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NASA NTRSDate not supplied

Introduction of the NASA Microgravity Research Library

As opportunities for conducting experiments in space are rare, more studies have been published using ground-based analogs that simulate microgravity conditions. For example, when conducting a literature search in PubMed for peer-reviewed articles and studies that used simulated microgravity conditions, results will yield over 5,000 publications dating back to 1961. The issue with this search technique and medium is that these articles are vast in quantity and spread out across multiple web-based databases, repositories, and libraries; some of which, are wholly inaccessible. For example, in PubMed for a single year, we found 1,000+ microgravity research articles among more than 12,000 general, space research articles; these, were within an overarching 350,000+ total, general medical research articles for just 2020. The KSC Microgravity Simulation Support Facility (MSSF), with support from the KSC Information Technology (IT) Applications Development Team and the NASA Space Biology Program, took the initiative to develop a database that would serve as the central repository for existing microgravity research. This repository site is open to the public and houses not only peer-reviewed publications relating to microgravity research, but also dissertations, technical publications such as white papers, NASA technical publications, and patent publications. In this presentation, we will discuss some of our literature research findings as well as present a working prototype version of the Library. It is our goal that the future infrastructure of this database advance to become a fully-functional, NASA Space Life-Sciences Research Library.

Anna Maria Ruby↗
NASA NTRSDate not supplied

Introduction of the NASA Microgravity Research Library

As opportunities for conducting experiments in space are rare, more studies have been published using ground-based analogs that simulate microgravity conditions. For example, when conducting a literature search in PubMed for peer-reviewed articles and studies that used simulated microgravity conditions, results will yield over 5,000 publications dating back to 1961. The issue with this search technique and medium is that these articles are vast in quantity and spread out across multiple web-based databases, repositories, and libraries; some of which, are wholly inaccessible. For example, in PubMed for a single year, we found 1,000+ microgravity research articles among more than 12,000 general, space research articles; these, were within an overarching 350,000+ total, general medical research articles for just 2020. The KSC Microgravity Simulation Support Facility (MSSF), with support from the KSC Information Technology (IT) Applications Development Team and the NASA Space Biology Program, took the initiative to develop a database that would serve as the central repository for existing microgravity research. This repository site is open to the public and houses not only peer-reviewed publications relating to microgravity research, but also dissertations, technical publications such as white papers, NASA technical publications, and patent publications. In this presentation, we will discuss some of our literature research findings as well as present a working prototype version of the Library. It is our goal that the future infrastructure of this database advance to become a fully-functional, NASA Space Life-Sciences Research Library.

Anna Maria Ruby↗
DOE OSTI2025

The Evolution of Randomized Clinical Trial Designs to Assess Therapeutics in Alzheimer Disease

Importance The success of recent randomized clinical trials (RCTs) for Alzheimer disease (AD), particularly those focusing on anti-amyloid therapies, has been discussed at length. However, the evolution of RCT design features for AD that preceded this success remain underexplored. Objective To describe temporal changes in the features of RCT design for interventions in AD. Evidence Review PubMed, Scopus, and Web of Science databases were searched in January 2025 for phase 2 and 3 AD RCTs published between January 1992 and December 2024. RCTs that investigated an intervention for AD, with a placebo or standard-of-care control group, were included. Four assessors independently reviewed full-text articles to capture study characteristics. Main Outcomes and Measures The number of participants and the duration of RCTs as well as the target population, outcomes, and funding were extracted from published reports. These features were analyzed with respect to time using linear regression and χ 2 analyses. Results The study included 203 RCTs with 79 589 participants testing interventions in AD. From 1992 to 2024, the mean sample size increased by 464% for phase 2 RCTs (from 42 to 237), and 50% for phase 3 RCTs (from 632 to 951), while the mean trial duration increased by 188% (from 16 to 46 weeks) for phase 2, and 256% (from 20 to 71 weeks) for phase 3 RCTs. This longer duration of RCTs may be partially attributed by a greater share of disease-modifying rather than symptomatic treatments. Similarly, more recent trials required AD biomarker evidence for enrollment (from 1 of 36 [2.7%] before 2006 to 40 of 76 [52.6%] since 2019). A substantial difference in the type of therapeutics researched was observed, with anti-amyloid and anti-tau RCTs being more likely to be funded by the pharmaceutical industry compared with neurotransmitter or other RCTs (anti-amyloid or anti-tau, 68 of 71 [95.8%]; neurotransmitter, 52 of 69 [77.6%]; other, 33 of 52 [63.5%]). RCT transparency improved, with more frequent data accessibility statements, registered reports, and better reporting on race and ethnicity. Conclusions and Relevance This methodology research of AD RCTs highlights substantial changes in key features of AD clinical trials from 1992 to 2024. AD RCTs have become larger and longer, such that they are powered to detect smaller clinical differences. The increased sample sizes and duration should enable the detection of smaller and more slowly occurring outcomes, which may lead to successful RCTs of therapies with slower and more subtle efficacy.

General & Internal Medicine↗
DOE OSTI2026

Citation network datasets for benchmarking spiking graph neural networks on experimental neuromorphic hardware

Spiking neural networks (SNNs) running on neuromorphic computers offer an energy-efficient alternative for AI tasks. Recently, spiking graph neural networks (S-GNNs) have been shown to produce encouraging results on benchmark citation network datasets such as Cora, CiteSeer, and PubMed for node classification tasks. These S-GNNs were run on SNN simulators only because they contain up to tens of thousands of neurons and up to millions of synapses, translating poorly to neuromorphic hardware. Therefore, in this paper, we create a suite of benchmark datasets from the CiteSeer dataset that can be accommodated on current neuromorphic hardware platforms. Our contribution consists of a collection of three datasets. First, we have an induced subgraph of CiteSeer, which we call MiniSeer, containing 2110 papers, 3604 binary features, and 6 topics. Second, MicroSeer is a very small dataset consisting of 84 papers, 1227 features, and 6 topics. Lastly, BiteSeer is a collection of 15 binary classification datasets. We present creation of these datasets along with accuracies, running times, and spike counts when simulated. We believe that our results in this paper will be used by the neuromorphic community to benchmark, test, and develop neuromorphic hardware and simulators.

Zhu, Kevin [George Mason University, Virginia]↗
DOE OSTI2025

The impact of curation errors in the PDBBind Database on machine learning predictions of protein–protein binding affinity

The PDBBind database has been widely utilized for the computational prediction of protein–protein binding affinities. While the accuracy of the PDBBind-curated equilibrium dissociation constants (K D ) has been reported for the protein–ligand subset of the PDBBind database, the curation accuracy has not been reported for the protein–protein subset. Here, we present a detailed manual analysis for the subset of PDBBind records with PubMed Central Open Access primary publications and find that ~19% of these records had K D values that were not supported by their primary publications. The impact of these putative curation errors on the machine learning-based prediction of K D from experimental protein–protein 3D structures was evaluated and correcting the curation errors improved the Pearson correlation coefficient between measured and random forest-predicted log 10 (K D ) values by ~8 percentage points. This finding underscores the importance of dataset accuracy for computational modelling and highlights the need for more stringent curation processes when extracting information from the scientific literature.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2024

Multicriteria Measures to Assess the Sustainability of Diets: A Systematic Review

Abstract Context Assessing the overall sustainability of a diet is a challenging undertaking requiring a holistic approach capable of addressing the multicriteria nature of this concept. Objective The aim was to identify and summarize the multicriteria measures used to assess the sustainability characteristics of diets reported at the individual level by healthy adults. Data Sources Articles were identified via PubMed, Scopus, and Web of Science. The search strategy consisted of key words and MeSH terms, and was concluded in September 2022, covering references in English, Spanish, and Portuguese. Data Extraction This systematic review followed the PRISMA guidelines. The search identified 5663 references, from which 1794 were duplicates. Two reviewers independently screened the titles and abstracts of each of the 3869 records and the full-text of the 144 references selected. Of these, 7 studies met the inclusion criteria. Data Analysis A total of 6 multicriteria measures were identified: 3 different Sustainable Diet Indices, the Quality Environmental Costs of Diet, the Quality Financial Costs of Diet, and the Environmental Impact of Diet. All of these incorporated a health/nutrition dimension, while the environmental and economic dimensions were the second and the third most integrated, respectively. A sociocultural sustainability dimension was included in only 1 of the measures. Conclusion Despite some methodological concerns in the development and validation process of the identified measures, their inclusion is considered indispensable in assessing the transition towards sustainable diets in future studies. Systematic Review Registration PROSPERO registration no. CRD42022358824.

Rei, Mariana (ORCID:0000000189453708)↗
DOE OSTI2026

polars-dovmed (dovmed) v0.1.0

polars-dovmed is a python package for text search and extraction from NCBI's PubMed Central Open Access subset. It is powered by the polars dataframe library and leverages modern file formats (parquet) to efficiently scan public literature.

Roux, Simon [Lawrence Berkeley National Laboratory↗
DOE OSTI2025

Replacing non-biomedical concepts improves embedding of biomedical concepts

Embeddings are semantically meaningful representations of words in a vector space, commonly used to enhance downstream machine learning applications. Traditional biomedical embedding techniques often replace all synonymous words representing biological or medical concepts with a unique token, ensuring consistent representation and improving embedding quality. However, the potential impact of replacing non-biomedical concept synonyms has received less attention. Embedding approaches often employ concept replacement to replace concepts that span multiple words, such as non-small-cell lung carcinoma, with a single concept identifier (e.g., D002289). Also, all synonyms of each concept are merged into the same identifier. Here, we additionally leveraged WordNet to identify and replace sets of non-biomedical synonyms with their most common representatives. This combined approach aimed to reduce embedding noise from non-biomedical terms while preserving the integrity of biomedical concept representations. We applied this method to 1,055 biomedical concept sets representing molecular signatures or medical categories and assessed the mean pairwise distance of embeddings with and without non-biomedical synonym replacement. A smaller mean pairwise distance was interpreted as greater intra-cluster coherence and higher embedding quality. Embeddings were generated using the Word2Vec algorithm applied to a corpus of 10 million PubMed abstracts. Our results demonstrate that the addition of non-biomedical synonym replacement reduced the mean intra-cluster distance by an average of 8%, suggesting that this complementary approach enhances embedding quality. Future work will assess its applicability to other embedding techniques and downstream tasks. Python code implementing this method is provided under an open-source license.

algorithms↗
DOE OSTI2025

AI-powered topic modeling: comparing LDA and BERTopic in analyzing opioid-related cardiovascular risks in women

Topic modeling is a crucial technique in natural language processing (NLP), enabling the extraction of latent themes from large text corpora. Traditional topic modeling, such as Latent Dirichlet Allocation (LDA), faces limitations in capturing the semantic relationships in the text document although it has been widely applied in text mining. BERTopic, created in 2022, leveraged advances in deep learning and can capture the contextual relationships between words. In this work, we integrated Artificial Intelligence (AI) modules to LDA and BERTopic and provided a comprehensive comparison on the analysis of prescription opioid-related cardiovascular risks in women. Opioid use can increase the risk of cardiovascular problems in women such as arrhythmia, hypotension etc. 1,837 abstracts were retrieved and downloaded from PubMed as of April 2024 using three Medical Subject Headings (MeSH) words: “opioid,” “cardiovascular,” and “women.” Machine Learning of Language Toolkit (MALLET) was employed for the implementation of LDA. BioBERT was used for document embedding in BERTopic. Eighteen was selected as the optimal topic number for MALLET and 23 for BERTopic. ChatGPT-4-Turbo was integrated to interpret and compare the results. The short descriptions created by ChatGPT for each topic from LDA and BERTopic were highly correlated, and the performance accuracies of LDA and BERTopic were similar as determined by expert manual reviews of the abstracts grouped by their predominant topics. The results of the t-SNE (t-distributed Stochastic Neighbor Embedding) plots showed that the clusters created from BERTopic were more compact and well-separated, representing improved coherence and distinctiveness between the topics. Our findings indicated that AI algorithms could augment both traditional and contemporary topic modeling techniques. In addition, BERTopic has the connection port for ChatGPT-4-Turbo or other large language models in its algorithm for automatic interpretation, while with LDA interpretation must be manually, and needs special procedures for data pre-processing and stop words exclusion. Therefore, while LDA remains valuable for large-scale text analysis with resource constraints, AI-assisted BERTopic offers significant advantages in providing the enhanced interpretability and the improved semantic coherence for extracting valuable insights from textual data.

Research & Experimental Medicine↗
DOE OSTI2024

The effects of exercise training interventions on depression in hemodialysis patients

Purpose Depression considerably influences the clinical outcomes, treatment compliance, quality of life, and mortality of hemodialysis patients. Exercise plays a beneficial role in depressive patients, but its quantitative effects remain elusive. This study aimed to summarize the effects of exercise training on depression in patients with end-stage renal disease undergoing hemodialysis. Methods The PUBMED, EMBASE, and Cochrane Library databases were systematically searched from inception to April 2023 to identify published articles reporting the effect of exercise training on the depression level of patients with End-Stage Renal Disease undergoing hemodialysis. Data were extracted from the included studies using predefined data fields by two independent researchers. The Cochrane Handbook for Systematic Reviews of Interventions and Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies were employed for quality evaluation. Results A total of 22 studies enrolling 1,059 patients who participated in exercise interventions were included. Hemodialysis patients exhibited superior outcomes with intradialytic exercise (SMD = −0.80, 95% CI: −1.10 to −0.49) and lower levels of depression following aerobic exercise (SMD = −0.93, 95%CI: −1.32 to −0.55) compared to combined exercise (c − 0.85, 95% CI: −1.29 to −0.41) and resistance exercise (SMD = −0.40, 95%CI: −0.96 to 0.17). Regarding exercise duration, patients manifested lower depression levels when engaging in exercise activities for a duration exceeding 6 months (SMD = −0.92, 95% CI: −1.67 to −0.17). Concerning the duration of a single exercise session, the most significant improvement was noted when the exercise duration exceeded 60 min (SMD = −1.47, 95% CI: −1.87 to −1.06). Conclusion Our study determined that exercise can alleviate depression symptoms in hemodialysis patients. This study established the varying impacts of different exercise parameters on the reduction of depression levels in hemodialysis patients and is anticipated to lay a theoretical reference for clinicians and nurses to devise tailored exercise strategies for interventions in patients with depression. Systematic review registration https://www.crd.york.ac.uk/prospero/ , This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database, with registration number CRD42023434181.

Yu, Huihui↗
NASA NTRS2007

Bisphosphonate Treatment: Risk Management in Long Duration Spaceflight

Bisphosphonates are a class of pharmaceuticals used to treat diverse bone disorders such as osteoporosis, Paget's disease, and multiple myeloma. They constitute a class of drugs which adhere to bony surfaces and interfere with the resorptive activity of osteoclasts. They also represent a potential countermeasure towards the loss of bone mass experienced by astronauts during spaceflight. Recently, the medical literature has revealed cases of osteonecrosis of the jaw in individuals receiving intravenous bisphosphonate therapy with a smaller number of cases occurring in individuals receiving the oral form of the medication. Risk management for long duration missions requires consideration of mission success and lifetime health care of astronauts. We performed MEDLINE and PubMed searches (1966 December 2006) using the following keywords: osteonecrosis, jaw, bisphosphonates. Additional references were obtained from the citations of the retrieved articles. Injectable bisphosphonates such as pamidronate and zoledronic acid have been highlighted recently in the literature due to a possible link with osteonecrosis of the jaw. The mechanism of action remains unclear but may be linked to physiologic microdamage in the jawbones resulting from suppression of bone metabolism. The most predisposing factors appear to be the type and dose of bisphosphonate used, a history of dental surgery, trauma, and/or dental infection. In addition, patients diagnosed with a malignancy such as breast cancer or multiple myeloma, who have been on intravenous bisphosphonate therapy for several months seem to be at increased risk. The use of oral bisphosphonates appears to place patients more at risk from acute events such as gastrointestinal tract injury or perforation. Although some studies report little to no increase in GI events compared to placebo, we must remember that in microgravity, astronauts may be unable to comply with medication instructions. They may have difficulty remaining upright for the required 30-45 minutes post-ingestion. We are currently unaware if this inability to comply with instructions on the package insert may lead to an increased risk for GI events. There is a potential long-term complication that resides with both forms of bisphosphonate therapy. In order to repair normally occurring physiologic microdamage to bone, both osteoclastic resorption and osteoblastic bone deposition must be functional. Controversy exists in the literature regarding whether prolonged use of bisphosphonates may lead to the suppression of bone turnover and accumulation of microdamage. Bisphosphonates are a powerful class of drugs that suppress bone turnover, but may cause serious adverse clinical events such as gastrointestinal tract injury or osteonecrosis of the jaw. Unfortunately, little to no data exists currently which may help us provide answers regarding the risks of their use in a healthy astronaut cohort. While controversy exists in the literature regarding their mechanism and long-term consequences, the potential mission impact or lifetime health care impact of an adverse clinical event resulting from bisphosphonate therapy must be considered.

Fogarty, Jennifer A.↗
NASA NTRS2012

Review of Human Cognitive Performance in Spaceflight

Human space exploration is inherently hazardous, particularly for lon g duration (LD) missions (22 days or longer). Maintenance of cognitive functioning is essential, but flight environments pose numerous pote ntial risks to the brain and cognitive performance (eg, radiation, to xins, chronic stress, sleep deprivation, hypercarbia, fluid shifts, h ormone imbalances, and injury). There have been persistent anecdotal reports of cognitive deficits during missions, but an up?-to-date rev iew of the evidence for such changes has remained unavailable. Method s: We identified and reviewed English language publications found via electronic searches in PubMed, PsycInfo, Inspec, the NASA Technical Report Server, and the Defense Technical Information Center, plus rec ursive searches of publication bibliographies. Search terms included the word cognition, cognitive, or performance along with spaceflight, flight, mission, or closely related terms. Results: Inter?-study variability precluded meta?-analysis. Some 32 published studies involving cognitive assessment during spaceflight were identified, involving a total of 110 participants (mean: 3.4 participants per study). The lo ngest?-duration study spanned 438 days, with six additional studies i nvolving flight durations of 90 days, and 11 more studies involved fl ight durations exceeding 21 days. The available evidence failed to st rongly support or refute the existence of cognitive deficits in LD sp aceflight, in part due to inadequate power or control conditions. Evi dence of increased variability in cognitive performance during spacef light, both within and between individuals, was common. Discussion: T hese results represent a negative finding based on small numbers of s ubjects for any given cognitive function. The increased variability within and (particularly) between individuals highlights the potential danger of generalizing from case studies. A mismatch therefore remain s between anecdotal reports describing generalized cognitive slowing, attention and memory problems during missions and the experimental e vidence supporting such deficits. Since a major justification for man ned spaceflight rests with the cognitive flexibility of humans, addit ional studies and further analysis of existing operational data appea rs warranted.

Strangman, Gary↗
NASA NTRS2020

Electromagnetic Pain Relief/Blocking: Feasibility Assessment

Context/Background: Astronauts use pharmaceuticals during spaceflight to manage acute and chronic pain, but use of analgesics will have drawbacks for exploration-class missions because the shelf life of these medications is limited, resupply will be curtailed, astronauts may develop tolerance and/or addiction to these medications, and side effects can include impairment of cognitive abilities. Electromagnetic devices have been developed that treat pain terrestrially by affecting neuromodulation–dubbed “electroceuticals”, these devices have varied mechanisms of action that either stimulate or suppress neural activity in the central nervous system or peripheral nerves. Objective/Purpose: The available literature was reviewed and FDA-approved pain treatments (both pharmacological and non-pharmacological), as well as those currently under development, were assessed for their suitability for use in exploration class spaceflight missions. Data Sources: Due to the COVID-19 pandemic and the resulting closure of libraries, data sources were restricted to those available digitally. Online database searches included PubMed, U.S. Patent and Trademark Office, federal grant award databases (National Aeronautics and Space Administration (NASA), Department of Defense (DoD), National Institutes of Health (NIH)), and general internet searches. More than 1,600 records were reviewed in this effort. Study Selection/Eligibility Criteria: Targeted searches included different aspects of pain management. Priority was given to review studies, to cover as much of the available literature as possible in this limited effort. Study Appraisal and Synthesis Methods/Data Extraction and Data Synthesis: The titles of the studies and the awards that were obtained by searching online databases were reviewed and further information was sought for the relevant titles. Abstracts or award summaries were generally available online; for journal abstracts, full text articles were either available online or were requested via interlibrary loan. Results: An overwhelming majority of the literature focuses on the treatment of chronic rather than acute pain because it is assumed that acute pain only rarely fails to resolve and instead transitions into chronic pain when the central nervous system becomes hypersensitized. The available electromagnetic devices marketed for pain treatment have varying levels of invasiveness, use different mechanisms of action, and have demonstrated varying efficacy when evaluated scientifically. A truly noninvasive, highly efficient device is desired for use during spaceflight. One portable, self-contained, FDA-approved device was identified that, from preliminarily assessment, best met these criteria; the device noninvasively applies pulsed shortwave therapy (PSWT) to modify pain signals from peripheral nerves, however, the device has limited battery life and the effects are relatively non-selective in type of neural signal modified. Limitations: This current effort, although extensive, did not identify a comprehensive list of all alternatives for pain treatment. Once the pandemic limitations are lifted, a longer, more thorough effort may find additional options. Conclusions/Implications: The ideal electromagnetic pain treatment device for use on exploration-class spaceflight missions does not yet exist, but it may be available soon. It is not feasible for NASA to develop medical devices due to the schedule constraints for pending exploration-class missions, but adapting a promising device that is already FDA-approved might be an option. Monitoring research that is ongoing at other federal agencies is recommended, and further review of the candidate PSWT device identified in this current effort may be warranted.

Carol Mullenax↗
NASA NTRSDate not supplied

Crowd Sourcing Medical Data Collection Using Medical Students

OBJECTIVE We undertook an upgrade of the Evidence Library database of NASA HRP’s Integrated Medical Model, assessing 120 medical conditions which integrate with a novel probabilistic risk assessment (IMPACT) tool of medical risk and resource utilization for long duration exploration human spaceflight. This data collection process included a selection of these conditions crowd sourced over one year via three 4-week medical student electives at the University of Colorado School of Medicine (IDPT 8059 Space Medicine: Human Spaceflight Factors & Medical Risk Assessment). Students undertook a rapid systematic review of each medical condition, under close preceptors with backgrounds in clinical medicine, library science, epidemiology, biostatistics, and evidence-based medicine. As part of the elective, students also received instruction in core space medicine concepts, evidence based medicine and problem based learning sessions as a flight surgeon supporting a simulated Mars mission. METHODS The list of 120 medical conditions includes both common, terrestrial illness/injury (epistaxis, diverticulitis) as well as spaceflight-specific ones (space adaptation conditions, EVA-related injuries). A rapid systematic review process was developed that would allow students to find the data for determining disease incidence/prevalence, return to definitive care (often a surrogate such as hospitalization rates), loss of crew life, and treatment duration. Each data point required a tailored, specialized search process using different databases and corresponding specialized search filters. Databases were selected on their ability to provide high quality literature in an efficient manner and prioritized by their ability to provide graded evidence via a set rubrics specific to human spaceflight. Students were responsible for performing all literature searches and identifying the highest quality available evidence for each data point. Completed student data sheets underwent initial review by faculty preceptors followed by a secondary editing review by the ExMC Clinical Science Team. RESULTS Over the course of three electives, approximately 105 medical conditions were researched by students using spreadsheets with pre-crafted search strategies. Overall, this process was successful in allowing students to perform the preponderance of work to update incidence, treatment duration, return to definitive care, and loss of crew life data points. Students were successful in running searches, identifying the necessary data points within the literature, and determining the types of terrestrial data that most aligns with the astronaut population for successful completion of their tasks. Limitations included variable student experience with search methodologies [PubMed], differing values of evidence grading [best practice evidence based medicine vs. relevant to spaceflight], and students’ unfamiliarity with spaceflight specific conditions. CONCLUSION Finding the relevant literature for medical conditions in spaceflight within terrestrial databases in a systematic method is time consuming and not intuitive. However, the stepwise process that balanced sensitivity with specificity allowed for students to be highly successful in a short amount of time. Additionally, as the process was refined over the course of three electives, preceptors were better able to anticipate where students were likely to encounter barriers, which allowed the course to be adjusted to account for certain data points needing more time for completion. This replicable process may be an efficient way to accomplish rapid systematic reviews for a large volume of data in a short amount of time.

J Lemery↗
NASA NTRSDate not supplied

Electromagnetic Pain Relief/Blocking: Feasibility Assessment

CONTEXT/BACKGROUND Astronauts use pharmaceuticals during spaceflight to manage acute and chronic pain, but use of analgesics will have drawbacks for exploration-class missions because the shelf life of these medications is limited, resupply will be curtailed, astronauts may develop tolerance and/or addiction to these medications, and side effects can include impairment of cognitive abilities. Electromagnetic devices have been developed that treat pain terrestrially by affecting neuromodulation–dubbed “electroceuticals”, these devices have varied mechanisms of action that either stimulate or suppress neural activity in the central nervous system or peripheral nerves. OBJECTIVE/PURPOSE The available literature was reviewed and FDA-approved pain treatments (both pharmacological and non-pharmacological), as well as those currently under development, were assessed for their suitability for use in exploration class spaceflight missions. DATA SOURCES Due to the COVID-19 pandemic and the resulting closure of libraries, data sources were restricted to those available digitally. Online database searches included PubMed, U.S. Patent and Trademark Office, federal grant award databases (National Aeronautics and Space Administration (NASA), Department of Defense (DoD), National Institutes of Health (NIH)), and general internet searches. More than 1,600 records were reviewed in this effort. STUDY SELECTION/ELIGIBILITY CRITERIA Targeted searches included different aspects of pain management. Priority was given to review studies, to cover as much of the available literature as possible in this limited effort. STUDY APPRAISAL AND SYNTHESIS METHODS/DATA EXTRACTION AND DATA SYNTHESIS The titles of the studies and the awards that were obtained by searching online databases were reviewed and further information was sought for the relevant titles. Abstracts or award summaries were generally available online; for journal abstracts, full text articles were either available online or were requested via interlibrary loan. RESULTS An overwhelming majority of the literature focuses on the treatment of chronic rather than acute pain because it is assumed that acute pain only rarely fails to resolve and instead transitions into chronic pain when the central nervous system becomes hypersensitized. The available electromagnetic devices marketed for pain treatment have varying levels of invasiveness, use different mechanisms of action, and have demonstrated varying efficacy when evaluated scientifically. A truly noninvasive, highly efficient device is desired for use during spaceflight. One portable, self-contained, FDA-approved device was identified that, from preliminarily assessment, best met these criteria; the device noninvasively applies pulsed shortwave therapy (PSWT) to modify pain signals from peripheral nerves, however, the device has limited battery life and the effects are relatively non-selective in type of neural signal modified. LIMITATIONS This current effort, although extensive, did not identify a comprehensive list of all alternatives for pain treatment. Once the pandemic limitations are lifted, a longer, more thorough effort may find additional options. CONCLUSIONS/IMPLICATIONS The ideal electromagnetic pain treatment device for use on exploration-class spaceflight missions does not yet exist, but it may be available soon. It is not feasible for NASA to develop medical devices due to the schedule constraints for pending exploration-class missions, but adapting a promising device that is already FDA-approved might be an option. Monitoring research that is ongoing at other federal agencies is recommended, and further review of the candidate PSWT device identified in this current effort may be warranted.

C A Mullenax↗
NASA NTRSDate not supplied

Venous Gas Embolism: Review to Quantify a Safe Volume of Air in Intravenous Fluids Bags for Spaceflight Applications

INTRODUCTION: The ability to create intravenous fluids (IVF) in-situ from the potable water supply of a spaceflight vehicle or habitat is a desired capability for an exploration medical system. In order to define an acceptable volume of air in IVF bags, an understanding of the volume of venous gas embolism as it relates to negative outcomes is needed. The purpose of this study is to review the literature to determine if there is a known volume of gas that contributes to mortality and/or morbidity that could be used to define requirements for rapid IVF infusion in microgravity. METHODS: A literature review was conducted of the PubMed database using the syntax: (Venous) AND (Gas OR Air) AND (Embolism) AND (Morbidity) AND (Mortality) AND (Volume) as well as manual review of references from relevant articles. 151 articles were screened excluding partial text and pediatric articles. Studies were reviewed for identification of volume of venous gas embolism associated with morbidity and/or mortality, which identified 27 articles. RESULTS: Reviewed literature included animal studies, case reports, and review articles. A high variation of proposed volumes contributing to mortality was reported. The limited human data values ranged from 20 ml to 200 ml of infused air with mortality estimated to be 48 – 80%. No studies evaluated human morbidity in any capacity. DISCUSSION: The lack of consensus on the safe volume of infused air has potential ramifications for IVF use in spaceflight as current technologies to create IVF from potable water may introduce air in IVF bags. While current microgravity infusion protocols call for the use of inline air removal filters, commercially available options have flow rate limitations that preclude rapid infusion in a resuscitation scenario. Such filters may be used in parallel to increase flow rate, but the time required to set up such a system may exclude its use during a medical emergency. Additionally, these consumable filters drive up the overall mass and volume of the medical system. Identification of a safe volume of air in IVF would allow for guidelines for the in-situ production of IVF in future spaceflight vehicles/habitats.

Christopher R Woodard↗
NASA NTRSDate not supplied

Comparison of Multispectral Imaging and Traditional Fundoscopy in the Detection of Terrestrial Retinal and Optic Nerve Pathologies like those Encountered During and/or Immediately Following Long-Duration Spaceflight

INTRODUCTION: The purpose of this investigation was to evaluate if MultiColor Imaging (MCI) can replace color fundus photography (CFP) as a diagnostic screening tool during spaceflight. MCI significantly reduces crew time (approx. 115 minutes/session, 36 hours/year) by eliminating nominal on-orbit fundoscopy sessions, while also providing the option to capture a larger field of view (55 vs. 35). METHODS: A comprehensive PubMed literature search was conducted using the following key words: multicolor, multispectral, imaging, retina, choroid, optic nerve, optic disc, and papilledema. Publications were filtered based on optic nerve and chorioretinal pathologies matching those seen during or immediately after spaceflight: optic disc edema (ODE), cotton wool spots (CWS), retinal hemorrhage, pigment epithelial detachment (PED), and serous chorioretinopathy (SCR). In a separate effort, 44 multicolor images (30 abnormal) of terrestrial patients were graded and compared to corresponding color fundus images acquired at the Doheny Eye Centers and UCLA. RESULTS: The search identified 340 articles; 9 describing MCI in relevant pathologies, 6 comparing MCI to CFP. MCI is superior in detecting CWS (1 paper), PED (2 papers), retinal hemorrhages (2 papers), and choroidal folds (1 paper), and can better delineate extent or boundaries of subretinal fluid and identify areas of RPE damage in SCR (2 papers). On MCI, ODE was described as a hyperreflective ring with a green shift and indistinct disc margins, with equaldetectability as using CFP (3 papers). Grading at Doheny Eye Institute confirmed these findings. DISCUSSION: MCI can effectively detect all retinal and optic nerve findings detectable by CFP during and immediately post-spaceflight and represents a suitable replacement as an on-orbit diagnostic screening tool. Additionally, by eliminating the nominal on-orbit fundoscopy sessions, dozens of crew hours are spared per year by utilizing MCI.

Jorge Nagel↗