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NASA NTRS2019

Oculometric Assessment of Mild Neural Impairment

For over 100 years, neurologists have used eye movements to identify neural impairment, disease, or injury. Prior to the age of modern imaging, qualitative assessment of eye movements was a critical, routine component of diagnosis and remains today a routine law-enforcement tool for detecting impaired driving due to drugs or alcohol. We will describe the application of a simple 5-minute oculomotor tracking task coupled with a broad range of quantitative analyses of high-resolution oculomotor measurements for the sensitive detection of sub-clinical neural impairment and for the potential differentiation of various causes. Specifically, we will show that there are distinct patterns of impairment across our set of oculometric parameters observed with brain trauma, sleep and circadian disruption, and alcohol consumption. Such differences could form the basis of a self-administered medical monitoring or diagnostic support tool.

Stone, Lee↗

NASA NTRS2020

Temporal Changes in Astronauts’ Muscle and Cardiorespiratory Physiology Pre-, In-, and Post-Spaceflight

NASA’s vision for future exploration missions depends on the ability to protect astronauts’ health and safety for performance of Extravehicular Activity (EVA), and to allow astronauts to safely egress from vehicles in a variety of landing scenarios (e.g. water landing upon return to Earth and undefined planetary/lunar landings). Prolonged exposure to spaceflight results in diminished tolerance to prolonged physical activity, decreased cardiac and sensorimotor function, and loss of bone mineral density, muscle mass, and muscle strength. For over 50 years exercise has been the primary countermeasure against these physiologic decrements during spaceflight, and while the resulting protection is adequate for ISS missions (i.e., Soyuz landing, microgravity EVAs), there is little information regarding time-course changes in muscle and aerobic performance. As spaceflight progresses towards longer exploration missions and vehicles with less robust exercise capabilities compared to ISS, countermeasures will need to be combined and optimized to protect crew health and performance across all organ systems over the course of exploration missions up to 3 years in duration. This will require a more detailed understanding of the dynamic effects of spaceflight on human performance. Thus, the focus of this study is quantifying decrements in physical performance over different mission durations, and to provide detailed information on the physiological rational for “why” and “when” observed changes in performance occur. The research proposed will temporally profile changes in astronauts’ cardiorespiratory fitness, muscle mass, strength, and endurance over spaceflight missions of 2 months, 6 months, and up to 1 year in duration. Additionally, an extrapolation model will provide predictions for changes associated with exploration missions 2-3 years in duration. To accomplish these objectives astronauts will be asked to participate in pre, in, post-flight measurement of muscle performance, muscle size, cardiorespiratory fitness and submaximal performance capabilities, as well as non-invasive assessment of cerebral and muscle oxygenation and perfusion (Table 1). Additionally, ambulatory and in-flight exercise, nutrition, and sleep will be monitored using a variety of commercial technologies and in-flight assessment tools. Significance: Our detailed testing protocol will provide valuable information for describing how and when spaceflight-induced muscle and aerobic based adaptations occur over the course of spaceflight missions up to and beyond 1 year. This information will be vital in the assessment as to whether humans can be physically ready for deep space exploration such as Mars missions with current technology, or if additional mitigation strategies are necessary.

Downs, M. E.↗

NASA NTRS2020

Work Scheduling and Fatigue Management

There are physiological limits to human performance, influenced by the internal programming of the sleep homeostat and circadian rhythms. There are known fatigue-related risks related to different work scheduling factors. This presentation was for presentation to supervisors and managers at Stennis Space Center to provide information about physiological risks factors associated with shiftwork scheduling practices and facilitate discussion about approaches to manage the related risks.

Gregory, Kevin↗

NASA NTRS2020

Evaluation of Performance, Fatigue and Workload during Real-time, Reactive Telerobotic Mission Control Operations

Telerobotic operations involve a user operating a robot from a different location from where the activity is taking place. It can be difficult for humans to maintain performance when faced with physiological stressors, such as fatigue or illness. Operations require vigilance for extended periods, raising safety concerns surrounding operator’s fatigue and workload. Every hour of wakefulness increases the drive to sleep, causing decreased reaction time (RT), increased lapses in attention (RT > 500 ms), and decreased memory capability. The NASA Task Load Index (NASA-TLX) was created to evaluate the multiple attributes surrounding workload (e.g., mental and physical demands). The upcoming Volatiles Investigating Polar Exploration Rover (VIPER) mission involves remotely controlling a lunar vehicle from an Earth-based mission control station. The goal of VIPER is to excavate the moon for volatiles (water) deep in the surface near the South Pole for a 100-day, continuous operation.

Fatigue↗

NASA NTRSDate not supplied

Clinical Decision Support - Concepts of Operation

We are entering a new era in space exploration to return to the moon and explore Mars. Crew members operating independently during long duration space exploration missions will require a clinical decision support system (CDSS) to increase autonomy by augmenting their knowledge, skills and abilities in different scenarios. Significant changes to in-flight and habitat medical care due to constraints on mass, volume, power, crew time and medical evacuation capabilities are needed to increase crew autonomy and self-reliance in decision making and task performance. The Exploration Medical Capability (ExMC) Element of the Human Research Program (HRP) pushes the boundary of space medical systems to advance the care of astronauts on future exploration missions beyond low Earth orbit by identifying and testing next-generation medical care and crew health maintenance technologies. Clinical decision support (CDS) presents knowledge and data in a context aware manner to augment a crew members’ knowledge, skills and abilities during the process of observation, orientation, decisions and action. A comprehensive crew health and performance CDSS is required to augment crew capability and will be used in different scenarios for several reasons. In general, the CDSS’s role is to assist the crew in prevention, detection, diagnosis and treatment of crew health and performance related conditions that may arise in exploration spaceflight. For example, CDSS would assist a high acuity scenario such as a heart attack by supplying clear instructions, vital signs and treatment reminders. A lower severity scenario such as kidney stone risk could interface to vehicle systems and display more complex predictive data during a diagnosis. A CDSS needs to contribute to successful missions by maintaining a high performing crew who can potentially exhibit countless medical conditions related to derangements from the space environment (sleep, cognition, nutrition and exercise) as well as conditions intrinsic to humans anywhere. While supporting the crew’s ability to make sound clinical decisions is desirable in any mission, it is essential for exploration missions with significant communication delays, no evacuation capability, and extended exposure to the flight environment. Such missions correspond with medical Level of Care V (LOC V), the highest level specified in NASA-STD-3001. The project focuses on CDS implementation research to derive requirements for LOC V, where the need for increased autonomy results in new practices and the inclusion of non-clinical data, such as vehicle environmental measures and physical exercise results, from other human and vehicle domains and advanced analytics. The CDS project describes how the CDSS is intended to be used by defining concepts of operations (ConOps). The process to derive ConOps focuses on increased autonomy that reduces the likelihood and consequences of accepted medical conditions. These crew health and performance inputs are grouped by common datasets and analysis models. Use cases are derived to research new clinical scenarios, architectural development and workflows. Implementation research is conducted with protypes to inform assumptions and derive requirements. The project also establishes how externally developed analysis and approaches can be added to expand a clinical decision support system and thus highlight how a comprehensive system can be globally developed with collaborators. This presentation will cover example scenarios from the CDS ConOps and the method to derive them. One example scenario will be CDSS alerting an increased kidney stone risk during a mission, with diagnosis and treatment options provided during the intervention.

clinical decision support↗

NASA NTRSDate not supplied

Market Survey 2020: Commercial Clinical Decision Support Systems and Wellness Tools

For long-duration, deep space exploration missions, current methods for managing and supporting crew health and medical conditions will be unsuitable. Communication and data transmission lags will necessitate the use of a sophisticated clinical decision support system (CDSS) that will tailor diagnosis and treatment guidance that is context-sensitive for anticipated astronaut health, wellness, and medical conditions. A variety of clinical decision support (CDS) and wellness tools (WT) are currently available in the commercial market and a broad-brush survey of this market can provide an initial impression of the current state of the art which, in turn, can inform the roadmap of NASA deep space CDSS development and associated requirements. Such a survey was undertaken during the first six months of 2020 using directed convenience sampling to obtain information provided by vendors on their websites; both commercially available CDS and WT (such as those used to track and monitor nutrition, exercise, and sleep) were included. Areas assessed were item type (e.g., software/application, device); primary purpose of the item (e.g., diagnostic support, nutrition tracking); additional purposes (if any); reported features, capabilities, and functionality; setting of use (e.g., inpatient, outpatient); intended user (e.g., clinician, patient); location and sources of data/information used or produced by the item; integration with patient electronic health record (EHR); compliance with interoperability ontologies and standards (e.g., Health Level 7 [HL7], Systematized Nomenclature of Medicine – Clinical Terminology [SNOMED-CT]); and whether the item is knowledge-based (derived from research findings) or non-knowledge-based (derived through artificial intelligence, machine learning, advanced probability and statistics), among others. Ninety-seven (97) vendor websites describing 196 CDS and 73 WT (269 total) were reviewed and coded. The primary purpose of the majority of CDS reviewed is diagnosis or diagnosis/treatment/drug decision support—targeted for clinician use— and the primary purpose of the majority of WT reviewed is the monitoring of different health metrics, most often through the use of a biosensor device (e.g., blood pressure)—targeted for patient use. Very few CDS or WT appear to comply with major international interoperability standards or can be integrated with a patient’s EHR data. None consider contextual factors, such as conditions of the physical environment (e.g., CO2 levels). The majority of CDS and WT reviewed are non-knowledge, cloud- or web-based applications or software. Forty-three (43) major findings were identified and the implications those findings have for NASA will be discussed. Example major findings include: CDS-WT capabilities range from diagnosis to treatment applications, CDS-WT may be wearable or non-wearable and are technologically advanced and only a few CDS-WT tools referenced compliance to ensure interoperability, among other findings. Recommendations will also be offered that will help to address ExMC Gap, Medical-701: Enhance medical capabilities within an exploration medical system.

market survey↗

NASA NTRSDate not supplied

Clinical Decision Support - Concepts of Operation

clinical decision support↗

NASA NTRSDate not supplied

The Influence of Self-Reported Distractions on the Psychomotor Vigilance Task (PVT) in Laboratory and Field Environments

Introduction: The Psychomotor Vigilance Task (PVT) is a measure of vigilant attention that is commonly used in laboratory environments to assess the neurobehavioral impact of sleep loss and circadian misalignment. The PVT has been increasing in popularity for use in field environments; however, the potential for distraction is higher in the field compared to the lab. It is unclear how distractions experienced by individuals taking the PVT in the real world may influence reaction time metrics. We investigated the influence of self-reported distraction on PVT outcomes across laboratory and field environments. Methods: We examined PVT data from five studies including short (n=36 participants, 3799 PVTs) and long-haul (n=75 participants, 3283 PVTs) airline personnel, control center personnel (n=5 participants, 96 PVTs), and healthy individuals who participated in a study involving at-home and laboratory assessments (n=12 participants, 486 and 310 PVTs). Individuals in all of the studies were asked to complete the five-minute NASA PVT at least three times daily. Participants were asked to indicate the number of distractions they experienced immediately after each PVT. Mean PVT reaction time (RT) and number of distractions were computed for each study and overall. Results: Participants reported more distractions in field environments compared to the lab (short-haul=1.29 +/- 1.48, long-haul=0.66 +/- 1.07, control-center=1.20 +/- 1.37, at-home=0.86 +/- 1.36, laboratory=0.46 +/- 1.07) Across all studies, we found that PVT RT slowed as self-reported distractions increased (all studies combined: 0 distractions=PVT RT 274.4ms; 1=284.6ms; 2=302.9ms; 3=321.2ms; >4=409.3ms). These findings were similar for healthy participants completing PVTs at home (0 distractions=287.1ms; 1=309.9ms; 2=328.3ms; 3=369.8ms; >4=385.1ms) but were less consistent during in-lab assessments (0 distractions=278.7ms; 1=316.2ms; 2=396.2ms; 3=370.4ms; >4=354.4ms). These findings were similar for other PVT outcomes. Conclusion: Participants reported more distractions in field environments compared to the laboratory. Our findings suggest that the number of distractions that individuals report experiencing while taking a PVT increases the reaction time registered by the device. Researchers should collect information about distractions during the PVT and should be aware that distractions may influence the recorded PVT reaction time.

behavior↗

NASA NTRSDate not supplied

Improving Efficacy and Safety of Pharmacological Treatment Through Precision Medicine and Pharmacogenomics for Human Deep Space Exploration

INTRODUCTION: Future spaceflight will require increased crew medical autonomy as exploration class missions expanding duration and distance from Earth, especially for Mars missions. As mission duration increases, it will be even more 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 further tailor medications included in the spacecraft formulary and increased examination of appropriate dosing regimens. BACKGROUND: Precision Health is an exciting area of cutting-edge research and medicine focused on maintaining an individual’s health and performance through in-depth understanding of an individual’s unique factors and molecular profiles. This approach can be adapted to better predict, monitor, and address physiological responses to the spaceflight environment. One example is the field of 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 pharmaceutical choice and dosing to avoid adverse drug events and maximize pharmacological efficacy. The goal of this study was to evaluate which drugs in the current space pharmacy 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 onboard the International Space Station (ISS) was analyzed for risk and likelihood of drug failure and PGX actionability. This analysis encompassed both personal astronaut medications, including supplements and over the counter drugs (n=151) and ISS MedKit formulary medications (n=95). Duplicate medications and different formulations were removed, which resulted in 157 total 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. Likelihood of individual drug failure was defined by whether existing processes are sufficient to prevent adverse 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 and ranked from 1 (very low) to 5 (very high).A comprehensive assessment of commercially available PGX solutions is currently underway to evaluate specimen requirements, cost/benefit analysis (cost vs. number of alleles assessed), utility of 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) indicated29medicationswere in the yellow or red zone driven predominantly by drug failure or safety concerns, with the remainder(n=128)of the medications in the green zone where risk is acceptable. 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 pre-flight PGX testing to reduce risk of mission failure due to ineffective or toxic medications, improve targeting drug efficacy and safety, and further open the door to countermeasure research exploring PGX-related allelic variants. 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 cost effective and more 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 crew autonomy and providing tailored countermeasures

Alice R W Tang↗

NASA NTRS2021

Topical: Reverse Translation Strategies to Support Cognitive and Behavioral Risk Characterization

A coordinated suite of measurements to assess humans and animals needs to be established to support the translation and harmonization of animal research data to the astronaut corps due to the necessity of using animal subjects for radiation testing. The identification of POLs and PELs for spaceflight stressors (i.e. space radiation, altered gravity, isolation and confinement, sleep disruption) individually and combined will depend on defining scaling factors or transfer functions that can be used to relate human and animal outcomes.

Gregory Nelson↗

NASA NTRSDate not supplied

Human Factors and Behavioral Performance Exploration Measures Harmonized Across HERA, NEK, and ISS Teams Risk

The Human Factors and Behavioral Performance Exploration Measures (HFBP-EM) suite is a set of standardized measures to assess behavioral health and performance risk related to future exploration class missions, and to support reduction of the Human Research Program’s (HRP) Behavioral Medicine (BMed), Team, Sleep, and Human Systems Integration Architecture risks. HFBP-EM were collected during Human Exploration Research Analogs (HERA) campaigns 4 (C4) and 5 (C5), and during SIRIUS 17 and 19 missions in the Russian Ground Based Experiment Complex, NEK, to document the feasibility, flexibility, and acceptability of these measures in analogs of the spaceflight environment. A subset of the HFBP-EM suite was collected during spaceflight as part HRP’s Standard Measures in Spaceflight Project. Whenever possible, the HFBP-EM protocol and measures are kept the same across studies, however, differences across research settings (e.g., experimental manipulations, mission scenarios, mission length) and implementation of the measures require the data are harmonized to ensure comparable views across missions. The purpose of our project is to develop a harmonized database of HFBP-EM data from different settings, and to summarize the trajectory of behavioral health and performance within and between research settings. In this presentation, we will summarize the harmonized dataset and the trajectory of measures related to the Team Risk, including team performance, team cohesion, team processes, and psychological safety, over time and between and within settings.

S T Bell↗

NASA NTRSDate not supplied

Human Factors and Behavioral Performance Exploration Measures Harmonized Across HERA, NEK, And ISS: Behavioral Medicine Risk

The Human Factors and Behavioral Performance Exploration Measures (HFBP-EM) suite is a set of standardized measures used to assess behavioral health and performance risks related to future exploration class space missions. The HFBP-EM addresses the Human Research Program’s (HRP) Behavioral Medicine (BMed), Team, Sleep, and Human Systems Integration Architecture risks. HFBP-EM were collected during Human Exploration Research Analog (HERA) campaigns 4 and 5, and during SIRIUS 17 and 19 missions in the Russian Ground Based Experiment Complex, NEK, to document the feasibility, flexibility, and acceptability of these measures in analogs of spaceflight environments. A subset of the HFBP-EM suite was collected in spaceflight as part of the HRP Standard Measures in Spaceflight Project. Whenever possible, the HFBP-EM protocol and measures are the same across studies, differences across research settings (e.g., experimental manipulations, mission scenarios, and mission length) and implementation of the measures require that the data are harmonized to ensure comparable views across missions. The purpose of our project was to develop a harmonized database of analyzable HFBP-EM data from spaceflight and analog settings, and to summarize the trajectory of behavioral health and performance outcomes within and between mission settings. In this presentation, we will summarize the harmonized dataset and the trajectory of BMed related measures including depression, neurobehavioral function, mood, cognition, and operationally relevant individual performance over time and by campaign and mission.

S T Bell↗

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 NTRS2022

Moon to Mars (M2M) Habitation Considerations: A Snap Shot As of January 2022

The following NASA Technical Memorandum (TM) is intended to provide a snapshot in time of NASA’s current considerations (ground rules and assumptions, functional allocations, logistics) for habitation systems for the lunar surface (non-roving) and Mars transits. As NASA continues to refine the reference designs to meet the needs of an evolving architecture, it is expected that this information will also be updated as a result. Where appropriate, relevant publicly released documents will be referenced to provide further detail. NASA’s human lunar exploration plan under the Artemis program calls for achieving the goal of sending the first woman and first person of color to the surface of the Moon in the mid- 2020s and working toward sustainable exploration by the end of the decade. Working with both commercial and international partners, NASA will establish a permanent human presence on the Moon to uncover new scientific discoveries and lay the foundation for private companies to build a lunar economy. Longer duration missions on the lunar surface and in lunar orbit will also serve as a test bed for technologies to support future Mars exploration campaigns. The agency will use what we learn on the Moon to prepare for humanity's next giant leap – sending astronauts to Mars. NASA intends to establish a sustained lunar presence with the development of the Artemis Base Camp to prove technologies and capabilities that will one day enable humans to live and work on Mars, beginning with core elements including the Lunar Terrain Vehicle (LTV), the Pressurized Rover (PR), the lunar Surface Habitat (SH), power systems, and in-situ resource utilization (ISRU) systems. For in space operations and eventual transport of humans to Mars, NASA will utilize a Mars Transit Habitat (TH). Following deployment, the TH will complete a series of longer duration missions and shakedown testing while docked at Gateway, leveraging Gateway’s habitation redundancy for safety measures. Proposed Gateway-TH missions will far exceed the longest duration cislunar human missions to date. They will be the first operational readiness tests of our long-duration deep space systems, and of the split crew (two crew on the surface, two crew in space) operations that are vital to the approach for the first human Mars mission. Both the SH and TH are major architectural elements of NASA’s Moon to Mars (M2M) approach, each with very different concepts of operation. The SH is intended for use on the lunar surface as a home for astronauts, surface operations base, science facility, hub for communications, extravehicular activity (EVA) equipment repair site, waste processing facility, and supply hub. It serves as an enabler for a sustained surface presence and preparation for partial gravity operations during Mars missions. The SH will be designed to be self-sufficient for operations on the lunar surface. The SH will independently provide several functions, including its own power generation, energy storage capability, sleep quarters, hygiene areas, work areas, and dining areas. It will be capable of communicating with surface assets, orbital assets, and directly with Earth ground stations. It is planned to operate with two crew in the habitat for ~28- day stays with crew swap-outs in which the PR crew of two trades places with the habitat crew. During the swap-out, the habitat will nominally support four crew for a short period of time. For contingency scenarios, the habitat must also be capable of supporting four crew for up to 7 days. The TH will be designed to be capable of up to ~1,200-day Mars missions with the ability to carry all food and supplies needed to support a crew of four for this duration. An assumed Mars mission profile for the TH is to carry crew and supplies for ~850-day roundtrips between Earth and Mars orbit that allows 30-day stays on the Martian surface. To test the systems for this long journey, the TH will be used to extend the duration of missions at Gateway, enabling the orbiting outpost to be used as a Mars analog. These analog missions will be accomplished by attaching the TH to Gateway and conducting lunar surface operations from the TH. The TH may also need to perform free-flying shakedown missions to test out all systems prior to leaving for Mars. The habitat provides many critical functions including: a contingency airlock, crew quarters, galley, hygiene areas, safe haven capability, and science equipment. It can receive docked items from either axial end or on a radial port.

Habitat↗

NASA NTRS2021

Ground-based Automated Scheduling for Operations of the Mars 2020 Rover Mission

The National Aeronautics and Space Administration’s (NASA) Mars 2020 Rover, named Perseverance, landed on the surface of Mars in Jezero Crater on February 18, 2021. Since the landing, the rover’s activities have been planned with the aid of a ground-based automated scheduling system called Copilot. Automated scheduling is very rare for planetary rover missions. Historically humans have created a schedule manually and ensured that the schedule satisfied all constraints. Higher levels of automation in the system allows science planners to produce schedules for the rover more quickly. In addition to scheduling user-provided activities, Copilot generates and schedules two types of support activities: sleep activities and heating activities. Some activities require the CPU to be on as they execute, so Copilot schedules wakeups and shutdowns of the CPU at the appropriate times. Some activities require areas of the rover to be heated before they can execute, and that heating must be maintained throughout the duration of the activity. Copilot schedules the preheat and maintenance heating activities for the user-provided activities that require them. To facilitate Copilot usage, the Crosscheck tool shows the science planners how Copilot constructed a schedule. For activities that fail to be scheduled, Crosscheck gives information on the constraints that the activity would have violated. This gives the users insight into how to change the input activities and constraints in order to achieve a schedule that satisfies their goals.

Towey, Shannon↗

NASA NTRSDate not supplied

Correlated Changes in Retinal Thickness and Visuomotor Function in Asymptomatic Plaquenil Toxicity Patients

We have previously shown that a 5-minute eye-movement test can capture a number of largely independent “oculometric” parameters of human visual/visuomotor function (Liston & Stone, 2014). This test has been successfully used to characterize mild neural impairment due to traumatic brain injury, sleep and circadian disruption, and alcohol consumption (Liston et al., 2017; Stone et al, 2019; Tyson et al, 2021). Here, we extend this approach to study patients at risk of progressive posterior-segment illness to see how oculometrics relate to standard clinical ophthalmological measures. Five female patients (<20:40 BCVA, 34-60 years old) undergoing hydroxychloroquine treatment (2-7mg/kg/day for 10-23 years for rheumatologic illness) have participated thus far. Under monocular viewing conditions in randomized order, they tracked a moving spot undergoing radial step-ramp motion in one of 90 randomized directions, at one of 5 randomized speeds, starting at random times (for details, see Stone et al, 2019). We computed nine independent oculometrics (latency, initial acceleration, steady-state gain, proportion smooth, saccadic rate, saccadic amplitude, direction noise, speed responsiveness, and speed noise). Spectral-domain optical coherence tomography (Zeiss, Dublin, CA) was used to measure the average thickness of the nine Early Treatment Diabetic Retinopathy Study macular sectors from the internal limiting membrane to the retinal pigmented epithelium. We used Pearson’s correlation between retinal thickness and our oculometrics with t-statistics to test separate one-sided hypotheses across 10 retinae. Our preliminary analysis found significant changes in several different aspects of visuomotor performance. Most notably, latency increased, initial acceleration decreased, and steady-state pursuit gain decreased as retinal thickness decreased (r2 = 0.364, 0.579, and 0.692; one-tailed P = 0.032, 0.005, and 0.001, respectively). Speed responsiveness appeared to decrease, but this effect was marginal for our current sample (r2 = 0.253, P = 0.069). Lastly, direction discrimination and saccadic behavior appeared unchanged. We conclude that oculometrics may provide sensitive measures of changes in retinal thickness. More importantly, oculometrics have the potential to detect impairment before it becomes evident with standard clinical imaging tools, while also providing insight into the behavioral implications of any resulting deficits in visual/visuomotor function.

eye movements↗

NASA NTRS2022

Risk of Performance and Behavioral Health Decrements Due to Inadequate Cooperation, Coordination, and Psychosocial Adaptions within a Team

The Risk of Performance and Behavioral Health Decrements Due to Inadequate Cooperation, Coordination, Communication, and Psychosocial Adaptation within a Team (the Team Risk) is primarily performance-focused, with a secondary emphasis on behavioral health outcomes resulting from team performance and interpersonal interactions. Monitoring tools, measures, and countermeasures are aimed at enhancing team processes and team composition configurations to optimize team performance and functioning. Long-duration exploration missions (LDEMs) will include major challenges that could affect team performance, including social isolation, physical confinement, a small and diverse crew, communication delays between crew and ground, limited or no crew rotation or evacuation options, limited or no resupply, and a high-consequence environment. Each of these conditions will affect the crew’s coordination, cooperation, psychological well-being, and performance. Although the International Space Station (ISS) remains important for studies that require spaceflight testing and validation, the current conditions on the ISS do not adequately mimic the exploration environment that is required for National Aeronautics and Space Administration (NASA) teams research, and thus access to terrestrial or ground-based analogs of LDEM conditions is paramount. The emphasis on analogs for research is reflected in this updated evidence review of the Team Risk, and includes data from studies conducted at isolated, confined, extreme (ICE) environments (e.g., Antarctic stations), and from several mission simulation analogs such as the Human Exploration Research Analog (HERA) (HERA Experiment Information Package, 2014), also known as isolated, confined, controlled (ICC) environments. These studies have characterized many team factors regarding LDEMs, and the Team Risk has now matured from risk characterization to focusing more on countermeasure development. Because spaceflight evidence for team-level research is lacking, no reliable data is available to quantify the impact of team-level variables on individual and team-level outcomes during spaceflight missions. Until recently, no systematic attempt had been undertaken to measure the performance effects of team cohesion, team composition, team training, or team-related psychosocial adaptation during spaceflight. The Team Risk is a relatively young research area for NASA, with substantial growth only since the 2000s, and with limited access to spaceflight performance data. As a result, spaceflight evidence is lacking to identify specifically what team composition, level of training, amount of cohesion, or quality of psychosocial adaptation is necessary to reduce the risk of performance errors in space. However, astronaut journals and interviews and reports from spaceflight subject matter experts (SMEs) provide testimonies that team performance during spaceflight is important for mission success and to maintain crew health. Team spaceflight data is now being collected as part of the Spaceflight Standard Measures task (Clement, 2021)—a set of core measurements related to many human spaceflight risks that are collected from astronauts before, during, and after long-duration missions. The team-related standard measures focus on team cohesion, team performance, group living, team climate, and team processes. Collection of standard measures data is ongoing and published data is not yet available. Finally, although spaceflight evidence is lacking, evidence gleaned from ground studies and spaceflight analog studies will help close the gaps outlined in the Team Risk. Ground-based studies provide quantitative evidence for team functioning in ICE environments. Academic research on teams has produced dozens of meta-analyses that can be used to understand the general relationships among team inputs (e.g., team member characteristics and skills, job context), team processes, and emergent states (e.g., coordination, communication, cooperation, cohesion, trust, shared cognition), and team outcomes (e.g., effectiveness, errors, adaptation). Teams are complex, incorporating individual characteristics of team members, but also existing at a level that is greater than the sum of its parts. Therefore, the Team Risk must be integrated with other individual-focused NASA Human Research Program (HRP) risks, including Behavioral Medicine (BMed), Sleep, and Human-Systems Integration Architecture (HSIA), and emerging research indicates more integration may needed between the Team Risk and the physiologically oriented risks. Much of this integration occurs through the Human Systems Risk Board (HSRB). A lack of team functioning may be a stressor in some circumstances, but the team often acts as a countermeasure. For example, support for team leaders and teammates can facilitate individual functioning and encourage psychological and physically healthy behaviors and attitudes. However, more research is needed regarding teams during LDEMs and the remaining gaps in the research are described in the current report.

Lauren Blackwell Landon↗

NASA NTRSDate not supplied

Behavioral Medicine Risks and Mitigations in Isolated, Confined, and Extreme Environments

Human spaceflight beyond low Earth orbit will present unique environmental challenges to astronauts’ operational performance and well-being. Crews will need to work and live in confined and hazardous environments for prolonged missions that involve variable workloads and limitations to privacy, food options, exercise capabilities, leisure outlets, and communication with ground support personnel and loved ones. Currently, behavioral and cognitive risks of spaceflight are mitigated by selecting exceptionally resilient crews and providing extensive individual and team skills training pre-mission, as well as in-mission crew support via a suite of countermeasures targeting sleep and performance optimization, stress management, family support, and team cohesion. However, current countermeasures are difficult or impossible to implement in long-distance exploration as they require real-time communication with Earth and routine resupply. New countermeasure approaches are needed to adapt and enhance the current complement for the new challenges ahead. NASA therefore conducts research at ground-based spaceflight analogs to aid in characterizing the behavioral and cognitive risks of living and working in isolated, confined, and extreme (ICE) operational environments. Antarctic research stations are among the few long-duration ICE analogs in existence and are therefore uniquely positioned to support behavioral medicine research to enable human exploration beyond Earth. In this review, we will discuss previous and ongoing efforts to better understand spaceflight behavioral medicine risks, as well as validate new countermeasure approaches for future missions to the moon and Mars.

Behavioral Health↗