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At least 757 records · Page 42

Fingernail Injuries and NASA's Integrated Medical Model

The goal of space medicine is to optimize both crew health and performance. Currently, expert opinion is primarily relied upon for decision-making regarding medical equipment and supplies flown in space. Evidence-based decisions are preferred due to mass and volume limitations and the expense of space flight. The Integrated Medical Model (IMM) is an attempt to move us in that direction!

Kerstman, Eric↗

Carbon Dioxide - Our Common "Enemy"

Health effects of brief and prolonged exposure to carbon dioxide continue to be a concern for those of us who manage this pollutant in closed volumes, such as in spacecraft and submarines. In both examples, considerable resources are required to scrub the atmosphere to levels that are considered totally safe for maintenance of crew health and performance. Defining safe levels is not a simple task because of many confounding factors, including: lack of a robust database on human exposures, suspected significant variations in individual susceptibility, variations in the endpoints used to assess potentially adverse effects, the added effects of stress, and the fluid shifts associated with micro-gravity (astronauts only). In 2007 the National Research Council proposed revised Continuous Exposure Guidelines (CEGLs) and Emergency Exposure Guidelines (EEGLs) to the U.S. Navy. Similarly, in 2008 the NASA Toxicology Group, in cooperation with another subcommittee of the National Research Council, revised Spacecraft Maximum Allowable Concentrations (SMACs). In addition, a 1000-day exposure limit was set for long-duration spaceflights to celestial bodies. Herein we examine the rationale for the levels proposed to the U.S. Navy and compare this rationale with the one used by NASA to set its limits. We include a critical review of previous studies on the effects of exposure to carbon dioxide and attempt to dissect out the challenges associated with setting fully-defensible limits. We also describe recent experiences with management of carbon dioxide aboard the International Space Station with 13 persons aboard. This includes the tandem operations of the Russian Vozduk and the U.S. Carbon Dioxide Removal System. A third removal system is present while the station is docked to the Shuttle spacecraft, so our experience includes the lithium hydroxide system aboard Shuttle for the removal of carbon dioxide. We discuss strategies for highly-efficient, regenerable removal of carbon dioxide that could meet the 1000-day SMAC of 0.5%, which would apply to long-duration voyages to Mars.

James, John T.↗

An Effective Health and Medical Technical Authority

The NASA Governance model directed the formation of three Technical Authorities, Engineering; Safety and Mission Assurance; and Health and Medical, to ensure that risks are identified and adjudicated efficiently and transparently in concert with the spaceflight programs and projects. The Health and Medical Technical Authority (HMTA) has been implemented at the Johnson Space Center (JSC) and consists of the Chief Medical Office (CMO), the Deputy CMO, and HMTA Delegates. The JSC HMTA achieves the goals of risk identification and adjudication through the discharge of the appropriate technical expertise to human space flight programs and projects and the escalation of issues within program and technical authority boards. The JSC HMTA relies on subject matter experts (SMEs) in the Space Life Sciences Directorate at JSC as well as experts from other Centers to work crew health and performance issues at the technical level, develop requirements, oversee implementation and validation of requirements, and identify risks and non-compliances. Once a risk or potential noncompliance has been identified and reported to the programs or projects, the JSC HMTA begins to track it and closely monitor the program's or project's response. As a risk is developed or a non-compliance negotiated, positions from various levels of decision makers are sought at the program and project control boards. The HMTA may support a program or project position if it is satisfied with the decision making and vetting processes (ex. the subject matter expert voiced his/her concerns and all dissenting opinions were documented) and finds that the position both acknowledges the risk and cost of the mitigation and resolves the issue without changing NASA risk posture. The HMTA may disagree with a program or project position if the NASA risk posture has been elevated or obfuscated. If the HMTA does disagree with the program or project position, it will appeal to successively higher levels of authority so that risk acceptance and risk trades will be acknowledged and sanctioned at the highest appropriate level; this includes Program Managers, Mission Directorate Associate Administrators and the Agency Administrator.

Fogarty, Jennifer A.↗

Developing a Gap Taxonomy to Address Crew Health Risks in NASA's Human Research Program

The mission of NASA's Human Research Program (HRP) is to understand and reduce the risk to crew health and performance in exploration missions. The HRP addresses 27 specific risks by identifying and then filling gaps in understanding the risks and in the ability to disposition the risks. The primary bases for identifying gaps have been past experience and requirements definition. This approach has been very effective in identifying some important, relevant gaps, but may be inadequate for identifying gaps outside the past experience base. We are exploring the use of a gap taxonomy as a comprehensive, underlying conceptual framework that allows a more systematic identification of gaps. The taxonomy is based on these stages in medical care: prediction, prevention, detection/diagnosis, treatment, monitoring, rehabilitation, and lifetime surveillance. This gap taxonomy approach identifies new gaps in HRP health risks. Many of the new gaps suggest risk reduction approaches that are more cost effective than present approaches. A major benefit of the gap taxonomy approach is to identify new, economical approaches that reduce the likelihood and/or consequence of a risk.

Kundrot, Craig E.↗

An Up-Close Look at Ares I-X

On October 28, 2009, one day later than the originally planned launch date, the Ares I-X suborbital test flight roared into the Florida sky. Flying its preplanned parabolic arc over the Atlantic, the development test vehicle for the Ares I crew launch vehicle performed as advertised, executing a perfect liftoff, 90-degree roll maneuver, ascent, and separation before its upper and lower stages descended into the ocean 150 miles downrange. This test flight, while carrying no astronauts, marked a major milestone for NASA, which had not flown a test launch of a human-rated rocket since the first flight of the Space Shuttle in 1981. During the flight, over 700 sensors collected over 900 measurements, which NASA will apply to validating the engineering models they used to design the vehicle in the first place. That data, telemetered to the ground and stored in a flight recorder onboard, was the primary "payload" of the mission.

Leahy, Bart↗

Towards Verification of Operational Procedures Using Auto-Generated Diagnostic Trees

The design, development, and operation of complex space, lunar and planetary exploration systems require the development of general procedures that describe a detailed set of instructions capturing how mission tasks are performed. For both crewed and uncrewed NASA systems, mission safety and the accomplishment of the scientific mission objectives are highly dependent on the correctness of procedures. In this paper, we describe how to use the auto-generated diagnostic trees from existing diagnostic models to improve the verification of standard operating procedures. Specifically, we introduce a systematic method, namely the Diagnostic Tree for Verification (DTV), developed with the goal of leveraging the information contained within auto-generated diagnostic trees in order to check the correctness of procedures, to streamline the procedures in terms of reducing the number of steps or use of resources in them, and to propose alternative procedural steps adaptive to changing operational conditions. The application of the DTV method to a spacecraft electrical power system shows the feasibility of the approach and its range of capabilities

Kurtoglu, Tolga↗

Effects of Long Duration Spaceflight on Venous and Arterial Compliance

The visual impairment and intracranial pressure syndrome (VIIP) is a newly described space flight-associated medical condition made up of a constellation of symptoms affecting at least 34% of American astronauts who have flown International Space Station (ISS) missions. VIIP is defined primarily by visual acuity deficits and anatomical changes to eye structures, and is thought to be related to elevated intracranial pressure secondary to space flightinduced cephalad fluid shifts. Loss of visual acuity could be a significant threat to crew health and performance and may be suggestive of other adaptations with implications for years post-flight. Our primary objective is to determine whether vascular compliance is altered by space flight and whether such adaptations are related to the incidence of VIIP. In particular, we will measure ocular parameters and vascular compliance in vessels of the head and neck in astronauts who have no space flight experience, in astronauts before, during, and after space flight, and in bed rest subjects with conditions similar to space flight. Additionally, we will analyze astronaut data from the Lifetime Surveillance of Astronaut Health (LSAH) archive to determine which factors might be predictive of the development of VIIP. The project will be conducted in four separate but related parts. To understand the baseline condition of astronauts without any prior space flight experience, we will study 10 astronauts who have never flown in space by performing a comprehensive evaluation of the vasculature of the head, neck and eyes. Hemodynamic data (stroke volume and blood pressure), ocular (tonometry and ocular ultrasound), venous and arterial parameters will be acquired across a range of tilt angles (20, 10, 0, -10, -20 degrees). Vessels to be studied include the temporal, jugular, and vertebral veins and the cerebral, carotid and vertebral arteries. Ophthalmic data from the annual physical will be obtained through data sharing. To examine the relation between vascular compliance in the head and neck and the development of VIIP after a long duration space flight, we will study 10 astronauts before, during, and after long-duration ISS missions. Pre- and post-flight testing will be identical to that described above. During flight, images of the same vessels of interest will be obtained for later analysis. Ophthalmic data including VIIP scores will be obtained through data sharing from medically-required tests. To investigate the effects of age and elevated sodium intake, two potential contributors to VIIP, we will study 24 men (in two age groups: 25-35 and 45-55) during a 14 day 6deg head-down bed rest, a well-accepted analog of space flight. Standard NASA bed rest conditions will be maintained except for dietary sodium. Sodium intake will be similar to that of ISS astronauts, which is higher than consumed in previous bed rest studies. Pre- and post-bed rest testing procedures will be identical to the testing protocol described above for astronauts. Ophthalmic testing (optical coherence tomography, fundoscopy, and tonometry) will be conducted on the same day that vascular compliance measures are obtained. To identify parameters that may relate to an increase in an astronaut's susceptibility to developing VIIP, we will use data mining techniques to evaluate astronaut data obtained from the LSAH. Medical history, family history, space flight history and its related exposures, and history of high performance jet aircraft exposure will be examined for their potential relationship to ocular data. We hypothesize that the cephalad fluid shift induced by space flight will result in structural and functional adaptations in head and neck vessels leading to decreased vascular compliance and related to the development of VIIP symptoms. Further, although VIIP has not been observed in previous bed rest studies, we hypothesize that an elevated sodium intake will increase the incidence of VIIP symptoms in this space flight analog. Finally, we hypothesize that data mining analyses will reveal relationships between health history, previous exposures (including space flight and high performance aircraft), and the development of VIIP in the astronaut population.

Ribeiro, L. C.↗

A Case for Hypogravity Studies Aboard ISS

Future human space exploration missions being contemplated by NASA and other spacefaring nations include some that would require long stays upon bodies having gravity levels much lower than that of Earth. While we have been able to quantify the physiological effects of sustained exposure to microgravity during various spaceflight programs over the past half-century, there has been no opportunity to study the physiological adaptations to gravity levels between zero-g and one-g. We know now that the microgravity environment of spaceflight drives adaptive responses of the bone, muscle, cardiovascular, and sensorimotor systems, causing bone demineralization, muscle atrophy, reduced aerobic capacity, motion sickness, and malcoordination. All of these outcomes can affect crew health and performance, particularly after return to a one-g environment. An important question for physicians, scientists, and mission designers planning human exploration missions to Mars (3/8 g), the Moon (1/6 g), or asteroids (likely negligible g) is: What protection can be expected from gravitational levels between zero-g and one-g? Will crewmembers deconditioned by six months of microgravity exposure on their way to Mars experience continued deconditioning on the Martian surface? Or, will the 3/8 g be sufficient to arrest or even reverse these adaptive changes? The implications for countermeasure deployment, habitat accommodations, and mission design warrant further investigation into the physiological responses to hypogravity. It is not possible to fully simulate hypogravity exposure on Earth for other than transient episodes (e.g., parabolic flight). However, it would be possible to do so in low Earth orbit (LEO) using the centrifugal forces produced in a live-aboard centrifuge. As we're not likely to launch a rotating human spacecraft into LEO anytime in the near future, we could take advantage of rodent subjects aboard the ISS if we had a centrifuge that could accommodate the rodent subjects for extended periods (weeks to months) at various hypogravity levels. Experiments aboard such a centrifuge could provide important insight into human exploration questions and simultaneously answer fundamental questions in gravitational physiology.

Paloski, William H.↗

A Third-Generation Evidence Base for Human Spaceflight Risks

NASA's Human Research Program seeks to understand and mitigate risks to crew health and performance in exploration missions center dot HRP's evidence base consists of an Evidence Report for each HRP risk center dot Three generations of Evidence Reports 1) Review articles + Good content - Limited authorship, infrequent updates 2) Wikipedia articles + Viewed often, very open to contributions - Summary of reviews, very few contributions 3) HRP‐controlled wiki articles + Incremental additions to review articles with editorial control

Kundrot, Craig E.↗

2013 Advanced Environmental Health/Advanced Food Technology Standing Review Panel Final Report

The 2013 Advanced Environmental Health/Advanced Food Technology (AEH/AFT) Standing Review Panel (from here on referred to as the SRP) participated in a WebEx/teleconference with members of the Space Human Factors and Habitability (SHFH) Element, representatives from the Human Research Program (HRP), and NASA Headquarters on November 22, 2013 (list of participants is in Section IX of this report). The SRP reviewed the updated research plans for the Risk of Adverse Health Effects Due to Alterations in Host-Microorganism Interactions (Host Microbe Risk) and the Risk of Performance Decrement and Crew Illness Due to an Inadequate Food System (Food Risk). The SRP also received a status update on the Risk of Adverse Health Effects of Exposure to Dust and Volatiles during Exploration of Celestial Bodies (Dust Risk). Overall, the SRP was impressed with the strong research plans presented by the scientists and staff associated with the SHFH Element. The SRP also thought that the updated research plans were thorough, well organized, and presented in a comprehensive manner. The SRP agrees with the changes made to the Host Microbe Risk and Food Risk portfolios and thinks that the targets for Gap closure are appropriate.

Steinberg, Susan↗

Path Toward a Unifid Geometry for Radiation Transport

The Direct Accelerated Geometry for Radiation Analysis and Design (DAGRAD) element of the RadWorks Project under Advanced Exploration Systems (AES) within the Space Technology Mission Directorate (STMD) of NASA will enable new designs and concepts of operation for radiation risk assessment, mitigation and protection. This element is designed to produce a solution that will allow NASA to calculate the transport of space radiation through complex computer-aided design (CAD) models using the state-of-the-art analytic and Monte Carlo radiation transport codes. Due to the inherent hazard of astronaut and spacecraft exposure to ionizing radiation in low-Earth orbit (LEO) or in deep space, risk analyses must be performed for all crew vehicles and habitats. Incorporating these analyses into the design process can minimize the mass needed solely for radiation protection. Transport of the radiation fields as they pass through shielding and body materials can be simulated using Monte Carlo techniques or described by the Boltzmann equation, which is obtained by balancing changes in particle fluxes as they traverse a small volume of material with the gains and losses caused by atomic and nuclear collisions. Deterministic codes that solve the Boltzmann transport equation, such as HZETRN [high charge and energy transport code developed by NASA Langley Research Center (LaRC)], are generally computationally faster than Monte Carlo codes such as FLUKA, GEANT4, MCNP(X) or PHITS; however, they are currently limited to transport in one dimension, which poorly represents the secondary light ion and neutron radiation fields. NASA currently uses HZETRN space radiation transport software, both because it is computationally efficient and because proven methods have been developed for using this software to analyze complex geometries. Although Monte Carlo codes describe the relevant physics in a fully three-dimensional manner, their computational costs have thus far prevented their widespread use for analysis of complex CAD models, leading to the creation and maintenance of toolkit-specific simplistic geometry models. The work presented here builds on the Direct Accelerated Geometry Monte Carlo (DAGMC) toolkit developed for use with the Monte Carlo N-Particle (MCNP) transport code. The workflow for achieving radiation transport on CAD models using MCNP and FLUKA has been demonstrated and the results of analyses on realistic spacecraft/habitats will be presented. Future work is planned that will further automate this process and enable the use of multiple radiation transport codes on identical geometry models imported from CAD. This effort will enhance the modeling tools used by NASA to accurately evaluate the astronaut space radiation risk and accurately determine the protection provided by as-designed exploration mission vehicles and habitats

Lee, Kerry↗

Humans vs Hardware: The Unique World of NASA Human System Risk Assessment

Understanding spaceflight risks to crew health and performance is a crucial aspect of preparing for exploration missions in the future. The research activities of the Human Research Program (HRP) provide substantial evidence to support most risk reduction work. The Human System Risk Board (HSRB), acting on behalf of the Office of Chief Health and Medical Officer (OCHMO), assesses these risks and assigns likelihood and consequence ratings to track progress. Unfortunately, many traditional approaches in risk assessment such as those used in the engineering aspects of spaceflight are difficult to apply to human system risks. This presentation discusses the unique aspects of risk assessment from the human system risk perspective and how these limitations are accommodated and addressed in order to ensure that reasonable inputs are provided to support the OCHMO's overall risk posture for manned exploration missions.

Anton, W.↗

Effects of Spaceflight on Venous and Arterial Compliance

The visual impairment and intracranial pressure (VIIP) syndrome is a spaceflight-associated medical condition consisting of a constellation of symptoms affecting less than 70% of American astronauts who have flown International Space Station (ISS) missions. VIIP is defined primarily by visual acuity deficits and anatomical changes to eye structures and is hypothesized to be related to elevated intracranial pressure secondary to spaceflight-induced cephalad fluid shifts, although other space flight factors (e.g., diet, environmental factors) may contribute. Loss of visual acuity could be a significant threat to crew health and performance during and after an exploration mission and may have implications for years postflight.

Platts, S. H.↗

2015 Advanced Environmental Health/Advanced Food Technology Standing Review Panel

The 2015 Advanced Environmental Health/Advanced Food Technology (AEH/AFT) Standing Review Panel (from here on referred to as the SRP) met for a site visit in Houston, TX on December 14 - 15, 2015. The SRP met with representatives from the Space Human Factors and Habitability (SHFH) Element and members of the Human Research Program (HRP) to review the updated research plans for the Risk of Adverse Health Effects Due to Host-Microorganism Interactions (MicroHost Risk) and the Risk of Performance Decrement and Crew Illness due to an Inadequate Food System (Food Risk). During the meeting, the SRP also met with the vehicle engineers to discuss possible food storage options. The SRP would like to commend Dr. Oubre and Dr. Douglas for their detailed presentations, as well the frank, refreshing, and comprehensive engineering presentation. This gave much needed perspective to the food storage issues and reassured the committee about NASA's approach to the problem. In terms of critiques, the SRP remains unconvinced about the rationale for probiotic use other than for specific applications supported by the literature. It is not clear what gap or problem is being addressed by the use of probiotics, and the rationale for their use needs to be clearly rooted in the available literature. The SRP thinks that if low-Earth orbit is associated with immune system impairment, then there may additional risks linked with the use of probiotics. It is not clear to the SRP how NASA will determine if probiotics are having their intended beneficial effect. A similar concern is raised as to what gaps or problems are being addressed by "functional foods". Mixed infections, rather than single species infections, which can augment severity of disease, also represent a significant concern. Overall, the SRP considers this to be a strong program that is well-organized, well-coordinated and generates valuable data.

Steinberg, Susan↗

Defining Medical Levels of Care for Exploration Missions

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.

Hailey, M.↗

Effects of Spaceflight on Venous and Arterial Compliance

The visual impairment and intracranial pressure (VIIP) syndrome is a spaceflight-associated set of symptoms affecting more than 50% of American astronauts who have flown International Space Station (ISS) missions. VIIP is defined primarily by visual acuity deficits and anatomical changes to eye structures (e.g. optic disc edema, choroidal folds, and globe flattening) and is hypothesized to be related to elevated intracranial pressure secondary to a cephalad fluid shift. However, ocular symptoms have not been replicated in subjects completing prolonged bed rest, a well-accepted spaceflight analog. Altered vascular compliance along with spaceflight factors such as diet, radiation exposure, or environmental factors may cause alterations in the cardiovascular system that contribute to the manifestation of ocular changes. Loss of visual acuity could be a significant threat to crew health and performance during and after an exploration mission and may have implications for years post-flight. The overall objective of this project is to determine if spaceflight alters vascular compliance and whether such an adaptation is related to the incidence of VIIP. This objective will be met by completing three separate but related projects.

Ribeiro, L. C.↗

Innovative Approaches to Using the International Space Station as a Mars Transit Analog

Human research on the International Space Station (ISS) crew has made significant advances in understanding of the effects of physiology on human health in space missions. However, ISS has not been as suitable for research on other hazards of human spaceflight such as isolation and communications delay. NASA recently completed a special assessment of whether modifications could be made to operations or facilities so that ISS could be used more effectively as an analog to simulate long-duration crew missions beyond low earth orbit. A cross-disciplinary team met to identify concept of operations, trade spaces, challenges, and opportunities to making ISS more operationally relevant as a Mars transit mission analog, and the results and implementation plans are summarized in this manuscript. In addition to the use case of 12-month missions (already in planning by the NASA ISS Program to bound expected Mars transit durations), three new use cases where ISS could provide valuable high-fidelity experience were identified. (1) Testing of operations procedures and medical care could be enhanced by demonstrating crew handling a simulated medical event in microgravity, autonomously, and with significant communications delay. (2) Isolation and confinement effects of deep space transit could be studied on ISS to validate current habitable volume requirements for Mars transit as well as provide context for evaluating the results of the extensive ground-based simulations in HERA and NEK. A trade study of possible operational and hardware changes that would make ISS applicable to these use cases was completed. (3) Surface operations after the physiological deconditioning of a long transit could be conducted to validate crew ability to perform critical ground tasks after 6-month Mars transit and aid in conceptual design of Mars surface element architectures. Each of the case studies includes a trade space between operational impacts on nominal ISS activities and degree of fidelity. A phased approach to implementation means that several "quick start" activities can be done in 2019-2020 at the same time as planning continues for more complex exploration analog options beginning as early as 2022. The team determined that many of these quick-start tasks could be done with available assets, entirely independent of other exploration system development timelines (such as Orion, Space Launch System). The consideration of the full suite of human spaceflight capabilities in the lunar vicinity can also be included as each step in human exploration serves as a simulation opportunity for some aspect of subsequent missions. Further discussions of options with the international community are critical for considering the benefits as well as impacts of simulation activities on ISS, as well as to better formulate future mission architectures.

Robinson, Julie A.↗

Supplying a Pharmacy for NASA Exploration Spaceflight: Challenges and Current Understanding

In order to maintain crew health and performance during long-duration spaceflight outside of low-Earth orbit, NASA and its international partners must be capable of providing a safe and effective pharmacy. Given few directed studies of pharmaceuticals in the space environment, it is difficult to characterize pharmaceutical effectiveness or stability during spaceflight; this in turn makes it challenging to select an appropriate formulary for exploration. Here we present the current state of literature regarding pharmaceutical stability, metabolism, and effectiveness during spaceflight. In particular, we have attempted to highlight the gaps in current knowledge and the difficulties in translating terrestrial-based drug studies to a meaningful interpretation of drug stability, safety, and effectiveness in space. We hope to identify high-yield opportunities for future research that might better define and mitigate pharmaceutical risk for exploration missions.

Rebecca S Blue↗