A Risk Reduction Strategy for Human Exploration of Space A Review of NASA's Bioastronautics Roadmap (2006) / Chapter Skim
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2 Considerations Regarding the BR Content
2 Considerations Regarding the BR Content
Pages 25-59
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. The risks are further described by their associated research and technology questions, and all of the above are further analyzed relative to the Design Reference Missions.
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to minimize adverse responses, especially in the context of longer-term missions · Radiation effects -- establishing risk-specific radiation exposure levels · Assessing the sources and impact of long-duration space flight on crew health and incremental risk · Autonomous medical care and self-care OVERARCHING ISSUES Overarching issues are those factors that, in the committee's view, deserve wide review and application throughout the current BR and in future revisions of the BR. They should be viewed as guiding principles or strategic approaches to the revision and management of the BR.
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Finally, to be included meaningfully in the mission planning process, biomedical countermeasures and life support technologies must be validated well in advance of the final integrated mission plan, thus adding temporal urgency to the time dimension. The committee notes that some of these dimensions of time are partially addressed by subdividing the risk analyses into the three Design Reference Missions in the BR, but concludes that time does not achieve the attention that is required to fully address risk priorities, determine countermeasure readiness, predict the maintainability of systems and equipment, and evaluate the impact of exploration missions flight on crew health.
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For example, nutrition is identified as a related risk for Risk 23 (human performance failure due to poor psychosocial adaptation) but not Risk 24 (human performance failure due to neurobehavioral changes)
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are the result of problems listed under Risk 24 (human performance failure due to poor psychosocial adaptation (NRC, 1998; IOM, 2001)
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subjects to demonstrate efficacy of concept. Subsystem prototype Evaluation with human 7 Countermeasure in a space environment.
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. 40 CRL TRL 30 20 Frequency 10 0 None 1 2 3 4 5 6 7 8 9 of trials Definition studies Proof Preliminary concept ValidationSpaceflight validation formulation Clinical simulation Countermeasure Flight Implementation FIGURE 2-1 Countermeasure and Technology Readiness Levels.
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Included in these unranked or low-readiness areas are substantial portions of the mitigation plans on behavioral health and performance, radiation, autonomous health care, and water quality monitoring, areas that the committee finds deserving of further attention from NASA (IOM, 2005)
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Practicality, however, would dictate that rather than "starting from scratch," the large amount of information that already exists from analog environments such as saturation diving, polar expeditions, bed rest, centrifuge, mock Crew Exploration Vehicle (CEV) expeditions, and submarines be used appropriately.
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Numerous other highly appropriate analog environments could be used. For example, the data from experimental saturation diving facilities could provide opportunities that mimic extravehicular activities, as well as crew quarters and environments; polar expeditions could provide information about long-term isolation; and prolonged bed rest can mimic at least several aspects of the musculoskeletal changes associated with microgravity.
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As evidence of the linkage among risks that currently fall within two separate cross-cutting categories, both Risk 24 (human performance failure due to poor psychosocial adaptation) and Risk 45 (poorly integrated ground, crew, and automation functions)
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(2001) , for example, identified the following technology issues for manned space missions: (1)
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Similar arguments apply to the control of radiation exposure and the identification of coping skills and other preventive measures to address the human factors associated with prolonged space flight. Recommendation 2.4 The committee recommends that NASA create a cross-cutting category that spans the two existing categories of "Behavioral Health and Performance" and "Space Human Factors Engi neering" risks listed currently in the area of the "Advanced Human Support Technologies." This new category should be labeled "Human Systems Integration," consistent with the ter minology currently in use by the U.S.
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. According to Smith et al., it is not known whether the observed decrease in folate -- attributed to inadequate food intake, not to food processing techniques -- would be accentuated during prolonged space missions.
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In addition to nutritional intake, the space environment itself may have marked effects on the nutritional status of astronauts; the abovementioned hematological changes during space flight are but one example. Another is the adverse effect of increased radiation in space, which may accelerate the degradation or oxidation of food components and alter the potential mitigation of these effects through the protective action of antioxidants (including various vitamins)
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Further, the committee recommends that the impact of inadequate food and nutrition on processes related to mental and physical health risks and maintenance of the space environment and life support systems be defined from the standpoints of food safety, quality, and quantity, and in terventions proposed if problems occur. SPECIFIC ISSUES Specific issues are those areas that deserve focused attention and refinement in the BR in order to more effectively accomplish its goals as a man
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Reclassification of Behavioral Health Risks The existing cross-cutting category "Behavioral Health and Performance" in the BR includes four categories of risk: human performance failure due to poor psychosocial adaptation (Risk 24) , human performance failure due to neurobehavioral problems (Risk 25)
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At present, the BR offers no guidelines for improving selectout procedures to reduce the likelihood of human performance failure due to poor psychosocial adaptation, neurobehavioral changes, cognitive overload, or disruption of sleep and circadian rhythms. Additional screening criteria that might benefit from further research include history of family disorders, childhood experiences of abuse or trauma, and stress reactivity.
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Recommendation 2.7 The committee recommends that behavioral health risks within the proposed new cross-cutting category of Human Sys tems Integration be grouped into categories based on clinical outcomes such as interpersonal conflict, affect regulation, dec rements in cognitive performance, mood disorders, and sleep disorders, rather than categories such as psychosocial, neurobehavioral, cognitive, and circadian rhythms, and that the interrelations between these categories be delineated clearly.
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Areas of concern for the 30-month Mars mission include the potential psychological and physiological consequences of sexual activity, consequences that could endanger life, crew cohesion, performance, and mission success. Some risks can be eliminated but others cannot.
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Cognitive effects associated with fatigue were also noted in hyperbaric chamber isolation studies. In actual extended space flights, fatigue increased over time, with associated increases in errors.
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Radiation Effects: Establishing Risk-Specific Radiation Exposure Levels Exposure to ionizing radiation from the solar wind, solar particle events (SPEs) , galactic cosmic rays (GCRs)
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However, the radiation environment of space travel beyond LEO is more complex, and less well understood, than the mostly low-dose radiation encountered by radiation workers and the general public that is the main concern of the broader radiation protection community. Also, individual tolerance for late health effect risks may be greater among the astronaut community than among the general population, although possibly not greater than that of some radiation workers.
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Radiation risks differ considerably between a 12-month mission in LEO aboard the ISS and a 30-month mission to Mars because the latter will be exposed to significantly greater galactic cosmic radiation, for example. Although the major technology issue is protecting astronauts from health risks associated with exposure to radiation, there are potential performance decrements associated with radiation exposure at lower levels than those that affect health.
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Assessing the Sources and Impact of Long-Duration Space Flight on Crew Health and Incremental Risk Crew performance can be compromised by (1) intrinsic health alterations that occur spontaneously due to natural processes in the space environment, (2)
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Af ter intrinsic health risks are estimated, NASA should then esti mate and/or model the contribution of the space environment and life support system malfunction to increased risk. The committee notes that such approaches are used currently for the assessment of radiation risks and believes that the expansion of this concept will benefit NASA operations and decision making, as well as the astronauts, as they assess the risks of long-duration exploration missions.
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To prepare for risk mitigation and autonomous medical care to the extent possible, it may be helpful to consider the research issues in three categories, based on the type of problem and the nature of the research required to address the problem. These categories are the following: · Biological issues: biological and pharmacological questions requiring basic research with cell cultures, animals, drugs, and so forth, in the space environment (most likely during the ISS and lunar missions)
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. Both the biological and the operational research issues are aimed not at fundamental science, but at support of the specific health care delivery issues that are focused on crew health and mission success.
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Under these circumstances, breast cancer -- and perhaps some other malignancies -- could move from the category of "cannot treat during mission" to the category of "pursue periodic screening and initiate treatment during mission." This example illustrates the benefits of focusing the mitigation strategies on the three areas described above and of using an iterative process to evaluate the current status of risks and mitigation strategies, as well as the importance again of linking technology, insight derived from models and simulation, and expert opinion when addressing risk mitigation in the BR.
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The committee concluded that it will be valuable to categorize health care risks into those with minimal and easily managed outcomes through those of increasing severity and decreasing capability for management due to complexity, distance, or duration of the mission in order to prioritize the biological, operational, and care delivery strategies related to the risks defined in the BR. Recommendation 2.11 The committee recommends that a system be developed for quantitatively evaluating the mental and physical health risks that could affect mission success and crew health and that pri orities for countermeasure development (i.e., definitive treat ment vs.
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2001. Space radiation cancer risks and uncertainties for Mars missions.
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2001a. Human interactions during Shuttle/Mir space missions.
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2005. Bioastronautics Roadmap- a risk reduction strategy for human space exploration.
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2005. The nutritional status of astronauts is altered after long-term space flight aboard the International Space Station.
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1999. Research priorities for the International Space Station.
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