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Martin, David

Publications and source records attributed to Martin, David.

Comparison of Venous Return Characteristics with Right Ventricular Mechanics During Cephalic Fluid Shift

For my summer internship project, I organized a pilot study to analyze the effects of a cephalic fluid shift on venous return and right ventricular mechanics to increase right ventricular and venous knowledge. To accomplish this pilot study, I wrote a testing protocol, obtained Institutional Review Board (IRB) approval, completed subject payment forms, lead testing sessions, and analyzed the data. This experiment used -20deg head down tilt (20 HDT) as the ground based simulation for the fluid shift that occurs during spaceflight and compared it to data obtained from the seated and supine positions. Using echocardiography, data was collected for the right ventricle, hepatic vein, internal jugular vein, external jugular vein, and inferior vena cava. Additionally, non-invasive venous pressure measurements, similar to those soon to be done in-orbit, were collected. It was determined that the venous return from below the heard is increased during 20 HDT, which was supported by increased hepatic vein velocities, increased right ventricular inflow, and increased right ventricular strain at 20 HDT relative to seated values. Jugular veins in the neck undergo an increase in pressure and area, but no significant increase in flow, relative to seated values when a subject is tilted 20 HDT. Contrary to the initial expectations based on this jugular flow, there was no significant increase in central venous pressure, as evidenced by no change in Doppler indices for right arterial pressure or inferior vena cava diameter. It is suspected that these differences in pressure are due to the hydrostatic pressure indifference point shifting during tilt; there is a potential for a similar phenomenon with microgravity. This data will hopefully lead to a more in-depth understanding of the response of the body to microgravity and how those relate to the previously mentioned cardiovascular risk of fluid shift that is associated with spaceflight. These results were presented in greater detail to the Cardiovascular Laboratory and the Space Life Science Summer Institute, which helped me prepare for future graduate school research presentations. This internship allowed me to apply and expand the anatomy, physiology, and mechanics information I learned during my undergraduate degree in Biomedical Engineering to the cardiovascular system with the unique zero gravity perspective. Additionally, I was able to develop skills with data analysis techniques involving speckle tracking for ventricular strain and Doppler waveforms for blood velocities. Additionally, I was able to expand upon my previous work in the Cardiovascular Laboratory by writing a literature review on a data analysis project I completed last summer. Ultimately, this internship and venous relationship comparison project provided me with a significant learning experience and additional skill sets, which are applicable to my goals of attaining a Ph.D. in biomedical engineering with a focus on tissue engineering and the cardiovascular system.

Elliott, Morgan

Virtual Ultrasound Guidance for Inexperienced Operators

Medical ultrasound or echocardiographic studies are highly operator-dependent and generally require lengthy training and internship to perfect. To obtain quality echocardiographic images in remote environments, such as on-orbit, remote guidance of studies has been employed. This technique involves minimal training for the user, coupled with remote guidance from an expert. When real-time communication or expert guidance is not available, a more autonomous system of guiding an inexperienced operator through an ultrasound study is needed. One example would be missions beyond low Earth orbit in which the time delay inherent with communication will make remote guidance impractical. The Virtual Ultrasound Guidance system is a combination of hardware and software. The hardware portion includes, but is not limited to, video glasses that allow hands-free, full-screen viewing. The glasses also allow the operator a substantial field of view below the glasses to view and operate the ultrasound system. The software is a comprehensive video program designed to guide an inexperienced operator through a detailed ultrasound or echocardiographic study without extensive training or guidance from the ground. The program contains a detailed description using video and audio to demonstrate equipment controls, ergonomics of scanning, study protocol, and scanning guidance, including recovery from sub-optimal images. The components used in the initial validation of the system include an Apple iPod Classic third-generation as the video source, and Myvue video glasses. Initially, the program prompts the operator to power-up the ultrasound and position the patient. The operator would put on the video glasses and attach them to the video source. After turning on both devices and the ultrasound system, the audio-video guidance would then instruct on patient positioning and scanning techniques. A detailed scanning protocol follows with descriptions and reference video of each view along with advice on technique. The program also instructs the operator regarding the types of images to store and how to overcome pitfalls in scanning. Images can be forwarded to the ground or other site when convenient. Following study completion, the video glasses, video source, and ultrasound system are powered down and stored. Virtually any equipment that can play back video can be used to play back the program. This includes a DVD player, personal computer, and some MP3 players.

Caine, Timothy

Extreme Tele-Echocardiography: Methodology for Remote Guidance of In-flight Echocardiography Aboard the International Space Station

Echocardiography is ideally suited for cardiovascular imaging in remote environments, but the expertise to perform it is often lacking. In 2001, an ATL HDI5000 was delivered to the International Space Station (ISS). The instrument is currently being used in a study to investigate the impact of long-term microgravity on cardiovascular function. The purpose of this report is to describe the methodology for remote guidance of echocardiography in space. Methods: In the year before launch of an ISS mission, potential astronaut echocardiographic operators participate in 5 sessions to train for echo acquisitions that occur roughly monthly during the mission, including one exercise echocardiogram. The focus of training is familiarity with the study protocol and remote guidance procedures. On-orbit, real-time guidance of in-flight acquisitions is provided by a sonographer in the Telescience Center of Mission Control. Physician investigators with remote access are able to relay comments on image optimization to the sonographer. Live video feed is relayed from the ISS to the ground via the Tracking and Data Relay Satellite System with a 2 second transmission delay. The expert sonographer uses these images along with two-way audio to provide instructions and feedback. Images are stored in non-compressed DICOM format for asynchronous relay to the ground for subsequent off-line analysis. Results: Since June, 2009, a total of 19 resting echocardiograms and 4 exercise studies have been performed in-flight. Average acquisition time has been 45 minutes, reflecting 26,000 km of ISS travel per study. Image quality has been adequate in all studies, but remote guidance has proven imperative for fine-tuning imaging and prioritizing views when communication outages limit the study duration. Typical resting studies have included 12 video loops and 21 still-frame images requiring 750 MB of storage. Conclusions: Despite limited crew training, remote guidance allows research-quality echocardiography to be performed by non-experts aboard the ISS. Analysis is underway and additional subjects are being recruited to define the impact of microgravity on cardiac structure and systolic and diastolic function.

Martin, David

On-Orbit Prospective Echocardiography on International Space Station

A number of echocardiographic research projects and experiments have been flown on almost every space vehicle since 1970, but validation of standard methods and the determination of Space Normal cardiac function has not been reported to date. Advanced Diagnostics in Microgravity (ADUM) -remote guided echocardiographic technique provides a novel and effective approach to on-board assessment of cardiac physiology and structure using a just-in-time training algorithm and real-time remote guidance aboard the International Space Station (ISS). The validation of remotely guided echocardiographic techniques provides the procedures and protocols to perform scientific and clinical echocardiography on the ISS and the Moon. The objectives of this study were: 1.To confirm the ability of non-physician astronaut/cosmonaut crewmembers to perform clinically relevant remotely guided echocardiography using the Human Research Facility on board the ISS. 2.To compare the preflight, postflight and in-flight echocardiographic parameters commonly used in clinical medicine.

Hamilton, Douglas R.

Integrated Resistance and Aerobic Training Study - Sprint

Space flight causes reductions in fitness/health: (1) Cardiovascular -- reduced VO2max, cardiac output (2) Bone -- reduced bone mineral density (3) Muscle -- reduced mass, strength and endurance. Exercise is the primary countermeasure to protect against these changes and was made operational before completely mature. Research continues to identify most effective/efficient exercise programs. Crew medical tests (cardio, muscle, bone) do not yield sufficient information to fine tune the effectiveness of exercise programs, thus there is a need for more detailed testing aimed at identifying the most effective training program. The objective of this program was to obtain detailed information about crew physical fitness pre-and post-flight and evaluate new evidence based exercise prescription with higher intensity, lower duration and frequency.

Ploutz-Snyder, Lori

Results of a Prospective Echocardiography Trial in International Space Station Crew

In the framework of an operationally oriented investigation, we conducted a prospective trial of a standard clinical echocardiography protocol in a cohort of long-duration crewmembers. The resulting primary and processed data appear to have no precedents. Our tele-echocardiography paradigm, including just-in-time e-training methods, was also assessed. A critical review of the imaging technique, equipment and setting limitations, and quality assurance is provided, as well as the analysis of "space normal" data.

Hamilton, Douglas R.

Acute Hemodynamic Effects of the Braslet-M Device on the International Space Station

The Braslet-M occlusion device is prescribed for cosmonauts as a countermeasure for early phases of spaceflight to temporarily alleviate symptoms associated with the cephalad fluid shift. Using a multipurpose ultrasound (US) device onboard, we assessed the acute hemodynamic effects of the Bracelet-M device on a long duration International Space Station (ISS) crewmember. Methods A combination of just-in-time training and real-time remote expert assistance was used to conduct the imaging procedures. An HDI-5000 imager (Philips, Bothell, WA) was used, provided by the ISS Human Research Facility. Superficial femoral artery (SFA), femoral vein (FV) flow spectra were obtained at mid-thigh level. Left ventricle was imaged through the apical 4-chamber view, with Color M-Mode to measure propagation velocity (V (p)). After 10 minutes of Bracelet-M use, data collection was repeated. All data were transmitted in DICOM format to ground for analysis. Results With Braslet-M, cardiac V(p) slope decreased (56ms to 42ms). A stagnation signature in the FV was seen suggesting impeded flow (rouleaux formation, too-low-to-measure velocity, and increase in diameter). Quadri-phasic flow in SFA was seen both before and after Braslet-M application. Velocities in the SFA decreased with Braslet-M (65cm/sec to 52cm/sec) and so did the time velocity integrals (16.97 to 12.4); the flow pattern spoke of resistivity increase in the vascular bed. Conclusion In the long duration ISS crewmember we observed effects of lower extremity venous occlusion through both central and peripheral indicators. A part of circulating volume transferred to peripheral potential vascular space. Impediment to venous outflow was demonstrated objectively, with a commensurate change in the flow pattern of the main feeding artery. Central volume reduction caused lower V(p). Additional studies are warranted to determine the time course of the changes and the dynamics in interstitial fluid sequestration, as well as the safe levels and duration of the compression forces.

Hamilton, Douglas R.

Second Harmonic Imaging improves Echocardiograph Quality on board the International Space Station

Ultrasound (US) capabilities have been part of the Human Research Facility (HRF) on board the International Space Station (ISS) since 2001. The US equipment on board the ISS includes a first-generation Tissue Harmonic Imaging (THI) option. Harmonic imaging (HI) is the second harmonic response of the tissue to the ultrasound beam and produces robust tissue detail and signal. Since this is a first-generation THI, there are inherent limitations in tissue penetration. As a breakthrough technology, HI extensively advanced the field of ultrasound. In cardiac applications, it drastically improves endocardial border detection and has become a common imaging modality. U.S. images were captured and stored as JPEG stills from the ISS video downlink. US images with and without harmonic imaging option were randomized and provided to volunteers without medical education or US skills for identification of endocardial border. The results were processed and analyzed using applicable statistical calculations. The measurements in US images using HI improved measurement consistency and reproducibility among observers when compared to fundamental imaging. HI has been embraced by the imaging community at large as it improves the quality and data validity of US studies, especially in difficult-to-image cases. Even with the limitations of the first generation THI, HI improved the quality and measurability of many of the downlinked images from the ISS and should be an option utilized with cardiac imaging on board the ISS in all future space missions.

Garcia, Kathleen

Validation of Ultrasound Imaging to Rule-out Thoracic Trauma on the International Space Station

Introduction: Aboard the International Space Station (ISS) an intra-thoracic injury may be disastrous to the crew member if the diagnosis is missed or even delayed. Pneumothorax and hemothorax commonly seen in trauma patients; the diagnosis is usually confirmed by chest X-ray or computed tomography. In this study, the ability of ultrasound to rule out pneumothorax by the presence "lung sliding" and hemothorax by the absence of pleural fluid was validated. Methods: The research activities were approved by the NASA Johnson Space Center Committee for the Protection of Human Subjects, and the participating crewmembers signed informed consent prior to the activity. ISS crewmembers received 2-hours of "hands on" ultrasound training 8 months prior to the on-orbit ultrasound exam. Baseline ultrasound images of the thorax were acquired on the crewmebers of Increment 8 and 9 prior to launch from Bakonur, Russia. Ultrasound examination of the thorax were performed on crewmembers at 30 day intervals (n=??) throughout their flight. Post flight images were acquired on or about landing day 10. Ultrasound images were acquired using the ISS Health Research Facility ultrasound system and examined by experts on the ground to rule out the presence of pneumothorax and hemothorax. Results: The presence of "lung sliding" which excludes pneumothorax, was seen in all subjects. The absence of pleural fluid, which excludes hemothorax was seen in all subjects. The optimal position between sonographer and patient under microgravity conditions and the amount and type of training for a non-physician crew medical officer for these procedures was also established for this procedure. Conclusion: Ultrasound can be performed on orbit under microgravity condition to rule thoracic trauma, such as pneumothorax and hemothorax.

Hamilton, Douglas R.

Diagnostic instrumentation aboard ISS: just-in-time training for non-physician crewmembers

INTRODUCTION: The performance of complex tasks on the International Space Station (ISS) requires significant preflight crew training commitments and frequent skill and knowledge refreshment. This report documents a recently developed "just-in-time" training methodology, which integrates preflight hardware familiarization and procedure training with an on-orbit CD-ROM-based skill enhancement. This "just-in-time" concept was used to support real-time remote expert guidance to complete ultrasound examinations using the ISS Human Research Facility (HRF). METHODS: An American and Russian ISS crewmember received 2 h of "hands on" ultrasound training 8 mo prior to the on-orbit ultrasound exam. A CD-ROM-based Onboard Proficiency Enhancement (OPE) interactive multimedia program consisting of memory enhancing tutorials, and skill testing exercises, was completed by the crewmember 6 d prior to the on-orbit ultrasound exam. The crewmember was then remotely guided through a thoracic, vascular, and echocardiographic examination by ultrasound imaging experts. RESULTS: Results of the CD-ROM-based OPE session were used to modify the instructions during a complete 35-min real-time thoracic, cardiac, and carotid/jugular ultrasound study. Following commands from the ground-based expert, the crewmember acquired all target views and images without difficulty. The anatomical content and fidelity of ultrasound video were adequate for clinical decision making. CONCLUSIONS: Complex ultrasound experiments with expert guidance were performed with high accuracy following limited preflight training and multimedia based in-flight review, despite a 2-s communication latency. In-flight application of multimedia proficiency enhancement software, coupled with real-time remote expert guidance, facilitates the successful performance of ultrasound examinations on orbit and may have additional terrestrial and space applications.

Inservice Training/methods

Evaluation of shoulder integrity in space: first report of musculoskeletal US on the International Space Station

Investigative procedures were approved by Henry Ford Human Investigation Committee and NASA Johnson Space Center Committee for Protection of Human Subjects. Informed consent was obtained. Authors evaluated ability of nonphysician crewmember to obtain diagnostic-quality musculoskeletal ultrasonographic (US) data of the shoulder by following a just-in-time training algorithm and using real-time remote guidance aboard the International Space Station (ISS). ISS Expedition-9 crewmembers attended a 2.5-hour didactic and hands-on US training session 4 months before launch. Aboard the ISS, they completed a 1-hour computer-based Onboard Proficiency Enhancement program 7 days before examination. Crewmembers did not receive specific training in shoulder anatomy or shoulder US techniques. Evaluation of astronaut shoulder integrity was done by using a Human Research Facility US system. Crew used special positioning techniques for subject and operator to facilitate US in microgravity environment. Common anatomic reference points aided initial probe placement. Real-time US video of shoulder was transmitted to remote experienced sonologists in Telescience Center at Johnson Space Center. Probe manipulation and equipment adjustments were guided with verbal commands from remote sonologists to astronaut operators to complete rotator cuff evaluation. Comprehensive US of crewmember's shoulder included transverse and longitudinal images of biceps and supraspinatus tendons and articular cartilage surface. Total examination time required to guide astronaut operator to acquire necessary images was approximately 15 minutes. Multiple arm and probe positions were used to acquire dynamic video images that were of excellent quality to allow evaluation of shoulder integrity. Postsession download and analysis of high-fidelity US images collected onboard demonstrated additional anatomic detail that could be used to exclude subtle injury. Musculoskeletal US can be performed in space by minimally trained operators by using remote guidance. This technique can be used to evaluate shoulder integrity in symptomatic crewmembers after strenuous extravehicular activities or to monitor microgravity-associated changes in musculoskeletal anatomy. Just-in-time training, combined with remote experienced physician guidance, may provide a useful approach to complex medical tasks performed by nonexperienced personnel in a variety of remote settings, including current and future space programs. (c) RSNA, 2004.

Space Flight/education

Balanced Expertise Distribution in Remote Ultrasound Imaging Aboard The International Space Station (ISS)

Astronaut training for ISS operations usually ensures independent performance. With small crew size same crews also conduct all science work onboard. With diverse backgrounds, a good "match" between the existing and required skills can only be anecdotal. Furthermore, full proficiency in most of the complex tasks can be attained only through long training and practice, which may not be justified and may be impossible given the scarcity of training time. To enable a number of operational and science advancements, authors have developed a new approach to expertise distribution in time and among the space and ground personnel. Methods: As part of NASA Operational Ultrasound Project (1998-2003) and the NASA-solicited experiment "Advanced Diagnostic Ultrasound in Microgravity-ADUM" (P.I. -S.D., ongoing), the authors have created a "Balanced Expertise Distribution" approach to perform complex ultrasound imaging tasks on ISS for both operational and science use. The four components of expertise are a) any pre-existing pertinent expertise; b) limited preflight training c) adaptive onboard proficiency enhancement tools; d) real-time ' guidance from the ground. Throughout the pre-flight training and flight time preceding the experiments, the four components are shaped in a dynamic fashion to meet in an optimum combination during the experiment sessions. Results: Procedure validation sessions and feasibility studies have given encouraging results. While several successful real-time remote guidance sessions have been conducted on ISS, Expedition 8 is the first to use an "on-orbit proficiency enhancement" tool. Conclusions: In spite of severely limited training time, daring peer-reviewed research and operational enhancements are feasible through a balanced distribution of expertise in time, as well as among the crewmembers and ground personnel. This approach shows great promise for biomedical research, but may be applicable for other areas of micro gravity-based science

Sargsyan, Ashot

Accelerated Training at Mach 20: A Brief Communication Submitted from the International Space Station

The performance of complex tasks on the International Space Station (ISS) requires significant preflight crew training commitments and frequent skill and knowledge refreshment. This report documents a recently developed just-in-time training methodology, which integrates preflight hardware familiarization and procedure training with an on-orbit CD-ROM-based skill enhancement. This just-in-time concept was used to support real-time remote expert guidance to complete medical examinations using the ISS Human Research Facility (HRF). An American and Russian ISS crewmember received 2-hours of hands on ultrasound training 8 months prior to the on-orbit ultrasound exam. A CD-ROM-based Onboard Proficiency Enhancement (OPE) interactive multimedia program consisting of memory enhancing tutorials, and skill testing exercises, was completed by the crewmember six days prior to the on-orbit ultrasound exam. The crewmember was then remotely guided through a thoracic, vascular, and echocardiographic examination by ultrasound imaging experts. Results of the CD ROM based OPE session were used to modify the instructions during a complete 35 minute real-time thoracic, cardiac, and carotid/jugular ultrasound study. Following commands from the ground-based expert, the crewmember acquired all target views and images without difficulty. The anatomical content and fidelity of ultrasound video were excellent and adequate for clinical decision-making. Complex ultrasound experiments with expert guidance were performed with high accuracy following limited pre-flight training and CD-ROM-based in-flight review, despite a 2-second communication latency. In-flight application of multimedia proficiency enhancement software, coupled with real-time remote expert guidance, can facilitate the performance of complex demanding tasks.

Foale, C. Michael

Environmentally Compatible Vapor-Phase Corrosion Inhibitor for Space Shuttle Hardware

USA-SRB Element is responsible for the assembly and refurbishment of the non-motor components of the SRB as part of Space Shuttle. Thrust Vector Control (TVC) frames structurally support components of the TVC system located in the aft skirt of the SRB (Solid Rocket Booster). TVC frames are exposed to the seacoast environment after refurbishment and, also, to seawater immersion after splashdown, and during tow-back to CCAFS-Hangar AF refurbishment facilities. During refurbishment operations it was found that numerous TVC frames were experiencing internal corrosion and coating failures, both from salt air and seawater intrusions. Inspectors using borescopes would visually examine the internal cavities of the complicated aluminum alloy welded tubular structure. It was very difficult for inspectors to examine cavity corners and tubing intersections and particularly. to determine the extent of the corrosion and coating anomalies. Physical access to TVC frame internal cavities for corrosion removal and coating repair was virtually impossible, and an improved method using a Liquid (water based) Vapor-phase Corrosion Inhibitor (LVCI) for preventing initiation of new corrosion, and mitigating and/or stopping existing corrosion growth was recommended in lieu of hazardous paint solvents and high VOC/solvent based corrosion inhibitors. In addition, the borescopic inspection method used to detect corrosion, and/or coating anomalies had severe limitations because of part geometry, and an improved non-destructive inspection (NDI) method using Neutron Radiography (N-Ray) was also recommended.

Novak, Howard L.

The Servicing Aid Tool

The Servicing Aid Tool (SAT) is a teleoperated manipulation system designed for use on the NSTS Orbiter. The system will assist EVA servicing of spacecraft such as the Hubble Space Telescope and Explorer platform. SAT components are spaceflight adaptations of existing ground-based designs from Robotics Research and Schilling Development. Fairchild Space is providing the control electronics, safety system, and flight integration. The manipulator consists of a 6-DOF Slave Arm mounted on a 1-DOF Positioning Link in the Payload Bay. The Slave Arm is controlled via a highly similar, 6-DOF, force-reflecting Master Arm. Each slave arm joint receives position commands from the corresponding master arm joint; torque commands are reflected to each master joint based on the current state of the slave joint and the master/slave relationship. Scaled and indexed control will be accommodated, as will various features to ensure safe operation. The paper will focus on the development of the safety system, and operations for the demonstration and servicing missions.

Pullen, John L.

The Amazon Boundary-Layer Experiment (ABLE 2B) - A meteorological perspective

The Amazon Boundary-Layer Experiments (ABLE) 2A and 2B, which were performed near Manaus, Brazil in July-August, 1985, and April-May, 1987 are discussed. The experiments were performed to study the sources, sinks, concentrations, and transports of trace gases and aerosols in rain forest soils, wetlands, and vegetation. Consideration is given the design and preliminary results of the experiment, focusing on the relationships between meteorological scales of motion and the flux, transports, and reactions of chemical species and aerosols embedded in the atmospheric fluid. Meteorological results are presented and the role of the meteorological results in the atmospheric chemistry experiment is examined.

Garstang, Michael