Index

A

Acceptable risk, determination of, 67

Actuarial data, using to estimate likelihood of intrinsic health alterations, 2, 11, 15, 49–50

Advanced human life support, the case of, 82–83

Advanced Human Support Technologies, 10, 82

Agency for Healthcare Research and Quality (AHRQ), 62

National Guideline Clearinghouse, 62

AHRQ. See Agency for Healthcare Research and Quality

Airway management, operational issues in, 52

Analog environments, 32

Anion exchange resin filtration, 29

Apollo program, 73

Appetite, lack of, 38

Approximate reasoning, 63

Astronaut Office, 11, 42, 61, 64–65

Autonomous medical care, 51–54

biological issues, 51

health care delivery issues, 51

operational issues, 51

B

Bayesian sequential trials approach, 79, 122

using to address the small sample size, 13, 15, 78–80

Bayesian updating, 8, 13, 69, 120–123

BCPR. See Bioastronautics Critical Path Roadmap

Behavioral health and performance, priority of, 65

Behavioral health risks

addressing issues of human sexuality in long-duration missions, 2

grouping into categories based on clinical outcomes, 2, 11, 15, 42–44

mitigation plans for, 32

reclassification of, 41–44

Behavioral interventions, for mental disorders, 44

Behavioral research support, conducting periodic assessment of additional risks from lack of resources and using this to make decisions about, 13, 15, 75–78



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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap Index A Acceptable risk, determination of, 67 Actuarial data, using to estimate likelihood of intrinsic health alterations, 2, 11, 15, 49–50 Advanced human life support, the case of, 82–83 Advanced Human Support Technologies, 10, 82 Agency for Healthcare Research and Quality (AHRQ), 62 National Guideline Clearinghouse, 62 AHRQ. See Agency for Healthcare Research and Quality Airway management, operational issues in, 52 Analog environments, 32 Anion exchange resin filtration, 29 Apollo program, 73 Appetite, lack of, 38 Approximate reasoning, 63 Astronaut Office, 11, 42, 61, 64–65 Autonomous medical care, 51–54 biological issues, 51 health care delivery issues, 51 operational issues, 51 B Bayesian sequential trials approach, 79, 122 using to address the small sample size, 13, 15, 78–80 Bayesian updating, 8, 13, 69, 120–123 BCPR. See Bioastronautics Critical Path Roadmap Behavioral health and performance, priority of, 65 Behavioral health risks addressing issues of human sexuality in long-duration missions, 2 grouping into categories based on clinical outcomes, 2, 11, 15, 42–44 mitigation plans for, 32 reclassification of, 41–44 Behavioral interventions, for mental disorders, 44 Behavioral research support, conducting periodic assessment of additional risks from lack of resources and using this to make decisions about, 13, 15, 75–78

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap Bioastronautics Critical Path Roadmap (BCPR), 17, 66 Bioastronautics Roadmap (BR) current printed and on-line versions of, 63, 68 as a dynamic and current database, 2, 9, 14, 68–70 hyperlinks in “Important References” section, 68 overall assessment of, 23–24 Risk Rating Categories and Priority Definitions, 20 updating and maintaining, 24 Bioastronautics Roadmap (BR) content, 25–59 creating the cross-cutting category “Food and Nutrition,” 37–40 creating the cross-cutting category “Human Systems Integration,” 35–37 fusing the relationships between human factors and technology in, 34–40 overarching issues, 26–34 specific issues, 40–54 Bioastronautics Roadmap (BR) context, 73–85 addressing the challenges posed by the small sample size, 78–80 analysis and prioritization to meet the launch schedule, 75–78 the case of advanced human life support, 82–83 efficiency and technology issues, 80–82 organizational characteristics and risk, 73–75 Bioastronautics Roadmap (BR) process, 60–72 determination of acceptable risk, 67 Independent Health and Medical Authority, 70–71 keeping the BR current, 69–70 risk assessment, 60–66 risk communication, 68–69 Bioastronautics Science Management Team (BSMT), 19, 61, 64–65 Biological issues, for autonomous medical care and self-care, 51 Bleeding control, operational issues in, 52 BMAD. See Bone mineral apparent density BMD. See Bone mineral density Bone fracture risk, associated with prolonged exposure to microgravity, 115–119 Bone loss countermeasures to, 32 priority of, 65 Bone mineral apparent density (BMAD), 116 Bone mineral density (BMD), 115–116 BR. See Bioastronautics Roadmap British Medical Research Council Cancer Trials, 121 BSMT. See Bioastronautics Science Management Team Bush, George W., 20, 22 C CAIB. See Columbia Accident Investigation Board Cardiopulmonary resuscitation (CPR), operational issues in, 52 Central nervous system (CNS) impairment, 6, 46–47, 49 CEV. See Crew Exploration Vehicle Challenger Space Shuttle, 73–74 Chief Engineer, 70 Circadian rhythm, problems with, 41 Clinically acute problems, 53 CNS. See Central nervous system impairment Cochrane Collaboration, 62 Cognitive therapy, brief forms of, 43 Columbia Accident Investigation Board (CAIB), 70, 74

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap Columbia Space Shuttle, 73 Committee on Aerospace Medicine and Medicine in Extreme Environments, 90 Committee on Review of NASA’s Bioastronautics Roadmap, 4, 90–95 charge to, 21–22 Content recommendations on overarching issues in the BR, 14 recommendations on specific issues in the BR, 11–12, 15 Context, recommendations on specific issues in the BR, 12–15 Continuous Risk Management Program, 8, 67–69 Coping skills, 37 affecting others’ work productivity, 29 Cost–utility analysis, 52 Countermeasure Readiness Level (CRL), 6, 29–31 status of, 51, 97–114 Countermeasures, 29 accelerating development of, 1, 6, 14, 29–34, 115 cost-effective, 61 for mental disorders, 43 CPR. See Cardiopulmonary resuscitation Crew Exploration Vehicle (CEV), 76 Crew selection criteria, validating current and future, 2, 11, 15, 41–42 Crews cognitive capabilities not matching task demands, 41 increased task performance expectations, 35 international, increasing complexity of health care delivery, 54 morale of, 38 CRL. See Countermeasure Readiness Level Cross-cutting categories, 2, 10, 35–40 Cultural preferences and expectations, 40 D Data-based evidence, in decision making, 8, 120–123 Decision making, integration of data-based evidence and expert opinion in, 8, 120–123 Bayesian updating, 8, 13, 69, 120–123 Deoxyribonucleic acid (DNA), damage to, 46 Depression major mood swings related to, 46 nutritional factors in understanding, 28 Derivation phase, 77 Design Reference Missions, 1, 3, 5, 11, 17–19, 21, 25, 49–50, 67, 69, 74–76, 79n, 83 Digital simulation, 32, 70 Disaggregation, of risk from mitigation of risk, 62–63 DNA. See Deoxyribonucleic acid Dual energy X-ray absorptiometry (DXA), 115–117 E “Efficiency” risks, 80–82 EVA. See Extravehicular activity Evidence-based interventions, for mental disorders, 43 Evidence-based risk assessment, 62 “Expert opinion,” in decision making, 8, 69, 120–123 Extravehicular activity (EVA), 6, 83 clothing for, 36, 49 decompression procedures for, 76 technology for, 82 F Fatigue, cognitive effects associated with, 45

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap Findings and recommendations, 5–9 radiation effects, establishing risk-specific radiation exposure levels, 6–7 risk assessment, 7–8 risk communication and keeping the BR current, 8–9 status of readiness levels, 5–6 Fixed effects methods, using to address the small sample size, 13, 15, 78–80 Food, grown and processed during flight, 39 “Food and Nutrition” category, creating, 2, 10, 14, 34–40 Fracture risk, assessment of, 116–117 Fuzzy sets, 63 G “G-suit” system, 63 Galactic cosmic rays (GCRs), 46–48 Gamma rays, 47 GCRs. See Galactic cosmic rays Ground-crew relations, dysfunctional, 35–36 Group relations, effective, 44 H Habitability studies, 36 Hazardous environments of space, 80 Health care delivery issues for autonomous medical care and self-care, 51 impact of crew selection on, 54 in nonterrestrial environments, 52 Health risks, quantitatively evaluating, 2 Hierarchical random methods, using to address the small sample size, 13, 15, 78–80 High-mass, high-Z, high-energy radiation (HZE), 6, 47–48 Homeostasis, 38 Homogeneous teams, 77 Houston Workshop, on the Bioastronautics Roadmap, 65, 79n, 89–95 Human life support, the case of advanced, 82–83 Human performance failure, due to organizational and cultural factors, 12–13, 15, 73–75 Human sexuality, in long-duration missions, addressing issues of, 11, 15, 44 Human system, impossibility of reengineering, 81 “Human Systems Integration” category, creating, 2, 10, 14, 34–40 Human-robot interactions, 36 Human-technology interactions, 35 Hyperlinks, in “Important References” section of the BR, 68 HZE. See High-mass, high-Z, high-energy radiation I ICRP. See International Commission on Radiological Protection Independent Health and Medical Authority (IHMA), 70–71 establishing, 12, 15, 70–71 Independent Technical Authority (ITA), 70–71 Individual tolerance, 47 Inherent risks, 29 Institute of Medicine (IOM), 3, 13, 21, 64, 80 International Commission on Radiological Protection (ICRP), 47 International crews, increasing complexity of health care delivery, 54 International Space Station (ISS), 3, 21, 34, 74. See also Design Reference Missions investigations aboard, 32, 77

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap Interpersonal therapy, brief forms of, 43 Interventions for mental disorders behavioral, 44 evidence-based, 43 Intrapersonal factors, 41 Intrinsic health alterations, using actuarial data to estimate likelihood of, 2, 11, 15, 49–50 Iodine, used as a bacteriostatic agent, 28, 33 IOM. See Institute of Medicine Ionizing radiation, from the solar wind, 46 Iran Nonproliferation Act, 76 Isolation studies, 45 ISS. See International Space Station Issues. See Overarching issues in the BR content; Specific issues ITA. See Independent Technical Authority J Johnson Space Center, 50, 89 L Launch schedule, analysis and prioritization to meet, 75–78 LEO. See Low Earth orbit Long-duration space flights, 35, 41, 46 addressing issues of human sexuality in, 11, 15, 44 assessing the impact on crew’s health and incremental risk, 49–50 simulating, 77 Longitudinal Study of Astronaut Health, 50 Low Earth orbit (LEO), 76 space travel below, 47 Low-readiness areas, 32 Lunar surface sojourn. See Design Reference Missions M Magnetic resonance (MR) scans, 53 Mania, major mood swings related to, 46 Mars journey. See Design Reference Missions Mealtimes, social interactions and connotations of, 40 Medical care autonomous, 51–54 priority of, 65 Mental disorders, 42 interventions or countermeasures for, 43 nutritional factors in understanding, 28 Mental health risks affecting crew health and mission success, developing a system for quantitative evaluation of, 12, 15, 51–54 quantitatively evaluating, 2 Methodology, 22–23, 89–95 Committee on Aerospace Medicine and Medicine in Extreme Environments, 90 Committee on Review of NASA’s Bioastronautics, 90–95 Institute of Medicine workshops, 90–95 Microgravity support, conducting periodic assessment of additional risks from lack of resources and using this to make decisions about, 13, 15, 75–78 Mir Space Station, 29, 41 Mitigation strategies, 27, 32 Mobility aids, 36 Mood swings, major, 45 Moon surface sojourn. See Design Reference Missions MR. See Magnetic resonance scans Muscle loss, 39 Musculoskeletal weakness, 36

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap N Narcissism, 42 Narrative descriptions of risks, 63 NASA. See National Aeronautics and Space Administration National Aeronautics and Space Administration (NASA), 2–8, 10–11, 13, 17–19, 60, 73, 115, 120. See also Bioastronautics Roadmap (BR) challenges to managers of, 25 constraints on the ISS imposed by, 76 Continuous Risk Management Program, 8, 67–69 Independent Technical Authority, 70–71 Office of Biological and Physical Research, 18 Office of Space Flight, 18 Office of the Chief Health and Medical Officer, 18, 61, 64 National Guideline Clearinghouse, 62 National Space Biomedical Research Institute (NSBRI), 19, 60 Naval Submarine Medical Research Laboratory (NSMRL), 33 Naval Undersea Medical Institute (NUMI), 33 Neurobehavioral problems, 41 Neurovestibular functionality, 27 priority of, 65 NSBRI. See National Space Biomedical Research Institute NSMRL. See Naval Submarine Medical Research Laboratory NUMI. See Naval Undersea Medical Institute Nutritional factors, 38, 118 in understanding depression and other mental disorders, 28 O Office of Biological and Physical Research, 18 Office of Space Flight, 18 Office of the Chief Health and Medical Officer, 18, 61, 64 Operational issues and solutions, 5 airway management, 52 for autonomous medical care and self-care, 51 bleeding control, 52 cardiopulmonary resuscitation, 52 suction, 52 Organizational characteristics, and risk, 73–75 Outcome-oriented approach, 31 Overarching issues in the BR content, 9–10, 26–34 countermeasure and technology readiness levels, 29–31 creating the cross-cutting categories “Human System Integration” and “Food and Nutrition,” 2, 10 interactions among risks, 10, 27–29 status of readiness levels, 29–34 the time factor and its impact on risk, 9, 26–27 P Palatability, 40 Performance. See also Human performance failure increased task expectations of crew, 35 priority of, 65 psychological and physical impacts of space flight on, 44–46 Personality disorders, 42 Physical health risks affecting crew health and mission success, developing a system for quantitative evaluation of, 12, 15, 51–54 quantitatively evaluating, 2 Physical restraints, 36 Possibility theory, 63 Preliminary Considerations Regarding NASA’s Bioastronautics Critical Path Roadmap, 21

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap President’s space initiative, 18, 22–23, 26, 74–75 vision for U.S. space exploration, 22 Principal recommendations, 5–9, 14 accelerating countermeasure and technology development, 6, 14, 29–34 ensuring that the BR is a dynamic and current database that enhances communication and conveys information effectively, 9, 14, 68–70 establishing a safe radiation exposure level for all relevant risks, 7, 14, 46–49 incorporating quality-of-evidence measures, 8, 14, 61–62 representing risk severity separately from the state of the mitigation strategy or countermeasure, 8, 14, 62–63 using standard uncertainty analysis techniques to quantify risk uncertainty, 8, 14, 63–66 Prioritization, 65 threshold for, 5 Process, recommendations on specific issues in the BR, 12, 15 Psychosocial adaptation, 41 Q Quality-of-evidence measures, incorporating, 2, 8, 14, 61–62 Quantitative computed tomographic (QCD)-derived measurements, 116 R Radiation exposure mitigation plans for, 32 priority of, 65 Radiation exposure levels establishing risk-specific, 6–7, 46–49 establishing safe, 1–2, 7, 14, 46–49 increased in space, 39 Random methods, hierarchical, used to address the small sample size, 13, 15, 78–80 RBCs. See Red blood cells Readiness levels. See Countermeasure Readiness Level (CRL); Technology Readiness Levels (TRLs) Reclassification, of behavioral health risks, 41–44 Recommendations, 14–15 principal, 14 summary of, 14 Recommendations on overarching issues in the BR content, 14 creating two new cross-cutting categories: human systems integration and food and nutrition, 10, 14, 34–40 defining, quantifying, and mitigating interactions among risks, 10, 14, 27–29 labeling risks by relevance to operational requirements and temporal urgency, 9, 14, 26–27 Recommendations on specific issues in the BR content, 11–12, 15 addressing issues of human sexuality in long-duration missions, 11, 15, 44 developing a system for quantitative evaluation of mental and physical health risks affecting crew health and mission success, 12, 15, 51–54 grouping behavioral health risks into categories based on clinical outcomes, 11, 15, 42–44 using actuarial data to estimate the likelihood of intrinsic health alterations as part of the selection criteria for the Mars mission crew, 11, 15, 49–50

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap validating current and future crew selection criteria, 11, 15, 41–42 Recommendations on specific issues in the BR context, 12–15 conducting periodic assessment of additional risks from lack of resources and using this to make decisions about microgravity and behavioral research support, 13, 15, 75–78 human performance failure due to organizational and cultural factors, 12–13, 15, 73–75 reframing risks as either health or technology related, 14–15, 80–82 using Bayesian sequential trials approach and hierarchical random or fixed effects methods to address the small sample size, 13, 15, 78–80 Recommendations on specific issues in the BR process, 12, 15 establishing an independent health and medical authority, 12, 15, 70–71 Red blood cells (RBCs), decreased release rate of, 39 Reengineering, 81 “Related risks,” 28 “Retiring” risks, 63 Risk assessment, 7–8, 19–20, 60–66 disaggregation of risk from mitigation of risk, 62–63 evidence-based, 62 expressing uncertainty, 63–66 Risk communication, 68–69 and keeping the BR current, 8–9 Risk uncertainty, using standard uncertainty analysis techniques to quantify, 8, 14, 63–66 Risks defining, quantifying, and mitigating interactions among, 10, 14, 27–29 “efficiency,” 80–81 identification of, 19 inherent, 29 labeling by relevance to operational requirements and temporal urgency, 9, 14, 26–27 narrative descriptions of, 63 organizational characteristics of, 73–75 quantitatively evaluating, 2 reframing as either health or technology related, 14–15, 80–82 representing severity of separately from the state of the mitigation strategy or countermeasure, 8, 14, 62–63 “retiring,” 63 S Safe Passage: Astronaut Care for Exploration Missions, 64 “Select-in” and “select-out” procedures, 41–42, 77 Self-care, 51–54 biological issues, 51 health care delivery issues, 51 operational issues, 51 Sex. See Human sexuality Silver nitrate, using as a bacteriostatic agent, 28–29 Sleep loss, 41 Small Clinical Trials: Issues and Challenges, 13, 80 Small sample size, addressing the challenges posed by, 78–80 Social interactions, 40 Solar particle events (SPEs), 46, 48 Solar wind, ionizing radiation from, 46 Space Medicine Office, 65 Spacelab Life Sciences Shuttle missions, 39 Spatial orientation, maintaining, 36 Specific issues, 10–15, 40–54 assessing the sources and impact of long-duration space flight on crew’s health and incremental risk, 49–50

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap autonomous medical care and self-care, 51–54 psychological and physical impacts of space flight on performance, 44–46 radiation effects and establishing risk-specific radiation exposure levels, 46–49 reclassification of behavioral health risks, 41–44 recommendations related to specific issues in the BR content, 11–12 recommendations related to specific issues in the BR context, 12–14 recommendations related to specific issues in the BR process, 12 SPEs. See Solar particle events Stakeholders, 9, 121–122 Standard uncertainty analysis techniques, using to quantify risk uncertainty, 8, 14, 63–66 Status of readiness levels, 5–6, 29–34, 97–114 Stress analyzing responses to, 46 high in tight quarters, 32 Stress hormones, increased concentrations of, 45 Submarine studies, 33 Suction, operational issues in, 52 Surrogates, using in assessment, 32 T Teams. See also Crews dynamics of, 77 homogeneous, 77 Technology development, 80–82 accelerating, 1, 6, 14, 29–34 Technology Readiness Levels (TRLs), 6, 13, 29–31, 78, 83 status of, 97–114 testing operationally, 76 Terrestrial parameters, 83 Thyroid dysfunction, 33 following water contamination, 28 Time factor, and its impact on risk, 9, 26–27 TRLs. See Technology Readiness Levels U Ultrasound units, handheld diagnostic, 53 Uncertainty analysis techniques for, 8, 14, 63–66 expressing, 63–66 Unranked areas, 32 U.S. Department of Defense, 10 V Variety issues, in diet, 40 Vegetarian diet, 40 Vitamin status, 38 W Water contamination, and consequent thyroid dysfunction, 28 Water quality monitoring, mitigation plans for, 32 WHO. See World Health Organization Women crew members, 34 Work productivity, of others, coping skills affecting, 29 Workshop on the Bioastronautics Roadmap, 65, 79n, 89–95 results of the CB/SD/BSMT consensus, 66 World Health Organization (WHO), 115

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