of Astronaut Health, LSAH, Astronaut Exposures and Risk in the Terrestrial and Spaceflight Environment

United States Astronauts have a very unique occupational exposure profile. In order to understand these risks and properly address them, the National Aeronautics and Atmospheric Administration, NASA, originally created the Longitudinal Study of Astronaut Health, LSAH. The first LSAH was designed to address a variety of needs regarding astronaut health and included a 3 to 1 terrestrial control population in order to compare United States "earth normal" disease and aging to that of a microgravity exposed astronaut. Over the years that program has been modified, now termed Lifetime Surveillance of Astronaut Health, still LSAH. Astronaut spaceflight exposures have also changed, with the move from short duration shuttle flights to long duration stays on international space station and considerable terrestrial training activities. This new LSAH incorporates more of an occupational health and medicine model to the study of occupationally exposed astronauts. The presentation outlines the baseline exposures and monitoring of the astronaut population to exposures, both terrestrial, and in space.

Keprta, Sean R.↗
NASA NTRSDate not supplied

Using A Guided Interview to Create an Individual Exposure Profile for The Lifetime Surveillance of Astronaut Health (LSAH)

BACKGROUND To support NASA’s Lifetime Surveillance of Astronaut Health (LSAH) project, Individual Exposure Profiles (IEPs) were developed to record an astronaut’s pre-, in-, and post-NASA exposures. NASA astronauts were invited to participate in a one-time guided interview to review known hazard exposures and medical history documented in NASA records and to add new information not otherwise reported. The purpose of the IEP project was to determine if any significant information was gained from these interviews and identify potential trends in long-term health. METHODOLOGY The pre-filled exposure profile data was extracted from several sources including medical records, biographies, and LSAH records. The information that was pre-filled before the interview included occupational exposures prior to selection to the Astronaut Corps, during active astronaut career (e.g., EVA and ground-based training, on-orbit exposures), and after active career. The IEPs also contained relevant medical history (e.g., audiometry, illnesses, injuries) and significant non-occupational exposures. 189 interviews were conducted from 2012-2014. A Microsoft Access database was created to store the information collected in the IEPs before and after the interviews. The database houses the information from the IEPs to track the updates made to the original data. By analyzing which astronauts supplied additional information and which kinds of data were consistently added, potential gaps and trends in missing data may be identified. In designing the database, an efficient structure was implemented for ease of inputting data and to create variables that would generate quantifiable data. Creating standardized variables within the structure helped ease the process of inputting, organizing data, and analyzing data. Additional updates/data were denoted and were categorized by type of update. The categories identified were “Confirmed”, “Confirmed & Supplemented”, “Supplemented”, “Denied”, “Denied & Supplemented”, and “Other”. STATISTICAL ANALYSIS AND RESULTS To assess frequency of exposure updates, descriptive statistics will be generated and stratified by relevant factors such as astronaut selection decade, age at selection, and program/era. Hypothesis testing will be performed to understand the associations between updates to exposure information and population characteristics.

Astronaut health↗
NASA NTRS2017

Tracking Historical NASA EVA Training: Lifetime Surveillance of Astronaut Health (LSAH) Development of the EVA Suit Exposure Tracker (EVA SET)

During a spacewalk, designated as extravehicular activity (EVA), an astronaut ventures from the protective environment of the spacecraft into the vacuum of space. EVAs are among the most challenging tasks during a mission, as they are complex and place the astronaut in a highly stressful environment dependent on the spacesuit for survival. Due to the complexity of EVA, NASA has conducted various training programs on Earth to mimic the environment of space and to practice maneuvers in a more controlled and forgiving environment. However, rewards offset the risks of EVA, as some of the greatest accomplishments in the space program were accomplished during EVA, such as the Apollo moonwalks and the Hubble Space Telescope repair missions. Water has become the environment of choice for EVA training on Earth, using neutral buoyancy as a substitute for microgravity. During EVA training, an astronaut wears a modified version of the spacesuit adapted for working in water. This high fidelity suit allows the astronaut to move in the water while performing tasks on full-sized mockups of space vehicles, telescopes, and satellites. During the early Gemini missions, several EVA objectives were much more difficult than planned and required additional time. Later missions demonstrated that "complex (EVA) tasks were feasible when restraints maintained body position and underwater simulation training ensured a high success probability".1,2 EVA training has evolved from controlling body positioning to perform basic tasks to complex maintenance of the Hubble Space Telescope and construction of the International Space Station (ISS). Today, preparation is centered at special facilities built specifically for EVA training, such as the Neutral Buoyancy Laboratory (NBL) at NASA's Johnson Space Center ([JSC], Houston) and the Hydrolab at the Gagarin Cosmonaut Training Centre ([GCTC], Star City, outside Moscow). Underwater training for an EVA is also considered hazardous duty for NASA astronauts. This activity places astronauts at risk for decompression sickness and barotrauma as well as various musculoskeletal disorders from working in the spacesuit. The medical, operational and research communities over the years have requested access to EVA training data to better understand the risks. As a result of these requests, epidemiologists within the Lifetime Surveillance of Astronaut Health (LSAH) team have compiled records from numerous EVA training venues to quantify the exposure to EVA training. The EVA Suit Exposure Tracker (EVA SET) dataset is a compilation of ground-based training activities using the extravehicular mobility unit (EMU) in neutrally buoyant pools to enhance EVA performance on orbit. These data can be used by the current ISS program and future exploration missions by informing physicians, researchers, and operational personnel on the risks of EVA training in order that future suit and mission designs incorporate greater safety. The purpose of this technical report is to document briefly the various facilities where NASA astronauts have performed EVA training while describing in detail the EVA training records used to generate the EVA SET dataset.

Laughlin, Mitzi S.↗
NASA NTRS2013

The Lifetime Surveillance of Astronaut Health (LSAH) Project

From 1989-2010 NASA conducted a research study, the Longitudinal Study of Astronaut Health, to investigate the incidence of acute and chronic morbidity and mortality in astronauts and to determine whether their occupational exposures were associated with increased risk of death or disability. In 2004, the Institute of Medicine recommended that NASA convert the longitudinal study into an occupational health surveillance program and in 2010, NASA initiated the Lifetime Surveillance of Astronaut Health project. The new program collects data on astronaut workplace exposures, especially those occurring in the training and space flight environments, and conducts operational and health care analyses to look for trends in exposure and health outcomes. Astronaut selection and retention medical standards are rigorous, requiring an extensive clinical testing regimen. As a result, this employee population has contributed to a large set of health data available for analyses. Astronauts represent a special population with occupational exposures not typically experienced by other employee populations. Additionally, astronauts are different from the general population in terms of demographic and physiologic characteristics. The challenges and benefits of conducting health surveillance for an employee population with unique occupational exposures will be discussed. Several occupational surveillance projects currently underway to examine associations between astronaut workplace exposures and medical outcomes will be described.

Bopp, Eugenia↗
NASA NTRS2016

Compiling a Comprehensive EVA Training Dataset for NASA Astronauts

Training for a spacewalk or extravehicular activity (EVA) is considered a hazardous duty for NASA astronauts. This places astronauts at risk for decompression sickness as well as various musculoskeletal disorders from working in the spacesuit. As a result, the operational and research communities over the years have requested access to EVA training data to supplement their studies. The purpose of this paper is to document the comprehensive EVA training data set that was compiled from multiple sources by the Lifetime Surveillance of Astronaut Health (LSAH) epidemiologists to investigate musculoskeletal injuries. The EVA training dataset does not contain any medical data, rather it only documents when EVA training was performed, by whom and other details about the session. The first activities practicing EVA maneuvers in water were performed at the Neutral Buoyancy Simulator (NBS) at the Marshall Spaceflight Center in Huntsville, Alabama. This facility opened in 1967 and was used for EVA training until the early Space Shuttle program days. Although several photographs show astronauts performing EVA training in the NBS, records detailing who performed the training and the frequency of training are unavailable. Paper training records were stored within the NBS after it was designated as a National Historic Landmark in 1985 and closed in 1997, but significant resources would be needed to identify and secure these records, and at this time LSAH has not pursued acquisition of these early training records. Training in the NBS decreased when the Johnson Space Center in Houston, Texas, opened the Weightless Environment Training Facility (WETF) in 1980. Early training records from the WETF consist of 11 hand-written dive logbooks compiled by individual workers that were digitized at the request of LSAH. The WETF was integral in the training for Space Shuttle EVAs until its closure in 1998. The Neutral Buoyancy Laboratory (NBL) at the Sonny Carter Training Facility near JSC opened in March 1997 and is the current site for US EVA training. Other space agencies also have used water to simulate weightlessness and train for EVAs. Russia has a training facility similar to the NBL named the Hydro Lab. The Hydro Lab began operations at the Gagarin Cosmonaut Training Center (GCTC) in 1980 and has been used extensively to the present. Although a majority of training in the Hydro Lab uses the Russian Orlan suit, a small number of sessions have been conducted using a NASA suit. The Japanese Weightlessness Environment Test System (WETS) went into service at the Tsukuba Space Center in 1997 but was closed in 2011 due to extensive earthquake damage. Several sessions were performed using a NASA suit, but these sessions were short and considered "development" runs. LSAH has assembled records from the WETF, NBL and Hydro Lab. Recording of the EVA training data has changed considerably from 1967 to present. The goal of early record keeping was to track use of hardware components, and the person involved was treated as a suited operator, not as a focus of interest. Records from the past two decades are fairly precise with the person, date, suit type and size noted. On occasion the length of the session was listed, but this data is not included on all records. Records were merged from data sources and extensive cleaning of the records was required since the multiple sources frequently overlapped and duplicated records. To date the LSAH EVA training dataset includes over 12,500 EVA training sessions performed by NASA astronauts since 1981. The following variables are included for most records: Name, Sex, Event date, Event name, HUT type, HUT size, Facility, and Estimated run time. For a smaller subset of records, the following variables are available: Actual run time, Time inverted, and the suit components Waist bearing type, Shoulder harness, Shoulder pads, and Teflon inserts. The LSAH dataset is currently the most complete resource for data regarding EVA training sessions performed by NASA astronauts. However, it is not 100 percent complete since the WETS (Japan) and NBS (Marshall) training facility data were not included. This dataset has been compiled by LSAH to study the relationship of EVA training to musculoskeletal injuries but has many other non-medical applications. This dataset can be provided to other groups in order to respond to program and research questions with appropriate board approvals.

Laughlin, M. S.↗
NASA NTRS2014

High Performance EVA Glove Collaboration: Glove Injury Data Mining Effort

Human hands play a significant role during extravehicular activity (EVA) missions and Neutral Buoyancy Lab (NBL) training events, as they are needed for translating and performing tasks in the weightless environment. It is because of this high frequency usage that hand- and arm-related injuries and discomfort are known to occur during training in the NBL and while conducting EVAs. Hand-related injuries and discomforts have been occurring to crewmembers since the days of Apollo. While there have been numerous engineering changes to the glove design, hand-related issues still persist. The primary objectives of this study are therefore to: 1) document all known EVA glove-related injuries and the circumstances of these incidents, 2) determine likely risk factors, and 3) recommend ergonomic mitigations or design strategies that can be implemented in the current and future glove designs. METHODS: The investigator team conducted an initial set of literature reviews, data mining of Lifetime Surveillance of Astronaut Health (LSAH) databases, and data distribution analyses to understand the ergonomic issues related to glove-related injuries and discomforts. The investigation focused on the injuries and discomforts of U.S. crewmembers who had worn pressurized suits and experienced glove-related incidents during the 1980 to 2010 time frame, either during training or on-orbit EVA. In addition to data mining of the LSAH database, the other objective of the study was to find complimentary sources of information such as training experience, EVA experience, suit-related sizing data, and hand-arm anthropometric data to be tied to the injury data from LSAH. RESULTS: Past studies indicated that the hand was the most frequently injured part of the body during both EVA and NBL training. This study effort thus focused primarily on crew training data in the NBL between 2002 and 2010. Of the 87 recorded training incidents, 19 occurred to women and 68 to men. While crew ages ranged from thirties to fifties, the age category most affected was in the forties range. Incident rate calculations (incidents per 100 training runs) revealed that the 2002, 2003, and 2004 time periods registered the highest reported incident rate levels (3.4, 6.1, and 4.1 respectively) when compared to the following years (all ≤ 1.0). In addition to general hand-arm discomfort being the highest reported result from training, specific types of hand injuries or symptoms included erythema, fingernail delamination, abrasions, muscle soreness/fatigue, paresthesia, bruising, blanching, and edema. Specific body locations most affected by hand injuries included the metacarpophalangeal joints, fingernails, finger crotches, fingers in general, interphalangeal joints, and fingertips. Causes of injuries reported in the LSAH data were primarily attributed to the forces that the gloved hands were exposed to due to hand intensive tasks and/or poor glove sizing. DISCUSSION: Although the age data indicate that most injuries are reported by male crewmembers in their forties, that is also the dominant gender and age range of most EVA crew therefore it is not an unexpected finding. Age and gender analysis will continue as more details on the uninjured population is accrued. While there is a reasonable mechanism to link training quantity to injury, the results were inconsistent and point to the need for a consistent method of suit-related injury screening and documentation. For instance, the high-incident rate levels for the years 2002 to 2004 could be attributed to a comprehensive medical review of crewmembers post-NBL EVA training that occurred from July 19, 2002 to January 16, 2004. Furthermore, there could have been increased awareness from an investigation at the NBL. These investigations may have temporarily increased the fidelity of reported injuries and discomforts during these dates as compared to surrounding years, when injury signs and symptom were no longer actively being investigated but rather voluntarily reported. Data mining for possible mechanistic factors continues and includes more detailed training timelines, hand anthropometry, and suit sizing information. The limited published data looking at hand-arm anthropometry correlated hand-anthropometry metrics with injuries stemming from glove design and operation. Future work will include further evaluation of body sizing and fit in relation to hand injury incidents.

Reid, C. R.↗
NASA NTRS2015

Email-Based Informed Consent: Innovative Method for Reaching Large Numbers of Subjects for Data Mining Research

Since the 2010 NASA authorization to make the Life Sciences Data Archive (LSDA) and Lifetime Surveillance of Astronaut Health (LSAH) data archives more accessible by the research and operational communities, demand for data has greatly increased. Correspondingly, both the number and scope of requests have increased, from 142 requests fulfilled in 2011 to 224 in 2014, and with some datasets comprising up to 1 million data points. To meet the demand, the LSAH and LSDA Repositories project was launched, which allows active and retired astronauts to authorize full, partial, or no access to their data for research without individual, study-specific informed consent. A one-on-one personal informed consent briefing is required to fully communicate the implications of the several tiers of consent. Due to the need for personal contact to conduct Repositories consent meetings, the rate of consenting has not kept up with demand for individualized, possibly attributable data. As a result, other methods had to be implemented to allow the release of large datasets, such as release of only de-identified data. However the compilation of large, de-identified data sets places a significant resource burden on LSAH and LSDA and may result in diminished scientific usefulness of the dataset. As a result, LSAH and LSDA worked with the JSC Institutional Review Board Chair, Astronaut Office physicians, and NASA Office of General Counsel personnel to develop a "Remote Consenting" process for retrospective data mining studies. This is particularly useful since the majority of the astronaut cohort is retired from the agency and living outside the Houston area. Originally planned as a method to send informed consent briefing slides and consent forms only by mail, Remote Consenting has evolved into a means to accept crewmember decisions on individual studies via their method of choice: email or paper copy by mail. To date, 100 emails have been sent to request participation in eight HRP-funded studies. The development of the Remote Consent process, the laws allowing transmission of consent via electronic means, total metrics to date, and remaining challenges (e.g., response issues, use of International Partner data, biospecimens/genetic data) for the research use of LSAH/LSDA data will be described.

Lee, Lesley R.↗
NASA NTRS2018

Assessing the Completeness of Occupational Exposure Data in the Lifetime Surveillance of Astronaut Health

INTRODUCTION: Longitudinal analysis on how spaceflight affects human health requires significant amounts of data. Missing data, especially if missing in a non-random fashion, could be a significant challenge to the success and validity of ongoing occupational surveillance and research. Astronaut occupational health data have been collected since 1959 in various formats and as part of several flight programs. As a result of changing methodologies over this span, epidemiologists in the NASA Lifetime Surveillance of Astronaut Health (LSAH) project regularly compile data sets with important exposure or outcome data missing. METHODS: NASA medical records of astronauts participating in voluntary annual LSAH examinations were reviewed and compiled to develop Individual Exposure Profiles (IEP) for each astronaut. These data were supplemented by an interview. If the interview yielded medically relevant information absent from the medical record, that information was considered an update. The IEPs were analyzed to identify trends regarding the characteristics of astronauts who provided updates and what kinds of information were consistently being updated. RESULTS: To date, 190 astronauts have participated in the IEP project. Medical information was updated for 119 individuals during these interviews. The astronauts' likelihood of updating their record upon interview was not significantly related to their spaceflight experience, era of active spaceflight, or duration of longest spaceflight. The most commonly updated categories of medical information were issues encountered during spaceflights, including CO2 symptoms, vision changes, back pain, headaches, and space motion sickness. DISCUSSION: The most commonly updated categories correspond to areas where LSAH has ongoing analysis efforts and therefore do not appear to have been reported at random. This presentation will address identification of missing astronaut health data and trends, forward work identified by the IEP project and how this information may be used for future LSAH data gap analyses.

Sieker, Jeremy↗
NASA NTRS2022

The Lifetime Surveillance of Astronaut Health Newsletter

This volume of the Newsletter discusses the Johnson Space Center Clinic (JSC) restarting in-person Lifetime Surveillance of Astronaut Health (LSAH) Formers Examinations after being on hold due to COVID-19 as well as introducing a forthcoming option for LSAH Virtual Surveillance. JSC welcomes three new members of the JSC Clinic who will be heavily involved in Formers Exams. Finally, from the LSAH team, the newsletter talks about how your health data is utilized through the IMPALA platform for research such as the SANS Maturation Project, and building the LSAH Evidence Base to understand prostate cancer trends in the astronaut corps compared to other comparison cohorts.

Joseph (Tim) LaVan↗
NASA NTRSDate not supplied

NASA’s Human Data Repositories: An In Depth Look at the New Data Request Process

As NASA transitions its focus to travel back to the moon and on to new destinations, the need to ensure the capture, analysis, and application of research and medical data is of greater urgency than at any other previous time. In this era of limited resources and challenging schedules, the Human Research Program (HRP), based at NASA’s Johnson Space Center (JSC), recognizes the need to extract the greatest possible amount of information from the data already captured. To this end, the HRP Chief Scientist Office (CSO), HRP Program Planning and Control (PP&C) Office, and the Space Medicine Operations Division have been working together to make reuse of both research data and medical monitoring data more accessible to the user community through the Life Science Data Archive (LSDA) and the Lifetime Surveillance of Astronaut Health (LSAH) Repositories. The task of both LSDA and LSAH repositories is to acquire, preserve, and distribute retrospective research (LSDA) and medical (LSAH) data and information both within the NASA community and to the science community at large, for knowledge discovery, retrospective analysis, and planning of future research studies. An additional goal is to encourage collaboration with non-NASA institutions also faced with enhancing human performance in extreme environments. In September 2022, the LSDA website and its contents transitioned to a new NASA Life Sciences Portal (https://nlsp.nasa.gov/explore/lsdahome). This site continues to feature publicly releasable information such as non-attributable datasets, experiment descriptions (from Project Mercury to ISS, as well as from multiple flight analog missions), descriptions of medical monitoring data, and LSAH newsletters (1992 - 2022). The website also provides an updated portal to request additional research and medical data not accessible from the public website. This presentation will provide an in-depth look at the new system as it relates to finding and requesting retrospective data. We will also detail processes from making a request to delivering data for different types of data requests (i.e., attributable, or non-attributable). This includes descriptions of various approval boards, what information and actions the requestor is responsible for, and key milestones in making data available for reuse.

D. M. Thomas↗
NASA NTRS2011

The Lifetime Surveillance of Astronaut Health Newsletter

The June 2010 LSAH newsletter introduced the change from the Longitudinal Study of Astronaut Health research study to the new Lifetime Surveillance of Astronaut Health program (An Overview of the New Occupational Surveillance Program for the Astronaut Corps). Instead of performing research-focused retrospective analyses of astronaut medical data compared to a JSC civil servant control population, the new program is focused on prevention of disease and prospective identification and mitigation of health risks in each astronaut due to individual exposure history and the unique occupational exposures experienced by the astronaut corps. The new LSAH program has 5 primary goals: (1) Provide a comprehensive medical exam for each LSAH participant; (2) Conduct occupational surveillance; (3) Improve communication, data accessibility, integrity and storage; (4) Support operational and healthcare analyses; and (5) Support NASA research objectives. This article will focus primarily on the first goal, the comprehensive medical exam. Future newsletters will outline in detail the plans and processes for addressing the remaining program goals.

Lee, Lesley↗
NASA NTRS2015

Got Graphs? An Assessment of Data Visualization Tools

Graphs are powerful tools for simplifying complex data. They are useful for quickly assessing patterns and relationships among one or more variables from a dataset. As the amount of data increases, it becomes more difficult to visualize potential associations. Lifetime Surveillance of Astronaut Health (LSAH) was charged with assessing its current visualization tools along with others on the market to determine whether new tools would be useful for supporting NASA's occupational surveillance effort. It was concluded by members of LSAH that the current tools hindered their ability to provide quick results to researchers working with the department. Due to the high volume of data requests and the many iterations of visualizations requested by researchers, software with a better ability to replicate graphs and edit quickly could improve LSAH's efficiency and lead to faster research results.

Schaefer, C. M.↗
NASA NTRS2024

Lifetime Surveillance of Astronaut Health Newsletter

Welcome to the April 2024 issue of the Lifetime Surveillance of Astronaut Health (LSAH) Newsletter. In this issue, we celebrate LSAH lead, Dr. Mary Wear’s retirement, inform you of the Apollo Records Synthesis Project (ARSP), and recap information shared at the 2024 Human Research Program (HRP) Investigators’ Workshop (IWS) by our LSAH Epidemiologists and NASA HRP team.

Anna C. Morgenthaler-Cejka↗
NASA NTRS2009

HRP Data Accessibility Current Status

Overview of talk: a) Content of Human Life Science data; b) Data archive structure; c) Applicable legal documents and policies; and d) Methods for data access. Life Science Data Archive (LSDA) contains research data from NASA-funded experiments, primarily data from flight experiments and ground analog data collected at NASA facilities. Longitudinal Study of Astronaut Health (LSAH) contains electronic health records (medical data) of all astronauts, including mission data. Data are collected for clinical purposes. Clinical data are analyzed by LSAH epidemiologists to identify trends in crew health and implement changes in pre-, in-, or post-flight medical care.

Sams, Clarence↗
NASA NTRS2011

The Challenges of Releasing Human Data for Analysis

The NASA Johnson Space Center s (NASA JSC) Committee for the Protection of Human Subjects (CPHS) recently approved the formation of two human data repositories: the Lifetime Surveillance of Astronaut Health Repository (LSAH-R) for clinical data and the Life Sciences Data Archive Repository (LSDA-R) for research data. The establishment of these repositories forms the foundation for the release of data and information beyond the scope for which the data was originally collected. The release of clinical and research data and information is primarily managed by two NASA groups: the Evidence Base Working Group (EBWG), consisting of members of both repositories, and the LSAH Policy Board. The goal of unifying these repositories and their processes is to provide a mutually supportive approach to handling medical and research data, to enhance the use of medical and research data to reduce risk, and to promote the understanding of space physiology, countermeasures and other mitigation strategies. Over the past year, both repositories have received over 100 data and information requests from a wide variety of requesters. The disposition of these requests has highlighted the challenges faced when attempting to make data collected on a unique set of subjects available beyond the original intent for which the data were collected. As the EBWG works through each request, many considerations must be factored into account when deciding what data can be shared and how - from the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act (HIPAA), to NASA s Health Information Management System (10HIMS) and Human Experimental and Research Data Records (10HERD) access requirements. Additional considerations include the presence of the data in the repositories and vetting requesters for legitimacy of their use of the data. Additionally, fair access must be ensured for intramural, as well as extramural investigators. All of this must be considered in the formulation of the charters, policies and workflows for the human data repositories at NASA.

Fitts, Mary↗