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All sourcesNASA NTRSDOE OSTI
DOE OSTI2022

Effectiveness of supervised exercise, home-based exercise, or walk advice strategies on walking performance and muscle endurance in patients with intermittent claudication (SUNFIT trial): a randomized clinical trial

Abstract Aims Supervised exercise is a guideline-recommended treatment in intermittent claudication (IC). Hospital-based supervised exercise programmes (SEPs) are underutilized, while home-based structured exercise programmes (HSEPs) have attracted interest. The results from HSEP in IC are inconsistent and may confer no benefit over walk advice (WA) and be less effective than SEP. The aim of the study was to compare the effectiveness of best medical treatment, including Nordic pole WA alone, or WA + SEP or WA + HSEP for patients with IC. Methods and results This three-armed, multicentre randomized clinical trial enrolled patients with IC; all patients received best medical treatment including walking poles and the advice of regular Nordic pole walking (WA). For HSEP and SEP, additional exercise programmes were provided. The primarily investigated hypothesis was a non-inferiority analysis of SEP vs. HSEP regarding the 6-min walk test (6MWT) maximum distance, with a pre-defined non-inferiority margin of 50 m. Supporting outcomes included muscle endurance tests and the walking impairment questionnaire. Outcomes were assessed at baseline, 3, 6, and 12 months by a blinded evaluator. Altogether 166 patients (mean age 72 years; 59% males) were randomized. In HSEP and SEP, 24 and 26% patients, respectively, were fully exercise adherent. All three groups improved pain-free walking distance over time, but there were no significant intergroup differences. The intergroup 6MWT difference between SEP and HSEP from 0 to 12 months was –11.6 m, 95% confidence interval: –36.4 to 13.0 m (i.e. within the pre-specified non-inferiority margin). Conclusion The HSEP was non-inferior to SEP in patients with IC. There were no significant differences observed between the three groups at 1 year. Registration ClinicialTrials.gov: NCT02341716.

Sandberg, Anna (ORCID:0000000258432784)↗
NASA NTRS2008

The Integrated Medical Model: Statistical Forecasting of Risks to Crew Health and Mission Success

The Integrated Medical Model (IMM) helps capture and use organizational knowledge across the space medicine, training, operations, engineering, and research domains. The IMM uses this domain knowledge in the context of a mission and crew profile to forecast crew health and mission success risks. The IMM is most helpful in comparing the risk of two or more mission profiles, not as a tool for predicting absolute risk. The process of building the IMM adheres to Probability Risk Assessment (PRA) techniques described in NASA Procedural Requirement (NPR) 8705.5, and uses current evidence-based information to establish a defensible position for making decisions that help ensure crew health and mission success. The IMM quantitatively describes the following input parameters: 1) medical conditions and likelihood, 2) mission duration, 3) vehicle environment, 4) crew attributes (e.g. age, sex), 5) crew activities (e.g. EVA's, Lunar excursions), 6) diagnosis and treatment protocols (e.g. medical equipment, consumables pharmaceuticals), and 7) Crew Medical Officer (CMO) training effectiveness. It is worth reiterating that the IMM uses the data sets above as inputs. Many other risk management efforts stop at determining only likelihood. The IMM is unique in that it models not only likelihood, but risk mitigations, as well as subsequent clinical outcomes based on those mitigations. Once the mathematical relationships among the above parameters are established, the IMM uses a Monte Carlo simulation technique (a random sampling of the inputs as described by their statistical distribution) to determine the probable outcomes. Because the IMM is a stochastic model (i.e. the input parameters are represented by various statistical distributions depending on the data type), when the mission is simulated 10-50,000 times with a given set of medical capabilities (risk mitigations), a prediction of the most probable outcomes can be generated. For each mission, the IMM tracks which conditions occurred and decrements the pharmaceuticals and supplies required to diagnose and treat these medical conditions. If supplies are depleted, then the medical condition goes untreated, and crew and mission risk increase. The IMM currently models approximately 30 medical conditions. By the end of FY2008, the IMM will be modeling over 100 medical conditions, approximately 60 of which have been recorded to have occurred during short and long space missions.

Fitts, M. A.↗
DOE OSTI2024

Machine learning models of intermittent operation of RO wellhead water treatment for salinity reduction and nitrate removal

Machine learning models were developed for intermittent multi-mode operation of a wellhead reverse osmosis water purification and desalination system to predict salt passage, nitrate passage, and permeate flux. The models, based on long short-term memory (LSTM) recurrent neural network (RNN) architecture, included an attention mechanism to increase model performance in proximity of the regulatory limit for nitrate. Training and testing of the models for the Startup, Production, Shutdown and Flushing operational modes were based on operational data (consisting of 22 process variables per data sample) acquired every 2–5 s over a six-month period. The significant sets of model input attributes for the different operational modes were assessed via Spearman ranking correlation, Self-Organizing Map (SOM) analysis and feed forward feature selection (FFFS). Although the variability of nitrate passage, salt passage and permeate flux was significant over the four operational modes, prediction performance for the three outcomes were with R2 and Average Absolute Relative Error (AARE) of 0.78–0.95 and 2.96–6.16 %, respectively. Model updates post membrane elements replacement demonstrated similar levels of prediction accuracy. The study results suggest that there is merit in exploring the utility of multi-mode models for sensor fault detection, data imputation, and for potential use in model-predictive control.

Intermittent RO operation↗
DOE OSTI2020

Uniaxial compression of [001]-oriented CaFe 2 As 2 single crystals:the effects of microstructure and temperature on superelasticity Part I: Experimental observations

Micropillar compression experiments on [001]-oriented CaFe 2 As 2 single crystals have recently revealed the existence of superelasticity with a remarkably high elastic limit of over 10%. The collapsed tetragonal phase transition, which is a uni-axial contraction process in which As-As bonds are formed across an intervening Ca-plane, is the main mechanism of superelasticity. Usually, superelasticity and the related structural transitions are affected strongly by both the microstructure and the temperature. As such, in this study, we investigated how the microstructure and temperature affect the superelasticity of [001]-oriented CaFe 2 As 2 micropillars cut from solution-grown single crystals, by performing a combination of in-situ cryogenic micromechanical testing and transmission electron microscopy studies. Our results show that the microstructure of CaFe 2 As 2 is influenced strongly by the crystal growth conditions and by subsequent heat treatment. The presence of Ca and As vacancies and FeAs nanoprecipitates affect the mechanical behavior significantly. In addition, the onset stress for the collapsed tetragonal transition decreases gradually as the temperature decreases. These experimental results are discussed primarily in terms of the formation of As-As bonds, which is the essential feature of this mechanism for superelasticity. Our research outcomes provide a more fundamental understanding of the superelasticity exhibited by CaFe 2 As 2 under uni-axial compression.

36 MATERIALS SCIENCE↗
NASA NTRS1975

Characterization of measurements in quantum communication

A characterization of quantum measurements by operator valued measures is presented. The generalized measurements include simultaneous approximate measurement of noncommuting observables. This characterization is suitable for solving problems in quantum communication. Two realizations of such measurements are discussed. The first is by adjoining an apparatus to the system under observation and performing a measurement corresponding to a self-adjoint operator in the tensor-product Hilbert space of the system and apparatus spaces. The second realization is by performing, on the system alone, sequential measurements that correspond to self-adjoint operators, basing the choice of each measurement on the outcomes of previous measurements. Simultaneous generalized measurements are found to be equivalent to a single finer grain generalized measurement, and hence it is sufficient to consider the set of single measurements. An alternative characterization of generalized measurement is proposed. It is shown to be equivalent to the characterization by operator-values measures, but it is potentially more suitable for the treatment of estimation problems. Finally, a study of the interaction between the information-carrying system and a measurement apparatus provides clues for the physical realizations of abstractly characterized quantum measurements.

Chan, V. W. S.↗
NASA NTRS1998

Spatial Aspects of Interspecific Competition

Using several variants of a stochastic spatial model introduced by Silvertown et al., we investigate the effect of spatial distribution of individuals on the outcome of competition. First, we prove rigorously that if one species has a competitive advantage over each of the others, then eventually it takes over all the sites in the system. Second, we examine tradeoffs between competition and dispersal distance in a two-species system. Third, we consider a cyclic competitive relationship between three types. In this case, a nonspatial treatment leads to densities that follow neutrally stable cycles or even unstable spiral solutions, while a spatial model yields a stationary distribution with an interesting spatial structure.

Durrett, Rick↗
DOE OSTI2024

High dimensional predictions of suicide risk in 4.2 million US Veterans using ensemble transfer learning

We present an ensemble transfer learning method to predict suicide from Veterans Affairs (VA) electronic medical records (EMR). A diverse set of base models was trained to predict a binary outcome constructed from reported suicide, suicide attempt, and overdose diagnoses with varying choices of study design and prediction methodology. Each model used twenty cross-sectional and 190 longitudinal variables observed in eight time intervals covering 7.5 years prior to the time of prediction. Ensembles of seven base models were created and fine-tuned with ten variables expected to change with study design and outcome definition in order to predict suicide and combined outcome in a prospective cohort. The ensemble models achieved c-statistics of 0.73 on 2-year suicide risk and 0.83 on the combined outcome when predicting on a prospective cohort of ~4.2 M veterans. The ensembles rely on nonlinear base models trained using a matched retrospective nested case-control (Rcc) study cohort and show good calibration across a diversity of subgroups, including risk strata, age, sex, race, and level of healthcare utilization. In addition, a linear Rcc base model provided a rich set of biological predictors, including indicators of suicide, substance use disorder, mental health diagnoses and treatments, hypoxia and vascular damage, and demographics. Similar content being viewed by others

60 APPLIED LIFE SCIENCES↗
DOE OSTI2025

Distinguishing Desirable and Undesirable Reactions in Multicomponent Systems for Redox Activation of the Uranyl Ion

Although it has been established that covalent functionalization of the U–O bonds in the uranyl dication (UO 2 2+ ) generally requires use of strong reductants and electrophiles, little work has examined how interactions between the individual reaction components could affect final outcomes in solution. Here, the patterns of such reactivity have been studied in a UO 2 2+ -containing model system supported by a workhorse pentadentate ligand, 2,2′-[(methylimino)bis(2,1-ethanediylnitrilomethylidyne)]bis-phenol. Oxo activation and functionalization have been tested with (i) electrochemical and chemical reduction, and (ii) coordinating and noncoordinating solvents. In acetonitrile, uranyl reduction was achieved cleanly, but treatment of the reduced species with tris(pentafluorophenyl)borane (BCF) resulted in a mixture of products arising from direct electron transfer to BCF. In dichloromethane (CH 2 Cl 2 ), electrochemical reduction of uranyl was achieved cleanly, but clean chemical reactivity was inaccessible. Despite these challenges, one trinuclear and oxo-deficient uranium-containing product was crystallized from CH 2 Cl 2 solution and characterized; thus, desirable electrophilic reactivity can proceed to some degree in CH 2 Cl 2 with BCF. Computational studies were used to investigate the properties of the trinuclear uranium product and the changes that could be inducible by further reduction. Here, taken together, the reactivity patterns identified here could inform design of improved systems for actinyl oxo functionalization.

cations↗
DOE OSTI2023

Substrate-Driven Catalyst Reducibility for Oxygen Evolution and Its Effect on the Operation of Proton Exchange Membrane Water Electrolyzers

To increase the efficiency of hydrogen production by proton exchange membrane water electrolyzers (PEMWEs), the relationships between the specific activity and stability of the membrane–electrode assembly (MEA) must be clarified. Ir oxide electrodeposited on Ti substrate is used as an oxygen electrode, and its electronic properties and electrochemical behavior in PEMWE operation are observed. The electrode, fabricated through a facile strategy based on annealing in the air atmosphere, enhances the specific oxygen evolution reaction (OER) activity and stability in PEMWE operation. Furthermore, the electronic catalyst–substrate interactions associated with different reducibilities in the heteroatom system are studied. The morphology, electronic properties, and chemical state of the oxygen electrode are investigated through X-ray spectroscopy, microscopy techniques, and computational analyses. Thermal treatment of the catalyst-coated substrate decreases the bulk oxidation state of Ir and increases the surface oxidation state. According to the electrochemical and physical behavior analyses of PEMWEs, the oxygen content in the Ir oxide structure, which defines the OER activity and its stability, is influenced by the crystalline structure and formation of a stable interface between the catalyst and substrate. The outcomes can facilitate the development of strategies for enhancing the performance of PEMWEs and designing rational MEAs.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗
NASA NTRS1997

Effects of exercise on knee joints with osteoarthritis: a pilot study of biologic markers

OBJECTIVE: To determine the effects of low intensity weight-bearing exercise on osteoarthritis (OA) of the knee. METHODS: Synovial fluid keratan sulfate (KS) and hydroxyproline were measured as markers of cartilage degradation. The Arthritis Impact Measurement Scales (AIMS) were used to measure health status, and a visual analog scale for pain assessment was used before and after intervention. An exercise (EX) group (n = 15) received a thrice-weekly 12-week low intensity exercise program and a weekly educational program, and a minimal treatment (Min RX) group (n = 15) received only the education program. RESULTS: Pain levels declined in the EX group, and the Min RX group showed improvement on the AIMS. Synovial fluid was obtained in 11 subjects before and after the intervention. Levels of KS and hydroxyproline did not change. CONCLUSION: Further study of exercise effects should include both clinical and biologic parameters to examine the outcome of exercise as a therapeutic intervention in OA of the knee.

Non-NASA Center↗
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↗
NASA NTRS2017

The Research Plan: Closing the ExMC Med02 "Pharmacy" Gap

HRP Human Research Roadmap: Risk and Gap Risk of Adverse Health Outcomes and Decrements in Performance due to Inflight Medical Conditions. Med02 "Pharmacy" Gap: We do not have the capability to provide a safe and effective medication formulary for exploration missions delivering a recommendation for a chemically stable, safe, and effective medication formulary that will support the operational needs of exploration space missions research strategy evidence-based formulary and models innovative analytical tools and methodologies novel treatments and preventive measures Planned review by a panel of experts from the pharmaceutical industry, regulatory, and academic scientific communities Formulary Selection Formulary Potency and Shelf life Formulary Safety and Toxicity Novel Technology Proof-of-Concept Portable real-time chemical analysis Innovative drug development / design

Daniels, Vernie↗
DOE OSTI2021

Machine-learning-accelerated multimodal characterization and multiobjective design optimization of natural porous materials

Natural porous materials such as nanoporous clays are used as green and low-cost adsorbents and catalysts. The key factors determining their performance in these applications are the pore morphology and surface activity, which are typically represented by properties such as specific surface area, pore volume, micropore content and pH. The latter may be modified and tuned to specific applications through material processing and/or chemical treatment. Characterization of the material, raw or processed, is typically performed experimentally, which can become costly especially in the context of tuning of the properties towards specific application requirements and needing numerous experiments. In this work, we present an application of tree-based machine learning methods trained on experimental datasets to accelerate the characterization of natural porous materials. The resulting models allow reliable prediction of the outcomes of experimental characterization of processed materials (R2 from 0.78 to 0.99) as well as identification of key factors contributing to those properties through feature importance analysis. Furthermore, the high throughput of the models enables exploration of processing parameter–property correlations and multiobjective optimization of prototype materials towards specific applications. We have applied these methodologies to pinpoint and rationalize optimal processing conditions for clays exploitable in acid catalysis. One of such identified materials was synthesized and tested revealing appreciable acid character improvement with respect to the pristine material. Specifically, it achieved 79% removal of chlorophyll-a in acid catalyzed degradation.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗
NASA NTRS1994

Multicomponent Gas Diffusion and an Appropriate Momentum Boundary Condition

Multicomponent gas diffusion is reviewed with particular emphasis on gas flows near solid boundaries-the so-called Kramers-Kistemaker effect. The aim is to derive an appropriate momentum boundary condition which governs many gaseous species diffusing together. The many species' generalization of the traditional single gas condition, either as slip or stick (no-slip), is not obvious, particularly for technologically important cases of lower gas pressures and very dissimilar molecular weight gases. No convincing theoretical case exists for why two gases should interact with solid boundaries equally but in opposite flow directions, such that the total gas flow exactly vanishes. ln this way, the multicomponent no-slip boundary requires careful treatment The approaches discussed here generally adopt a microscopic model for gas-solid contact. The method has the advantage that the mathematics remain tractable and hence experimentally testable. Two new proposals are put forward, the first building in some molecular collision physics, the second drawing on a detailed view of surface diffusion which does not unphysically extrapolate bulk gas properties to govern the adsorbed molecules. The outcome is a better accounting of previously anomalous experiments. Models predict novel slip conditions appearing even for the case of equal molecular weight components. These approaches become particularly significant in view of a conceptual contradiction found to arise in previous derivations of the appropriate boundary conditions. The analogous case of three gases, one of which is uniformly distributed and hence non-diffusing, presents a further refinement which gives unexpected flow reversals near solid boundaries. This case is investigated alone and for aggregating gas species near their condensation point. In addition to predicting new physics, this investigation carries practical implications for controlling vapor diffusion in the growth of crystals used in medical diagnosis (e.g. mercuric iodide) and semiconductors.

Noever, David A.↗
NASA NTRSDate not supplied

Nasa Exploration Atmosphere Tests 3 & 4: Development and Validation of Planetary Extravehicular Activity Prebreathe Protocols for Alternate Atmospheres and Suit Pressures

INTRODUCTION: Space suits operate at low pressures to optimize astronauts’ performance. The drop in pressure from the habitat environment to the suit carries a risk of decompression sickness (DCS), which is mitigated by a 95% O2 prebreathe protocol. Prebreathe protocols for the lunar surface have a significantly higher risk compared to International Space Station microgravity Extravehicular Activities (EVA). In previous studies, we validated a prebreathe protocol from a 56.5 kPa 34% O2 cabin to a 29.6 kPa EVA pressure; however, the enriched oxygen cabin environment poses a flammability risk that requires significant changes to material design and selections. Here, we report outcomes for prebreathe protocols from a sub-30% O2 cabin and associated changes necessary to control DCS risk critical to upcoming lunar missions. METHODS: Fourteen volunteers completed 11-day hypobaric chamber studies with an “alternate exploration atmosphere” of 66.2kPa, 28.5% O2. Subjects acclimated for 48 hrs and then participated in five 6-hour simulated EVAs at 29.6 or 35.6kPa, 95% O2. Prior to EVA, subjects underwent a 20, 90, or 150-minute prebreathe. The EVA simulation was designed to be representative of future planetary EVAs, proportionate to the subject’s VO2max. Decompression stress was monitored by real-time doppler and echocardiograph alternating every 15 min, as well as clinical monitoring for DCS signs/symptoms. Venous gas emboli (VGE) and DCS outcomes were verified against NASA-STD-3001 acceptance criteria. RESULTS AND DISCUSSION: Venous gas emboli (VGE) were identified during all EVAs. A neurological DCS case was identified in the 90-min/29.6kPa prebreathe, terminating further testing of this protocol. No DCS cases were identified in the 150 min/29.6kPa protocol. The 20 min/36.5kPa protocol was rejected due to a Type II DCS case. All DCS symptoms resolved with treatment, with no sequelae post initial treatment of DCS. These various test points highlighted to the significant benefit of elevated suit pressure to shorten prebreathe protocols, but also the difficulty in assessing and managing DCS during sustained EVA operations in remote planetary surfaces.

decompression sickness↗
NASA NTRS2003

Evaluation of NASA Foodbars as a Standard Diet for Use in Short-Term Rodent Space Flight Studies

A standard rodent diet for space flight must meet the unique conditions imposed by the space environment and must be nutritionally adequate since diet can influence the outcome of experiments. This paper evaluates the use of National Aeronautics and Space Administration (NASA) developed Foodbars as a standard space flight diet for rats. The Foodbar's semi-purified formulation permits criteria such as nutrient consistency, high nutrient bioavailability and flexibility of formulation to be met. Extrusion of the semi-purified diet produces Foodbars with the proper texture and a non-crumbing solid form for use in space. Treatment of Foodbar with 0.1% potassium sorbate prevents mold growth. Irradiation (15-25 kGy) prevents bacterial growth and in combination with sorbate-treatment provides added protection against mold for shelf-stability. However, during the development process, nutrient analyses indicated that extrusion and irradiation produced nutrient losses. Nutrients were adjusted accordingly to compensate for processing losses. Nutrient analysis of Foodbars continues to be performed routinely to monitor nutrient levels. It is important that the standard rodent diet provide nutrients that will prevent deficiency but also avoid excess that may mask physiological changes produced by space flight. All vitamins levels in the Foodbars, except for vitamin K conformed to or exceeded the current NRC (1995) recommendations. All indispensable amino acids in Foodbar conformed to or exceeded the NRC nutrient recommendation for mice growth and rat maintenance. However, some indispensable amino acids were slightly below recommendations for rat reproduction/growth. Short-term (18-20 d) animal feeding studies indicated that Foodbars were palatable, supported growth and maintained health in rats. Results indicated that NASA rodent Foodbars meet both the physical and nutritional criteria required to support rodents in the space environment and thus, may be used successfully as a standard diet for short-term space flight studies. However, nutritional adequacy of NASA Rodent Foodbars as a standard diet on longer duration (>20 d) space flight missions remains to be determined.

Tou, Janet↗
NASA NTRS1995

Preservation of auditory and vestibular function after surgical removal of bilateral vestibular schwannomas in a patient with neurofibromatosis type 2

The outcome of acoustic neuroma (vestibular schwannoma) surgery continues to improve rapidly. Advances can be attributed to several fields, but the most important contributions have arisen from the identification of the genes responsible for the dominant inheritance of neurofibromatosis types 1 (NF1) and 2 (NF2) and the development of magnetic resonance imaging with gadolinium enhancement for the early anatomic confirmation of the pathognomonic, bilateral vestibular schwannomas in NF2. These advances enable early diagnosis and treatment when the tumors are small in virtually all subjects at risk for NF2. The authors suggest that advising young NF2 patients to wait until complications develop, especially hearing loss, before diagnosing and operating for bilateral eighth nerve schwannomas may not always be in the best interest of the patient. To the authors' knowledge, this is the first reported case of preservation of both auditory and vestibular function in a patient after bilateral vestibular schwannoma excision.

Case Reports↗
NASA NTRS2017

The Pathway to a Safe and Effective Medication Formulary for Exploration Spaceflight

PURPOSE: Exploration space missions pose several challenges to providing a comprehensive medication formulary designed to accommodate the size and space limitations of the spacecraft; while addressing the individual medications needs and preferences of the Crew; the negative outcome of a degrading inventory over time, the inability to resupply before expiration dates; and the need to properly forecast the best possible medication candidates to treat conditions that will occur in the future. METHODS: The Pharmacotherapeutics Discipline has partnered with the Exploration Medical Capabilities (ExMC) Element to develop and propose a research pathway that is comprehensively focused on evidence-based models and theories, as well as on new diagnostic tools and treatments or preventive measures aimed at closure of the Med02 “Pharmacy” Gap; defined in the Human Research Program’s (HRP) risk-based research strategy. The Med02 Gap promotes the challenge to identify a strategy to ensure that medications used to treat medical conditions during exploration space missions are available, safe, and effective. It is abundantly clear that pharmaceutical intervention is an essential component of risk management planning for astronaut healthcare during exploration space. However, the quandary still remains of how to assemble a formulary that is comprehensive enough to prevent or treat anticipated medical events; and is also chemically stable, safe, and robust enough to have sufficient potency to last for the duration of an exploration space mission. In cases where that is not possible, addressing this Gap requires exploration of novel drug development techniques, dosage forms, and dosage delivery platforms that enhance chemical stability as well as therapeutic effectiveness. RESULTS: The proposed research pathway outlines the steps, processes, procedures, and a research portfolio aimed at identifying a capability that will provide a safe and effective pharmacy for any specific exploration Design Reference Mission (DRM). The proposed approach to building this research portfolio is to seek research projects that concentrate on four major focus areas; (1) Formulary selection, (2) Formulary potency and shelf life, (3) Formulary safety and toxicity, and (4) Novel technology and innovation such as portable real-time chemical analysis innovative drug therapies and dosage and delivery platforms. CONCLUSION: The research pathway has been completed and presented to the HRP. In spring 2017, it is scheduled to be reviewed by a panel of pharmaceutical and clinical experts that will evaluate the scientific merit and operational feasibility of the research pathway, as well as make suggestions for any warranted additions or improvements. Once finalized, the ExMC Element will proceed with the execution of this research pathway with the goal of gathering as much data, and learning as much as possible, to provide a safe and effective pharmaceutical formulary for use during exploration missions.

Daniels, V. R.↗