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At least 145 records · Page 8
All sourcesNASA NTRSDOE OSTI
NASA NTRS2013

Estimated Probability of Traumatic Abdominal Injury During an International Space Station Mission

The Integrated Medical Model (IMM) is a decision support tool that is useful to spaceflight mission planners and medical system designers when assessing risks and optimizing medical systems. The IMM project maintains a database of medical conditions that could occur during a spaceflight. The IMM project is in the process of assigning an incidence rate, the associated functional impairment, and a best and a worst case end state for each condition. The purpose of this work was to develop the IMM Abdominal Injury Module (AIM). The AIM calculates an incidence rate of traumatic abdominal injury per person-year of spaceflight on the International Space Station (ISS). The AIM was built so that the probability of traumatic abdominal injury during one year on ISS could be predicted. This result will be incorporated into the IMM Abdominal Injury Clinical Finding Form and used within the parent IMM model.

Lewandowski, Beth E.↗
NASA NTRS2013

Estimated Probabililty of Chest Injury During an International Space Station Mission

The Integrated Medical Model (IMM) is a decision support tool that is useful to spaceflight mission planners and medical system designers when assessing risks and optimizing medical systems. The IMM project maintains a database of medical conditions that could occur during a spaceflight. The IMM project is in the process of assigning an incidence rate, the associated functional impairment, and a best and a worst case end state for each condition. The purpose of this work was to develop the IMM Chest Injury Module (CIM). The CIM calculates the incidence rate of chest injury per person-year of spaceflight on the International Space Station (ISS). The CIM was built so that the probability of chest injury during one year on ISS could be predicted. These results will be incorporated into the IMM Chest Injury Clinical Finding Form and used within the parent IMM model.

Lewandowski, Beth E.↗
NASA NTRS2014

Analysis of Advanced Respiratory Support Onboard ISS and CCV

NASA is collaborating with private entities for the development of commercial space vehicles. The Space and Clinical Operations Division was tasked to review the oxygen and respiratory support system and recommend what capabilities, if any, the vehicle should have to support the return of an ill or injured crewmember. The Integrated Medical Model (IMM) was utilized as a data source for the development of these recommendations. The Integrated Medical Model (IMM) was used to simulate a six month, six crew, International Space Station (ISS) mission. Three medical system scenarios were considered based on the availability of (1) oxygen only, (2) oxygen and a ventilator, or (3) neither oxygen nor ventilator. The IMM analysis provided probability estimates of medical events that would require either oxygen or ventilator support. It also provided estimates of crew health, the probability of evacuation, and the probability of loss of crew life secondary to medical events for each of the three medical system scenarios. These IMM outputs were used as objective data to enable evidence‐based decisions regarding oxygen and respiratory support system requirements for commercial crew vehicles. The IMM provides data that may be utilized to support informed decisions regarding the development of medical systems for commercial crew vehicles.

Shah, Ronak V.↗
NASA NTRS2012

Interoperability Standards for Medical Simulation Systems

The Modeling and Simulation Community successfully developed and applied interoperability standards like the Distributed Interactive Simulation (DIS) protocol (IEEE 1278) and the High Level Architecture (HLA) (IEEE 1516). These standards were applied for world-wide distributed simulation events for several years. However, this paper shows that some of the assumptions and constraints underlying the philosophy of these current standards are not valid for Medical Simulation Systems. This paper describes the standards, the philosophy and the limits for medical applications and recommends necessary extensions of the standards to support medical simulation.

Tolk, Andreas↗
NASA NTRS1975

Portable medical status system

Electrical schematics and outline drawings of the portable medical status unit are presented along with recommendations for future units.

Source record↗
NASA NTRS2023

A Pilot Project for Quantifying the Effect of Medical Provider Knowledge, Skills, and Abilities on Outcomes for Spaceflight Using a Probabilistic Risk Assessment Tool

In order to enable the future of long-duration deep space exploration we must confront the uncertainty in medical risk. Limitations of communication, resupply, and evacuation in deep space will require a high degree of crew autonomy and accurate risk assessment will be critical to ensure adequate crew training and medical system design. To address this, NASA’s Human Research Program Exploration Medical Capability Element has developed the Informing Mission Planning via Analysis of Complex Tradespaces Tool (IMPACT). IMPACT is a suite of tools that can provide evidence-based, data-driven trade space assessments between available medical resources in the mass- and volume-constrained environment of a deep space exploration vehicle. In the current model, medical conditions either can or cannot be treated based on the availability of medical system resources and equipment. However, medical outcomes often depend just as much on the knowledge, skills, and abilities (KSA) of the provider operating the system. This paper presents a method for modeling and quantifying the effect of medical officer KSA on medically relevant mission risk outcomes during spaceflight.

capabilities↗
NASA NTRS2017

Medical Optimization Network for Space Telemedicine Resources

INTRODUCTION: Long-duration missions beyond low Earth orbit introduce new constraints to the space medical system such as the inability to evacuate to Earth, communication delays, and limitations in clinical skillsets. NASA recognizes the need to improve capabilities for autonomous care on such missions. As the medical system is developed, it is important to have an ability to evaluate the trade space of what resources will be most important. The Medical Optimization Network for Space Telemedicine Resources was developed for this reason, and is now a system to gauge the relative importance of medical resources in addressing medical conditions. METHODS: A list of medical conditions of potential concern for an exploration mission was referenced from the Integrated Medical Model, a probabilistic model designed to quantify in-flight medical risk. The diagnostic and treatment modalities required to address best and worst-case scenarios of each medical condition, at the terrestrial standard of care, were entered into a database. This list included tangible assets (e.g. medications) and intangible assets (e.g. clinical skills to perform a procedure). A team of physicians working within the Exploration Medical Capability Element of NASA's Human Research Program ranked each of the items listed according to its criticality. Data was then obtained from the IMM for the probability of occurrence of the medical conditions, including a breakdown of best case and worst case, during a Mars reference mission. The probability of occurrence information and criticality for each resource were taken into account during analytics performed using Tableau software. RESULTS: A database and weighting system to evaluate all the diagnostic and treatment modalities was created by combining the probability of condition occurrence data with the criticalities assigned by the physician team. DISCUSSION: Exploration Medical Capabilities research at NASA is focused on providing a medical system to support crew medical needs in the context of a Mars mission. MONSTR is a novel approach to performing a quantitative risk analysis that will assess the relative value of individual resources needed for the diagnosis and treatment of various medical conditions. It will provide the operational and research communities at NASA with information to support informed decisions regarding areas of research investment, future crew training, and medical supplies manifested as part of the exploration medical system.

Shah, R. V.↗
NASA NTRSDate not supplied

Venous Gas Embolism: Review to Quantify a Safe Volume of Air in Intravenous Fluids Bags for Spaceflight Applications

INTRODUCTION: The ability to create intravenous fluids (IVF) in-situ from the potable water supply of a spaceflight vehicle or habitat is a desired capability for an exploration medical system. In order to define an acceptable volume of air in IVF bags, an understanding of the volume of venous gas embolism as it relates to negative outcomes is needed. The purpose of this study is to review the literature to determine if there is a known volume of gas that contributes to mortality and/or morbidity that could be used to define requirements for rapid IVF infusion in microgravity. METHODS: A literature review was conducted of the PubMed database using the syntax: (Venous) AND (Gas OR Air) AND (Embolism) AND (Morbidity) AND (Mortality) AND (Volume) as well as manual review of references from relevant articles. 151 articles were screened excluding partial text and pediatric articles. Studies were reviewed for identification of volume of venous gas embolism associated with morbidity and/or mortality, which identified 27 articles. RESULTS: Reviewed literature included animal studies, case reports, and review articles. A high variation of proposed volumes contributing to mortality was reported. The limited human data values ranged from 20 ml to 200 ml of infused air with mortality estimated to be 48 – 80%. No studies evaluated human morbidity in any capacity. DISCUSSION: The lack of consensus on the safe volume of infused air has potential ramifications for IVF use in spaceflight as current technologies to create IVF from potable water may introduce air in IVF bags. While current microgravity infusion protocols call for the use of inline air removal filters, commercially available options have flow rate limitations that preclude rapid infusion in a resuscitation scenario. Such filters may be used in parallel to increase flow rate, but the time required to set up such a system may exclude its use during a medical emergency. Additionally, these consumable filters drive up the overall mass and volume of the medical system. Identification of a safe volume of air in IVF would allow for guidelines for the in-situ production of IVF in future spaceflight vehicles/habitats.

Christopher R Woodard↗
NASA NTRS1975

The medical story

The paper discusses the medical program of the Skylab missions. The major medical systems discussed include the food system, the waste-management system, the personal-hygiene system, and the inflight medical support system. The life-sciences experiments conducted on Skylab are reviewed. These dealt with the cardiovascular system, mineral balance and bioassay of fluids, sleep, blood, metabolic activity, vestibular function, and time and motion studies. The medical operations were accomplished with only minor problems.

Johnston, R. S.↗
NASA NTRSDate not supplied

Challenges, Considerations, and Opportunities for Exercise and Medical Accommodation Inside a Small Pressurized Rover

Pressurized Rovers (PR) can enable crew to explore away from a lander or surface habitat at distances not possible on foot or even in unpressurized rovers. Sustaining crew for multiple days, they can rove for weeks, independent of other surface elements. Because these are essentially mobile habitats, it is critical that they provide sufficient volume to accommodate the exercise and medical systems to maintain human health in remote, low gravity environments such as the Moon and Mars. This is an area of extensive unknowns as requirements have not yet been developed for exercise or medical systems in pressurized rovers. Yet they must be considered in vehicle sizing studies as they are significant volume drivers, requiring allocation for stowed and deployed hardware inside the rover cabin. Previously flown spacecraft have allocated varying amounts of volume based on the expected crew mission and the state of the art in these systems. NASA-STD-3001 provides high-level requirements for standards of medical care and exercise capabilities. Crew injuries are possible both inside the cabin and on extravehicular activities (EVA), therefore requiring medical capability. Exercise countermeasures are needed to counteract the debilitating effects of lowered gravity. This may include both reconditioning following a lengthy microgravity transit as well as ongoing countermeasures against the effect of low surface gravity. The NASA reference concept for the PR dates back to the Constellation Program and prototypes have been extensively tested in NASA’s Desert Research and Technology Studies (DRATS) program as well as at the NASA Johnson Space Center. The PR cabin is designed to accommodate two crewmembers and is subdivided into a forward cockpit area and a main body for crew habitation. EVAs are accomplished by transitioning through suit ports in the aft bulkhead into spacesuits. While no exercise devices have been developed for the PR, some have been prototyped and demonstrated in DRATS analog missions. A cycle ergometer performed reasonably well in DRATS testing as an aerobic exercise device and recent analysis work has theorized that a combination aerobic and resistive device could be packaged into a form factor similar to the DRATS ergometer. It is therefore suitable for use as an initial volumetric placeholder. No sensorimotor devices have been considered for the PR to aid in adaptation to surface gravity. However, there are commercially available treadmills that at minimum represent examples of the type of exercise system that could potentially be used for such a purpose. A combination of field test data, analysis, and CAD modeling will be used to perform a first pass assessment of whether these exercise devices can be stowed and deployed within the PR. Medical inventories from the International Space Station will be used as a volume placeholder for the PR medical system. A configuration will be discussed for medical deployment, including positioning of caregiver, patient, and medical equipment / supplies.

Pressurized Rover↗
NASA NTRS2017

Medical Optimization Network for Space Telemedicine Resources

INTRODUCTION: Long-duration missions beyond low Earth orbit introduce new constraints to the space medical system. Beyond the traditional limitations in mass, power, and volume, consideration must be given to other factors such as the inability to evacuate to Earth, communication delays, and limitations in clinical skillsets. As NASA develops the medical system for an exploration mission, it must have an ability to evaluate the trade space of what resources will be most important. The Medical Optimization Network for Space Telemedicine Resources (MONSTR) was developed over the past year for this reason, and is now a system for managing data pertaining to medical resources and their relative importance when addressing medical conditions. METHODS: The MONSTR web application with a Microsoft SQL database backend was developed and made accessible to Tableau v9.3 for analysis and visualization. The database was initially populated with a list of medical conditions of concern for an exploration mission taken from the Integrated Medical Model (IMM), a probabilistic model designed to quantify in-flight medical risk. A team of physicians working within the Exploration Medical Capability Element of NASA's Human Research Program compiled a list diagnostic and treatment medical resources required to address best- and worst-case scenarios of each medical condition using a terrestrial standard of care and entered this data into the system. This list included both tangible resources (e.g. medical equipment, medications) and intangible resources (e.g. clinical skills required to perform a procedure). The physician team then assigned criticality values to each instance of a resource, representing the importance of that resource to diagnosing or treating its associated condition(s). Medical condition probabilities of occurrence during a Mars mission were pulled from the IMM and imported into the MONSTR database for use within a resource criticality-weighting algorithm. DISCUSSION: The MONSTR tool is a novel approach to assess the relative value of individual resources needed for the diagnosis and treatment of medical conditions. Future work will add resources for prevention and long term care of these conditions. Once data collection is complete, MONSTR will provide the operational and research communities at NASA with information to support informed decisions regarding areas of research investment, future crew training, and medical supplies manifested as part of any exploration medical system.

Rubin, D.↗
NASA NTRSDate not supplied

Clinical Decision Support - Overview and Update

We are entering a new era in space exploration to return to the moon and explore Mars. These ambitious goals will require significant changes to in-flight and habitat medical care due to constraints on mass, volume, power, crew time and medical evacuation capabilities. These constraints make it absolutely necessary to develop transformative solutions using new technologies. 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. The Clinical Decision Support (CDS) project addresses the gap Medical-701 within the Inflight Medical Conditions risk: Enhance medical capabilities within an exploration medical system. For long-duration, deep space missions, computational and data resources will play an important role in maintaining crew health, wellness and performance where the crew will need to be more self-reliant. The aim of the CDS project is to develop and provide recommended requirements for an in-vehicle CDSS that acts as an assistant for delivering optimal health and performance and medical care during exploration missions. The CDSS is envisioned as a software-based tool that will augment a crewmembers’ knowledge, skills and abilities to assist in decision-making and crew health and performance (CHP) management thus increasing CHP systems capabilities. The human interface will be context aware and lessen the cognitive load to assimilate and use information as well as combine large disparate data sets in such a manner that provides the crew with actionable insight to decisions related to crew medical, health and performance management. Crew autonomy will be provided through a CDS that 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. The CDS project addresses the need for crew members to operate independently during long duration space exploration missions that require medical Levels of Care (LoC) V, the highest level specified by NASA-STD-3001 and described in more detail by the ExMC interpretation of LoC document (NASA/TM-2017-219290), where significant changes to in-flight and habitat medical care necessitate increasing crew autonomy in decision making and task performance. The CDS project will develop and test a series of iterative and increasingly more complex system prototypes. These annual demonstrations of the data system integration with the crew health and performance domain will inform exploration medical system requirements for an on-board Clinical Decision Support System (CDSS) through a series of use cases that guide CDS prototype functionality. CDS concepts are based on ExMC Concept of Operations documents (presented separately) and will highlight architecture extensibility to other more complex analyses and tests using core crew health and performance integrated data management, processing and visualization capabilities. This approach also establishes how externally developed analyses and approaches could be added to expand a clinical decision support system and thus highlight how a comprehensive system can be commercially and/or globally developed. The CDS project will build upon the concept of an integrated data management approach based on the Medical Data Architecture (MDA) project to more fully address challenges associated with in-flight and habitat medical, health and performance care due to constraints on mass, volume, power, crew time and medical evacuation capabilities required for medical LoC V. These requirements will be derived through systems engineering approaches and software prototype developments over the course of the multi-year CDS project to address crew health and performance decision-making and task performance, often autonomously executed by the crew, in a manner that is consistent with the appropriate medical level of care for the mission. This presentation will provide an overview of the vision for the CDS project and highlight the initial accomplishments in project planning, implementation and requirements identification in fiscal year 2020.

clinical decision support system↗
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. These ambitious goals will require significant changes to in-flight and habitat medical care due to constraints on mass, volume, power, crew time and medical evacuation capabilities. These constraints make it absolutely necessary to develop transformative solutions using new technologies. 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. The Clinical Decision Support (CDS) project addresses the gap Medical-701 within the Inflight Medical Conditions risk: Enhance medical capabilities within an exploration medical system. For long-duration, deep space missions, computational and data resources will play an important role in maintaining crew health, wellness and performance where the crew will need to be more self-reliant. The aim of the CDS project is to develop and provide recommended requirements for an in-vehicle CDSS that acts as an assistant for delivering optimal health and performance and medical care during exploration missions. The CDSS is envisioned as a software-based tool that will augment a crewmembers’ knowledge, skills and abilities to assist in decision-making and crew health and performance (CHP) management thus increasing CHP systems capabilities. The human interface will be context aware and lessen the cognitive load to assimilate and use information as well as combine large disparate data sets in such a manner that provides the crew with actionable insight to decisions related to crew medical, health and performance management. Crew autonomy will be provided through a CDS that 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. The CDS project addresses the need for crew members to operate independently during long duration space exploration missions that require medical Levels of Care (LoC) V, the highest level specified by NASA-STD-3001 and described in more detail by the ExMC interpretation of LoC document (NASA/TM-2017-219290), where significant changes to in-flight and habitat medical care necessitate increasing crew autonomy in decision making and task performance. The CDS project will develop and test a series of iterative and increasingly more complex system prototypes. These annual demonstrations of the data system integration with the crew health and performance domain will inform exploration medical system requirements for an on-board Clinical Decision Support System (CDSS) through a series of use cases that guide CDS prototype functionality. CDS concepts are based on ExMC Concept of Operations documents (presented separately) and will highlight architecture extensibility to other more complex analyses and tests using core crew health and performance integrated data management, processing and visualization capabilities. This approach also establishes how externally developed analyses and approaches could be added to expand a clinical decision support system and thus highlight how a comprehensive system can be commercially and/or globally developed. The CDS project will build upon the concept of an integrated data management approach based on the Medical Data Architecture (MDA) project to more fully address challenges associated with in-flight and habitat medical, health and performance care due to constraints on mass, volume, power, crew time and medical evacuation capabilities required for medical LoC V. These requirements will be derived through systems engineering approaches and software prototype developments over the course of the multi-year CDS project to address crew health and performance decision-making and task performance, often autonomously executed by the crew, in a manner that is consistent with the appropriate medical level of care for the mission. This presentation will provide an overview of the vision for the CDS project and highlight the initial accomplishments in project planning, implementation and requirements identification in fiscal year 2020.

clinical decision support↗
NASA NTRS1988

Insulin Delivery System

When Programmable Implantable Medication System (PIMS) is implanted in human body, it delivers precise programmed amounts of insulin over long periods of time. Mini-Med Technologies has been refining the Technologies since initial development at APL. The size of a hockey puck, and encased in titanium shell, PIMS holds about 2 1/2 teaspoons of insulin at a programmed basal rate. If a change in measured blood sugar level dictates a different dose, the patient can vary the amount of insulin delivered by holding a small radio transceiver over the implanted system and dialing in a specific program held in the PIMS computer memory. Insulin refills are accomplished approximately 4 times a year by hypodermic needle.

Source record↗
NASA NTRS2003

Evaluation of Human Research Facility Ultrasound With the ISS Video System

Most medical equipment on the International Space Station (ISS) is manifested as part of the U.S. or the Russian medical hardware systems. However, certain medical hardware is also available as part of the Human Research Facility. The HRF and the JSC Medical Operations Branch established a Memorandum of Agreement for joint use of certain medical hardware, including the HRF ultrasound system, the only diagnostic imaging device currently manifested to fly on ISS. The outcome of a medical contingency may be changed drastically, or an unnecessary evacuation may be prevented, if clinical decisions are supported by timely and objective diagnostic information. In many higher-probability medical scenarios, diagnostic ultrasound is a first-choice modality or provides significant diagnostic information. Accordingly, the Clinical Care Capability Development Project is evaluating the HRF ultrasound system for its utility in relevant clinical situations on board ISS. For effective management of these ultrasound-supported ISS medical scenarios, the resulting data should be available for viewing and interpretation on the ground, and bidirectional voice communication should be readily available to allow ground experts (sonographers, physicians) to provide guidance to the Crew Medical Officer. It may also be vitally important to have the capability of real-time guidance via video uplink to the CMO-operator during an exam to facilitate the diagnosis in a timely fashion. In this document, we strove to verify that the HRF ultrasound video output is compatible with the ISS video system, identify ISS video system field rates and resolutions that are acceptable for varying clinical scenaiios, and evaluate the HRF ultrasound video with a commercial, off-the-shelf video converter, and compare it with the ISS video system.

Melton, Shannon↗
NASA NTRSDate not supplied

Candidate Formulary Development for Exploration Missions

An interdisciplinary team of clinician, pharmacist, and system engineer subject matter experts (SMEs) collaborated to match pharmaceutical resources to the medical conditions anticipated to occur during exploration class missions. This effort began by using a SME generated Exploration Medical Conditions List and the associated medical system capabilities necessary to treat them. Using the systems engineering software MagicDraw™ and knowledge of pharmaceutical use and efficacy in spaceflight, the team traced appropriate medications to the medical conditions. These traces were used to pilot the process for generating a candidate formulary for level of care 4 and level of care 5 medical systems. This presentation will discuss the collaborative efforts of the team as they developed the content, detail the challenges of utilizing systems engineering software to describe clinical resources, and provide an overview of how the candidate medication formulary for exploration class missions was developed. It will also discuss how the lessons learned from this pilot effort can be applied to streamline future work.

S. Kurian↗