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All sourcesNASA NTRSDOE OSTI
NASA NTRS2004

Risk Assessment and Control through Countermeasure System Iplementation for Long-term Crew Exposure to Microgravity

Experience with the International Space Station (ISS) program demonstrates the degree to which engineering design and operational solutions must protect crewmembers from health risks due to long-term exposure to the microgravity environment. Risks to safety and health due to degradation in the microgravity environment include crew inability to complete emergency or nominal activities, increased risk of injury, and inability to complete safe return to the ground due to reduced strength or embrittled bones. These risks without controls slowly increase in probability for the length of the mission and become more significant for increasing mission durations. Countermeasures to microgravity include hardware systems that place a crewmember s body under elevated stress to produce an effect similar to daily exposure to gravity. The ISS countermeasure system is predominately composed of customized exercise machines. Historical treatment of microgravity countermeasure systems as medical research experiments unintentionally reduced the foreseen importance and therefore the capability of the systems to function in a long-term operational role. Long-term hazardous effects and steadily increasing operational risks due to non-functional countermeasure equipment require a more rigorous design approach and incorporation of redundancy into seemingly non- mission-critical hardware systems. Variations in the rate of health degradation and responsiveness to countermeasures among the crew population drastically increase the challenge for design requirements development and verification of the appropriate risk control strategy. The long-term nature of the hazards and severe limits on logistical re-supply mass, volume and frequency complicates assessment of hardware availability and verification of an adequate maintenance and sparing plan. Design achievement of medically defined performance requirements by microgravity countermeasure systems and incorporation of adequate failure tolerance significantly reduces these risks. Future implementation of on-site monitoring hardware for critical health parameters such as bone mineral density would allow greater responsiveness, efficiency, and optimized design of the countermeasures system.

Gernand, Jeremy M.↗
NASA NTRSDate not supplied

ExMC Systems Engineering Developments

The Exploration Medical Capability (ExMC) Element within the Human Research Program (HRP) applies systems engineering (SE) principles along with the use of Model-Based Systems Engineering (MBSE) tools to identify and communicate the requirements for medical and crew health and performance (CHP) systems. In the past fiscal year, the MBSE approach sought to advance the digital engineering toolset for medical and CHP system representation. These digital artifacts provide enhanced views of the relationships among requirements, standards, functions, and capabilities, to name a few, that is best suited for a user’s objectives. The MBSE tools and SE practices were applied to the development of the revised Earth Independent Medical Operations (EIMO) medical system and the Artemis III and IV CHP System models. In addition, a System of Systems concept was integrated into the EIMO model to facilitate the identification of system interfaces that interact with the medical system. Finally, the ExMC SE team has initiated several efforts to bring operationally relevant digital engineering practices to the Human Health and Performance Directorate (HHPD). This included the development of a pilot program within the directorate to help foster utilization of tools such as MagicDraw for system modeling and Power BI for visualizing extracted data in an easily accessible dashboard format. Additionally, with the increase in complexity of the integration effort for Artemis missions, ExMC has endeavored to bring digital engineering strategies to potentially increase efficiency in review processes. This talk will provide a high-level overview of the ExMC SE team accomplishments since the last Investigators’ Workshop, an introduction to upcoming SE talks, and the ongoing systems engineering work.

systems engineering↗
NASA NTRS1977

Development of a character, line and point display system

A compact graphics terminal for use as the input to a computerized medical records system is described. The principal mode of communication between the terminal and the records system is by checklists and menu selection. However, the terminal accepts short, handwritten messages as well as conventional alphanumeric input. The terminal consists of an electronic tablet, a display, a microcomputer controller, a character generator, and a refresh memory for the display. An Intel SBC 80/10 microcomputer controls the flow of information and a 16 kilobyte memory stores the point-by-point array of information to be displayed. A specially designed interface continuously generates the raster display without the intervention of the microcomputer.

Owen, E. W.↗
NASA NTRS2007

Autonomous Medical Care for Exploration Class Space Missions

The US-based health care system of the International Space Station (ISS) contains several subsystems, the Health Maintenance System, Environmental Health System and the Countermeasure System. These systems are designed to provide primary, secondary and tertiary medical prevention strategies. The medical system deployed in Low Earth Orbit (LEO) for the ISS is designed to enable a "stabilize and transport" concept of operations. In this paradigm, an ill or injured crewmember would be rapidly evacuated to a definitive medical care facility (DMCF) on Earth, rather than being treated for a protracted period on orbit. The medical requirements of the short (7 day) and long duration (up to 6 months) exploration class missions to the Moon are similar to LEO class missions with the additional 4 to 5 days needed to transport an ill or injured crewmember to a DCMF on Earth. Mars exploration class missions are quite different in that they will significantly delay or prevent the return of an ill or injured crewmember to a DMCF. In addition the limited mass, power and volume afforded to medical care will prevent the mission designers from manifesting the entire capability of terrestrial care. NASA has identified five Levels of Care as part of its approach to medical support of future missions including the Constellation program. In order to implement an effective medical risk mitigation strategy for exploration class missions, modifications to the current suite of space medical systems may be needed, including new Crew Medical Officer training methods, treatment guidelines, diagnostic and therapeutic resources, and improved medical informatics.

Hamilton, Douglas↗
NASA NTRSDate not supplied

How Autonomous Intelligent Systems Can Facilitate Earth-independent Medical Care: Going Beyond Telepresence

During the last decade, teleoperated robotic systems have extended humans’ sensorimotor competence to digitally fly beyond the physical barrier of distance and scale and thus transmit sensorimotor skills of the human through direct communication. Telepresence capabilities have enabled tele-physical remote access at small scales thanks to telerobotic mediums. Although the concept was initially motivated by space applications, such technologies quickly have expanded into the medical domain and resulted in teleoperated medical robots, including telerobotic surgical systems (such as the da Vinci surgical system). Effective telepresence fundamentally depends on an agile, reliable, and secure communication medium that can transmit real-time information between the operator and a remote device. However, direct telepresence may not be achievable for long-duration exploration spaceflight missions. Thus, autonomous systems and local intelligence represent potential solutions to the aforementioned issues. One example solution employs demonstration systems which enable learning from the pre-captured inputs of a skilled human operator. These will be computationally modeled and later probabilistically replicated toward the completion of remote physical tasks when direct telepresence is not viable - such as under communication blackout conditions. In other words, trained autonomous systems (e.g., robots) can perform remote operations that mimic the physical performance of experts during remote operations/training. Beyond learning the physics of the task, autonomous agents can also be used to conduct algorithmic decision-making that mimics the higher-level cognition of the expert. Thus, using an autonomous system, pre-trained cognitive and manipulation-based skills can be leveraged (acquired during pre-mission events) to produce digital twins of an intelligent operator. Such systems can be used for the real-time conduction of intricate tasks in complex and unstructured environments. Such systems will operationalize “cognitive digital twins” and can expand the reach of human cognition and manipulation through the power of data-driven learning from demonstration algorithms. This system category will be discussed as a fully autonomous operation in this talk. In addition to the above, we will also propose and discuss the possibility of partial-automation using remote intelligence and remote sensing. In contrast to full automation, partial automation can close the loop through a local operator equipped with augmented sensory awareness through wearable systems. Such technologies will allow the local operator to conduct delicate tasks while being guided using sensory augmentation and being monitored to gauge her/his level of cognitive focus and performance. The difference with the previous category is that a remote human will conduct the task. Further, rather than making a digital twin of human cognition, we will augment the control inputs of the local human to match those of the skilled expert operator who is not accessible in real-time. Going beyond classic telepresence and thus approaching intelligent telepresence, our vision is that autonomous agents will eventually enable the safe, consistent and efficient delivery of complex, remote and smart medical care during space exploration across operators in an Earth-independent fashion. We will discuss our collective vision from NASA and MERIIT@NYU lab in this talk.

Telepresence↗
NASA NTRSDate not supplied

CLINICAL DECISION SUPPORT: PATH TO FUNCTIONAL REQUIREMENTS

Long-duration, deep-space exploration missions present significant challenges to crew health and performance. These challenges include the individual and combined effects of microgravity, radiation exposure, isolation, limited resources (mass, volume, power, data and crew time), limited options for evacuation and those associated with delayed or constrained communications, all of which demand greater crew autonomy. Specifically, as the communication delays intensify the further we explore space, the unqualified need for Earth-independent medical operations focused on autonomous diagnosis, treatment and prevention will be key to mission continuation and success. To augment the requisite knowledge, skills and abilities (KSAs) of a time-constrained crew operating under stressful conditions, combatting fatigue, and facing a potential medical crisis, a robust clinical decision support system (CDSS) is a probable solution that would facilitate, guide and inform Earth-independent medical operations, while assisting crewmembers through various clinical presentations. The Exploration Medical Capability (ExMC) Element of the Human Research Program (HRP) is expanding the boundaries of space medical systems to advance the care of astronauts on future exploration missions beyond low Earth orbit. ExMC is actively identifying and testing next-generation medical care and crew health maintenance technologies. The Clinical Decision Support (CDS) project addresses gap Medical-701 within the Inflight Medical Conditions risk: “Enhance medical capabilities within an exploration medical system.” Though mass, volume, and power will face increasing constraints, the projected computational capabilities of spacecraft systems will increase exponentially as information technology continues to advance this decade and beyond. Hence, data, software and computational resources will play an essential and synergistic role in maintaining crew health, wellness and performance in deep space missions. The focus of the CDS project is to develop recommended requirements for an in-vehicle CDSS that acts as a ‘virtual assistant’ for delivering optimal health, performance and medical care during exploration missions. The CDSS is envisioned as an integrated, software-based tool deployed on a laptop computer or handheld device. The CDSS will assist the crew and ground support when interacting with knowledge/databases (e.g. records, pharmacy, schedule), instrumentation (e.g. imaging, physiological monitoring devices), and habitat (e.g. wellness system, task performance system) and vehicle systems (e.g. environmental system, communication system). In addition, the human interface will employ a context-based approach that accounts for the crew’s situation. Thus, extraneous and clinically/operationally non-relevant information are reduced to avoid an increase in cognitive load. The framework of an ideal spaceflight CDSS is to include core and advanced analytical features that incorporate work from collaborators yet maintain a flexible platform for integrating new technology in the future. In fiscal year 2021 (FY21), the CDS project identified requirements through two primary mechanisms: (i) the development of software implementation prototypes and (ii) the application of systems engineering processes. The CDS project developed and tested a series of increasingly complex system prototypes that were based on use cases derived from the CDSS concept of operations (ConOps). These software implementations yielded insights on CDSS functionality as well as lessons learned that provided the initial requirements for CDSS capability. By applying a systems engineering (SE) approach, medical scenarios provided in the ConOps and the use cases for software implementation underwent functional decomposition to identify CDSS functionality. Also, systems-based modeling language (SysML) tools such as activity diagrams were developed from the same ConOps and use cases to identify CDSS functionality. The lessons learned from software implementation defined both specific requirements and broad areas of requirements. Within these defined broad requirement areas, further analysis of the SE products identified specific capability that resulted in the final functional requirements. In summary, the software prototypes, functional decomposition of the ConOps and use cases, and SysML diagrams provided the basis for the CDSS requirements developed in FY21. In the upcoming year, these requirements will be refined for their final ExMC baseline review in latter FY22.

clinical decision support↗
NASA NTRS2007

Organization, Management and Function of International Space Station (ISS) Multilateral Medical Operations

Long duration crews have inhabited the ISS since November of 2000. The favorable medical outcomes of its missions can be largely attributed to sustained collective efforts of all ISS Partners medical organizations. In-flight medical monitoring and support, although crucial, is just a component of the ISS system of Joint Medical Operations. The goal of this work is to review the principles, design, and function of the multilateral medical support of the ISS Program. The governing documents, which describe the relationships among all ISS partner medical organizations, were evaluated, followed by analysis of the roles, responsibilities, and decision-making processes of the ISS medical boards, panels, and working groups. The degree of integration of the medical support system was evaluated by reviewing the multiple levels of the status reviews and mission assurance activities carried out throughout the last six years. The Integrated Medical Group, consisting of physicians and other essential personnel in the mission control centers represents the front-line medical support of the ISS. Data from their day-to-day activities are presented weekly at the Space Medicine Operations Team (SMOT), where known or potential concerns are addressed by an international group of physicians. A broader status review is conducted monthly to project the state of crew health and medical support for the following month, and to determine measures to return to nominal state. Finally, a comprehensive readiness review is conducted during preparations for each ISS mission. The Multilateral Medical Policy Board (MMPB) issues medical policy decisions and oversees all health and medical matters. The Multilateral Space Medicine Board (MSMB) certifies crewmembers and visitors for training and space flight to the Station, and physicians to practice space medicine for the ISS. The Multilateral Medical Operations Panel (MMOP) develops medical requirements, defines and supervises implementation of operational countermeasures, environmental monitoring, medical care, and emergency medical services. MMOP assures the medical readiness of the Station for each subsequent mission or critical event. All boards and panels have functioned effectively and without interruptions even in various challenging circumstances. Based on the experience of the authors, consensus has prevailed as the primary nature of decisions made by all ISS medical groups, at all levels. The six first years of piloted operation have demonstrated the ability of the ISS medical authority groups and the medical infrastructure to implement medical policies and requirements, effectively interface with non-medical groups, and maintain the health and productivity of the crew in an integrated, multilaterally coordinated fashion. The medical support system appears to be mature and ready for further expansion of all Partners roles, and for the anticipated increase in the size of ISS crews.

Duncan, James M.↗
NASA NTRS2011

Ultracapacitor-Based Uninterrupted Power Supply System

The ultracapacitor-based uninterrupted power supply (UPS) system enhances system reliability; reduces life-of-system, maintenance, and downtime costs; and greatly reduces environmental impact when compared to conventional UPS energy storage systems. This design provides power when required and absorbs power when required to smooth the system load and also has excellent low-temperature performance. The UPS used during hardware tests at Glenn is an efficient, compact, maintenance-free, rack-mount, pure sine-wave inverter unit. The UPS provides a continuous output power up to 1,700 W with a surge rating of 1,870 W for up to one minute at a nominal output voltage of 115 VAC. The ultracapacitor energy storage system tested in conjunction with the UPS is rated at 5.8 F. This is a bank of ten symmetric ultracapacitor modules. Each module is actively balanced using a linear voltage balancing technique in which the cell-to-cell leakage is dependent upon the imbalance of the individual cells. The ultracapacitors are charged by a DC power supply, which can provide up to 300 VDC at 4 A. A constant-voltage, constant-current power supply was selected for this application. The long life of ultracapacitors greatly enhances system reliability, which is significant in critical applications such as medical power systems and space power systems. The energy storage system can usually last longer than the application, given its 20-year life span. This means that the ultracapacitors will probably never need to be replaced and disposed of, whereas batteries require frequent replacement and disposal. The charge-discharge efficiency of rechargeable batteries is approximately 50 percent, and after some hundreds of charges and discharges, they must be replaced. The charge-discharge efficiency of ultracapacitors exceeds 90 percent, and can accept more than a million charges and discharges. Thus, there is a significant energy savings through the efficiency improvement, and there is far less downtime for applications and labor involved in replacing an ultracapacitor versus batteries. Also, the lengthy lifespan of this design would greatly reduce the disposal problems posed by lead acid, nickel cadmium, lithium, and nickel metal hydride batteries. This innovation is recyclable by nature, which further reduces system costs. The disposal of ultracapacitors is simple, as they are constructed of non-hazardous components. They are also safer than batteries in that they can be easily discharged, and left indefinitely in a safe, discharged state where batteries cannot.

Eichenberg, Dennis J.↗
NASA NTRS1991

Medical evaluations on the KC-135 1990 flight report summary

The medical investigations completed on the KC-135 during FY 1990 in support of the development of the Health Maintenance Facility and Medical Operations are discussed. The experiments are comprised of engineering evaluations of medical hardware and medical procedures. The investigating teams are made up of both medical and engineering personnel responsible for the development of medical hardware and medical operations. The hardware evaluated includes dental equipment, a coagulation analyzer, selected pharmaceutical aerosol devices, a prototype air/fluid separator, a prototype packaging and stowage system for medical supplies, a microliter metering system, and a workstation for minor surgical procedures. The results of these engineering evaluations will be used in the design of fleet hardware as well as to identify hardware specific training requirements.

Lloyd, Charles W.↗
NASA NTRS1989

Space Technology for Patient Monitoring

A contract for the development of an astronaut monitoring system in the early days of the space program provided Mennen Medical, Inc. with a foundation in telemetry that led to the development of a computerized medical electronic system used by hospitals. Mennen was the first company to adopt solid state design in patient monitoring and to offer multipatient telemetry monitoring. Telemetry converts instrument data to electrical signals and relays them to a remote receiver where they are displayed. From a central station, a nurse can monitor several patients. Company products include VISTA systems and Horizon 2000 Monitor.

Source record↗
NASA NTRS2009

Effectiveness of Needles Vial Adaptors and Blunt Cannulas for Drug Administration in a Microgravity Environment

The need for a new system of injectable medications aboard the International Space Station (ISS) was identified. It is desired that this system fly medications in their original manufacturer's packaging, allowing the system to comply with United States Pharmacopeia (USP) guidelines while minimizing the resupply frequency due to medication expiration. Pre-filled syringes are desired, however, the evolving nature of the healthcare marketplace requires flexibility in the redesign. If medications must be supplied in a vial, a system is required that allows for the safe withdrawal of medication from the vial into a syringe for administration in microgravity. During two reduced gravity flights, the effectiveness of two versions of a blunt cannula and needleless vial adaptors was evaluated to facilitate the withdrawal of liquid medication from a vial into a syringe for injection. Other parameters assessed included the ability to withdraw the required amount of medication and whether this is dependent on vial size, liquid, or the total volume of fluid within the vial. Injectable medications proposed for flight on ISS were used for this evaluation. Due to differing sizes of vials and the fluid properties of the medications, the needleless vial adaptors proved to be too cumbersome to recommend for use on the ISS. The blunt cannula, specifically the plastic version, proved to be more effective at removing medication from the various sizes of vials and are the recommended hardware for ISS. Fluid isolation within the vials and syringes is an important step in preparing medication for injection regardless of the hardware used. Although isolation is a challenge in the relatively short parabolas during flight, it is not an obstacle for sustained microgravity. This presentation will provide an overview of the products tested as well as the challenges identified during the microgravity flights.

Hailey, Melinda↗
NASA NTRS1991

Shuttle abort landing site emergency medical services

NASA and DOD studies of medical-planning and logistical problems are reviewed as applicable to providing emergency medical care at remote transoceanic abort landing (TAL) sites. Two options are analyzed including a modified surgical response team and a combination physician/medical technician team. The two concepts are examined in terms of cost-effectiveness, specific types of medical support such as blood procurement, and search-and-rescue requirements. It is found that the physician/technician team is more economically efficient, and the description of the concept permits the development of an effective TAL-site astronaut medical-support system. A balance is struck between the competing problems of cost and medical capability by planning for on-scene medical stabilization and air evacuation to DOD tertiary medical centers.

Mckenas, David K.↗
NASA NTRSDate not supplied

How ExMC Communicates a System Model to Non-Modelers

NASA’s Human Research Program (HRP) Exploration Medical Capability (ExMC) Element adopted Systems Engineering (SE) principles and Model Based Systems Engineering (MBSE) tools to capture the system functions, system architecture, requirements, interfaces, and clinical capabilities for a future exploration medical system. There are many different stakeholders who may use the information in the model: systems engineers, clinicians (physicians, nurses, and pharmacists), scientists, and mission planners. Many of these stakeholders have neither access to MBSE modeling tools nor experience with SE modeling techniques. The challenge faced by ExMC SE team was how to present the content in the model to non-modelers in a way they would understand the content with limited training in MBSE and without using the modeling tool. ExMC SE team created a Hypertext Markup Language (HTML) report that shows key model content and is accessible to anyone with a browser. When creating the HTML report, the ExMC SE received stakeholder feedback on what content they wanted and how to display this content. Incorporating this feedback, the report arranges the content in a way that directs readers through the SE process taken to derive the requirements and helps them to understand the fundamental steps in an SE approach. The report includes links to source information (e.g., NASA documentation that describes levels of care) and other SE products (e.g., Concept of Operations). These links were provided to aid in the understanding of how the team created this content through a methodical SE approach. This presentation outlines the process used to develop the model, the data chosen to share with stakeholders, many of the model elements used in the report, the review process stakeholders followed, the comments received from the stakeholders, and the lessons ExMC learned through producing this HTML report.

J. Cohen↗
NASA NTRSDate not supplied

Earth Independent Medical Operations (EIMO)

Inherent in interplanetary space travel are unprecedented challenges that could threaten mission success and negatively impact crew health and performance. Return to definitive care is essentially untenable and resources will be constrained with practically no re-supply capability. Access to ground-based medical expertise will be significantly delayed under nominal conditions with exacerbation during conjunction or prolonged dust storms. Taken together, these challenges necessitate the development of a progressively autonomous medical operational support system to assist the crew medical officer (CMO). While support from ground based medical experts will remain indispensable for pre-mission planning, the approach to management of acute/emergent medical contingencies will require a gradual transition of medical care and decision making from terrestrial to space-based assets, enabling support of astronaut health and performance and reducing overall mission risk. To progressively enable EIMO, a series of meetings were convened with subject matter experts from within NASA, academia and industry to facilitate mapping of the path to support autonomous medical operations. Topics explored in these meetings included the scope of data (storage capacity, usage, transmission rate and bandwidth, computing capacity), CMO training, supply and resource management and task load balance. Recommendations from these meetings will inform the EIMO Concept of Operations and definition of the associated requirements culminating in updates to the NASA 3001 standards. The EIMO project team will work with stakeholders to conceptualize a clinical decision support system (CDSS) to assist the CMO in response to medical contingencies when terrestrial support is delayed or otherwise unavailable. The CDSS will be a system of systems that will utilize data from numerous input vectors. Successful deployment of the CDSS will facilitate medical decision making while decreasing the cognitive load leading to an improvement in task load balancing. Additional benefits of the envisioned CDSS include assistance with inventory management, locating resources, storage/retrieval of medical records, highlighting trends in recorded data, in addition to providing a consult for diagnosis and treatment. More advanced features might include passive monitoring to identify early warning signs of behavioral or medical anomalies to possibly pre-empt onset of conditions that would compromise crew health and performance.

Benjamin Easter↗
NASA NTRS1998

Applications of telemedicine in the United States space program

Since the beginning of human space flight, NASA has been placing humans in extreme and remote environments. There are many challenges in maintaining humans in outer space, including the provision of life-support systems, radiation shielding, and countermeasures for minimizing the effect of microgravity. Because astronauts are selected for their health, among other factors, disease and illness are minimized. However, it is still of great importance to have appropriate medical care systems in place to address illness and injury should they occur. With the exception of the Apollo program, exploration of space has been limited to missions that are within several hundred miles of the surface of the Earth. At the drawn of the 21st century and the new millennium, human exploration will be focused on operation of the International Space Station (ISS) and preparation for human missions to Mars. These missions will present inherent risks to human health, and, therefore, appropriate plans must be established to address these challenges and risks. Crews of long-duration missions must become more independent from ground controllers. New systems, protocols, and procedures are currently being perfected. Application of emerging technologies in information systems and telecommunications will be critical to inflight medical care. Application of these technologies through telemedicine will provide crew members access to information, noninvasive procedures for assessing health status, and guidance through the integration of sensors, holography, decision-support systems, and virtual environments. These technologies will also serve as a basis to enhance training and medical education. The design of medical care for space flight should lead to a redesign of the practice of medicine on Earth.

Review, Tutorial↗
NASA NTRS1975

Bioinstrumentation

The Apollo bioinstrumentation system (BIS) and related hardware is described. The BIS requirements evolved as a continuation and refinement of medical monitoring systems utilized throughout the Mercury and Gemini programs. The BIS provided physiological data to ground-based medical personnel for operational inflight safety monitoring, for inflight medical experiments; and for ground-based operations safety monitoring. The overall performance of the BIS is evaluated.

Stanley M. Luczkowski↗
NASA NTRSDate not supplied

The potable water system in Skylab

Description of the medical requirements, development, system operation, and in-flight performance of the Skylab potable water system. Emphasized is the description of the unique features involving new space-flight concepts, procedures, and design incorporated in Skylab. The water supplied to the three Skylab missions was preloaded in stainless-steel tanks. These tanks were fitted with positive expulsion stainless-steel bellows. In-flight iodination of the water, for bacterial control, was accomplished as required. An in-flight bactericide monitor was used periodically to determine the level of bactericide in the water. Prior to the delivery of the water to the crewmen for consumption, the water was passed through a cation exchange resin for metallic ion removal and then heated for food reconstitution or chilled for drinking.

R. L. Sauer↗