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NASA NTRS2021

Microbial Food Safety in Space Production Systems

While traveling to deep space is difficult for many reasons, food is a crucial one. Round-trip Mars mission scenarios last 3 years, demanding food with a shelf-life of 5 years; this means that feeding human crew sustainably for long-duration missions beyond low Earth orbit (LEO) will ultimately lead to a paradigm shift away from the current Earth-based food production system, which depends upon storing and transporting prepackaged foods, and toward bio-regenerative production of food in space. Pharmaceuticals and nutritional supplements face similar challenges. Moreover, the methods we currently use to detect dangerous microbes in food require sample return to Earth, a situation not viable for deep-space missions. While the science behind generating foods and bioproducts is covered by other white papers, in this paper we discuss a crucial gap uniting all of them: how to ensure that such products are free of unwanted microbial contamination and safe for crew to consume. Because Earth-based food safety systems cannot be directly applied in space, safety assurance is currently a critical bottleneck in the space production of food and other bioproducts. Future sustainable deep-space missions will require NASA to devote more resources in the coming decade to understanding the biological and physical science principles underlying microbial food safety in space, and to developing efficient, reliable methods in this area.

microbiology↗

NASA NTRS2021

Topical: Boiling, Condensation and Two-Phase Flows in Microgravity

The white paper addresses both fundamental and technological questions in the science of phase-change fluid flows aimed at understanding thermal transport in flow boiling and condensation and the use of these processes in space and terrestrial thermal systems. While flow boiling and condensation are widely employed in Earth-based thermal equipment to reduce the cost, size, and power required to transfer heat, a lack of data and predictive models on the impact of gravity on these phenomena hinders the use of two-phase heat transport in a low-gravity environment. The white paper presents research tasks in long-duration microgravity recommended to expand our knowledge on phase-changing flows. Due to elimination of the masking gravity effects, the proposed research will provide a unique opportunity to bring new insights into the role of capillary and hydrodynamic forces in phase-changing flows. The potential impact of the proposed research ranges from the space power, thermal and cryogenic systems to various terrestrial applications in the petrochemical, pharmaceutical, biochemical, nuclear, and metallurgical industries.

Phase-change fluid flow↗

NASA NTRSDate not supplied

In-situ Raman Instrumentation and Measurements in Supercritical Water Oxidation Systems

Due to the advent of recent advances in reactor designs and operational procedures, renewed attention has been given to a host of supercritical water oxidation (SCWO) technology applications. This includes resource recovery, water reclamation, and solid waste destruction. SCWO is often recognized as a “green technology” because of its ability to extract useful energy while producing benign products from environmentally challenging waste streams (e.g., wet organic wastes, pharmaceutical wastes, military wastes). The present work was motivated by NASA’s interests in solid waste management and water recovery for long-duration space missions. To that end, the main focus of this paper is to present work on characterizing the behavior of supercritical water oxidation systems utilizing state of the art laser Raman spectroscopy. The main benefit of Raman diagnostics is its ability to identify chemical composition and to measure concentrations of the compounds involved in the reaction. Two separate Raman systems for SCWO measurements that have been developed for this study will be described. The first system is a 2-D traversing system useful for making in-situ measurements in conditions where spatial gradients of species and temperature are important and has been successfully utilized in making species (ethanol, oxygen, water, nitrogen and carbon dioxide) concentrations and temperature measurements in ethanol hydrothermal jet flames. The second system is a packaged modular Raman probe unit for portable deployment to different reactors and is more suitable for relatively homogeneous systems such as a batch reactor. The design, development, and examples of obtained results from both systems will be presented for various reactant streams. Reaction rate and fuel conversion estimates from chemistry models will also be presented.

supercritical water oxidation↗

NASA NTRS2022

Western Montana Ecological Forecasting II: Enhancing Habitat Suitability Modeling of Mustelid Species and Contaminant Monitoring in Northern Montana Using NASA Earth Observations

Environmental contaminants in aquatic ecosystems threaten both human and ecosystem health. Western Montana’s rivers possess great economic and ecological value, yet the status of contaminants in these systems can be unclear. Contaminants such as brominated flame-retardants, heavy metals, and pharmaceuticals negatively affect ecosystem health by traveling through the food chain and bioaccumulating in apex predators. Exposure to these contaminants can result in neurological, endocrine, and reproductive impairments in wildlife and humans. American mink (Neovison vison) and North American river otter (Lontra canadensis) have a predominantly aquatic diet and serve as reliable indicator species of environmental health. Working Dogs for Conservation (WD4C) uses detection dogs to locate scat samples of these species which are assessed for contaminants by the Virginia Institute of Marine Science (VIMS). With Software for Assisted Habitat Modeling (SAHM), the team generated current (2013-2020) and projected (2021-2040) habitat suitability models for mink and otter utilizing NASA Earth observations from Terra Moderate Resolution Imaging Spectroradiometer (MODIS), Global Precipitation Measurement Integrated Multi-Satellite Retrievals for GPM (GPM IMERG), Shuttle Radar Topography Mission (SRTM), and Soil Moisture Active Passive (SMAP). The habitat suitability maps’ study region encompassed Flathead National Forest and Blackfeet Indian Reservation. Additionally, the team created site accessibility and precipitation anomaly maps that display the viability of survey locations. The current habitat suitability models performed well (AUC-PR=0.88). The most important predictor variables for suitable habitat were distance to rivers, elevation, and land cover. These end products will further inform WD4C survey site selection and contaminant monitoring.

Chelsea Morton↗

NASA NTRSDate not supplied

Medical Database Accomplishments and Lessons Learned - 2021

The Medical Database (MD) is a virtual repository consisting of two software components: the Medical Item Database (MedID) and the Evidence Library (EL). MedID consists of engineering data and associated information for specific medical resource items (e.g., pharmaceutical, medical devices, and supporting components), while the EL is a tool which provides all of the medical evidence necessary. The Medical Database will serve as the single “source of truth” for the Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool suite for both medical evidence and medical resource engineering data. It will be used in conjunction with the IMPACT tool suite to inform research prioritizations and perform systematic trade study evaluations using probabilistic risk assessment and simulated human spaceflight missions to aid stakeholders in making informed decisions during Pre-Phase-A planning of human spaceflight missions. The IMPACT project is conducted under the Exploration Medical Capability (ExMC) element of the Human Research Program (HRP), within NASA’s Human Exploration and Operations Mission Directorate. Over the past year, the MedID software has been successfully merged with the Evidence Library into one cohesive Medical Database with two independent user interface experiences for modifying either clinical evidence or resource engineering data. As MD has evolved substantially over the past year, a number of challenges have been encountered and overcome along the way. A number of ‘lessons learned’ and practical/logistical realizations have emerged which will be detailed in the forthcoming Medical Database presentation.

Exploration Medical Capability↗

NASA NTRSDate not supplied

Synthetic biology off planet for game-changing solutions for a greener Earth

Synthetic biology – creating new capabilities with life – promises to create a greener future for planet Earth, from fields as diverse as pharmaceuticals to manufacturing, agriculture and nanotechnology. Progress can be stymied by such considerations as economics, politics, legal and philosophical issues surrounding GMOs. Often solutions to these problems already exist, so it is difficult for a new, superior method to displace the old. As we move humans beyond Earth, to long duration stays in the International Space Station, and then onward to the Moon and Mars, the challenges of supporting human life will need radical new solutions. For example, while life on Earth uses an enzymatic machinery which evolved close to 3 billion years ago, synthetic biology promises to be able to engineer the systems to adapt to current natural or industrial environments. A focus on solutions off planet require a focus on a circular economy. While there are new constraints, such as worrying about the mass of a solution, constraints offer opportunities for game-changing solutions that will then allow revolutions back on our home planet.

Lynn J Rothschild↗

NASA NTRSDate not supplied

Improving Efficacy and Safety of Pharmacological Treatment Through Precision Health and Pharmacogenomics

INTRODUCTION: Future spaceflight will require increased crew medical autonomy as exploration class missions expand in duration and distance from Earth, especially for Mars missions. As mission duration increases, it will be essential to have appropriate amounts of effective medication to ensure the maintenance of crew health and performance. Conversely, mass and volume constraints will become more severe as future spaceflight expands beyond low Earth orbit, where resupply is difficult or becomes impossible. These constraints thus convey an urgency to tailor medications for individual crewmembers and further examine appropriate dosing regimens. BACKGROUND: Precision Health is an exciting area of medicine focused on maintaining an individual’s health and performance through in-depth understanding of an individual’s unique clinical and environmental history, genetic makeup, and molecular profiles. This approach can be adapted to better predict, monitor, and address physiological responses to the spaceflight environment. A subset of this field is pharmacogenomics (PGX), the study of how the expressed genome impacts drug responses with the goal of prescribing the right dose of the right drug at the right time. Specifically, PGX testing provides valuable information on an individual’s precise allelic variations to guide physicians in making informed decisions on drug choice and dosing to avoid adverse events and maximize efficacy. The study goal was to identify which current space pharmacy drugs could be evaluated using PGX testing and to understand the potential impact on the health and wellness of the astronaut population. Additionally, we sought to evaluate clinically available FDA-approved PGX testing solutions to better understand its applicability. METHODS: A complete list of drugs on the ISS was analyzed for risk and likelihood of drug failure and PGX actionability. This analysis encompassed both astronauts’ personal medications, including supplements and over the counter drugs (n=151) contained in the ISS medical accessory kit (IMAK), and ISS MedKit formulary medications (n=95). Duplicate medications and different formulations were removed, which resulted in a total of 157 drugs used in the subsequent analysis. A 5x5 risk assessment table was produced by examining the likelihood of drug failure compared to the consequence of drug failure (LxC). Likelihood of individual drug failure was defined by whether existing processes are sufficient to prevent ineffective treatment or impactful side effect events, as ranked from 1 (very low, can easily be prevented) to 5 (very high, cannot be prevented) during a Mars mission. In contrast, the consequence of drug failure was defined by impact to safety, schedule, cost, or technical criteria and ranked from 1 (very low) to 5 (very high). An assessment of PGX reference laboratories is currently underway to evaluate sample requirements, benefit analysis (cost vs. utility of allele variant analysis), relevance to inflight medication usage, quality of reporting in enabling clinical application, and ease of integration into electronic medical records. RESULTS: Risk assessments (LxC 5x5 table) indicated 128 medications were in the green zone where risk is acceptable, with the remaining 29 of the medications in the yellow or red zone driven predominantly due to drug failure or safety concerns. We found that current PGX testing results could impact 21% of the total medications in the ISS MedKit and IMAK; of these, 9 medications currently have direct clinically actionable guidance available. Results of the clinical PGX solution evaluations as related to these medications will be presented. CONCLUSION: PGX testing has demonstrated clear benefits in terrestrial medicine and clinical environments for the selection of proper medications, avoiding adverse drug reactions, and maximizing drug efficacy. We propose that similar benefits would be bestowed on the astronaut and commercial spaceflight passenger population by performing preemptive preflight PGX testing to reduce risk of mission failure due to ineffective or toxic medications, improve drug efficacy, and further open the door to countermeasure research. For example, PGX results could allow tailoring of specific medications at optimal doses more precisely to each individual astronaut, particularly in areas of space motion sickness, sleep aids, and analgesics. An additional benefit is that PGX results could provide information for better planning of the components of a space pharmacy for deep space missions to be more effective and efficient in the utilization of limited pharmaceutical resources. Finally, while PGX testing of the astronaut corps is not currently conducted, this approach could provide immediate impact in support of mission success by reducing risks, optimizing astronaut performance, and providing valuable insights into long-term astronaut health. Such advancements in clinical decision making are important next steps in building dynamic individual risk profiles for astronauts, increasing selection of the best treatment choice, and providing tailored countermeasures for individual crewmembers.

Pharmacogenomics↗

NASA NTRSDate not supplied

Medical countermeasures for extraterrestrial environments: Current status and future prospects with focus on acute injuries

In all space exploratory activities involving humans there are associated risks to health and well-being. Exposure to ionizing radiation represents one of the more serious health concerns. Although medical issues can arise shortly following the rare acute exposures, the more likely radiation-associated injuries will manifest in a delayed fashion following sub-acute exposures or protracted exposures to relatively low radiation doses. The radiological conditions that present these health risks during extraterrestrial space travel are presented in this article, along with current physical and medical countermeasures for such exposure contingencies. The aim of this article is to discuss radiation medical countermeasures that may be considered for future space exploration and travel. Biomedical advances have occurred toward the control and minimization of acute, sub-acute, and fractionated radiation exposure injuries, whether they stem from intentional application of radio-therapeutic procedures or unintentional, accidental terrestrial-based exposures. Those advances, based largely on novel bioengineering, genetic, and combinatorial pharmaceutical strategies, are briefly reviewed here, along with the promising prospects of additional, new and improved medical countering systems/agents that will be forthcoming with additional research and development efforts.

Acute/chronic radiation injuries↗

NASA NTRS2023

Intravenous Fluid Generation Mini (IVGEN Mini) Summary and Related Research

This paper assists the ongoing effort to support NASA Glenn’s mission and its Human Research Program (HRP) core competency by investigating a technology demonstration to mitigate human health and performance risks during space exploration. Crew health and performance are critical to successful human exploration beyond low Earth orbit. Four hundred forty-two medical conditions have been identified and may present and require treatment during long-duration space exploration missions. One hundred fifteen out of four hundred forty-two identified medical conditions would require medical fluid treatment, generating a need for an on-demand or continuous supply of medical fluid. Intravenous Fluid Generation Mini (IVGEN Mini) is a technology demonstration designed to demonstrate a water purification and pharmaceutical mixing system that can make intravenous (IV) fluid in microgravity and builds on the success of the original Intravenous Fluid Generation for Exploration Missions (IVGEN) experiment, which flew on the ISS in March 2010. IVGEN Mini seeks to increase the Technology Readiness Level (TRL) and the overall function of the original IVGEN experiment to reduce the dependence of a needed medical consumable and streamline the size of the device and process to generate IV fluid IVGEN Mini is funded by the Advanced Exploration Systems (AES) directorate via the Exploration Medical Integrated Product Team (XMIPT) as a part of their mission to advance exploration medical technologies to benefit the overall health and safety of crews for beyond low Earth orbit space missions. This paper discusses a collection of related research topics such as microgravity fluid mixing and studying past efforts of IV fluid usage in extreme environments to aid IVGEN Mini project scientists in developing the IVGEN Mini technology.

iv generation↗

NASA NTRSDate not supplied

Analysis of the Value Added When Deploying a Model-Based Approach for the Validation and Verification of the Medical Database Software

The Medical Database (MD) is a virtual repository consisting of two software components: Medical Item Database (MedID) and the Evidence Library (EL). MedID consists of engineering data and associated information for specific medical resource items (e.g., pharmaceutical, medical devices, and supporting components), while the EL is a tool which provides all of the medical evidence necessary. The MD will 1) serve as the single “source of truth” for the Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool suite for both medical evidence and medical resource engineering data and 2) will be used in conjunction with the IMPACT tool suite to inform research prioritizations and perform systematic trade study evaluations to aid stakeholders in making informed decisions regarding simulated human spaceflight missions. The MD project used a Model-Based Systems Engineering (MBSE) approach to support all life cycles of the software development, while in parallel the human factors engineering team used modeling to support Human Centered Design (HCD) strategies in an effort to improve software usability. HCD is a frequently used approach in design frameworks that develops resolutions to complexities and challenges by involving the human perspective in all steps of the problem-solving process. By integrating the model-based approaches used for systems engineering and human factors activities, the project is able to leverage the model-based artifacts originally created for HCD activities for system level and human factors validation. In this presentation, our team highlights the value added when leveraging these model-based artifacts to support the on-going verification and validation activities.

C. Laing↗

NASA NTRSDate not supplied

Bionutrients: Microbial Production of on-Demand Nutrients on the International Space Station

Providing adequate nutrition to crew members is essential as deep-space missions cannot rely on consistent Earth-based resupply. The current NASA pre-packaged food system is designed for low-earth-orbit missions with a stated shelf-life of two years and notable vitamin degradation over time. One strategy to mitigate nutrient loss is to implement bioregenerative food sources to supplement the pre-packaged food system. The BioNutrients project is designed to provide targeted production of short shelf-life nutrients in a single-use production pack. BioNutrients-1 includes two strains of edible yeast that have been genetically engineered to produce carotenoids, β-carotene, and zeaxanthin. This five-year mission on the International Space Station (ISS), launched in 2019, tests the long-term storage and nutrient production of the microorganisms of interest. Additional microorganisms are also stored in stasis packs to determine the effects of long-duration storage on the ISS. These organisms may be useful for production of fermented foods, pharmaceuticals, or biomanufacturing processes. Improving on the BioNutrients-1 project, BioNutrients-2 has optimized the production pack hardware by reducing the overall mass and volume of the system. Furthermore, BioNutrients-2 has expanded the projects scope by investigating novel products and microbial food sources. BioNutrients-2 is a six-month mission, launched in 2022, which tests production of fresh foods such as yogurt and kefir. The BioNutrients missions seek to provide advances for in-space biomanufacturing by addressing safe and reliable production of high-value nutrients and on-demand foods for future exploration efforts.

BioNutrients↗

NASA NTRS2024

Evolution of Spaceflight Renal Stone Risks and Update to the NASA Human Research Program (HRP) Renal Stone Evidence Report and Integrated Concept of Operations

BACKGROUND: The NASA HRP Evidence Report on the Risk of Renal Stone Formation is being updated based on new information obtained from 9 years of data from NASA’s astronaut renal stone surveillance program. In addition, the Concept of Operations for missions beyond Low Earth Orbit (LEO) was created to supplement the Evidence Report, and the NASA clinical practice guideline(CPG)for renal stone surveillance was updated. OVERVIEW: A literature review was performed to evaluate the state of literature regarding renal stone prevention, mitigation, and management both in terrestrial and spaceflight environments. Current renal stone treatment guidelines for the ISS, which were created by the Inflight Clinical Medicine Working Group and approved by the Multilateral Medical Operations Panel (MMOP)were reviewed, as well as recent ultrasound technology demonstrations onboard the ISS. This information was used in conjunction with emerging evidence from the surveillance program to update the Evidence Report and in-flight Concept of Operations. DISCUSSION: There are known and emerging renal stone prevention strategies including astronaut selection, the use of medications and resistive exercise, early diagnosis with regular urine studies and ultrasound imaging. In-flight treatment options include pharmaceuticals, use of lithotripsy and propulsive ultrasound, placement of percutaneous drains and other modalities. This information is useful to gauge future risks and update our strategies for prevention and management of renal stones in astronauts to reduce the risk of in-flight renal stone colic that could cause morbidity and mission impact.

E Stratton↗

NASA NTRSDate not supplied

Exploration Medical Capability - Advancing Medical System Design and Risk-Informed Decision Making for Deep Space Exploration

BACKGROUND: Within NASA’s Human Research Program, the Exploration Medical Capability (ExMC) Element has three primary focus areas: clinical and scientific research, systems engineering and trade space analysis, and technology development and demonstrations. These focus areas feed into the overarching goal of enabling progressively Earth-Independent Medical Operations (EIMO), a new paradigm that will be necessary for future Artemis and Mars medical and vehicle systems. This EIMO end state aligns with NASA’s Moon to Mars Objectives, which clearly outline the need for NASA deep space exploration missions to reduce their reliance upon Earth and become increasingly autonomous, in preparation for the first human Mars mission. OVERVIEW: To advance exploration medical systems and ultimately, integrated crew health and performance systems, ExMC’s portfolio includes: funding ground development & testing of novel medical capabilities; creation of new approaches for the development of medical protocols and procedures; deployment of innovative technologies into analog environments; technology demonstrations in spaceflight; and eventual transition to operations of new capabilities for deep space exploration missions. The portfolio also includes: pharmaceutical research targeting stability, pharmacokinetics, and pharmacodynamics; integrated data architectures and clinical decision support tools; and systems engineering and trade space analysis tools to assist NASA in the development of future medical system models as well as the medical system requirements that can serve as a foundation for deep space exploration missions. All of these investments are done in a collaborative and coordinated fashion with other NASA stakeholders, such as the Environmental Control and Life Support Systems – Crew Health and Performance System Capability Leadership Team and the Health and Medical Technical Authority. DISCUSSION: In this presentation, ExMC will provide an overview of our work from across our portfolio, all of which will inform future EIMO efforts at NASA. ExMC’s research and development investments are targeted to reduce the human system risks associated with deep space exploration to the Moon and Mars.

Kris Lehnhardt↗

NASA NTRSDate not supplied

Bionutrients: Microbial Production of on-Demand Nutrients on the International Space Station

BioNutrients↗

NASA NTRSDate not supplied

CHP-PRA: Sensorimotor Countermeasures Proof of Concept

The capabilities included in Crew Health and Performance (CHP) systems are designed to keep the crew healthy, happy, and productive. In doing so, the CHP system allows reductions in human related risks to be realized. All human missions, though particularly future Artemis and Mars missions, have constraints on the mass and volume allocated to the CHP system. Thus, trades must be made on how to best buy down risk while still meeting other requirements. Understanding how different CHP capabilities influence medical, performance, and long-term health risks is key to making informed choices among these trades. To address this, an integrated CHP Probabilistic Risk Assessment (PRA) model is being developed. Much like how IMPACT is designed to allow medical resource trades informed by medical risks, CHP PRA will enable analogous trades in human system risks across all CHP functions and capabilities. There are 29 Human System Risk Board (HSRB) risk areas to consider for model implementation. This effort focused solely on the implementation of countermeasures associated with sensorimotor risk. The framework and lessons learned from this proof of concept will benefit the implementation of other risks and countermeasures. Astronauts experience sensorimotor changes when entering or exiting a microgravity environment. While most sensorimotor issues are resolved within a few days, they pose a serious risk to crew health and performance during the adaptation period. This adaptation period aligns with gravity transitions and key mission phases where the crew members may be required to complete challenging tasks ideally with an undisturbed sensorimotor system. Countermeasures such as training or pharmaceuticals can be used to mitigate risk. This effort began by identifying physiological changes to the sensorimotor system that could lead to functional performance decrements or medical conditions and potential countermeasures, so that the overall effect of sensorimotor disturbance on human risk could be captured. We then selected example countermeasures, mapped relationships between countermeasures and outcomes, and used results from existing sensorimotor investigations to define the relationship between a sensorimotor countermeasure and subsequent performance of a sensorimotor-affected task. Specifically, using shuttle landing performance data, we compared the use or absence of inflight training capabilities to yield a relative performance change that can be applied to the prediction of the risk associated with manual control performance in future missions, as depicted in the figure. This sensorimotor proof of concept demonstrates how HRP research information can be transformed into quantifiable relationships to describe changes in HSRB medical and performance risks.

Caroline R Austin↗

NASA NTRS2023

Evolutionary Flexibility and Rigidity in the Bacterial Methylerythritol Phosphate (Mep) Pathway

Terpenoids are a diverse class of compounds with wide-ranging uses including as industrial solvents, pharmaceuticals, and fragrances. Efforts to produce terpenoids sustainably by engineering microbes for fermentation are ongoing, but industrial production still largely relies on nonrenewable sources. The methylerythritol phosphate (MEP) pathway generates terpenoid precursor molecules and includes the enzyme Dxs and two iron–sulfur cluster enzymes: IspG and IspH. IspG and IspH are rate limiting-enzymes of the MEP pathway but are challenging for metabolic engineering because they require iron–sulfur cluster biogenesis and an ongoing supply of reducing equivalents to function. Therefore, identifying novel alternatives to IspG and IspH has been an on-going effort to aid in metabolic engineering of terpenoid biosynthesis. We report here an analysis of the evolutionary diversity of terpenoid biosynthesis strategies as a resource for exploration of alternative terpenoid biosynthesis pathways. Using comparative genomics, we surveyed a database of 4,400 diverse bacterial species and found that some may have evolved alternatives to the first enzyme in the pathway, Dxs making it evolutionarily flexible. In contrast, we found that IspG and IspH are evolutionarily rigid because we could not identify any species that appear to have enzymatic routes that circumvent these enzymes. The ever-growing repository of sequenced bacterial genomes has great potential to provide metabolic engineers with alternative metabolic pathway solutions. With the current state of knowledge, we found that enzymes IspG and IspH are evolutionarily indispensable which informs both metabolic engineering efforts and our understanding of the evolution of terpenoid biosynthesis pathways.

Bailey Marshall↗

NASA NTRS2024

ISS Technology Demonstrations for Future Spaceflight Medical Systems

Throughout the history of human spaceflight, crewmembers have experienced various in-flight medical conditions including illness and injury. Planned missions to the Moon and Mars will require capabilities to maintain the health of future space travelers. Mass, power, and volume available in the vehicles and habitats for these missions will be severely constrained; resupply of resources will be limited or non-existent, as will opportunities for evacuation to Earth. Furthermore, ground-based support will be hampered by communication latencies and blackouts. These vehicle and mission constraints will necessitate a medical system that has been efficiently planned, providing on-board procedural guidance in addition to a variety of medical devices and consumable resources. Medical capabilities required for the diagnosis and treatment of potential medical conditions during future spaceflight missions may include real-time health monitoring, medical imaging, and biomarker analyses ( e.g., blood or urine). Terrestrial medicine shares these needs, thus many of these medical capabilities could likely be satisfied by Commercial-Off-The-Shelf (COTS) devices and methodologies; however, in some cases the unique space environment and increased mission duration will drive the need to modify technologies and the way care is provided. NASA’s Human Research Program (HRP) Exploration Medical Capability (ExMC) Element and Mars Campaign Office’s Exploration Medical Integrated Product Team (XMIPT) are working together to decrease medical risk during exploration missions. Flight-tested medical diagnostic and treatment technologies are necessary to effectively manage medical conditions relevant to exploration missions while meeting vehicle constraints, integrating with medical decision-support tools, and enabling increasingly Earth-independent operations. Several projects have leveraged the ISS as a testbed for exploration, including 1) i n- situ blood analysis, 2) medical inventory, 3) intravenous fluid generation, and 4) autonomous medical procedure guidance. Management of several in-flight medical conditions, such as bacterial and viral infections and acute radiation syndrome, is dramatically improved with ability to assess blood cell populations, electrolytes, and metabolites. I n December 2020 and January 2021 ExMC performed an ISS technology demonstration (Tech Demo) of the HemoCue® WBC DIFF analyzer (HemoCue, Brea, CA), a COTS device that was modified to enable functionality in a spaceflight environment. This Tech Demo marked the first time that hematology measurements were successfully performed real-time in microgravity. Also modified and demonstrated was the reusable Handheld Electrolytes and Lab Technology for Humans (rHEALTH) ONE analyzer (rHEALTH, Bedford, MA), which uses flow cytometry and sheath-based hydrodynamic focusing methodologies. The rHEALTH ONE ISS Tech Demo in May 2022 demonstrated test results obtained in-flight matched those on the ground. NASA currently relies on crew self-reporting to manage and maintain medical inventory on ISS.The ability to maintain an accurate inventory becomes more critical during long duration missions since the crew will need to be increasingly autonomous in finding and utilizing medical items, including those scenarios when alternative treatments need to be considered due to limited or no resupply. HRP’s Medical Consumables Tracking (MCT) project was developed by ZIN Technologies, Inc. (Cleveland, OH), and demonstrated real-time tracking of medical supplies aboard the ISS between December 2016 and July 2018. The MCT system design utilized Radio Frequency Identification Device (RFID) technology to perform automated inventory and was installed in the Crew Health Care System (CHeCS) Resupply Stowage Rack (RSR). The challenge of limited shelf life, exacerbated by the lack of resupply opportunities, affects a plethora of medical system components including consumables, pharmaceuticals, and intravenous (IV) fluid. In 2010, ExMC funded ZIN Technologies, Inc. (Cleveland, OH), to develop the Intravenous Fluid Generation (IVGEN) system. IV fluids were successfully generated with IVGEN using the potable water supply on ISS during ISS Expedition 23. The XMIPT is in the process of developing a miniaturized version of the original IVGEN hardware for a future Tech Demo aboard the ISS. Current ISS medical operations rely heavily on preflight training and real-time remote guidance, both of which become impractical or impossible for exploration missions. The primary goal of the Autonomous Medical Officer Support (AMOS) Software Tech Demos on ISS was to confirm telemedical proof-of-concept for autonomous medical imaging in an operational setting. This novel software tool shifts emphasis from preflight training and real-time remote guidance to in-flight just-in-time instruction, a new and necessary paradigm for crew medical autonomy. AMOS introduces a novel, streamlined skill management concept for exploration missions featuring comprehensive training and guidance modules for ultrasound examinations using the ISS Ultrasound 2 (a modified GE Vivid-q™; General Electric HealthCare, Chicago, IL). With no prior crew training or remote guidance, two Tech Demos on the ISS (April 2020 and June 2022) resulted in high quality, clinically useful image sets. We will provide a review of historical, current, and planned medical devices and technologies considered for inclusion within future spaceflight medical systems and summarize hardware development activities and medical device tech demos conducted on the ISS.

Astronaut health and performance↗

NASA NTRS2024

Risk of Bone Fracture due to Spaceflight-induced Changes to Bone

The Human Research Program (HRP) is taking a biomechanical approach to assessing subsequent fracture risk in active astronauts as a consequence of spaceflight exposure. Triennial testing of active and retired astronauts continues as Space Medicine monitors for a premature diagnosis of primary osteoporosis, which is associated with age-related bone loss and skeletal fragility. This updated 2023 Fracture Evidence Report has expanded the description of skeletal changes to capture the full effects of spaceflight on bone: • Recent analysis of fractures from health records of the full astronaut cohort, suggests an increased incidence rate of hip and spine fractures in astronauts following longer spaceflight duration flights compared to incident rates found in shorter duration flights. • Routine preflight-to-postflight surveillance by DXA (dual-energy x-ray absorptiometry) does not provide the full detection of loss and recovery in the long-duration (LD) astronaut nor the full recovery of hip trabecular bone. • The inclusion of hip quantitative computed tomography (QCT) in flight studies delineates effects of spaceflight, of countermeasures, and of post-flight recovery on cortical and trabecular bone parameters—some of which are verified predictors of hip fracture in the aged. • QCT detects and compares the distinct countermeasure effects of the pharmaceutical alendronate and of resistive exercise (on the Advanced Resistive Exercise Device, ARED) in specific cortical and trabecular bone sub-regions during spaceflight. • A published comparison of QCT-determined loss rates of hip trabecular bone in LD astronauts compared to terrestrial cohorts suggest that accelerated loss rates in trabecular volumetric BMD (vBMD) during spaceflight might be analogous to skeletal effects of accelerated loss rates in females due to menopause, potentially leading to disruptions in trabecular microarchitecture. • A dataset of finite element (FE) estimates of hip bone strength in aging terrestrial cohorts (spanning astronaut age-range) provides comparative context for changes in the FE of hip bone strength in LD astronauts, including comparison (force unit of newton) to percentiles (50th, 75th, and 100th) of sex-matched aged humans with hip fractures. • Risk of fracture, due to the mechanical overloading of bones, is being updated with IMPACT, the next-generation tool suite for probabilistic risk assessment (PRA) for exploration missions being created by the Exploration and Medical Capability Element (ExMC) at NASA. IMPACT is currently in development and will not be included in this 2024 update. The risk for fracture necessitates understanding the relationship between applied loads to bone and the biomechanical competence of bone. The Risk for Early Onset Osteoporosis focuses on the weakened condition of bone (including development of new technologies, measurements of novel skeletal attributes, translation of multiple measures to an index of bone fragility, and interpretations of data used to reflect a weakened bone), while the Risk for Fracture assesses factors that influence the probability an astronaut would encounter applied loads exceeding the biomechanical competence of bones, resulting in fracture. This Evidence Report combines the research gaps and tasks associated with both risks.

Fracture↗