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This publication documents the outcome of subject matter experts assessment of the status and progress of research and clinical activities intended to mitigate the risk of venous thromboembolism during spaceflight.
BACKGROUND: NASA has amassed sixty years of knowledge and experience relevant to maintenance of crew health and performance in low earth orbit. The Apollo Program introduced the importance of ensuring progressively autonomous operational capability. Earth Independent Medical Operations (EIMO) will require a gradual shift in the balance of medical responsibility, management, and authority from terrestrial to space-based assets. Terrestrial assets will continue to be essential for pre-mission screening and planning in addition to maintenance of crew health and performance. However, new capabilities are needed to enable EIMO and the amount of data required to support these systems, and mitigate the impacts of data transmission delays and reduced bandwidth coupled with lack of cloud-like resources and on-board computing capacity that is currently unclear or operationally insufficient. OVERVIEW: The overall goal of EIMO is to develop artificial intelligence (AI)-based solutions to analyze crew health and performance data utilizing a clinical decision support system (CDSS) to provide crew medical officers (CMO) with the equivalent of real-time, on-board medical consults. The EIMO ecosystem is envisioned as a “system of systems” where embedded reference databases and real-time data streams from multiple input vectors continuously and seamlessly assess crew health and performance. EIMO will be designed to make recommendations to the CMO using multi-modal AI-based natural language processing and machine learning methods with interoperability to push/pull data within and between multiple vehicle and habitat architectures. DISCUSSION: Data flows and storage/retrieval capacity are severely constrained during space missions and the challenges will become even greater during exploration missions. Just as each past program from Mercury to the International Space Station (ISS) required rethinking the interaction between ground-based controllers and space-based crew, so too will future missions to the Moon and Mars. While the NASA High-Performance Spaceflight Computing Processor project aims to increase computational capacity by 100 times over current spaceflight computers, the projected deliverable still lags considerably behind what will be needed to enable an AI-driven CDSS. Restrictions in processing speed and data storage capacity, coupled with transmission bottlenecks and delays, necessitate definition and optimization of an integrated data architecture to enable a progressively autonomous medical capability.
The Medical Informatics and Health Care Systems group in the Office of Space Medicine at NASA Johnson Space Center (JSC) has been tasked by NASA with improving overall medical care on the International Space Station (ISS) and providing insights for medical care for future exploration missions. To accomplish this task, a three day Operational and Research Musculoskeletal Summit was held on August 23-25th, 2005 at Space Center Houston. The purpose of the summit was to review NASA#s a) current strategy for preflight health maintenance and injury screening, b) current treatment methods in-flight, and c) risk mitigation strategy for musculoskeletal injuries or syndromes that could occur or impact the mission. Additionally, summit participants provided a list of research topics NASA should consider to mitigate risks to astronaut health. Prior to the summit, participants participated in a web-based pre-summit forum to review the NASA Space Medical Conditions List (SMCL) of musculoskeletal conditions that may occur on ISS as well as the resources currently available to treat them. Data from the participants were compiled and integrated with the summit proceedings. Summit participants included experts from the extramural physician and researcher communities, and representatives from NASA Headquarters, the astronaut corps, JSC Medical Operations and Human Adaptations and Countermeasures Offices, Glenn Research Center Human Research Office, and the Astronaut Strength, Conditioning, and Reconditioning (ASCR) group. The recommendations in this document are based on a summary of summit discussions and the best possible evidence-based recommendations for musculoskeletal care for astronauts while on the ISS, and include recommendati ons for exploration class missions.
Simulator calibrates and checks out phonocardiograms used in physiological monitoring of astronauts in flight and during flight simulation. It is also used to check out telemetry systems and instrumentation systems for phonocardiogram monitoring in hospitals and medical care centers, and in training personnel to use such systems.
NASA medical care standards establish requirements for providing health and medical programs for crewmembers during all phases of a mission. These requirements are intended to prevent or mitigate negative health consequences of long-duration spaceflight, thereby optimizing crew health and performance over the course of the mission. Current standards are documented in the two volumes of the NASA-STD-3001 Space Flight Human-System Standard document, established by the Office of the Chief Health and Medical Officer. Its purpose is to provide uniform technical standards for the design, selection, and application of medical hardware, software, processes, procedures, practices, and methods for human-rated systems. NASA-STD-3001 Vol. 1 identifies five levels of care for human spaceflight. These levels of care are accompanied by several components that illustrate the type of medical care expected for each. The Exploration Medical Capability (ExMC) of the Human Research Program has expanded the context of these provided levels of care and components. This supplemental information includes definitions for each component of care and example actions that describe the type of capabilities that coincide with the definition. This interpretation is necessary in order to fully and systematically define the capabilities required for each level of care in order to define the medical requirements and plan for infrastructure needed for medical systems of future exploration missions, such as one to Mars.
The Remote Monitoring System (RMS) is manufactured by Perkin Elmer Corporation. The principal component of the RMS was originally developed for spacecraft use to monitor astronaut's respiratory gases in NASA's Gemini and Apollo program. At Wishard Memorial Hospital in Indianapolis, IN, the RMS is used in operating rooms for analysis of anesthetic gases and measurement of oxygen, carbon dioxide and nitrogen concentrations. It assures that the patient undergoing surgery has the proper breathing environment.
In October 2020, International Space Station (ISS) Partner Agencies held a set of international workshops to solicit and develop creative and forward-looking ideas for using the ISS as an analog for preparation for Mars missions during its 3rd decade of operations. The workshops brought together participants from nine international space agencies or organizations, with stakeholders consisting of research managers, discipline experts, technology developers, flight physicians, flight operators, and astronauts. Breakout meetings and brainstorming sessions were conducted focusing on the following topics: Critical hazards and countermeasures for the transit to Mars; gravity transitions and early surface operations; environmental control and life support systems; food systems; human microbiome, microbial monitoring, and planetary protection; medical operations for Mars missions; isolation and confinement; autonomous systems and crew-centered autonomy; and communications delay effects on operations. In many cases the scenarios and approaches identified were compelling but challenging to implement under the current utilization structure used to manage the ISS for experiments. Following the series of workshops, a team of utilization leaders across the ISS partnership worked to compile the workshop recommendations and extract a set of use-cases with their prerequisites and constraints. The work considered the following aspects: what can be effectively done on ISS; which new technologies, approaches and scenarios are feasible; what alternatives could be considered; and what steps should be taken to enable integrated testing and future use of ISS as an analog for Mars missions. The final report will be published so that the use cases can be considered in each agency’s strategic planning processes. This paper will cover the process of international assessment in detail and how this process has influenced and broadened the vision of ISS utilization beyond single experiments to integrated studies and testing for future Mars missions. This approach to international collaboration informs both the next decade of international exploration research on the ISS and advancement of its utilization as an analog for deep space missions. For many of the participating partners, it also helps to frame the strategy for human research in Artemis as we begin planning for human missions to the moon. We conclude with a summary of the progress on the actions in the report and the additional implementation discussions that have occurred across the partnership.
The NASA-Ames Sensors 2000! Program has developed a small, compact, modular, programmable, sensor signal conditioning and measurement system, initially targeted for Life Sciences Spaceflight Programs. The system consists of a twelve-slot, multi-layer, distributed function backplane, a digital microcontroller/memory subsystem, conditioned and isolated power supplies, and six application-specific, physiological signal conditioners. Each signal condition is capable of being programmed for gains, offsets, calibration and operate modes, and, in some cases, selectable outputs and functional modes. Presently, the system has the capability for measuring ECG, EMG, EEG, Temperature, Respiration, Pressure, Force, and Acceleration parameters, in physiological ranges. The measurement system makes heavy use of surface-mount packaging technology, resulting in plug in modules sized 125x55 mm. The complete 12-slot system is contained within a volume of 220x150x70mm. The system's capabilities extend well beyond the specific objectives of NASA programs. Indeed, the potential commercial uses of the technology are virtually limitless. In addition to applications in medical and biomedical sensing, the system might also be used in process control situations, in clinical or research environments, in general instrumentation systems, factory processing, or any other applications where high quality measurements are required.
Some crewmembers have experienced changes in their vision after long-duration spaceflight on the ISS. These impairments include visual performance decrements, development of cotton-wool spots or choroidal folds, optic-disc edema, optic nerve sheath distention, and/or posterior globe flattening with varying degrees of severity and permanence. These changes are now used to define the visual impairment/intracranial pressure (VIIP) syndrome. It is known that many medications can have side effects that are similar to VIIP symptoms. Some medications raise blood pressure, which can affect intracranial pressure. Many medications that act in the central nervous system can affect intracranial pressures and/or vision. About 40% of the medications in the ISS kit are known to cause side effects involving changes in blood pressure, intracranial pressure and/or vision. For this reason, we have begun an investigation of the potential relationship between ISS medications and their risk of causing or exacerbating VIIP-like symptoms.
Some crewmembers have experienced changes in their vision after long-duration spaceflight on the ISS. These impairments include visual performance decrements, development of cotton-wool spots or choroidal folds, optic-disc edema, optic nerve sheath distention, and/or posterior globe flattening with varying degrees of severity and permanence. These changes are now used to define the visual impairment/intracranial pressure (VIIP) syndrome. The reasons for these potentially debilitating medical issues are currently unknown. The potential role of administered medications has not yet been examined, but it is known that many medications can have side effects that are similar to VIIP symptoms. Some medications raise blood pressure, which can affect intracranial pressure. Many medications that act in the central nervous system can affect intracranial pressures and/or vision. About 40% of the medications in the ISS kit are known to cause side effects involving changes in blood pressure, intracranial pressure and/or vision. For this reason, we proposed an investigation of the potential relationship between ISS medications and their risk of causing or exacerbating VIIP-like symptoms. The purpose of this study was to use medication usage records for affected and unaffected crew to determine if use of particular medications seemed to correlate with VIIP occurrence or severity.
Goal: Current Space Medicine operations depend on terrestrial support to manage medical events. As astronauts travel to destinations such as the Moon, Mars, and beyond, distance will substantially limit this support and require increasing medical autonomy from the crew. This paper defines Earth Independent Medical Operations (EIMO) and identifies key elements of a conceptual EIMO system. Methods: The NASA Human Research Program Exploration Medical Capability Element held a 2-day conference at Johnson Space Center in Houston, TX with NASA experts representing all aspects of Space Medicine. Results: EIMO will be a process enabling progressively resilient deep space exploration systems and crews to reduce risk and increase mission success. Terrestrial assets will continue to provide pre-mission screening, planning, health maintenance, and prevention, while onboard medical care will increasingly be the purview of the crew. Conclusions: This paper defines and describes the key components of EIMO.
An overview of NASA's Thin Route satellite telecommunication project is presented. Thin Route employs applications technology satellites (ATS) in place of more costly commercial multi- transponder telecommunications satellites. This system allows remote and underdeveloped areas to communicate with the outside world for purposes of obtaining medical assistance among other things. The system represents a substantial cost saving over commercial systems.
In many future NASA missions, such as deep space planetary exploration and the Next Generation Space Telescope, electrical components and systems must operate reliably and efficiently in extremely low temperature environments. Most modern electronic components cannot operate below moderately low operating temperatures (-40 to -55 C). The low-temperature electronics program at the NASA Lewis Research Center is focusing on the development and characterization of low-temperature components and the integration of the developed devices into demonstrable very low-temperature (-200 C) power systems such as dc-dc converters. Such low-temperature electronics will not only tolerate hostile environments but also will reduce system size and weight by eliminating radioisotope heating units, thereby reducing launch cost, improving reliability and lifetime, and increasing energy densities. Low-temperature electronic components will also have a great influence on terrestrial applications such as medical instrumentation, magnetic levitation transportation systems, and arctic and antarctic exploration. Lewis researchers are now performing extensive evaluations of commercially available as well as custom-made devices. These include various types of energy storage and signal capacitors, power switching devices, magnetic and superconducting materials, and primary lithium batteries, to name a few.
Function of adrenal gland and hematopoietic system under temporary and prolonged hypoxia during mountain climbing - medical study
The complex and intimate interactions between the sleep and immune systems have been the focus of study for several years. Immune factors, particularly the interleukins, regulate sleep and in turn are altered by sleep and sleep deprivation. The sleep-wake cycle likewise regulates normal functioning of the immune system. Although a large number of studies have focused on the relationship between the immune system and sleep, relatively few studies have examined the effects of sleep deprivation on immune parameters. Studies of sleep deprivation's effects are important for several reasons. First, in the 21st century, various societal pressures require humans to work longer and sleep less. Sleep deprivation is becoming an occupational hazard in many industries. Second, to garner a greater understanding of the regulatory effects of sleep on the immune system, one must understand the consequences of sleep deprivation on the immune system. Significant detrimental effects on immune functioning can be seen after a few days of total sleep deprivation or even several days of partial sleep deprivation. Interestingly, not all of the changes in immune physiology that occur as a result of sleep deprivation appear to be negative. Numerous medical disorders involving the immune system are associated with changes in the sleep-wake physiology--either being caused by sleep dysfunction or being exacerbated by sleep disruption. These disorders include infectious diseases, fibromyalgia, cancers, and major depressive disorder. In this article, we will describe the relationships between sleep physiology and the immune system, in states of health and disease. Interspersed will be proposals for future research that may illuminate the clinical relevance of the relationships between sleeping, sleep loss and immune function in humans. Copyright 2001 by W.B. Saunders Company.
Medical considerations for long duration manned space missions are examined. The requirements and hardware for medical operations on the Space Station are diagrammatically presented. The physiological and psychological changes that have been observed during space flights are discussed. Crew health maintenance and medical care in the Space Station environment require earth-based and in flight continuity. It is also necessary to identify the appropriate zero-G therapeutic methods for treating a patient. Techniques for transferring patients in orbit and to earth are studied. Considerations are given to control and life support systems and data management for medical operations.
The NASA Lewis Research Center (LeRC) is managing stand-alone photovoltaic (PV) system activities sponsored by the U.S. Department of Energy (DOE) and the U.S. Agency for International Development (AID). The DOE project includes village PV power demonstration projects in Gabon (four sites) and the Marshall Islands, PV-powered medical refrigerators in six countries, PV system microprocessor control development activities and PV-hybrid system assessments. The AID project includes a large village system in Tunisia, a water pumping/grain grinding project in Upper Volta, five medical clinics in four countries, PV-powered remote earth station application. These PV activities and summarizes significant findings to data are reviewed.
Exploration-class and International Space Station (ISS) missions have significantly different levels of associated medical risk for crewmembers. The Integrated Medical Model (IMM), the probabilistic risk assessment tool used for ISS medical trade-space analyses, uses a Functional Impairment (FI) metric to determine quality time lost should a crewmember be afflicted with a medical condition. While IMM-based FI has been successful for ISS operations, it has limitations when applied to exploration-class missions. As the National Aeronautics and Space Administration (NASA) looks ahead to Gateway, Artemis, and Martian missions, a novel, dynamic, and mission-appropriate impairment paradigm is necessary for accurate contingency planning. This paradigm, Task Impairment (TI), fulfills that need by utilizing mission-specific tasks. TI will allow future capability for a loss of mission metric, previously not available with IMM. TI serves as a replacement metric for FI within IMPACT, the next-generation trade-space analysis tool suite created to replace the IMM. IMPACT significantly increases the fidelity of probabilistic risk assessment for exploration-class missions. The Human Exploration of Mars Preliminary List of Crew Tasks (MTL, a source of 1100+ exploration-class mission-specific tasks for crewmembers) was used to calculate TI. Using the Task List, 18 individual Human System Categories were identified as being required to perform each task (e.g., Cardiopulmonary, Cognitive, etc.). Each of the 1200+ tasks were mapped to the Human System categories listed in the Task List. The total number of tasks in each category were tallied to determine how many tasks required each Human System. Lastly, each of the 120 medical conditions from the IMPACT condition list were mapped to the Human System categories to complete the TI calculation. NASA subject matter experts across five medical specialties established consensus for the mapping of each condition. The resulting total tasks impaired by each condition were used to calculate discrete TI values. This process was repeated for each of the four severity/resource utilization variants of each condition, and for each of the three phases of clinical care. Through this process, discrete TI values were calculated for each of the 120 IMPACT medical conditions and their variants. The Task Impairment metric provides higher fidelity, dynamic utility, and quicker analysis of medical impairment compared to the previous Functional Impairment metric used for the Integrated Medical Model. TI will be used for higher fidelity medical impairment analysis and contingency planning during Lunar, Martian, and other long-term exploration-class missions.