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Psychological Health Maintenance on Space Station Freedom

The scheduling of crew rotations for up to 180 days on Space Station Freedom presents a special challenge for behavioral scientists who are tasked with providing psychological support for the crews, their families, and mission flight controllers. Preflight psychological support planning may minimize the negative impact of psychological and social issues on mission success, as well as assist NASA management in making real-time mission planning decisions in the event of a significant social event (for example, the death of a family member). During flight, the combined psychological, emotional, and social stressors on the astronauts must be monitored, along with other aspects of their health. The Health Maintenance Facility (HMF) will have the capability of providing preventive, diagnostic, and therapeutic assistance for significant psychiatric and interpersonal problems which may develop. Psychological support will not end with the termination of the mission. Mental health professionals must be part of the team of medical personnel whose job will be to facilitate the transition—physical and mental—from the space environment back to planet Earth. This paper reviews each phase of mission planning for Space Station Freedom and specifies those factors that may be critical for psychological health maintenance on extended-duration space missions.

Patricia A Santy↗

Commercialization and Industrial Development for the Fetal Hear Rate Monitor

The primary objectives for this task were to continue the development and testing of the NASA/ODU passive acoustic fetal heart rate monitor, with the goal of transferring the technology to the commercial sector. Areas of work included: 1. To assist in the development of a new hardware front end electronics box for the fetal heart rate monitor, so as to reduce the size of the electronics box, and also to provide for a "low-frequency" and "high-frequency" mode of operation. To make necessary changes in the operating software to support the two modes of operation. 2. To provide an option for a strip chart recording for the system, so that medical personnel could more easily make comparisons with ultra sound strip chart recordings. and 3. To help with continued testing of the system.

Zahorian, Stephen↗

New Help for MS Patients

The Mark VII MicroClimate Medical Personal Cooling system enables multiple sclerosis' victims, as well as cerebral palsy, spinabifida patients and others to lower their body temperatures. Although this is not a cure, cooling can produce a dramatic improvement in symptoms. The Multiple Sclerosis Association of America has placed cool suits in MS research care centers. This technology originated in the need for cooling systems in spa@esuits. "Cool Suits" are now used by hazardous materials workers, armored vehicle crews, firefighters and crop dusters. A surgical personal cooling system has also been developed for medical personnel working in hot operating room environments.

Source record↗

Uterine Contraction Modeling and Simulation

Building a training system for medical personnel to properly interpret fetal heart rate tracing requires developing accurate models that can relate various signal patterns to certain pathologies. In addition to modeling the fetal heart rate signal itself, the change of uterine pressure that bears strong relation to fetal heart rate and provides indications of maternal and fetal status should also be considered. In this work, we have developed a group of parametric models to simulate uterine contractions during labor and delivery. Through analysis of real patient records, we propose to model uterine contraction signals by three major components: regular contractions, impulsive noise caused by fetal movements, and low amplitude noise invoked by maternal breathing and measuring apparatus. The regular contractions are modeled by an asymmetric generalized Gaussian function and least squares estimation is used to compute the parameter values of the asymmetric generalized Gaussian function based on uterine contractions of real patients. Regular contractions are detected based on thresholding and derivative analysis of uterine contractions. Impulsive noise caused by fetal movements and low amplitude noise by maternal breathing and measuring apparatus are modeled by rational polynomial functions and Perlin noise, respectively. Experiment results show the synthesized uterine contractions can mimic the real uterine contractions realistically, demonstrating the effectiveness of the proposed algorithm.

Liu, Miao↗

Different Perspectives on Asthenia in Astronauts and Cosmonauts: International Research Literature

The Behavioral Health and Performance (BHP) Element is one of the six elements within the NASA Human Research Program (HRP) and is responsible for managing four risks: a) The Risk of Performance Decrements due to inadequate Cooperation, Coordination, Communication and Psychological Adaptation within a Team (Team), b) the Risk of Performance Errors due to Sleep Loss, Circadian De-synchronization, Fatigue and Work Overload (Sleep), c) Risk of Behavioral Conditions (BMed), and d) the Risk of Psychiatric Disorders (BMed). The aim of this report is to address some of the recommendations made by the recent NASA HRP Standing Review Panel for the Behavioral Medicine Risk of Psychiatric Disorders. Such recommendations included: a) the inclusion of important national and international literature in English and non-English language materials; including journals, books, magazines, conference reports and b) an extensive literature review of certain types of psychological states to predict, detect, and assess adverse mental states that may negatively affect the psychological well being of the astronauts, specifically asthenia. This report was a collaborative international work effort focused on the evaluation and determination of the importance of continuing research on asthenia as a possible psychological problem that might affect the optimal psychological functioning among crewmembers during long-duration space flight missions. Russian medical personnel (flight surgeons and psychologist) have observed symptoms of asthenia (weakness, increased fatigue, irritability, and attention and memory disorders) in cosmonauts after four months in space (Myasnikov& Zamaleddinov1996; Grigorieve, 1996 ) and believe that asthenia is one of the greater risks that will affect crews? optimal psychological functioning.

Sandoval, Luis↗

Analyzers Provide Water Security in Space and on Earth

Resourcefulness is a key quality for living in space, and on the International Space Station (ISS), that means making the most of water supplies. In 2008, the installation of the Water Processing Assembly (WPA) onboard the ISS allowed the space station s crew to do just that. The WPA purifies moisture from nearly every possible source - sweat, water vapor, wastewater, and even urine - for drinking and oxygen generation. Capable of producing 35 gallons of potable, recycled water a day, the system has reduced the need for water delivered to the ISS by over 1,000 gallons a year, saving significant payload costs in the process. As with any drinking water, quality is a concern, particularly when that water has been recycled. This is an issue of particular interest in space, where ISS crewmembers would have to deal with any illness far from the nearest medical personnel and facilities. The WPA employs sensors that monitor water quality by measuring its conductivity, and rounding out the system s quality assurance methods is a device developed for NASA by a private industry partner. That company has now made the technology available for ensuring the purity of water for consumption and industrial uses on Earth.

Source record↗

Fatigue‐Related Countermeasures for Long‐Duration Exploration Missions

The NASA Human Research Program's (HRP) Behavioral Health and Performance Element (BHP) supports and conducts research to mitigate deleterious outcomes related to fatigue, sleep loss, circadian desynchronization, and work overload. Objective evidence indicates that within the context of the International Space Station (ISS), sleep is reduced and there is circadian misalignment. Despite chronic sleep loss and high workloads; however, astronauts successfully complete their missions. Contributing to their success is not only the tremendous skills and capabilities of each astronaut, but also the collaborative team efforts amongst the crew, between flight and ground crews, and through real‐time care provided by medical personnel. It is anticipated that risks to human health and performance will increase in the context of exploration missions, where crewmembers will venture to deep space for extended durations and in small vehicles with limited communication with home. Hence, fatigue‐related countermeasures are being developed and/or validated that include unobtrusive monitoring technologies to detect fatigue‐related performance decrements, environmental countermeasures, and sleep education and training for flight and ground crews. Given that fatigue is an issue in current ISS missions, the BHP works collaboratively with Space Medicine operations to collect data in the operational environment, to validate fatigue-related countermeasures, and provide evidence‐based mitigations. Our presentation will summarize fatigue‐related operational research that is underway through NASA's BHP in partnership with its operational counterparts. Efforts include studies evaluating the effects of hypnotics, lighting protocols as countermeasures for circadian entrainment, and investigations involving education and training. This presentation will further identify, based on flight and terrestrial evidence, additional sleep and circadian countermeasures that may still be needed to support exploration missions. Lessons learned from transitioning research deliverables into ISS operations will also be discussed.

Whitmire, A.↗

Space Biology and Medicine: Space and Its Exploration - Volume I

Perhaps one of the greatest gifts that has been given to the people of the world in the last few hundred years has been an emerging sense of the place of our planet and its inhabitants within the context of the vast universe. Our knowledge of the rest of the universe has not come quickly, nor was the process of attaining it only recently begun; however, the unprecedented acceleration of that process has benefitted from a fundamental new aspect of our species that has only manifested itself in the last 30 years or so, the ability to travel in space. Before the space age, the Universe was studied only through observations from the Earth. All that has changed with the beginning of the space age. Machines built by humans have flown to all but one of the nine planets that revolve around our Sun, have ventured billions of miles from the Earth and looked back, and have landed on three other worlds. Spacecraft in orbit around the Earth have viewed the sky at a vast number of electromagnetic wavelengths, detecting the shape of the galaxy and the universe, and even measuring the remnants of the universe's beginning. Human explorers have ventured forth, first for short stays in orbit, then, later, walking upon the Moon and living for long periods in space. As they did so, billions of people on the Earth came to view the Earth in a fundamentally different way, not just as the familiar day to- day backdrop for their lives, but as a small oasis suspended in the night sky above an alien landscape. It is this new view of the Earth that is the true gift of space exploration. Space exploration has at once given us a new perspective on the value of our world, and a new perspective from which to understand how it operates. It has shown us that the Earth is by far the most precious place in the solar system in terms of supporting human life, while revealing that other destinations may still be compelling. The exploration of space has at once become a challenge for humanity to overcome and a path to our common future. But for humanity to embark on this path, we need to understand ourselves in a new environment. As such, an understanding of the biological consequences of and opportunities in space flight is essential. In this, the first volume of a joint U.S./Russian series on space biology and medicine, we describe the current status of our understanding of space and present general information that will prove useful when reading subsequent volumes. Since we are witnesses to the beginning of a new era of interplanetary travel, a significant portion of the first volume will concentrate on the physical and ecological conditions that exist in near and outer space, as well as heavenly bodies from the smallest ones to the giant planets and stars. While space exploration is a comparatively recent endeavor, its foundations were laid much more than 30 years ago, and its history has been an eventful one. In the first part of this volume, Rauschenbach, Sokolskiy, and Gurjian address the "Historical Aspects of Space Exploration" from its beginnings to a present-day view of the events of the space age. The nature of space itself and its features is the focus of the second section of the volume. In the first chapter of the part, "Stars and Interstellar Space," the origin and evolution of stars, and the nature of the portions of space most distant from Earth are described by Galeev and Marochnik. In Chapter 2, Pisarenko, Logachev, and Kurt in "The Sun and Interplanetary Space" bring us to the vicinity of our own solar system and provide a description and discussion of the nearest star and its influence on the space environment that our Earth and the other planets inhabit. In our solar system there are many fascinating objects, remnants of the formation of a rather ordinary star in a rather obscure portion of the galaxy. Historical accident has caused us to be much more curious (and knowledgeable) about "The Inner Planets of the Solar System" than about any of these other objects. In Chapter 3, Marov describes the planets Mercury, Venus, Earth, and Mars, their history and origin, and their environmental conditions, and in Chapter 4 Owen provides similar information about Jupiter, Saturn, Uranus, Neptune, and Pluto, "The Outer Planets of the Solar System." Morrison provides a thorough discussion of "Asteroids, Comets, and Other Small Bodies" in Chapter 5. The understanding of these relics of the formation of the solar system may form the center of our ability to understand the origin of solar systems in general, and of the critical role that the beginning of the solar system had on the prospects for the origin of life and its continued survival and evolution in the face of their recurrent impacts on Earth. In Chapter 6, the first chapter of the third part, Rummel describes the area of "Exobiology," the study of the origin, evolution, and distribution of life in the context of the origin and evolution of the universe. The same processes that have given rise to life on Earth may have given rise to life elsewhere. In Chapter 7, the "Earth and the Biosphere," the nature and function of the Earth are discussed as a specific instance of planetary and biological evolution. The effects of biological processes on the Earth under the influence of human activities are also addressed by Moore and Bartlett in Chapter 7. The final chapter in this section concerns the prospects that life in the universe may be widespread; "SETI," the Search for Extraterrestrial Intelligence, by Billingham and Tarter, presents the arguments for conducting a search for evidence of life elsewhere in the galaxy, and describes the various methods proposed for conducting such a search. While SETI has a distinctly exploration al character, more direct means are available for exploring the solar system around us. The fourth part of the volume addresses this subject of space exploration. Considering the prospects for research on space biology and medicine, the means of providing "Access to Space" are described by Feoktistov and Briggs in Chapter 9. This chapter addresses carriers and launch systems, the unmanned and manned spacecraft that they loft into space, and the task of mission operations by which these precious vessels are monitored, navigated, and controlled. Despite the successes of the past and the capabilities of the present, it is clear that the study of space biology and medicine will be even more rewarding in the future than it has been to date. The work of the next few years that will be undertaken by the U.S. and Russia, both independently and jointly, will focus first on enabling greater capabilities in the exploration of space, and then on using the unique characteristics of the space environment to provide insight and greater understanding into biological systems, their behavior, development, and origin. The chapters of the first volume were written by leaders in their fields from the U.S. and Russia. The material presented summarizes our current understanding of space and its exploration. We understand that the first volume will be of interest not only to medical personnel and biologists, but also to general readers who want information about space beyond their own particular fields of expertise.

Nicogossian, Arnauld E.↗

Wearable Health Monitoring Systems

The shrinking size and weight of electronic circuitry has given rise to a new generation of smart clothing that enables biological data to be measured and transmitted. As the variation in the number and type of deployable devices and sensors increases, technology must allow their seamless integration so they can be electrically powered, operated, and recharged over a digital pathway. Nyx Illuminated Clothing Company has developed a lightweight health monitoring system that integrates medical sensors, electrodes, electrical connections, circuits, and a power supply into a single wearable assembly. The system is comfortable, bendable in three dimensions, durable, waterproof, and washable. The innovation will allow astronaut health monitoring in a variety of real-time scenarios, with data stored in digital memory for later use in a medical database. Potential commercial uses are numerous, as the technology enables medical personnel to noninvasively monitor patient vital signs in a multitude of health care settings and applications.

Bell, John↗

NEEMO 21: Tools, Techniques, Technologies and Training for Science Exploration

The 21st mission of the National Aeronautics and Space Administration (NASA) Extreme Environment Mission Operations (NEEMO) was a highly integrated operational field test and evaluation of tools, techniques, technologies, and training for science driven exploration during extravehicular activity (EVA). The mission was conducted in July 2016 from the Aquarius habitat, an underwater laboratory, off the coast of Key Largo in the Florida Keys National Marine Sanctuary. An international crew of eight (comprised of NASA and ESA astronauts, engineers, medical personnel, and habitat technicians) lived and worked in and around Aquarius and its surrounding reef environment for 16 days. The integrated testing (both interior and exterior objectives) conducted from this unique facility continues to support current and future human space exploration endeavors. Expanding on the scientific and operational evaluations conducted during NEEMO 20, the 21st NEEMO mission further incorporated a diverse Science Team comprised of planetary geoscientists from the Astromaterials Research and Exploration Science (ARES/XI) Division from the Johnson Space Center, marine scientists from the Department of Biological Sciences at Florida International University (FIU) Integrative Marine Genomics and Symbiosis (IMaGeS) Lab, and conservationists from the Coral Restoration Foundation. The Science Team worked in close coordination with the long-standing EVA operations, planning, engineering, and research components of NEEMO in all aspects of mission planning, development, and execution.

Graff, T.↗

An Unobtrusive System to Measure, Assess, and Predict Cognitive Workload in Real-World Environments

Across many careers, individuals face alternating periods of high and low attention and cognitive workload, which can result in impaired cognitive functioning and can be detrimental to job performance. For example, some professions (e.g., fire fighters, emergency medical personnel, doctors and nurses working in an emergency room, pilots) require long periods of low workload (boredom), followed by sudden, high-tempo operations during which they may be required to respond to an emergency and perform at peak cognitive levels. Conversely, other professions (e.g., air traffic controllers, market investors in financial industries, analysts) require long periods of high workload and multitasking during which the addition of just one more task results in cognitive overload resulting in mistakes. An unobtrusive system to measure, assess, and predict cognitive workload could warn individuals, their teammates, or their supervisors when steps should be taken to augment cognitive readiness. In this talk I will describe an approach to this problem that we have found to be successful across work domains including: (1) a suite of unobtrusive, field-ready neurophysiological, physiological, and behavioral sensors that are chosen to best suit the target environment; (2) custom algorithms and statistical techniques to process and time-align raw data originating from the sensor suite; (3) probabilistic and statistical models designed to interpret the data into the human state of interest (e.g., cognitive workload, attention, fatigue); (4) and machine-learning techniques to predict upcoming performance based on the current pattern of events, and (5) display of each piece of information depending on the needs of the target user who may or may not want to drill down into the functioning of the system to determine how conclusions about human state and performance are determined. I will then focus in on our experimental results from our custom functional near-infrared spectroscopy sensor, designed to operate in real-world environments to be worn comfortably (e.g., positioned into a baseball cap or a surgeons cap) to measure changes in brain blood oxygenation without adding burden to the individual being assessed.

workload collection↗

NASA Medical Response to Human Spacecraft Accidents

Manned space flight is risky business. Accidents have occurred and may occur in the future. NASA's manned space flight programs, with all their successes, have had three fatal accidents, one at the launch pad and two in flight. The Apollo fire and the Challenger and Columbia accidents resulted in a loss of seventeen crewmembers. Russia's manned space flight programs have had three fatal accidents, one ground-based and two in flight. These accidents resulted in the loss of five crewmembers. Additionally, manned spacecraft have encountered numerous close calls with potential for disaster. The NASA Johnson Space Center Flight Safety Office has documented more than 70 spacecraft incidents, many of which could have become serious accidents. At the Johnson Space Center (JSC), medical contingency personnel are assigned to a Mishap Investigation Team. The team deploys to the accident site to gather and preserve evidence for the Accident Investigation Board. The JSC Medical Operations Branch has developed a flight surgeon accident response training class to capture the lessons learned from the Columbia accident. This presentation will address the NASA Mishap Investigation Team's medical objectives, planned response, and potential issues that could arise subsequent to a manned spacecraft accident. Educational Objectives are to understand the medical objectives and issues confronting the Mishap Investigation Team medical personnel subsequent to a human space flight accident.

Patlach, Robert↗

Human Factors Assessment and Redesign of the ISS Respiratory Support Pack (RSP) Cue Card

The Respiratory Support Pack (RSP) is a medical pack onboard the International Space Station (ISS) that contains much of the necessary equipment for providing aid to a conscious or unconscious crewmember in respiratory distress. Inside the RSP lid pocket is a 5.5 by 11 inch paper procedural cue card, which is used by a Crew Medical Officer (CMO) to set up the equipment and deliver oxygen to a crewmember. In training, crewmembers expressed concerns about the readability and usability of the cue card; consequently, updating the cue card was prioritized as an activity to be completed. The Usability Testing and Analysis Facility at the Johnson Space Center (JSC) evaluated the original layout of the cue card, and proposed several new cue card designs based on human factors principles. The approach taken for the assessment was an iterative process. First, in order to completely understand the issues with the RSP cue card, crewmember post training comments regarding the RSP cue card were taken into consideration. Over the course of the iterative process, the procedural information was reorganized into a linear flow after the removal of irrelevant (non-emergency) content. Pictures, color coding, and borders were added to highlight key components in the RSP to aid in quickly identifying those components. There were minimal changes to the actual text content. Three studies were conducted using non-medically trained JSC personnel (total of 34 participants). Non-medically trained personnel participated in order to approximate a scenario of limited CMO exposure to the RSP equipment and training (which can occur six months prior to the mission). In each study, participants were asked to perform two respiratory distress scenarios using one of the cue card designs to simulate resuscitation (using a mannequin along with the hardware). Procedure completion time, errors, and subjective ratings were recorded. The last iteration of the cue card featured a schematic of the RSP, colors, borders, and simplification of the flow of information. The time to complete the RSP procedure was reduced by approximately three minutes with the new design. In an emergency situation, three minutes significantly increases the probability of saving a life. In addition, participants showed the highest preference for this design. The results of the studies and the new design were presented to a focus group of astronauts, flight surgeons, medical trainers, and procedures personnel. The final cue card was presented to a medical control board and approved for flight. The revised RSP cue card is currently onboard ISS.

Byrne, Vicky↗

Crew Medical Officer Training and Role of Ground Support for International Space Station (ISS) Operations

Medical systems supporting exploration-class missions to the Moon and Mars will require greater inflight medical decision-making autonomy. An understanding of current ISS training regimens for Crew Medical Officers (CMOs) as well as the role of ground support personnel in medical operations is needed to identify the starting point from which exploration medical system design must evolve in order to achieve inflight medical autonomy.

Rachel Richardson↗

Medical Simulations for Exploration Medicine

Medical simulation is a useful tool that can be used to train personnel, develop medical processes, and assist cross-disciplinary communication. Medical simulations have been used in the past at NASA for these purposes, however they are usually created ad hoc. A stepwise approach to scenario development has not previously been used. The NASA Exploration Medical Capability (ExMC) created a medical scenario development tool to test medical procedures, technologies, concepts of operation and for use in systems engineering (SE) processes.

Reyes, David↗

Medical Operation KC-135 Familiarization Flight

As new personnel join the Medical Operations Branch, it is critical that they understand the effects of microgravity on medical procedures, hardware, and supplies. The familiarization flight provided new personnel with a better understanding of the effects of microgravity on (1) medical procedures, (2) patient and rescuer restraint, (3) medical fluids, and (4) medical training for space flight. The flight process also provided experience in flight proposal preparation, flight test plan preparation and execution, and final report preparation. In addition, first time flyers gained insight on their performance level in microgravity for future flights.

Dawson, Chris↗

A Framework for Patient-Centered Pathways of Care for Radiopharmaceutical Therapy: An ASTRO Consensus Document

Radiopharmaceutical therapy (RPT) is an area of projected growth and importance with several agents in clinical use, new agents in late-phase clinical trials, and many others under testing and development. This article proposes a framework for developing pathways of care that can be broadly applied to all RPTs, representing the current status of RPT. It suggests foundational elements for many pathways of care for patients with cancer and concludes with areas in active development and the future horizon for RPT treatment centers. Developing a framework for patient-centered pathways of care is a critical step in establishing RPT as standard therapy for patients with a diverse spectrum of cancers. This expected increase in RPT treatment options will affect a much larger population of patients with complex cancer. It will also require enhanced coordination and collaboration among appropriately qualified personnel with diverse expertise in image acquisition, image interpretation, quantitative imaging, dosimetry calculation, radiation quality assurance and safety as well as oncology care and RPT-induced sequelae and response assessment. The essential role of this evolving RPT care team within multidisciplinary oncology care is a cornerstone of this framework for a patient-centered pathway of care for RPT. Given the status of current RPT practice and the horizon for future applications, this patient-centered pathway of care guidance is timely and should help inform future clinical RPT practice paradigms. A task force was recruited from the Theranostic Working Group of the American Society for Radiation Oncology (ASTRO) in May 2019 with equal representation from the nuclear medicine community. The task force expanded on a framework that was originally conceived by the Working Group for patient-centered care. This framework was developed to incorporate the strengths of both radiation oncologists and nuclear medicine physicians. The manuscript was then developed by the task force and posted on the ASTRO website for a 6-week public comment period ending in July 2020. Comments were adjudicated, and the draft was sent to external organizations for potential endorsement. This document was sent to the ASTRO Board of Directors in October 2020 for approval.

62 RADIOLOGY AND NUCLEAR MEDICINE↗