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NASA NTRS1996

Submaximal exercise VO2 and Qc during 30-day 6 degrees head-down bed rest with isotonic and isokinetic exercise training

BACKGROUND: Maintaining intermediary metabolism is necessary for the health and well-being of astronauts on long-duration spaceflights. While peak oxygen uptake (VO2) is consistently decreased during prolonged bed rest, submaximal VO2 is either unchanged or decreased. METHODS: Submaximal exercise metabolism (61 +/- 3% peak VO2) was measured during ambulation (AMB day-2) and on bed rest days 4, 11, and 25 in 19 healthy men (32-42 yr) allocated into no exercise (NOE, N = 5) control, and isotonic exercise (ITE, N = 7) and isokinetic exercise (IKE, N = 7) training groups. Exercise training was conducted supine for two 30-min periods per day for 6 d per week: ITE training was intermittent at 60-90% peak VO2; IKE training was 10 sets of 5 repetitions of peak knee flexion-extension force at a velocity of 100 degrees s-1. Cardiac output was measured with the indirect Fick CO2 method, and plasma volume with Evans blue dye dilution. RESULTS: Supine submaximal exercise VO2 decreased significantly (*p < 0.05) by 10.3%* with ITE and by 7.3%* with IKE; similar to the submaximal cardiac output decrease of 14.5%* (ITE) and 20.3%* (IKE), but different from change in peak VO2 (+1.4% with ITE and -10.2%* with IKE) and decrease in plasma volume of -3.7% (ITE) and -18.0%* (IKE). Reduction of submaximal VO2 during bed rest correlated 0.79 (p < 0.01) with submaximal Qc, but was not related to change in peak VO2 or plasma volume. CONCLUSION: Reduction in submaximal oxygen uptake during prolonged bed rest is related to decrease in exercise but not resting cardiac output; perturbations in active skeletal muscle metabolism may be involved.

NASA Discipline Regulatory Physiology↗
NASA NTRSDate not supplied

Spaceflight Associated Neuro-Ocular Syndrome: A Brief for Astronaut Candidates

INTRODUCTION: Spaceflight Associated Neuro-ocular Syndrome (SANS) was first described in 2011 as a clinical process involving degradation of visual acuity and structural changes of the eye when exposed to microgravity. This syndrome poses a risk to astronaut vision, safety, and mission performance, especially during extended-duration missions. The modern astronaut cohort is a diverse group of men and women including scientists, engineers, teachers, pilots, business professionals, and artists. Given their diverse backgrounds, it is imperative all crews are educated on SANS risks and potential countermeasures. This education must be comprehensive and easily understood, regardless of academic background or specific expertise. TOPIC: A PowerPoint was created to serve as a presentation and stand-alone educational aid for all astronaut candidates (ASCANS). This medium was chosen as it can be updated dynamically as new information emerges. The brief was split into sections to facilitate organized delivery of complex content in easy-to-understand components. Sections included descriptive statistics, signs and symptoms, outcomes, myths and ongoing research, countermeasures, ongoing surveillance, and unknown and future directions. More research is necessary in order to understand this syndrome, and without continued ASCAN participation in research, acquisition of data will not be possible. These efforts will become increasingly critical with deep space and exploration missions. APPLICATION: We recommend regular use of this brief for all ASCANS, and potentially veteran crewmembers, given the high risks and potentially poor outcomes associated with SANS. For ASCANS, recommendations include that this brief be provided at the start of their training, with a bi-annual refresher course for all astronauts. This ensures they are current on SANS information, given the dynamic nature of this syndrome. Additionally, this brief will be made available to all as a self-study aid, utilized as a refresher immediately prior to launch. It is anticipated that this brief will promote the health, safety, and wellbeing of professional and private crews alike, during and after long-duration spaceflight. RESOURCES: Brunstetter, T., Tarver, B., & Tsung, A. (2022, October). Spaceflight Associated Neuro-ocular Syndrome (Sans) and its Risk to Nasa Astronauts. JSC Aerospace Medicine Clerkship. Houston, TX; Lyndon B. Johnson Space Center. Laurie, S. S., Macias, B. R., Pardon, L. P., Brunstetter, T., Tarver, W. J., Gibson, C. R., Greenwald, S. H., Jasien, K. V., Mason, S., & Tsung, A. (2022). (rep.). Evidence Report: Risk of Spaceflight Associated Neuro-ocular Syndrome (SANS). Houston, TX: National Aeronautics and Space Administration. Mader, T. H., Gibson, C. R., Pass, A. F., Kramer, L. A., Lee, A. G., Fogarty, J., ... & Polk, J. D. (2011). Optic disc edema, globe flattening, choroidal folds, and hyperopic shifts observed in astronauts after long-duration space flight. Ophthalmology, 118(10), 2058-2069. LEARNING OBJECTIVES: • The audience will be able to describe current Spaceflight Associated Neuro-ocular Syndrome (SANS) findings, significance, and countermeasures. • The audience will understand the importance of astronauts’ familiarity with SANS prior to flying and the large risks associated with this syndrome. CME QUESTIONS (3 QUESTIONS, MULTIPLE CHOICE A-D): 1. What is the approximate prevalence rate of SANS in astronauts? A. 22% B. 50% C. 66% D. 80% Answer: C. 2. Which of the ocular findings are NOT associated with SANS? A. Optic disc edema B. Retinal detachment C. Globe flattening D. Chorioretinal folds Answer: B. 3. Which of the following diagnostic technologies are NOT available in-flight? A. Ocular ultrasound B. Retinal photography C. MRI Orbit D. Optical Coherence Tomography (OCT) Answer: C.

Sara Stroble Mason↗
NASA NTRS1987

Autogenic-feedback training: A preventive method for space adaptation syndrome

The progress made to date on the reduction of data for Spacelab 3 Shuttle experiment, No. 3AFT23 is reported. Four astronauts participated as subjects in this experiment. Crewmen A and B served as treatment subjects (i.e., received preflight training for control of their own motion sickness symptoms) and Crewmen C and D served as control (i.e., did not receive training). A preliminary evaluation of Autogenic Feedback Training (AFT) was made from visual inspections of graphs that were generated from the preflight and inflight and inflight physiological data which included: (1) Baseline rotating chair tests for all crewmen; (2) Posttraining rotating chair tests of treatment groups subjects; (3) Preflight data from Joint Integrated Simulations for all crewmen; and (4) Flight data for all crewmen during mission days 0 through 4, and mission day 6 for treatment subjects only. A summary of the findings suggested by these data is outlined.

Cowings, Patricia S.↗
NASA NTRS2010

Training Enhances Both Locomotor and Cognitive Adaptability to a Novel Sensory Environment

During adaptation to novel gravitational environments, sensorimotor disturbances have the potential to disrupt the ability of astronauts to perform required mission tasks. The goal of this project is to develop a sensorimotor adaptability (SA) training program to facilitate rapid adaptation. We have developed a unique training system comprised of a treadmill placed on a motion-base facing a virtual visual scene that provides an unstable walking surface combined with incongruent visual flow designed to enhance sensorimotor adaptability. The goal of our present study was to determine if SA training improved both the locomotor and cognitive responses to a novel sensory environment and to quantify the extent to which training would be retained. Methods: Twenty subjects (10 training, 10 control) completed three, 30-minute training sessions during which they walked on the treadmill while receiving discordant support surface and visual input. Control subjects walked on the treadmill but did not receive any support surface or visual alterations. To determine the efficacy of training all subjects performed the Transfer Test upon completion of training. For this test, subjects were exposed to novel visual flow and support surface movement, not previously experienced during training. The Transfer Test was performed 20 minutes, 1 week, 1, 3 and 6 months after the final training session. Stride frequency, auditory reaction time, and heart rate data were collected as measures of postural stability, cognitive effort and anxiety, respectively. Results: Using mixed effects regression methods we determined that subjects who received SA training showed less alterations in stride frequency, auditory reaction time and heart rate compared to controls. Conclusion: Subjects who received SA training improved performance across a number of modalities including enhanced locomotor function, increased multi-tasking capability and reduced anxiety during adaptation to novel discordant sensory information. Trained subjects maintained their level of performance over six months.

Bloomberg, J. J.↗
NASA NTRS2013

Clinical Practice Guideline for Vitamin D

Vitamin D and its metabolites have clinical significance because they play a critical function in calcium homeostasis and bone metabolism. Although not all of the pathologic mechanisms have been adequately described, vitamin D insufficiency and deficiency, as measured by low levels of 25-OH vitamin D, are associated with a variety of clinical conditions including osteoporosis, falls and fractures in the elderly, decreased immune function, bone pain, and possibly colon cancer and cardiovascular health.2 Apart from inadequate dietary intake, patients may present with low levels of vitamin D if they receive inadequate sunlight. The astronaut population is potentially vulnerable to low levels of vitamin D for several reasons. Firstly, they may train for long periods in Star City, Russia, which by virtue of its northern latitude receives less sunlight in winter months. Secondly, astronauts are deprived of sunlight while aboard the International Space Station (ISS). In addition, ISS crew members are exposed to microgravity for prolonged durations and are likely to develop low bone mineral density despite the use of countermeasures. Therefore, closely monitoring and maintaining adequate vitamin D levels is important for the astronaut corps.

Tarver, William J.↗
NASA NTRSDate not supplied

Immersive Technologies for Human-in-the-Loop Lunar Surface Simulations

NASA, the National Aeronautics and Space Administration, continually seeks innovative solutions to enhance its operations, particularly in the realms of testing, evaluation, and training for future missions. Immersive technologies, such as virtual, augmented, and mixed reality have proven to be powerful tools for realistic, interactive, and engaging environments. This paper explores how the Simulation and Graphics Branch at NASA’s Johnson Space Center (JSC) leverages immersive technology, modern commercial rendering engines, and physics-based systems simulations to develop human-in-the-loop systems for humanity’s return to the Moon through the Artemis program. When NASA returns to the Moon, astronauts will travel to the Moon’s South Pole where lighting conditions will cause a more complex operational environment. Human-in-the-loop testing plays a crucial role in NASA's mission planning, spacecraft and space systems development, and evaluation of operational scenarios. The development of immersive environments such as a lunar rover mockup at a video wall enables engineers and astronauts to simulate and experience mission scenarios, integrated spacecraft systems, and operational procedures in a relevant environment before deployment. By integrating realistic virtual environments, immersive technology allows for the visualization and interaction with virtual spacecraft models, mission landscapes, and complex operational tasks. This approach helps identify potential design flaws, operational challenges, and safety considerations. It also provides valuable insights for risk reduction and helps improve mission efficiency and effectiveness. With advanced motion tracking systems and custom virtual environments data can be gathered and evaluated to help NASA refine training protocols, develop specialized training procedures and optimize human-robotic interactions for future space missions. Furthermore, immersive technology offers opportunities for future training initiatives at NASA. The Virtual Reality Laboratory at JSC has pioneered training with Virtual Reality (VR) since the Hubble Space Telescope repair missions in the early 1990’s. Extended Reality (XR) simulations enable astronauts to rehearse complex spacewalks, spacecraft maneuvers, and extravehicular activities in a safe and controlled environment. By replicating the physical and cognitive challenges of space missions, immersive training experiences enhance astronauts' situational awareness, decision-making abilities, and adaptability to unexpected scenarios. Additionally, immersive technology facilitates collaborative training, allowing geographically dispersed crew and mission control personnel to engage in synchronized simulations, fostering teamwork and effective communication. The adoption of immersive technology in NASA's testing, evaluation, and future training programs has yielded significant benefits. By incorporating human-in-the-loop testing for studies involving Extra Vehicular Activities (EVA), surface mobility and landing systems, NASA can identify and mitigate risks, optimize operational procedures, and enhance mission success. Ultimately, immersive training experiences can empower astronauts to better navigate the complexities of space missions, ensuring their safety, productivity, and success in the dynamic and challenging environments they will experience at the Lunar South Pole.

Simulation Modeling Virtual Reality Immersive Tech↗
NASA NTRS2010

Commercial Spacewalking: Designing an EVA Qualification Program for Space Tourism

In the near future, accessibility to space will be opened to anyone with the means and the desire to experience the weightlessness of microgravity, and to look out upon both the curvature of the Earth and the blackness of space, from the protected, shirt-sleeved environment of a commercial spacecraft. Initial forays will be short-duration, suborbital flights, but the experience and expertise of half a century of spaceflight will soon produce commercial vehicles capable of achieving low Earth orbit. Even with the commercial space industry still in its infancy, and manned orbital flight a number of years away, there is little doubt that there will one day be a feasible and viable market for those courageous enough to venture outside the vehicle and into the void, wearing nothing but a spacesuit, armed with nothing but preflight training. What that Extravehicular Activity (EVA) preflight training entails, however, is something that has yet to be defined. A number of significant factors will influence the composition of a commercial EVA training program, but a fundamental question remains: 'what minimum training guidelines must be met to ensure a safe and successful commercial spacewalk?' Utilizing the experience gained through the development of NASA's Skills program - designed to qualify NASA and International Partner astronauts for EVA aboard the International Space Station - this paper identifies the attributes and training objectives essential to the safe conduct of an EVA, and attempts to conceptually design a comprehensive training methodology meant to represent an acceptable qualification standard.

Gast, Matthew A.↗
NASA NTRS1999

Visual Orientation in Unfamiliar Gravito-Inertial Environments

The goal of this project is to better understand the process of spatial orientation and navigation in unfamiliar gravito-inertial environments, and ultimately to use this new information to develop effective countermeasures against the orientation and navigation problems experienced by astronauts. How do we know our location, orientation, and motion of our body with respect to the external environment ? On earth, gravity provides a convenient "down" cue. Large body rotations normally occur only in a horizontal plane. In space, the gravitational down cue is absent. When astronauts roll or pitch upside down, they must recognize where things are around them by a process of mental rotation which involves three dimensions, rather than just one. While working in unfamiliar situations they occasionally misinterpret visual cues and experience striking "visual reorientation illusions" (VRIs), in which the walls, ceiling, and floors of the spacecraft exchange subjective identities. VRIs cause disorientation, reaching errors, trigger attacks of space motion sickness, and potentially complicate emergency escape. MIR crewmembers report that 3D relationships between modules - particularly those with different visual verticals - are difficult to visualize, and so navigating through the node that connects them is not instinctive. Crew members learn routes, but their apparent lack of survey knowledge is a concern should fire, power loss, or depressurization limit visibility. Anecdotally, experience in mockups, parabolic flight, neutral buoyancy and virtual reality (VR) simulators helps. However, no techniques have been developed to quantify individual differences in orientation and navigation abilities, or the effectiveness of preflight visual. orientation training. Our understanding of the underlying physiology - for example how our sense of place and orientation is neurally coded in three dimensions in the limbic system of the brain - is incomplete. During the 16 months that this human and animal research project has been underway, we have obtained several results that are not only of basic research interest, but which have practical implications for the architecture and layout of spacecraft interiors and for the development of astronaut spatial orientation training countermeasures.

Oman, Charles M.↗
NASA NTRS1995

Effects of Space Missions on the Human Immune System: A Meta-Analysis

Future spaceflight will require travelers to spend ever-increasing periods of time in microgravity. Optimal functioning of the immune system is of paramount importance for the health and performance of these travelers. A meta-analysis statistical procedure was used to analyze immune system data from crew members in United States and Soviet space missions from 8.5 to 140 days duration between 1968 and 1985. Ten immunological parameters (immunoglobulins A, G, M, D, white blood cell (WBC) count, number of lymphocytes, percent total lymphocytes, percent B lymphocytes, percent T lymphocytes, and lymphocyte reactivity to mitogen) were investigated using multifactorial, repeated measure analysis of variance. With the preflight level set at 100, WBC count increased to 154 +/- 14% (mean +/- SE; p less than or equal to 0.05) immediately after flight; there was a decrease in lymphocyte count (83 +/- 4%; p less than or equal to 0.05) and percent of total lymphocytes (69 +/- 1%; p less than or equal to 0.05) immediately after flight, with reduction in RNA synthesis to phytohemagglutinin (PHA) to 51 +/- 21% (p less than or equal to 0.05) and DNA synthesis to PHA to 61 +/- 8% (p less than or equal to 0.05) at the first postflight measurement. Thus, some cellular immunological functions are decreased significantly following spaceflight. More data are needed on astronauts' age, aerobic power output, and parameters of their exercise training program to determine if these immune system responses are due solely to microgravity exposure or perhaps to some other aspect of spaceflight.

Greenleaf, J. E.↗
NASA NTRS2000

Vision Aspects of Space Flight

Vision, being one of our most important senses, is critically important in the unique working environment of space flight. Critical evaluation of the astronauts visual system begins with pre-selection examinations resulting in an average of 65% of all medical disqualification's caused by ocular findings. With an average age of 42, approximately 60% of the astronaut corps requires vision correction. Further demands of the unique training and working environment of microgravity, variable lighting from very poor to extreme brightness of sunlight and exposure to extremes of electromagnetic energy results in unique eyewear and contact lens applications. This presentation will describe some of those unique eyewear and contact lens applications used in space flight and training environments. Additionally, ocular findings from 26 shuttle and 5 MIR mission post-flight examinations will be presented.

Manuel, Keith↗
NASA NTRS2000

Clinical Space Medicine Panel

The practice of space medicine is diverse. It includes routine preventive medical care of astronauts and pilots, the development of inflight medical capability and training of flight crews as well as the preflight, inflight, and postflight medical assessment and monitoring. The Johnson Space Center Medical Operations Branch is a leader in the practice of space medicine. The papers presented in this panel will demonstrate some of the unique aspects of space medicine.

Baisden, Denise L.↗
NASA NTRS1991

Tethered Satellite System (TSS-1) (STS Flight 46): System Description - Volume 2

This Document Has Been Prepared to: 1) Provide an In-Depth System Description for Technical Reviews and Briefings By NASA and Martin Marietta Astronautics Group (MMAG) Personnel; and 2) Provide TSS-1 Familiarization Training for New Personnel Who Are Assigned to the NASA and MMAG Project for Future Missions.

Source record↗
NASA NTRS2002

An expert system for fault management assistance on a space sleep experiment

The expert system, Principal Investigator-in-a-box, or [PI], was designed to assist astronauts or other operators in performing experiments outside their expertise. Currently, the software helps astronauts calibrate instruments for a Sleep and Respiration Experiment without contact with the investigator on the ground. It flew on the Space Shuttle missions STS-90 and STS-95. [PI] displays electrophysiological signals in real time, alerts astronauts via the indicator lights when a poor signal quality is detected, and advises astronauts how to restore good signal quality. Thirty subjects received training on the sleep instrumentation and the [PI] interface. A beneficial effects of [PI] and training reduced troubleshooting time. [PI] benefited subjects on the most difficult scenarios, even though its lights were not 100% accurate. Further, questionnaires showed that most subjects preferred monitoring waveforms with [PI] assistance rather than monitoring waveforms alone. This study addresses problems of complex troubleshooting and the extended time between training and execution that is common to many human operator situations on earth such as in power plant operation, and marine exploration.

NASA Discipline Neuroscience↗
NASA NTRS2010

Public Participation in Earth Science from the ISS

The Gateway to Astronaut Photography of Earth (GAPE) is an online database (http://eol.jsc.nasa.gov) of terrestrial astronaut photography that enables the public to experience the astronaut s view from orbit. This database of imagery includes all NASA human-directed missions from the Mercury program of the early 1960 s to the current International Space Station (ISS). To date, the total number of images taken by astronauts is 1,025,333. Of the total, 621,316 images have been "cataloged" (image geographic center points determined and descriptive metadata added). The remaining imagery provides an opportunity for the citizen-scientist to become directly involved with NASA through cataloging of astronaut photography, while simultaneously experiencing the wonder and majesty of our home planet as seen by astronauts on board the ISS every day. We are currently developing a public cataloging interface for the GAPE website. When complete, the citizen-scientist will be able to access a selected subset of astronaut imagery. Each candidate will be required to pass a training tutorial in order to receive certification as a cataloger. The cataloger can then choose from a selection of images with basic metadata that is sorted by difficulty levels. Some guidance will be provided (template/pull down menus) for generation of geographic metadata required from the cataloger for each photograph. Each cataloger will also be able to view other contributions and further edit that metadata if they so choose. After the public inputs their metadata the images will be posted to an internal screening site. Images with similar geographic metadata and centerpoint coordinates from multiple catalogers will be reviewed by NASA JSC Crew Earth Observations (CEO) staff. Once reviewed and verified, the metadata will be entered into the GAPE database with the contributors identified by their chosen usernames as having cataloged the frame.

Willis, Kimberly J.↗
NASA NTRS2016

Development of a Protocol to Test Proprioceptive Utilization as a Predictor for Sensorimotor Adaptability

Astronauts returning from space flight show significant inter-subject variations in their abilities to readapt to a gravitational environment because of their innate sensory weighting. The ability to predict the manner and degree to which each individual astronaut will be affected would improve the effectiveness of countermeasure training programs designed to enhance sensorimotor adaptability. We hypothesize participant's ability to utilize individual sensory information (vision, proprioception and vestibular) influences adaptation in sensorimotor performance after space flight. The goal of this study is to develop a reliable protocol to test proprioceptive utilization in a functional postural control task. Subjects "stand" in a supine position while strapped to a backpack frame holding a friction-free device using air-bearings that allow the subject to move freely in the frontal plane, similar to when in upright standing. The frame is attached to a pneumatic cylinder, which can provide different levels of a gravity-like force that the subject must balance against to remain "upright". The supine posture with eyes closed ensures reduced vestibular and visual contribution to postural control suggesting somatosensory and/or non-otolith vestibular inputs will provide relevant information for maintaining balance control in this task. This setup is called the gravity bed. Fourteen healthy subjects carried out three trials each with eyes open alternated with eyes closed, "standing" on their dominant leg in the gravity bed environment while loaded with 60 percent of their body weight. Subjects were instructed to: "use your sense of sway about the ankle and pressure changes under the foot to maintain balance." Maximum length of a trial was 45 seconds. A force plate underneath the foot recorded forces and moments during the trial and an inertial measurement unit (IMU) attached on the backpack's frame near the center of mass of the subject recorded upper body postural responses. Series of linear and non-linear analyses were carried out on several force plate and IMU data including stabilogram diffusion analysis on the center of pressure (COP) to find a subset of parameters that were sensitive to detect differences in postural performance between eyes open and closed conditions. Results revealed that seven parameters (root mean square (RMS) of medio-lateral (ML) COP, range of ML COP, RMS of roll moment, range of trunk roll, minimum time-to-boundary (TTB), integrated TTB, and critical mean square planar displacement (delta r (sup 2) (sub c)) were significantly different between eyes open and closed conditions. We will present data to show the efficacy of using performance in single leg stance with eyes closed on the gravity bed to assess individuals' ability to utilize proprioceptive information in a functional postural control task to predict re-adaptation for sensorimotor and functional performance.

Goel, R.↗
NASA NTRSDate not supplied

Spaceflight Food System Impacts to Nutritional Adequacy, Health, Performance, and Resources in Space Exploration

Despite high physical standards and training protocols, physiological and behavioral decrements have been documented in astronauts on both short (1-2 weeks) and long (6+ month) missions in spaceflight, including dysregulation of the immune system, cardiovascular and musculoskeletal deconditioning, ophthalmic changes, weight loss, and increased stress and fatigue. Optimizing food and nutrition intakes are key underpinnings for the proper function and performance of all physiological systems and the resulting physical and behavioral health and performance outcomes of astronauts. Much has been learned about the role of nutrition in human health on Earth over the past hundred years, from the identity and role of specific vitamins to the importance of the quantities of some nutrients to immune function. The requirements for providing adequate nutrition to astronauts seem obvious. However, providing a safe, reliable, and nutritious food system for space exploration missions remains a challenge. In fact, food is one of the greatest resource and logistical challenges, which is part of why it remains a “red” risk for Mars missions.

Grace L Douglas↗
NASA NTRS2005

An operational approach to long-duration mission behavioral health and performance factors

NASA's participation in nearly 10 yr of long-duration mission (LDM) training and flight confirms that these missions remain a difficult challenge for astronauts and their medical care providers. The role of the astronaut's crew surgeon is to maximize the astronaut's health throughout all phases of the LDM: preflight, in flight, and postflight. In support of the crew surgeon, the NASA-Johnson Space Center Behavioral Health and Performance Group (JSC-BHPG) has focused on four key factors that can reduce the astronaut's behavioral health and performance. These factors are defined as: sleep and circadian factors; behavioral health factors; psychological adaptation factors; and human-to-system interface (the interface between the astronaut and the mission workplace) factors. Both the crew surgeon and the JSC-BHPG must earn the crewmember's trust preflight to encourage problem identification and problem solving in these four areas. Once on orbit, the crew medical officer becomes a valuable extension of the crew surgeon and BHPG on the ground due to the crew medical officer's constant interaction with crewmembers and preflight training in these four factors. However, the crew surgeon, BHPG, and the crew medical officer need tools that will help predict, prevent, monitor, and respond to developing problems. Objective data become essential when difficult mission termination decisions must be made. The need for behavioral health and performance tool development creates an environment rich for collaboration between operational healthcare providers and researchers. These tools are also a necessary step to safely complete future, more autonomous exploration-class space missions.

Review↗