ALBERT

Description: Vision changes identified in long duration spaceflight astronauts has led Space Medicine at NASA to adopt a more comprehensive clinical monitoring protocol. Optical Coherence Tomography (OCT) was recently implemented at NASA, including on board the International Space Station in 2013. NASA is collaborating with Heidelberg Engineering to increase the fidelity of the current OCT data set by integrating the traditional circumpapillary OCT image with radial and horizontal block images at the optic nerve head. The retinal nerve fiber layer was segmented by two experienced individuals. Intra-rater (N=4 subjects and 70 images) and inter-rater (N=4 subjects and 221 images) agreement was performed. The results of this analysis and the potential benefits will be presented.

Description: Retrospective research and medical data collected on astronauts can be a valuable resource for researchers. This data can be requested from two separate NASA Archives. The Lifetime Surveillance of Astronaut Health (LSAH) holds astronaut medical data, and the Life Sciences Data Archive (LSDA) holds research data. One condition of use of astronaut research and medical data is the requirement that all abstracts, publications and presentations using this data must be reviewed for attributability. All final versions of abstracts, presentations, posters, and manuscripts must be reviewed by LSDA/LSAH prior to submission to a conference, journal, or other entities outside the Principal Investigator (PI) laboratory [including the NASA Export Control Document Availability Authorization (DAA) system]. If material undergoes multiple revisions (e.g., journal editor comments), the new versions must also be reviewed by LSDA/LSAH prior to re-submission to the journal. The purpose of this review is to ensure that no personally identifiable information (PII) is included in materials that are presented in a public venue or posted to the public domain. The procedures for submitting materials for review will be outlined. The process that LSAH/LSDA follows for assessing attributability will be presented. Characteristics and parameter combinations that often prompt attributability concerns will be identified. A published case report for a National Football League (NFL) player will be used to demonstrate how, in a population of public interest, a combination of information can result in inadvertent release of private or sensitive information.

Description: Understanding the kinds of evidence available and using the best evidence to answer a question is critical to evidenced-based decision-making, and it requires synthesis of evidence from a variety of sources. Categorization of human system risks in spaceflight, in particular, focuses on how well the integration and interpretation of all available evidence informs the risk statement that describes the relationship between spaceflight hazards and an outcome of interest. A mature understanding and categorization of these risks requires: 1) sufficient characterization of risk, 2) sufficient knowledge to determine an acceptable level of risk (i.e., a standard), 3) development of mitigations to meet the acceptable level of risk, and 4) identification of factors affecting generalizability of the evidence to different design reference missions. In the medical research community, evidence is often ranked by increasing confidence in findings gleaned from observational and experimental research (e.g., "levels of evidence"). However, an approach based solely on aspects of experimental design is problematic in assessing human system risks for spaceflight. For spaceflight, the unique challenges and opportunities include: (1) The independent variables in most evidence are the hazards of spaceflight, such as space radiation or low gravity, which cannot be entirely duplicated in terrestrial (Earth-based) analogs, (2) Evidence is drawn from multiple sources including medical and mission operations, Lifetime Surveillance of Astronaut Health (LSAH), spaceflight research (LSDA), and relevant environmental & terrestrial databases, (3) Risk metrics based primarily on LSAH data are typically derived from available prevalence or incidence data, which may limit rigorous interpretation, (4) The timeframe for obtaining adequate spaceflight sample size (n) is very long, given the small population, (5) Randomized controlled trials are unattainable in spaceflight, (6) Collection of personal and environmental data on the astronaut population may create opportunities for advanced analytics and human-environment modeling that goes beyond that achieved in isolated experimental designs; and (7) Translation of relevant research to operations is a complex, transdisciplinary enterprise in which the approach must apply across the physical, biological, behavioral, and social sciences. The approach to synthesizing evidence must address both source and fidelity of data, and reflect the most general attributes of quality of evidence in science and engineering: reliability and validity. The authors are developing a two-factor approach which includes the various kinds of evidence required to understand risks and for the integrated interpretation of all evidence that is essential to develop standards and countermeasures. A unified framework for aggregating and assessing different kinds of evidence provides a consistent, traceable, evidence-based decision-making process to translate research to operations in an environment where engineers, scientists, physicians, and managers all engage in analyzing the trade space of vehicle design, standards, requirements and solutions for spaceflight.

Description: Since the 2010 NASA directive to make the Life Sciences Data Archive (LSDA) and Lifetime Surveillance of Astronaut Health (LSAH) data archives more accessible by the research and operational communities, demand for astronaut medical data has increased greatly. LSAH and LSDA personnel are working with Human Research Program on many fronts to improve data access and decrease lead time for release of data. Some examples include the following: Feasibility reviews for NASA Research Announcement (NRA) data mining proposals; Improved communication, support for researchers, and process improvements for retrospective Institutional Review Board (IRB) protocols; Supplemental data sharing for flight investigators versus purely retrospective studies; Work with the Multilateral Human Research Panel for Exploration (MHRPE) to develop acceptable data sharing and crew consent processes and to organize inter-agency data coordinators to facilitate requests for international crewmember data. Current metrics on data requests crew consenting will be presented, along with limitations on contacting crew to obtain consent. Categories of medical monitoring data available for request will be presented as well as flow diagrams detailing data request processing and approval steps.

Description: Training for a spacewalk or extravehicular activity (EVA) is considered a hazardous duty for NASA astronauts. This places astronauts at risk for decompression sickness as well as various musculoskeletal disorders from working in the spacesuit. As a result, the operational and research communities over the years have requested access to EVA training data to supplement their studies. The purpose of this paper is to document the comprehensive EVA training data set that was compiled from multiple sources by the Lifetime Surveillance of Astronaut Health (LSAH) epidemiologists to investigate musculoskeletal injuries. The EVA training dataset does not contain any medical data, rather it only documents when EVA training was performed, by whom and other details about the session. The first activities practicing EVA maneuvers in water were performed at the Neutral Buoyancy Simulator (NBS) at the Marshall Spaceflight Center in Huntsville, Alabama. This facility opened in 1967 and was used for EVA training until the early Space Shuttle program days. Although several photographs show astronauts performing EVA training in the NBS, records detailing who performed the training and the frequency of training are unavailable. Paper training records were stored within the NBS after it was designated as a National Historic Landmark in 1985 and closed in 1997, but significant resources would be needed to identify and secure these records, and at this time LSAH has not pursued acquisition of these early training records. Training in the NBS decreased when the Johnson Space Center in Houston, Texas, opened the Weightless Environment Training Facility (WETF) in 1980. Early training records from the WETF consist of 11 hand-written dive logbooks compiled by individual workers that were digitized at the request of LSAH. The WETF was integral in the training for Space Shuttle EVAs until its closure in 1998. The Neutral Buoyancy Laboratory (NBL) at the Sonny Carter Training Facility near JSC opened in March 1997 and is the current site for US EVA training. Other space agencies also have used water to simulate weightlessness and train for EVAs. Russia has a training facility similar to the NBL named the Hydro Lab. The Hydro Lab began operations at the Gagarin Cosmonaut Training Center (GCTC) in 1980 and has been used extensively to the present. Although a majority of training in the Hydro Lab uses the Russian Orlan suit, a small number of sessions have been conducted using a NASA suit. The Japanese Weightlessness Environment Test System (WETS) went into service at the Tsukuba Space Center in 1997 but was closed in 2011 due to extensive earthquake damage. Several sessions were performed using a NASA suit, but these sessions were short and considered "development" runs. LSAH has assembled records from the WETF, NBL and Hydro Lab. Recording of the EVA training data has changed considerably from 1967 to present. The goal of early record keeping was to track use of hardware components, and the person involved was treated as a suited operator, not as a focus of interest. Records from the past two decades are fairly precise with the person, date, suit type and size noted. On occasion the length of the session was listed, but this data is not included on all records. Records were merged from data sources and extensive cleaning of the records was required since the multiple sources frequently overlapped and duplicated records. To date the LSAH EVA training dataset includes over 12,500 EVA training sessions performed by NASA astronauts since 1981. The following variables are included for most records: Name, Sex, Event date, Event name, HUT type, HUT size, Facility, and Estimated run time. For a smaller subset of records, the following variables are available: Actual run time, Time inverted, and the suit components Waist bearing type, Shoulder harness, Shoulder pads, and Teflon inserts. The LSAH dataset is currently the most complete resource for data regarding EVA training sessions performed by NASA astronauts. However, it is not 100 percent complete since the WETS (Japan) and NBS (Marshall) training facility data were not included. This dataset has been compiled by LSAH to study the relationship of EVA training to musculoskeletal injuries but has many other non-medical applications. This dataset can be provided to other groups in order to respond to program and research questions with appropriate board approvals.

Description: Enhanced screening for the Visual Impairment/Intracranial Pressure (VIIP) Syndrome, including in-flight ultrasound, was implemented in 2010 to better characterize the changes in vision observed in some long-duration crewmembers. Suggested possible risk factors for VIIP include cardiovascular changes, diet, anatomical and genetic factors, and environmental conditions. As a potent vasodilator, carbon dioxide (CO (sub 2)), which is chronically elevated on the International Space Station (ISS) relative to typical indoor and outdoor ambient levels on Earth, seems a plausible contributor to VIIP. In an effort to understand the possible associations between CO (sub 2) and VIIP, this study analyzes the relationship between ambient CO (sub 2) levels on ISS and ultrasound measures of the eye obtained from ISS fliers. CO (sub 2) measurements will be pulled directly from Operational Data Reduction Complex for the Lab and Node 3 major constituent analyzers (MCAs) on ISS or from sensors located in the European Columbus module, as available. CO (sub 2) measures between ultrasound sessions will be summarized using standard time series class metrics in MATLAB including time-weighted means and variances. Cumulative CO (sub 2) exposure metrics will also be developed. Regression analyses will be used to quantify the relationships between the CO (sub 2) metrics and specific ultrasound measures. Generalized estimating equations will adjust for the repeated measures within individuals. Multiple imputation techniques will be used to adjust for any possible biases in missing data for either CO (sub 2) or ultrasound measures. These analyses will elucidate the possible relationship between CO (sub 2) and changes in vision and also inform future analysis of inflight VIIP data.