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JSC Pharmacy Services for Remote Operations

The Johnson Space Center Pharmacy began operating in March of 2003. The pharmacy serves in two main capacities: to directly provide medications and services in support of the medical clinics at the Johnson Space Center, physician travel kits for NASA flight surgeon staff, and remote operations, such as the clinics in Devon Island, Star City and Moscow; and indirectly provide medications and services for the International Space Station and Space Shuttle medical kits. Process changes that occurred and continued to evolve in the advent of the installation of the new JSC Pharmacy, and the process of stocking medications for each of these aforementioned areas will be discussed. Methods: The incorporation of pharmacy involvement to provide services for remote operations and supplying medical kits was evaluated. The first step was to review the current processes and work the JSC Pharmacy into the existing system. The second step was to provide medications to these areas. Considerations for the timeline of expiring medications for shipment are reviewed with each request. The third step was the development of a process to provide accountability for the medications. Results: The JSC Pharmacy utilizes a pharmacy management system to document all medications leaving the pharmacy. Challenges inherent to providing medications to remote areas were encountered. A process has been designed to incorporate usage into the electronic medical record upon return of the information from these remote areas. This is an evolving program and several areas have been identified for further improvement.

Stoner, Paul S.↗

USSR Space Life Sciences Digest, issue 2

The second issue of the bimonthly digest of USSR Space Life Sciences is presented. Abstracts are included for 39 Soviet periodical articles in 16 areas of aerospace medicine and space biology and published in Russian during the first half of 1985. Selected articles are illustrated with figures from the original. Translated introductions and tables of contents for 14 Russian books on 11 topics related to NASA's life science concerns are presented. Areas covered are: adaptation, biospheric, body fluids, botany, cardiovascular and respiratory systems, cybernetics and biomedical data processing, gastrointestinal system, group dynamics, habitability and environmental effects, health and medical treatment, hematology, immunology, life support systems, metabolism, musculoskeletal system, neurophysiology, psychology, radiobiology, and space biology. Two book reviews translated from Russian are included and lists of additional relevant titles available either in English or in Russian only are appended.

Hooke, L. R.↗

Space shuttle operations at the NASA Kennedy Space Center: the role of emergency medicine

The Division of Emergency Medicine at the University of Florida coordinates a unique program with the NASA John F. Kennedy Space Center (KSC) to provide emergency medical support (EMS) for the United States Space Transportation System. This report outlines the organization of the KSC EMS system, training received by physicians providing medical support, logistic and operational aspects of the mission, and experiences of team members. The participation of emergency physicians in support of manned space flight represents another way that emergency physicians provide leadership in prehospital care and disaster management.

Emergency Medicine/education/organization & admini↗

The medical story

An overview of the Skylab medical program is given. All medical subsystems provided in the orbital workshop functioned satisfactorily. Major systems included the food system, the waste management system, and provisions per personal hygiene. A series of lockers in the wardroom was used to stow the inflight medical support system. Cardiovascular counter pressure garments were launched in the orbital workshop for all three crews. Life services experiments were carried out. Two experiments were conducted in the Skylab missions to study the performance of the cardiovascular system during weightless flight and return to earth and the one g environment. A series of experiments was conducted to study mineral balance and the bioassay of body fluids.

Johnston, R. S.↗

Rewet Temperature Correlations for Liquid-Nitrogen Boiling Pipe Flows Across Varying Flow Conditions and Orientations

In many convective liquid-vapor phase change heat transfer engineering applications, cryogenic fluids are widely used in industrial processes, spacecraft and cryosurgery systems, and so on. For example, cryogens are usually used as liquid fuels such as liquid hydrogen and oxygen in the rocket industry, liquid nitrogen (LN2) and helium are frequently used to cool superconducting magnetic device for medical applications. In these systems, proper transport, handling, and storage of cryogenic fluids are of extreme importance. Among all the cryogenic transport processes performed in room temperatures, quenching, also termed chilldown, is a unavoidable initial, transient phase-change heat transfer process that brings the system down to the cryogenic condition. The Leidenfrost temperature or rewet temperature that signals the end of film boiling is practically considered the completion point of a quenching process. Therefore, rewet temperature has been considered the most important parameter for the engineering design of cryogenic thermal management systems. As most of the previous correlations for predicting the Leidenfrost temperature and the rewet temperature have been basically developed for water, they are shown to disagree with recent liquid nitrogen pipe chilldown experiments in upward and downward flow directions over a wide range of flow rates, pressures, and degrees of inlet subcooling. In addition to a complete review of the literature, two new correlations are presented in this work, one based on bubble growth and another based on the theoretical maximum limit of superheat. Each correlation performs well over the entire data set.

liquid nitrogen↗

Food Sanitation Device for Use in Microgravity

EDEN is a transportation/orbital habitat that carries large amounts of crew members, food, and supplies from Earth to Mars and back, but can also act as a permanent, simulated-1g-environment space station in Martian orbit. The focus of the project is to create a temporary, but long-term living environment that focuses on human health and food production. The project is composed of four major habitable parts (in addition to other major components). Moving from the center out, the first is a central core that acts as a hub that connects to the structural spokes, the main propulsion rockets and serves as a place for other spacecraft to dock onto, in addition to housing some of the basic station control, navigation and automated computer systems. The second set of parts are the spokes that connect the ring to the central core; these are the primary structural components with elevators in the middle carrying people from the ring to the core. The ‘lower’ portions, near the ring and it’s 1g environment, also act as storage centers. The third part is the 2-story outer ring This project served as an engineering senior design project at Temple University, and as part of NASA’s eXploration and Habitation (X-Hab) 2018 Academic Innovation Challenge. The goal of the project was to design, construct, and test a device which would be used in microgravity to sanitize produce. This is part of a NASA’s effort to grow and sanitize fresh produce on the International Space Station (ISS), in order to provide more nutritious meal options to the astronauts. Our team designed a 3-D printed spherical device with UV-C LEDs lining the interior. The designed device consists of an 8” spherical chamber, 10 UV-C LEDs, and a touchscreen user interface to control the device. Our design meets the project requirements by offering several features: a simple user interface, minimal crew time to operate, no waste produced, and the ability to sanitize multiple types of produce. The main reductions in Salmonella bacteria and Aspergillus Flavus mold were not verified. However, the aerobic plate count requirement was greatly exceeded and validated. Testing of the device resulted in visual results confirming significant decrease in E. coli activity with increased UV-C exposure, as well as quantitative results confirming significant reduction in CFU/g for the aerobic plate count. These reductions achieved from 1.464 x 10 7 to 2 x 10 4 CFU/g (2.86 log reduction) after 5 minutes, were significantly more than the requirements given by NASA ( of the craft, which holds all of the food production along with medical bays, a control center and a few parks. This ring also integrates the rigid keystone modules, which are the interface between the spokes, the expandable-construction portions of the ring and the habitation pods. The keystone modules also incorporate redundant, distributed ECLSS systems, medical storage, airlocks, and other integral station functions. The last parts are the habitation pods; these hold the sleeping quarters along with the bathrooms, showers, kitchen space and lounge areas. These expandable modules latch onto the keystone modules of the ring, which serves as a circulatory link between the different habitation pods.

Damien Gordon↗

ISS Medical Checklist Procedures Validation and Training

The Health Maintenance System (HMS) hardware will be used to support a medical contingency for the International Space Station (ISS). During two test flights, the procedures for performing Advanced Cardiac Life Support (ACLS) were evaluated to determine the required level of detail, assess the logic of the steps and division of tasks among crew members.

Tom Marshburn↗

The integration of system specifications and program coding

Experience in maintaining up-to-date documentation for one module of the large-scale Medical Literature Analysis and Retrieval System 2 (MEDLARS 2) is described. Several innovative techniques were explored in the development of this system's data management environment, particularly those that use PL/I as an automatic documenter. The PL/I data description section can provide automatic documentation by means of a master description of data elements that has long and highly meaningful mnemonic names and a formalized technique for the production of descriptive commentary. The techniques discussed are practical methods that employ the computer during system development in a manner that assists system implementation, provides interim documentation for customer review, and satisfies some of the deliverable documentation requirements.

Luebke, W. R.↗

Patient Monitoring

In photo above, the electrocardiogram of a hospitalized patient is being transmitted by telemetry. Widely employed in space operations, telemetry is a process wherein instrument data is converted to electrical signals and sent to a receiver where the signals are reconverted to usable information. In this instance, heart readings are picked up by the electrode attached to the patient's body and delivered by wire to the small box shown, which is a telemetry transmitter. The signals are relayed wirelessly to the console in the background, which converts them to EKG data. The data is displayed visually and recorded on a printout; at the same time, it is transmitted to a central control station (upper photo) where a nurse can monitor the condition of several patients simultaneously. The Patient Monitoring System was developed by SCI Systems, Inc., Huntsville, Alabama, in conjunction with Abbott Medical Electronics, Houston, Texas. In developing the system, SCI drew upon its extensive experience as a NASA contractor. The company applied telemetry technology developed for the Saturn launch vehicle and the Apollo spacecraft; instrumentation technology developed for heart, blood pressure and sleep monitoring of astronauts aboard NASA's Skylab long duration space station; and communications technology developed for the Space Shuttle.

Source record↗

Postlanding optimum designs for the assured crew return vehicle

The optimized preliminary engineering design concepts for postlanding operations of a water-landing Assured Crew Return Vehicle (ACRV) during a medical rescue mission are presented. Two ACRVs will be permanently docked to Space Station Freedom, fulfilling NASA's commitment to Assured Crew Return Capability in the event of an accident or illness. The optimized configuration of the ACRV is based on an Apollo command module (ACM) derivative. The scenario assumes landing a sick or injured crewmember on water with the possibility of a delayed rescue. Design emphasis is placed on four major areas. First is the design of a mechanism that provides a safe and time-critical means of removing the sick or injured crewmember from the ACRV. Support to the assisting rescue personnel is also provided. Second is the design of a system that orients and stabilizes the craft after landing so as to cause no further injury or discomfort to the already ill or injured crewmember. Third is the design of a system that provides full medical support to a sick or injured crewmember aboard the ACRV from the time of separation from the space station to rescue by recovery forces. Last is the design of a system that provides for the comfort and safety of the entire crew after splashdown up to the point of rescue. The four systems are conceptually integrated into the ACRV.

Hosterman, Kenneth C.↗

Supporting Crew Medical Decisions on Deep Space Missions: A Real-Time Performance Monitoring

Crewed missions into deep space will require astronauts to respond autonomously to safety- and time-critical anomalies. These and other potential issues will require the continuous monitoring and recognition of potentially subtle, but complex, anomalous data patterns. NASA continues to investigate real-time metrics for Extravehicular Operations1 and for providing feedback to improve performance2. Since it is unknown how long-term exposure to deep space will affect crew health, continuous monitoring of clinical and subclinical status is warranted. NASA is characterizing crew medical decision-support needs and identifying the recommended requirements of a Clinical Decision Support System (CDSS) within the Exploration Medical Capability Element (ExMC) of the Human Research Program3. Early detection, and continuous monitoring, of performance may provide an effective prognostic capability for assessing crew health state, and the identified requirements could be provided for an in-vehicle CDSS that acts as an assistant for delivering optimal health and performance and medical care during exploration missions. There is evidence to suggest that automatic, unobtrusive collection of keystroke features, such as alphanumeric key latencies, backspaces or typing rhythm, could be a valuable performance screening tool. Keystroke features show significant differences between control subjects and patients with overt clinical illness, such as multiple sclerosis4 and Parkinson’s disease5, as well as behavioral health and performance issues, such as mild cognitive impairment6 and depression7. This work is exploring a capability for the assessment of early task performance decline in crew as they perform daily activities. Timestamped keyboard entries are continuously collected and stored. Nominal keystroke interactions are compared to those obtained after exposure to spaceflight stressors, e.g., fatigue, to determine the methods sensitivity. This work will pave the way toward an objective detection tool that may be deployed in a spaceflight setting.

clinical↗

Designing for human presence in space: An introduction to environmental control and life support systems

Human exploration and utilization of space requires habitats to provide appropriate conditions for working and living. These conditions are provided by environmental control and life support systems (ECLSS) that ensure appropriate atmosphere composition, pressure, and temperature; manage and distribute water, process waste matter, provide fire detection and suppression; and other functions as necessary. The functions that are performed by ECLSS are described and basic information necessary to design an ECLSS is provided. Technical and programmatic aspects of designing and developing ECLSS for space habitats are described including descriptions of technologies, analysis methods, test requirements, program organization, documentation requirements, and the requirements imposed by medical, mission, safety, and system needs. The design and development process is described from initial trade studies through system-level analyses to support operation. ECLSS needs for future space habitats are also described. Extensive listings of references and related works provide sources for more detailed information on each aspect of ECLSS design and development.

Wieland, Paul↗

Implantable Wireless MEMS Sensors for Medical Uses

Sensors designed and fabricated according to the principles of microelectromechanical systems (MEMS) are being developed for several medical applications in outer space and on Earth. The designs of these sensors are based on a core design family of pressure sensors, small enough to fit into the eye of a needle, that are fabricated by a "dissolved wafer" process. The sensors are expected to be implantable, batteryless, and wireless. They would be both powered and interrogated by hand-held radio transceivers from distances up to about 6 in. (about 15 cm). One type of sensor would be used to measure blood pressure, particularly for congestive heart failure. Another type would be used to monitor fluids in patients who have hydrocephalus (high brain pressure). Still other types would be used to detect errors in delivery of drugs and to help patients having congestive heart failure.

Chimbayo, Alexander↗

Inflight Medical Events in the Shuttle Program

Since the first launch of the Space Shuttle in 1981, the astronauts and their flight surgeons have dealt with a variety of inflight medical issues. A review will be provided of these issues as well as medications used in the treatment of these medical problems. Detailed medical debriefs are conducted by the flight ,surgeon with the individual crewmembers three days after landing. These debriefs were review for Shuttle flights from 1988 through 1999 to determine the frequency of inflight medical events. Medical events were grouped by ICD category and the frequency of medical events within those categories were reviewed. The ICD category of Symptoms, Signs and Ill-defined Conditions had the most medical events. Facial fullness and headache were the most common complaints within this category. The ICD category of Respiratory System had the next most common medical events with sinus congestion being the most common complaint. This was followed by Digestive System complaints and Nervous System/Sense Organ complaints. A variety of inflight medical events have occurred throughout the Shuttle program. Fortunately, the majority of these problems have been minor and have been well within the capability of the medical equipment flown and the skills of the Crew Medical Officers. Medical ,problems/procedures that are routine on the ground often present unique problems in the space flight environment. It is important that the flight surgeon understand the common medical problems encountered.

Baisden, Denise L.↗

Dextroamphetamine: a pharmacologic countermeasure for space motion sickness and orthostatic dysfunction

Dextroamphetamine has potential as a pharmacologic agent for the alleviation of two common health effects associated with microgravity. As an adjuvant to Space Motion Sickness (SMS) medication, dextroamphetamine can enhance treatment efficacy by reducing undesirable Central Nervous System (CNS) side effects of SMS medications. Secondly, dextroamphetamine may be useful for the prevention of symptoms of post-mission orthostatic intolerance caused by cardiovascular deconditioning during spaceflight. There is interest in developing an intranasal delivery form of dextroamphetanmine for use as a countermeasure in microgravity conditions. Development of this dosage form will require an analytical detection method with sensitivity in the low ng range (1 to 100 ng/mL). During the 1995 Summer Faculty Fellowship Program, two analytical methods were developed and evaluated for their suitability as quantitative procedures for dextroamphetamine in studies of product stability, bioavailability assessment, and pharmacokinetic evaluation. In developing some of the analytical methods, beta-phenylethylamine, a primary amine structurally similar to dextroamphetamine, was used. The first analytical procedure to be evaluated involved hexane extraction and subsequent fluorescamine labeling of beta-phenylethylamine. The second analytical procedure to be evaluated involved quantitation of dextroamphetamine by an Enzyme-Linked ImmunoSorbent Assay (ELISA).

Snow, L. Dale↗

NASA Electric Vertical Takeoff and Landing (eVTOL) Aircraft Technology for Public Services – A White Paper

History has shown that our personal life is highly dependent on the technology that people have developed. A strategic scan of the aerospace environment at the beginning of the 21st century strongly suggests that the world might be approaching a new age of airpower—the era of electrified/hybrid aircraft propulsion. Undeniably, starting from the Montgolfier Brothers balloon flight in 1783, to the Wright Brothers piston engine flight in 1903, and the jet engine of the 1960s, or the space age of today, one can say that leaps in propulsion technology have marked the different ages of human flight. The technological advancements, brought at the beginning of 21st century by the revolution in data exchange, computational power, sensors, wireless communication, internet, and autonomy, contributed to the vision of this new age of propulsion we are approaching. Historically, conventional vertical takeoff and landing (VTOL) aircraft have been equipped with propulsion units relying on complex internal combustion machines (turbines, piston engines, for example), and complex mechanical arrangements (gearboxes, shafts, variable pitch propeller). By contrast, electric VTOL aircraft (eVTOL)1 rely on simpler propulsion units (electric motors and in some cases fixed-pitch propellers). This promotes redundancy and improves tolerance to failures, in turn improving safety. The use of simpler electric propulsion units should also allow significant acquisition and operating cost reductions. Whether full-electric (relying solely on batteries) or hybrid-electric (relying on a combination of batteries, fuel-powered engines, and generators.), eVTOLs are also expected to generate less noise and air pollution than conventional aircraft with similar payloads. According to the 2019 Annual Review of IATA (International Air Transport Association) [ref.1], due to an expected increase in air transport traffic by 5% every year and a doubling of air transport passenger numbers to 8.2 billion by 2037 significant challenges are posed to the aviation industry. Furthermore, this report does not factor in the expected demand for short-range (intra-city) air transportation, which is in development and yet to be operational. The increased demand to fly creates a responsibility to expand in a sustainable manner and an endeavor to develop more environmentally-friendly aircraft. eVTOL aircraft, either piloted or autonomous, is gathering considerable interest worldwide. Modern and novel full-electric or hybrid-electric eVTOL configurations enable a new paradigm shift in air transportation as the aviation industry remains committed to its goals of carbon-neutral growth from 2020 onwards and cutting CO2 emissions to half 2005 levels by 2050. While electric power has been used for decades, recent developments in mobile electric/hybrid propulsion coupled with advanced materials and autonomous systems may create the possibility to transition into the next age of air mobility propelled by electric/hybrid VTOL aircraft technology. Although eVTOL aircraft might seem like an incremental improvement or even a counterintuitive regression with regard to past VTOL development, it has in fact the potential to transform air mobility across a wide range of government applications. Previous transformations in aviation generated dramatic leaps in performance, but the cost was commensurate with performance, limiting quantity produced. This next age appears to take a different approach. Performance may not increase, but at this moment technology is poised for future urban mobility that will spawn commercial passenger drone services, that is, autonomous (pilotless) air taxis and thereby add a new dimension to the urban transportation mix of the future [ref. 2]. Advances in electric propulsion, autonomous flight technology, and 5G communication networks will enable this fast new-growing market to become a reality. It is now time to envision the introduction of electric/hybrid eVTOL aircraft for Public Services2. We believe that in the next decades eVTOL aircraft will have the potential to become an essential tool to Public Service agencies around the world in applications such as firefighting, public safety, search and rescue, disaster relief and law enforcement. This is due to several major factors. • First, with the increasing popularity of small, unmanned aircraft vehicles (UAVs) or drones, many companies today are focusing on the development of passenger UAVs designed to accommodate up to five passengers or equivalent cargo payload. Many such configurations are electric or hybrid-electric designs with VTOL capabilities. Several of these projects have started a flight test program and many more are expected to be in the experimental and development phase in 2020. Such revolutionary vehicles could be in commercial operations by 2030. These eVTOL systems could be ready for selected Public Services missions even sooner. • Second, although these advanced eVTOL vehicles under development still need access to fuel (hybrid) and/or electric charging capability, they can take off and land from almost anywhere. Therefore, such vehicles, both manned and unmanned can be successfully integrated for the critical missions of the Public Services with extra deployment flexibilities. • Third, advancement in electric propulsion systems in the automotive industry together with NASA’s leading efforts in electrification of aircraft propulsion systems, FAA’s ongoing active eVTOL certification programs, and EASA’s proposed framework for the certification of electric/hybrid small category VTOL aircraft in Europe [ref. 3] will help accelerate industry electric propulsion system development and integration. • Finally, eVTOL vehicles could be deployed for Public Services sooner than air taxi or other commercial applications, since Public Services missions may be more easily approved based on specific mission criteria, localized airworthiness authority for public-use aircraft3, and are normally operating under centralized airspace management and control by the theater command. Moreover, public perception and acceptance are generally less of a concern when operations save lives and benefit the wider community. The prioritized introduction of eVTOL aircraft in Public Services is ambitious, but we believe it is achievable in the coming decades if fundamental enablers (people and technologies) are engaged in defining the objectives and needs of these missions. The revolution that is currently taking place in eVTOL aircraft represents an unprecedented opportunity to develop a safer, more affordable, more available and more environmentally friendly future of vertical flight. To ensure that these novel aircraft meet the future expectations of Public Services, it is essential to take a collaborative and multi-disciplinary approach to their development, across engineering disciplines, policy-making, program management, business case development, manufacturing, and flight demonstrations. It should be noted that the term eVTOL (in the near term) used throughout this publication implies aircraft capable of transporting up to 5 persons which may or may not include a pilot if operated fully autonomously, assuming an average of 200 pounds (91 kg) per person or equivalent payload and a range up to 60 miles plus a suitable reserve. Hybrid or hydrogen powered eVTOLs would have greater range. For example, a “3-seat” eVTOL aircraft may only be able to carry two fully equipped firemen, and payload capacity is more relevant when used for the supply mission. Moreover, this paper concentrates on the “last-mile” solutions with a deployment time of no more than 6 hours. Although not specifically discussed in this document, it is understood that the future of Transformative Vertical Flight in general and Public Services, in particular, will also involve smaller UAVs that will undoubtedly play a crucial role in future aerial operations. For example, smaller unmanned aircraft may be used to dispatch medical supplies, portable filtration systems or perform the Search task of future Search and Rescue (SAR) operations. Close collaboration between the aircraft industry, the Civil Aviation Authorities (CAA), e.g., Federal Aviation Administration (FAA), European Aviation Safety Agency (EASA), Transport Canada Civil Aviation (TCCA) and the Department of Defense (DoD) certifiers, will help identify Public Services requirements, define expectations and limit development cost and timescales. Take the US Air Force Agility Prime as an example, the majority of the eVTOL application opportunities and mission elements identified are in line with the NASA TVF WG-4 objectives and use cases. Together, it forms a strong partnership to accelerate the development, certification, and practical deployment for public service missions. The US Air Force Agility Prime has been a collaboration partner on this white paper, and provided valuable input and recommendations. Most of the eVTOL public service mission elements discussed in this paper and additional use cases envisioned by the NASA TVF WG-4 team are shared by the Agility Prime program. The focus and efforts of the Agility Prime in product and system development, industry and government partnership, accelerated certifications as well as early test and deployment are totally in sync with the path forward recommended by this white paper. This kind of collaboration and partnership will help enable the practical use of the eVTOL for public service missions, benefit the eVTOL public acceptance, and accelerate the eVTOL industry revolution.

Johnny T. Doo↗

Linking Asthma Exacerbation and Air Pollution Data: A Step Toward Public Health and Environmental Data Integration

Studies have shown that reducing exposure to triggers such as air pollutants can reduce symptoms and the need for medication in asthma patients. However, systems that track asthma are generally not integrated with those that track environmental hazards related to asthma. Tlvs lack of integration hinders public health awareness and responsiveness to these environmental triggers. The current study is a collaboration between health and environmental professionals to utilize NASA-derived environmental data to develop a decision support system (DSS) for asthma prediction, surveillance, and intervention. The investigators link asthma morbidity data from the University of Mississippi Medical Center (UMMC) and Mississippi Department of Health (MDH) with air quality data from the Mississippi Department of Environmental Quality (MDEQ) and remote sensing data from NASA. Daily ambient environmental hazard data for PM2.5 and ozone are obtained from the MDEQ air quality monitoring locations and are combined with remotely sensed data from NASA to develop a state-wide spatial and time series profile of environmental air quality. These data are then used to study the correlation of these measures of air quality variation with the asthma exacerbation incidence throughout the state over time. The goal is to utilize these readily available measures to allow real-time risk assessment for asthma exacerbations. GeoMedStat, a DSS previously developed for biosurveillance, will integrate these measures to monitor, analyze and report the real-time risk assessment for asthma exacerbation throughout the state.

Faruque, Fazlay↗