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NASA NTRSDate not supplied

Biological Research and Space Health Enabled by Machine Learning to Support Deep Space Missions

A key science goal of the NASA “Moon to Mars” campaign is to understand how biology responds to the Lunar, Martian, and deep space environments in order to advance fundamental knowledge, reduce risk, and support safe, productive human space missions. Through the powerful emerging computer science approaches of artificial intelligence (AI) and machine learning (ML), a paradigm shift has begun in biomedical science and engineered astronaut health systems, to enable Earth-independence and autonomy of mission operations. We present a decadal view of AI/ML architecture to support deep space mission goals, developed in concert with leaders in the field. We describe current AI/ML methods to support 1) fundamental biology, 2) in situ analytics, 3) high performance computing hardware, 4) automated science, 5) self-driving labs, 6) remote data management, 7) integrated real-time mission biomonitoring, and 8) a Precision Space Health system. Cutting-edge AI/ML approaches that can be integrated to support these domains include active learning, explainable AI, adaptive learning, causal inference, knowledge graphs, federated learning, transfer learning, and large language models. Finally, we present results from several current ML projects that are underway in the field to address key challenges of small sample n, high feature count, heterogeneity, and sparse data. These include 1) connecting omics data to phenotypic data using an ensemble model to infer causality of spaceflight rodent liver health disruption, 2) usage of explainable ML to interrogate the muscular underpinnings of spaceflight muscle atrophy, 3) ML models analyzing and determining directed acyclic graphs of human space health risk leveraging rodent bone datasets, 4) usage of large pre-trained models connecting biomedical knowledgebases with small spaceflight datasets to understand gene-to-gene interaction networks, and 5) a suite of benchmarked open science datasets (spaceflight mouse liver; radiation DNA damage) enabling programmers to identify the best ML algorithms to answer space biological science questions.

space biology↗
NASA NTRSDate not supplied

Biological Research and Space Health Enabled by Machine Learning to Support Deep Space Missions

A key science goal of the NASA “Moon to Mars” campaign is to understand how biology responds to the Lunar, Martian, and deep space environments in order to advance fundamental knowledge, reduce risk, and support safe, productive human space missions. Through the powerful emerging computer science approaches of artificial intelligence (AI) and machine learning (ML), a paradigm shift has begun in biomedical science and engineered astronaut health systems, to enable Earth-independence and autonomy of mission operations. We present a decadal view of AI/ML architecture to support deep space mission goals, developed in concert with leaders in the field. We describe current AI/ML methods to support 1) fundamental biology, 2) in situ analytics, 3) high performance computing hardware, 4) automated science, 5) self-driving labs, 6) remote data management, 7) integrated real-time mission biomonitoring, and 8) a Precision Space Health system. Cutting-edge AI/ML approaches that can be integrated to support these domains include active learning, explainable AI, adaptive learning, causal inference, knowledge graphs, federated learning, transfer learning, and large language models. Finally, we present results from several current ML projects that are underway in the field to address key challenges of small sample n, high feature count, heterogeneity, and sparse data. These include 1) connecting omics data to phenotypic data using an ensemble model to infer causality of spaceflight rodent liver health disruption, 2) usage of explainable ML to interrogate the muscular underpinnings of spaceflight muscle atrophy, 3) ML models analyzing and determining directed acyclic graphs of human space health risk leveraging rodent bone datasets, 4) usage of large pre-trained models connecting biomedical knowledgebases with small spaceflight datasets to understand gene-to-gene interaction networks, and 5) a suite of benchmarked open science datasets (spaceflight mouse liver; radiation DNA damage) enabling programmers to identify the best ML algorithms to answer space biological science questions.

space biology↗
NASA NTRS2010

Human Behavior and Performance Support for ISS Operations and Astronaut Selections: NASA Operational Psychology for Six-Crew Operations

The Behavioral Health and Performance group at NASA Johnson Space Center provides psychological support services and behavioral health monitoring for ISS astronauts and their families. The ISS began as an austere outpost with minimal comforts of home and minimal communication capabilities with family, friends, and colleagues outside of the Mission Control Center. Since 1998, the work of international partners involved in the Space Flight Human Behavior and Performance Working Group has prepared high-level requirements for behavioral monitoring and support. The "buffet" of services from which crewmembers can choose has increased substantially. Through the process of development, implementation, reviewing effectiveness and modifying as needed, the NASA and Wyle team have proven successful in managing the psychological health and well being of the crews and families with which they work. Increasing the crew size from three to six brought additional challenges. For the first time, all partners had to collaborate at the planning and implementation level, and the U.S. served as mentor to extrapolate their experiences to the others. Parity in available resources, upmass, and stowage had to be worked out. Steady progress was made in improving off-hours living and making provisions for new technologies within a system that has difficulty moving quickly on certifications. In some respect, the BHP support team fell victim to its previous successes. With increasing numbers of crewmembers in training, requests to engage our services spiraled upward. With finite people and funds, a cap had to placed on many services to ensure that parity could be maintained. The evolution of NASA BHP services as the ISS progressed from three- to six-crew composition will be reviewed, and future challenges that may be encountered as the ISS matures in its assembly-complete state will be discussed.

VanderArk, Steve↗
NASA NTRS2017

Growing Beyond Earth; Students Exploring Plant Varieties for Future Space Exploration

Future space exploration and long duration space flight will pose an array of challenges to the health and wellbeing of astronauts. Since 2015, Fairchild Tropical Botanic Garden (FTBG), in partnership with NASA's Veggie team, has been testing edible crops for space flight potential through a series of citizen science experiments. FTBG's interest in classroom-based science projects, along with NASA's successful operation of the Veggie system aboard the International Space Station (ISS), led to a NASA-FTBG partnership that gave rise to the Growing Beyond Earth STEM Initiative (GBE). Established in 2015, GBE now involves 131 middle and high school classrooms in South Florida, all conducting simultaneous plant science experiments. The results of those experiments (both numeric and visual) are directly shared with the space food production researchers at KSC. Through this session, we will explore the successful classroom implementation and integration into the curriculum, how the data is being used and the impact of the project on participating researchers, teachers, and students. Participating schools were supplied with specialized LED-lit growth chambers, mimicking the Veggie system on ISS, for growing edible plants under similar physical and environmental constraints. Research protocols were provided by KSC scientists, while edible plant varieties were selected mainly by the botanists at FTBG. In a jointly-led professional development workshop, participating teachers were trained to conduct GBE experiments in their classrooms. Teachers were instructed to not only teach basic botany concepts, but to also demonstrate practical applications of math, physics and chemistry. As experiments were underway, students shared data on plant germination, growth, and health in an online spreadsheet. Results from the students research show a promising selection of new plant candidates for possible further testing. Over a two year period, more than 5000 South Florida students, ages 11 to 18, participated in GBE. Evaluation of the program shows an increased knowledge of and interest in science and science careers among students. The program has also boosted the demand for summer high school internships at FTBG, further developing expertise in plant research and science related to space exploration. Supported by a grant from NASA (NNX16AM32G) to Fairchild Tropical Botanic Garden.

Veggie↗
NASA NTRS2010

Development of an Integrated Countermeasure Device for Long Duration Space Flight and Exploration Missions

Musculoskeletal, cardiovascular, and sensorimotor deconditioning have been observed consistently in astronauts and cosmonauts following long-duration spaceflight. Studies in bed rest, a spaceflight analog, have shown that high intensity resistive or aerobic exercise attenuates or prevents musculoskeletal and cardiovascular deconditioning, respectively, but complete protection has not been achieved during spaceflight. Exercise countermeasure hardware used during earlier International Space Station (ISS) missions included a cycle ergometer, a treadmill, and the interim resistive exercise device (iRED). Effectiveness of the countermeasures may have been diminished by limited loading characteristics of the iRED as well as speed restrictions and subject harness discomfort during treadmill exercise. The Advanced Resistive Exercise Device (ARED) and the second generation treadmill were designed to address many of the limitations of their predecessors, and anecdotal reports from ISS crews suggest that their conditioning is better preserved since the new hardware was delivered in 2009. However, several countermeasure devices to protect different physiologic systems will not be practical during exploration missions when the available volume and mass will be severely restricted. The combined countermeasure device (CCD) integrates a suite of hardware into one device intended to prevent spaceflight-induced musculoskeletal, cardiovascular, and sensorimotor deconditioning. The CCD includes pneumatic loading devices with attached cables for resistive exercise, a cycle for aerobic exercise, and a 6 degree of freedom motion platform for balance training. In a proof of concept test, ambulatory untrained subjects increased muscle strength (58%) as well as aerobic capacity (26%) after 12-weeks of exercise training with the CCD (without balance training), improvements comparable to those observed with traditional exercise training. These preliminary results suggest that this CCD can concurrently improve musculoskeletal and cardiovascular conditioning in ambulatory subjects, but further work is required to validate its use as countermeasure to spaceflight-induced deconditioning.

Lee, S. M. C.↗
NASA NTRS2011

Comparison of Ocular Outcomes in Two 14-Day Bed Rest Studies

Reports of astronauts visual changes raised concern about ocular health during long-duration spaceflight. Some of these findings included hyperopic shifts, choroidal folds, optic disc edema, retinal nerve fiber layer (RNFL) thickening, and cotton wool spots. While the etiology remains unknown, hypotheses speculate that hypertension in the brain caused by cephalad fluid shifts during spaceflight is a possible mechanism for these ocular changes. Head-down tilt (HDT) bed rest is a spaceflight analog that induces cephalad fluid shifts. In addition, previous studies of the HDT position demonstrated body fluid shifts associated with changes in intraocular pressure (IOP). For these reasons, vision monitoring of HDT bed rest subjects was implemented for NASA bed rest studies. Subjects selected for these studies were healthy adults (14 males and 5 females). Average age was 37.5 plus or minus 9.1 years, weight was 77.4 plus or minus 11.3 Kg, and height was 173.4 plus or minus 7.2 14 cm. Controlled conditions followed for all NASA bed rest studies were implemented. These conditions included factors such as eating a standardized diet, maintaining a strict sleep wake cycle, and remaining in bed for 24 hours each day. In one study, subjects maintained a horizontal (0 degree) position while in bed and were exercised six days per week with an integrated resistance and aerobic training (iRAT) program. In the other study, subjects were placed at 6 degrees HDT while in bed and did not engage in exercise. All subjects underwent pre- and post bed rest vision testing. While the battery of vision tests for each study was not identical, measures common to both studies will be presented. These measures included IOP and measures that provided an indication of optic disc swelling as derived from optical coherence tomography (OCT) testing: average retinal nerve fiber layer (RNFL) thickness (millimeters), disc area (square millimeters), rim area (square millimters), and average cup to disc (C/D) ratio. For all measures, there was no significant difference between subject groups for pre-bed rest testing. Post bed rest values also remained similar between groups. Comparison of pre- to post bed rest testing within each group did not demonstrate any statistical differences. These preliminary results from 14-day bed rest studies suggest that the combination of exercise and horizontal bed rest as compared to 6 degrees HDT bed rest did not produce differences in the ocular response with regard to IOP and optic disc parameters. The ocular measures reported here only included pre- and post bed rest time points. Further investigation is needed to examine both the acute response and long term adaptation of structural and functional ocular parameters in the bed rest platform and determine its usefulness for studying spaceflight phenomena. From a clinical perspective, the ability to study ocular responses in the controlled environment of the bed rest platform can provide valuable information for the care of patients restricted to bed rest.

Cromwell, R. L.↗
NASA NTRS1997

Resistance exercise prevents plantar flexor deconditioning during bed rest

Because resistance exercise (REX) and unloading induce opposing neuromuscular adaptations, we tested the efficacy of REX against the effects of 14 d of bed rest unloading (BRU) on the plantar flexor muscle group. Sixteen men were randomly assigned to no exercise (NOE, N = 8) or REX (N = 8). REX performed 5 sets x 6-10 repetitions to failure of constant resistance concentric/eccentric plantar flexion every other day during BRU. One-repetition maximum (1RM) strength was tested on the training device. The angle-specific torque-velocity relationship across 5 velocities (0, 0.52, 1.05, 1.75, and 2.97 rad.s-1) and the full range-of-motion power-velocity relationship were assessed on a dynamometer. Torque-position analyses identified strength changes at shortened, neutral, and stretched muscle lengths. Concentric and eccentric contractile work were measured across ten repetitions at 1.05 rad.s-1. Maximal neural activation was measured by surface electromyography (EMG). 1RM decreased 9% in NOE and improved 11% in REX (P < 0.05). Concentric (0.52 and 1.05 rad.s-1), eccentric (0.52 and 2.97 rad.s-1), and isometric angle-specific torques decreased (P < 0.05) in NOE, averaging 18%, 17%, and 13%, respectively. Power dropped (P < 0.05) in NOE at three eccentric (21%) and two concentric (14%) velocities. REX protected angle-specific torque and average power at all velocities. Concentric and eccentric strength decreased at stretched (16%) and neutral (17%) muscle lengths (P < 0.05) in NOE while REX maintained or improved strength at all joint positions. Concentric (15%) and eccentric (11%) contractile work fell in NOE (P < 0.05) but not in REX. Maximal plantar flexor EMG did not change in either group. In summary, constant resistance concentric/eccentric REX completely prevented plantar flexor performance deconditioning induced by BRU. The reported benefits of REX should prove useful in prescribing exercise for astronauts in microgravity and for patients susceptible to functional decline during bed- or chair-bound hospital stays.

NASA Discipline Musculoskeletal↗
NASA NTRS2010

Evaluating the Medical Kit System for the International Space Station(ISS) - A Paradigm Revisited

Medical capabilities aboard the International Space Station (ISS) have been packaged to help astronaut crew medical officers (CMO) mitigate both urgent and non-urgent medical issues during their 6-month expeditions. Two ISS crewmembers are designated as CMOs for each 3-crewmember mission and are typically not physicians. In addition, the ISS may have communication gaps of up to 45 minutes during each orbit, necessitating medical equipment that can be reliably operated autonomously during flight. The retirement of the space shuttle combined with ten years of manned ISS expeditions led the Space Medicine Division at the NASA Johnson Space Center to reassess the current ISS Medical Kit System. This reassessment led to the system being streamlined to meet future logistical considerations with current Russian space vehicles and future NASA/commercial space vehicle systems. Methods The JSC Space Medicine Division coordinated the development of requirements, fabrication of prototypes, and conducted usability testing for the new ISS Medical Kit System in concert with implementing updated versions of the ISS Medical Check List and associated in-flight software applications. The teams constructed a medical kit system with the flexibility for use on the ISS, and resupply on the Russian Progress space vehicle and future NASA/commercial space vehicles. Results Prototype systems were developed, reviewed, and tested for implementation. Completion of Preliminary and Critical Design Reviews resulted in a streamlined ISS Medical Kit System that is being used for training by ISS crews starting with Expedition 27 (June 2011). Conclusions The team will present the process for designing, developing, , implementing, and training with this new ISS Medical Kit System.

Hailey, Melinda J.↗
NASA NTRS2017

Modeling Microgravity Induced Fluid Redistribution Autoregulatory and Hydrostatic Enhancements

Space flight induces a marked cephalad (headward) redistribution of blood and interstitial fluid potentially resulting in a loss of venous tone and reduction in heart muscle efficiency upon introduction into the microgravity environment. Using various types of computational models, we are investigating how this fluid redistribution may induce intracranial pressure changes, relevant to reported reductions in astronaut visual acuity, part of the Visual Impairment and Intracranial Pressure (VIIP) syndrome. Methods: We utilize a lumped parameter cardiovascular system (CVS) model, augmented by compartments comprising the cerebral spinal fluid (CSF) space, as the primary tool to describe how microgravity, and the associated lack of hydrostatic gradient, impacts fluid redistribution. Models of ocular fluid pressures and biomechanics then accept the output of the above model as boundary condition input to allow more detailed, local analysis (see IWS Abstract by Ethier et al.). Recently, we enhanced the capabilities our previously reported CVS model through the implementation of robust autoregulatory mechanisms and a more fundamental approach to the implementation of hydrostatic mechanisms. Modifying the approach of Blanco et al., we implemented auto-regulation in a quasi-static manner, as an averaged effect across the span of one heartbeat. This approach reduced the higher frequency perturbations from the regulatory mechanism and was intended to allow longer simulation times (days) than models that implement within-beat regulatory mechanisms (minutes). A more fundamental approach to hydrostatics was implemented by a quasi-1D approach, in which compartment descriptions include compartment length, orientation and relative position, allowed for modeling of body orientation, relative body positioning and, in the future, alternative gravity environments. At this time the inclusion of hydrostatic mechanisms supplies additional capabilities to train and validate the CVS model with terrestrial data. Results and Conclusions: With the implementation of auto-regulation and hydrostatic modeling capabilities, the model performs as expected in the maintaining the CA (Central Artery) compartment pressure when simulating orientations ranging from supine to standing. The model appears to generally overpredict heart rate and thus cardiac output, possibly indicating sensitivity to the nominal heart rate, which is used as an initial set point of the regulation mechanisms. Despite this sensitivity, the model performs consistently for many hours of simulation time, indicating the success of our quasi-static implementation approach.

biomechanics↗
NASA NTRS2016

Estimating the Rate of Occurrence of Renal Stones in Astronauts

Changes in urine chemistry, during and post flight, potentially increases the risk of renal stones in astronauts. Although much is known about the effects of space flight on urine chemistry, no inflight incidence of renal stones in US astronauts exists and the question "How much does this risk change with space flight?" remains difficult to accurately quantify. In this discussion, we tackle this question utilizing a combination of deterministic and probabilistic modeling that implements the physics behind free stone growth and agglomeration, speciation of urine chemistry and published observations of population renal stone incidences to estimate changes in the rate of renal stone presentation. The modeling process utilizes a Population Balance Equation based model developed in the companion IWS abstract by Kassemi et al. (2016) to evaluate the maximum growth and agglomeration potential from a specified set of urine chemistry values. Changes in renal stone occurrence rates are obtained from this model in a probabilistic simulation that interrogates the range of possible urine chemistries using Monte Carlo techniques. Subsequently, each randomly sampled urine chemistry undergoes speciation analysis using the well-established Joint Expert Speciation System (JESS) code to calculate critical values, such as ionic strength and relative supersaturation. The Kassemi model utilizes this information to predict the mean and maximum stone size. We close the assessment loop by using a transfer function that estimates the rate of stone formation from combining the relative supersaturation and both the mean and maximum free stone growth sizes. The transfer function is established by a simulation analysis which combines population stone formation rates and Poisson regression. Training this transfer function requires using the output of the aforementioned assessment steps with inputs from known non-stone-former and known stone-former urine chemistries. Established in a Monte Carlo system, the entire renal stone analysis model produces a probability distribution of the stone formation rate and an expected uncertainty in the estimate. The utility of this analysis will be demonstrated by showing the change in renal stone occurrence predicted by this method using urine chemistry distributions published in Whitson et al. 2009. A comparison to the model predictions to previous assessments of renal stone risk will be used to illustrate initial validation of the model.

gravitational physiology↗
NASA NTRS2011

Which Way is Up? Lessons Learned from Space Shuttle Sensorimotor Research

The Space Shuttle Program provided the opportunity to examine sensorimotor adaptation to space flight in unprecedented numbers of astronauts, including many over multiple missions. Space motion sickness (SMS) severity was highly variable across crewmembers. SMS generally lasted 2-3 days in-flight with approximately 1/3 of crewmembers experiencing moderate to severe symptoms, and decreased incidence in repeat flyers. While SMS has proven difficult to predict from susceptibility to terrestrial analogs, symptoms were alleviated by medications, restriction of early activities, maintaining familiar orientation with respect to the visual environment and maintaining contact cues. Adaptive changes were also reflected by the oculomotor and perceptual disturbances experienced early inflight and by the perceptual and motor coordination problems experienced during re-entry and landing. According to crew self-reports, systematic head movements performed during reentry, as long as paced within one's threshold for motion tolerance, facilitated the early readaptation process. The Shuttle provided early postflight crew access to document the initial performance decrements and time course of recovery. These early postflight measurements were critical to inform the program of risks associated with extending the duration of Shuttle missions. Neurological postflight deficits were documented using a standardized subjective rating by flight surgeons. Computerized dynamic posturography was also implemented as a quantitative means of assessing sensorimotor function to support crew return-to-duty assessments. Towards the end of the Shuttle Program, more emphasis has been placed on mapping physiological changes to functional performance. Future commercial flights will benefit from pre-mission training including exposures to launch and entry G transitions and sensorimotor adaptability assessments. While SMS medication usage will continue to be refined, non-pharmacological countermeasures (e.g., sensory aids) will have both space and Earth-based applications. Early postflight field tests are recommended to provide the evidence base for best practices for future commercial flight programs. Learning Objective: Overview of the Space Shuttle Program regarding adaptive changes in sensorimotor function, including what was learned from research, what was implemented for medical operations, and what is recommended for commercial flights.

Wood, S. J.↗
NASA NTRS2023

U.S. Spacesuit Knowledge Capture – Expanding Our Future

NASA is going to the Moon. And it will don a new spacesuit when it reaches its destination. NASA is partnering with industry to build the spacesuit and supporting systems (i.e., surface mobility tools) that astronauts will use on the Moon, starting with Artemis III. The Johnson Space Center’s (JSC) Extravehicular Activity and Human Surface Mobility Program (EHP) is managing this effort, and the U.S. Spacesuit Knowledge Capture (SKC) Program is expanding its scope to help. For 15 years, the SKC Program has collected, archived, and disseminated decades of spacesuit-related knowledge, as appropriate, to help NASA scientists, technicians, and engineers support space exploration. The SKC Program captures its knowledge by hosting and recording subject-matter expert (SME) lectures, interviews, and workshops. It also collects retired SMEs’ reports, drawings, and schematics containing legacy spacesuit knowledge. To build a technically capable spacesuit essential for future lunar exploration, spacesuit professionals borrowed much of their knowledge from legacy Extravehicular Activity (EVA) spacesuits. Most of the SKC Program’s captured knowledge has focused on legacy and current spacesuits. To support EHP, the SKC Program is expanding its knowledge capture focus beyond the spacesuit and will seek to collect knowledge from other pertinent topics (e.g., Lunar Terrain Vehicle and EVA tools). In 2007, the SKC Program began as an independent source, without funding. As demand for capturing essential spacesuit knowledge increased, consequently, the SKC Program’s funding increased. Expansion of the SKC Program was evident in 2019, when it seized the opportunity to capture the Exploration Extravehicular Mobility Unit (xEMU) buildup at JSC. In 2021, its collaboration with the xEMU Technical Community of Practice facilitated training and knowledge sharing with the xEMU team. In 2022, the SKC Program began supporting EHP. This paper describes the SKC Program’s expansive evolution, plans to support EHP, and more.

Cinda Chullen↗
NASA NTRS2001

Combining Information on Multiple Detection Techniques to Estimate the Effect of Patent Foramen Ovale on Susceptibility to Decompression Illness

The assembly and the maintenance of the International Space Station is expected to require hundreds of extravehicular excursions (EVA's) in the next 10 years. During an EVA, in order to allow movement and bending of limbs, spacesuit pressures are reduced to about 4.3 psi. as compared with about 14.7 psi. for normal atmospheric pressure at sea level. However, the exposure of astronauts to reduced pressures in spacesuits, is conducive to fonnation and growth of gas bubbles within venous blood or tissues, which could cause decompression illness (DCI), a pathology best known to occur among deep-sea divers when they return to the surface. To reduce the risk of DCI, astronauts adjust to the reduced pressure in stages for a prolonged time known as a "pre-breathe" period prior to their extravehicular activity. Despite the use of pre-breathe protocols, an increased risk of DCI can arise for about 25% of humans who have a small hole, known as a patent foramen ovale (PFO), between two chambers of the heart. The atrial septum's fossa oval is, an embryological remnant of a flap between the septae primum and secundum allows fetal right atrial blood to pass into the left atrium, and usually closes after birth (Hagen, et al,. 1984). If fusion does not occur, a valve-like opening, the foramen ovale persists between the two atria. It has been suggested that astronauts with PFO's might be at greater risk of stroke or other serious neurological DCI because bubbles from a venous site may traverse a PFO, travel to the aorta and then enter the cerebral circulatory system causing a stroke (Figure 1). Astronauts are not now screened for PFO's, however consideration is being given to doing so. Here, we study three main methods abbreviated here as "ITE", "TCD" and "TEE", for detecting PFO's in living subjects. All involve the introduction of bubbles into a vein, immediately after which a sensory probe attempts to detect the bubbles in systemic circulation. Presence of the injected bubbles in the systemic circulation is indicative of a PFO. More detailed descriptions are given after the explanation of PFO's under Figure I. Even if a true PFO affects the risk of DCI, there remains a question of how effective screening would be if the detection method has errors of omission and/or commission. Of the three methods studied here, TEE is the "gold standard", matching autopsy results with near-perfect sensitivity and specificity (Schneider, et al. , 1996). However TEE is also the most difficult method to implement, requiring an internal esophagal probe, and is therefore not widely used. Currently, the easiest to use and most common PFO detection method is TTE, which uses an external chest probe. This method has a specificity of near 100%, but suffers from a low sensitivity rate (about 30%). More recently, TCD has been developed, which uses ultrasound probes to detect the presence of bubbles in cerebral arteries. Studies indicate that TCD is quite effective, having a sensitivity of about 91% and a specificity of about 93% (Droste, et al., 1999) when applied correctly, however implementation is difficult and requires considerable training.

Feiveson, Alan H.↗
NASA NTRSDate not supplied

Summary of Technical Interchange Meetings (TIMs) Designed to Enable Earth Independent Medical Operations (EIMO)

The Exploration Medical Capability Element (ExMC) in NASA’s Human Research Program hosted a series of TIMs in 2023-2024 designed to stimulate discussion around specific topics with the goal of enabling EIMO. In context of the thematic constituent elements of EIMO, namely pre-mission planning, acute/emergent/prolonged medical decision making, supply/resource management and task load management, subject matter experts from industry, academia and government (NASA and other Agencies) provided valuable and actionable guidance and recommendations. Earth-based medical experts will remain indispensable for pre-mission planning, however, management of acute/emergent medical contingencies will require a gradual transition of medical care and decision making from terrestrial to space-based assets to enable support of astronaut health and performance and reduce overall mission risk. Key to achieving these enhancements is providing an integrated data system platform capable of utilizing multiple data streams in concert with a variety of on-board databases and passive monitoring of video and wearable sensors to enable a multi-modal, agentic AI-based clinical decision support system (CDSS) to support crew medical officer (CMO) medical decision-making. The EIMO series of TIMs (I-V) have proven to be instructive and portend a significant paradigm shift will be necessary to maintain crew health and performance on exploration class missions. Importantly, since the expected paradigm shift will be significantly different from the methods of operation that have been employed for the majority of missions from the inception of human spaceflight to date, any proposed methods must be deployed in the setting of ongoing operations early and be “tested, reviewed and practiced” while reliable back-up is available to facilitate an Enterprise-wide level of comfort and acceptance. Serious constraints on data transmission coupled with a large and expanding universe of on-board medical informatics data streams will necessitate implementation of a CDSS to supplant the current reliance on support provided by ground-based SMEs. Establishment of trust in the system by CMO/crew and the ground-based medical support team will be essential. Co-development of a CDSS with industry partners will assure that state of the art tools can be employed, and industry efficiencies can be leveraged. Training regimens, materials and tools must evolve to be responsive (just-in-time training) and facilitate autonomous execution of procedures. Proficiency metrics should be established and be based on validated competencies or milestones as opposed to a prescribed number of training hours. Training should be prioritized for broad, translatable skills that have universal application across a variety of medical conditions. Repetition was deemed to be the key to achieving proficiency and emphasis should lie in procedural training which is known to extinguish more rapidly than diagnostic skills. Advanced tools, e.g., extended reality, can provide more realistic and effective training. Use of advanced probabilistic risk assessment tools will be essential to optimize the medical system capability while carefully balancing risk relative to mass/power/volume limitations. Importance of factoring use-life of medical supplies and maintaining awareness of redundancy and opportunity to re-purpose under off nominal situations was emphasized. Consideration of adopting optimized performance standards vs. “good-enough” performance thresholds is warranted. The use of legacy systems as opposed to creating new systems may be preferable. Managing task load and associated cognitive load will be essential to maintain operational safety and behavioral health. ExMC aspires to create a shared EIMO paradigm and strategic vision for advancing medical system design through novel technologies, training, protocols, and support capabilities, built upon the spirit of successful strategies and innovations over the past six decades of space medicine operations.

Jay Lemery↗
NASA NTRS2016

A First Look at the Upcoming SISO Space Reference FOM

Spaceflight is difficult, dangerous and expensive; human spaceflight even more so. In order to mitigate some of the danger and expense, professionals in the space domain have relied, and continue to rely, on computer simulation. Simulation is used at every level including concept, design, analysis, construction, testing, training and ultimately flight. As space systems have grown more complex, new simulation technologies have been developed, adopted and applied. Distributed simulation is one those technologies. Distributed simulation provides a base technology for segmenting these complex space systems into smaller, and usually simpler, component systems or subsystems. This segmentation also supports the separation of responsibilities between participating organizations. This segmentation is particularly useful for complex space systems like the International Space Station (ISS), which is composed of many elements from many nations along with visiting vehicles from many nations. This is likely to be the case for future human space exploration activities. Over the years, a number of distributed simulations have been built within the space domain. While many use the High Level Architecture (HLA) to provide the infrastructure for interoperability, HLA without a Federation Object Model (FOM) is insufficient by itself to insure interoperability. As a result, the Simulation Interoperability Standards Organization (SISO) is developing a Space Reference FOM. The Space Reference FOM Product Development Group is composed of members from several countries. They contribute experiences from projects within NASA, ESA and other organizations and represent government, academia and industry. The initial version of the Space Reference FOM is focusing on time and space and will provide the following: (i) a flexible positioning system using reference frames for arbitrary bodies in space, (ii) a naming conventions for well-known reference frames, (iii) definitions of common time scales, (iv) federation agreements for common types of time management with focus on time stepped simulation, and (v) support for physical entities, such as space vehicles and astronauts. The Space Reference FOM is expected to make collaboration politically, contractually and technically easier. It is also expected to make collaboration easier to manage and extend.

Mueller, Bjorn↗
NASA NTRS2004

EVA Performance Prediction

Astronaut physical performance capabilities in micro gravity EV A or on planetary surfaces when encumbered by a life support suit and debilitated by a long exposure to micro gravity will be less than unencumbered pre flight capabilities. The big question addressed by human factors engineers is: what can the astronaut be expected to do on EVA or when we arrive at a planetary surface? A second question is: what aids to performance will be needed to enhance the human physical capability? These questions are important for a number of reasons. First it is necessary to carry out accurate planning of human physical demands to ensure that time and energy critical tasks can be carried out with confidence. Second it is important that the crew members (and their ground or planetary base monitors) have a realistic picture of their own capabilities, as excessive fatigue can lead to catastrophic failure. Third it is important to design appropriate equipment to enhance human sensory capabilities, locomotion, materials handling and manipulation. The evidence from physiological research points to musculoskeletal, cardiovascular and neurovestibular degradation during long duration exposure to micro gravity . The evidence from the biomechanics laboratory (and the Neutral Buoyancy Laboratory) points to a reduction in range of motion, strength and stamina when encumbered by a pressurized suit. The evidence from a long history of EVAs is that crewmembers are indeed restricted in their physical capabilities. There is a wealth of evidence in the literature on the causes and effects of degraded human performance in the laboratory, in sports and athletics, in industry and in other physically demanding jobs. One approach to this challenge is through biomechanical and performance modeling. Such models must be based on thorough task analysis, reliable human performance data from controlled studies, and functional extrapolations validated in analog contexts. The task analyses currently carried out for EVA activities are based more on extensive domain experience than any formal analytic structure. Conversely, physical task analysis for industrial and structured evidence from training and EV A contexts. Again on earth there is considerable evidence of human performance degradation due to encumbrance and fatigue. These industrial models generally take the form of a discounting equation. The development of performance estimates for space operations, such as timeline predictions for EVA is generally based on specific input from training activity, for example in the NBL or KC135. uniformed services tasks on earth are much more formalized. Human performance data in the space context has two sources: first there is the micro analysis of performance in structured tasks by the space physiology community and second there is the less structured evidence from training and EV A contexts.

Peacock, Brian↗
NASA NTRS2010

Visual Performance Challenges to Low-Frequency Perturbations After Long-Duration Space Flight, and Countermeasure Development

Astronauts experience sensorimotor disturbances after long-duration space flight. After a water landing, crewmembers may need to egress the vehicle within a few minutes for safety and operational reasons in various sea state conditions. Exposure to even low-frequency motions induced by sea conditions surrounding a vessel can cause significant motor control problems affecting critical functions. The first objective of this study was to document human visual performance during simulated wave motion below 2.0 Hz. We examined the changes in accuracy and reaction time when subjects performed a visual target acquisition task in which the location of the target was offset vertically during horizontal rotation at an oscillating frequency of 0.8 Hz. The main finding was that both accuracy and reaction time varied as a function of target location, with greater performance decrements occurring when vertical targets were acquired at perturbing frequencies of 0.8 Hz in the horizontal plane. A second objective was to develop a countermeasure, base d on stochastic resonance (SR), to enhance sensorimotor capabilities with the aim of facilitating rapid adaptation to gravitational transitions after long-duration space flight. SR is a mechanism by which noise can enhance the response of neural systems to relevant sensory signals. Recent studies have shown that applying imperceptible stochastic electrical stimulation to the vestibular system (SVS) significantly improved balance and oculomotor responses. This study examined the effectiveness of SVS on improving balance performance. Subjects performed a standard balance task while bipolar SVS was applied to the vestibular system using constant current stimulation through electrodes placed over the mastoid process. The main finding of this study was that balance performance with the application of SR showed significant improvement in the range of 10%-25%. Ultimately an SR-based countermeasure might be fielded either as preflight training to enhance adaptability, or as a miniature patch-type stimulator worn post flight.

Mulavara, Ajitkumar↗
NASA NTRSDate not supplied

Comparison of Active and Passive Head Impulse Testing of the Horizontal Vestibulo-Ocular Reflex: Exploring the Feasibility of Different Approaches for Spaceflight

INTRODUCTION: Astronauts experience a wide variety of sensorimotor disturbances primarily due to microgravity-induced vestibular adaptations during spaceflight. Head Impulse Testing (HIT) will be conducted during the Complement of Integrated Protocols for Human Exploration Research program(CIPHER) Vestibular Health study to examine changes in the horizontal vestibulo-ocular reflex in response to high-velocity head movements to detect changes in peripheral vestibular function [1,2]. However, correct interpretation will require consideration of potential artifacts and the constraints of conducting this test across different phases of the mission. Therefore, the aims of our study were to (1) examine reliability across different test operators, and (2) compare results of active (aHIT) versus passive (pHIT) approaches to evaluate the feasibility of self-administered versus operator-assisted approaches. A comparison of responses with visual viewing of a wall target (default condition) versus vision occluded evaluated the influence of other oculomotor control influence across conditions, and comparison with computer-generated rotator head impulse tests (rHIT) examined the variability associated with the ocular responses independent of the variability in executing the head movements themselves. METHODS: Seventeen non-astronaut volunteers (male n=12, age=22.9 ± 3.0; female n=5, age=27.0 ± 6.0, mean ± std) completed HIT testing using video-oculography (VOG) goggles and a high-torque rotator system. The test order was counterbalanced across conditions: (1) passive head-on-torso (pHIT, default condition for flight study) using two operators (Op1 and Op2), (2) active head-on-torso (aHIT, subject initiated), and (3) passive head and torso using rotary chair (rHIT). Eye and head movement data were processed to obtain gain in each direction. The main outcome measures were average gain and asymmetry [1], as well as the percentage of acceptable trials not excluded due to insufficient head amplitude or recording artifacts. RESULTS: While the pHIT gains were similar with vision (1.032 ± 0.043) and vision occluded (1.029 ± 0.038) conditions, the percentage of acceptable trials was greater with vision (Op1 = 93.0%, Op2 = 93.2%) versus occluded (Op1 = 70.7%, Op2 = 67.6%). The reliability between operators was greater for pHIT gain (Intraclass Correlation, ICC = 0.66, p = 0.001) than for pHIT asymmetry (ICC = 0.57, p = 0.01). The percentage of acceptable trials reduced by ~20% during the self-administered aHITs for both visual conditions and tended to be lower than computer-generated rHITs (76% versus 83%). While the aHIT gains were not significantly different than pHIT gains for vision or vision occluded conditions, these measures were poorly correlated. Both aHIT and pHIT gains were significantly greater than the rHIT gains, presumably due to the reduced velocities from the rotator. The asymmetry measures were poorly correlated across pHIT, aHIT, and rHIT conditions, although none of the subjects had asymmetries greater than 16%. DISCUSSION: Our findings support the feasibility of using the standard pHIT methodology for spaceflight. Similarities between visual conditions reflect that these responses are mediated by the peripheral lateral canals rather than other oculomotor mechanisms. The inter-tester reliability was acceptable despite differences in the tester training. In addition to concerns of non-vestibular mechanisms introduced during self-administered aHITs [2], operator-assisted pHITs resulted in higher percentage of acceptable trials and should result in more efficient and reliable measures during spaceflight.

M R Ehrenburg↗