Review of NASA's Evidence Reports on Human Health Risks 2014 Letter Report (2015) / Chapter Skim
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Review of NASA's Evidence Reports on Human Health Risks: 2014 Letter Report
Review of NASA's Evidence Reports on Human Health Risks: 2014 Letter Report
Pages 1-56
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.1 The committee w will provide an independeent revieww of the more than 30 evidence reports tthat NASA hhas compiled on human n health riskss for long-durration and exxploration spaaceflights. Thhis 2014 letter l report builds b on the work of the 22008 IOM report and exam mines seeven evidencee reports: 1.
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In summary, this report examines the quality of the evidence, analysis, and overall construction of each report; identifies existing gaps in report content; and provides suggestions for additional sources of expert input. This report also builds on the 2008 IOM report Review of NASA's Human Research Program Evidence Books: A Letter Report, which assessed the process for developing NASA's evidence reports and provided an initial and brief review of NASA's original evidence report.2 The committee approached its task by analyzing each evidence report's overall quality, which included readability; internal consistency; the source and breadth of cited evidence; identification of existing knowledge and research gaps; authorship expertise; and, if applicable, response to recommendations from the 2008 IOM letter report previously described.
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The evidence reports, which are publicly available, are categorized into five broad categories: (1) behavioral health and performance; (2)
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. Furthermore, as noted in the 2013 IOM letter report, substantial variability exists in the formatting, internal consistency, and completeness of the references among individual evidence reports, making it difficult to compare cited evidence for related human health risks.
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. As outlined in Figure 1, the evidence reports are the first part of the roadmap, which is followed by clarifying the risks, specifying the research gaps to address those risks, implementing research tasks, and obtaining deliverables.
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Becau use these channges may poteentiate the infeection prrocess, know wledge about them is criticcal to accuraately predict iinflight infectious dissease risks fo or long-duratiion missions.. The evidennce report Risk of Ad dverse Health h Effects Duue to Alteraations in HostMicroo organism Inteeractions (Ch hatterjee et all., 2012)
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This evidence report generally identifies and provides good context and broad support for the research gaps presented and for the existence of high-priority knowledge gaps. More research on the underlying mechanisms and the causality of the observed effects of spaceflight and spaceflight-analog culture on microbial responses and host-microorganism interactions on crew health is needed.
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, limited knowledge exists about the mechanisms initiating microbial responses. Likewise, inadequate data exist about operational experience with illness, which does not always comport with current evidence about microbial virulence, pathogenesisrelated host responses, and the causality for infectious disease during spaceflight.
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. Collectively, evidence of spaceflight-induced alterations in microbial virulence, pathogenesis-related characteristics, evolutionarily conserved spaceflight response mechanisms, potential microbiome shifts, and immune function suggest that spaceflight could have a negative impact on crew health (Crabbé et al., 2011, 2013; Crucian and Sams, 2009; Crucian et al., 2013, 2014a; Guéguinou et al., 2009; Ilyin, 2005;.
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However, the committee identified additional significant research gaps that were not adequately addressed and remain to be explored. The committee acknowledges that its focus is normally on evaluating research gaps related to identified health risks, rather than on research gaps related to the countermeasures applied to reduce those risks.
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Moreover, both short- and long-duration spaceflight and ground-based spaceflight analog studies are need ed to understand both transient and heritable changes in microbes and host-microbial interactions, as well as microbial growth char acteristics, and alterations in microbiome composition. • Evaluation of virulence changes: Information on virulence changes in additional pathogens, alone or in the context of mixed microbial co-cultures, would greatly improve understanding of the impact of spaceflight on crew health risk.
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. • Effect of sex/gender on infectious disease risks: Because males and females differ in the intensity, prevalence, and pathogenesis of microbial infections, further information is needed on the ef fect of sex/gender on infectious disease risk in flight.
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Does the Evidence Report Address Relevant Interactions Among Risks? This evidence report discusses health risks that have the potential to interact with risks discussed in a number of other evidence reports, including (1)
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As with a review of any broad scientific field, additional perspectives could strengthen this report, despite having been authored, in part, by a renowned expert in the field of spaceflight microbiology. These evidence reports deal with inherently complex systems, and, as such, these sys
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. The risk that altered immune response will have a negative effect on crew health is amplified with the increased duration of exploration class missions.
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A better mechanistic understanding of the relationship between spaceflight, the immune system, and disease manifestation is needed, which should allow for the development and application of efficacious countermeasures to ensure crew health and mission success. The committee provides the following assessment of the NASA evidence report Risk of Crew Adverse Health Event Due to Altered Immune Response (Crucian et al., 2009)
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. As noted in the discussion on the host-microbe interactions report, the evidence for this BOX 3 Additional Research Gaps Identified in the Human Research Roadmap IM1: The extent to which spaceflight alters various aspects of human im munity during spaceflight missions up to 6 months.
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These additional research gaps deserve consideration: • Sex/gender differences: As males and females differ in the inten sity, prevalence, and pathogenesis of both infectious diseases and autoimmune diseases, further understanding of this risk will ne cessitate more information on sex/gender differences on innate mucosal and adaptive immune function. • Microbiome composition: Given the association between micro biome composition and health status, investigations are needed to understand the impact of spaceflight on the crew microbiome and how that correlates with changes in immune status and dis ease risk.
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accessing information from the longitudinal follow-up of astro naut health to monitor potential spaceflight-induced alterations in immune function and adverse health events that may take years to manifest (especially given the small sample size)
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. While a clear link was made between this evidence report and the Alterations in Host-Microorganism Interactions report, links between other evidence reports were not immediately evident.
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It may be beneficial to include an infectious disease expert in subsequent versions of this evidence report to assist in the interpretation of findings on host-microbe interactions relevant to immune system function and to help align current evidence regarding spaceflight-induced alterations in microbial responses and immune function with disease causality. As noted in the section about the Host-Microorganism report, it may be useful to include a content expert in systems biology and/or complex systems science in future revisions.
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This remains a major gap in knowledge in the current evidence report. RISK OF INADEQUATE DESIGN OF HUMAN AND AUTOMATION/ROBOTIC INTEGRATION The committee examined the evidence report Risk of Inadequate Design of Human and Automation/Robotic Integration (Marquez et al., 2013)
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Given the rapid advances in this domain and the rapidly growing experience and literature base, future evidence reports will be able to more clearly define the specific risk issues. Particularly relevant for this purpose is recent ground robot research specifically addressing issues in collaboration between humans and robot systems (Ososky et al., 2013; Philips et al., 2011; Wiltshire et al., 2013)
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The automation discussion in the report assumes that tasks are largely separable and that the primary decision is how to allocate responsibility between humans and automation. This has been the historical BOX 4 Additional Research Gaps Identified in the Human Research Roadmap: Human and Automation/Robotic Integration • SHFE-HARI-01: We need to evaluate, develop, and validate meth ods and guidelines for identifying human-automation/robot task in formation needs, function allocation, and team composition for future long duration, long distance space missions.
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For long-duration space missions, greater flexibility in the distribution of responsibilities between humans and automation may be necessary, due to limits on the number of crew members and delays in communication with ground control personnel on Earth. The concept of active interaction and collaboration among humans, robots, and automation of all kinds should be addressed.
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The report quite correctly identified a number of issues associated with human-robot teaming and humanautomation collaboration; however, the report could benefit from citing more recent publications that address issues of shared mental models between robots and humans, trust and confidence, human perception of robot action, and human-robot teaming. Furthermore, the report needs to explore the challenges and research gaps that are being seen in automation and robotic integration in fields such as manufacturing, distribution, and vehicle and human factors design.
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In the 2008 report, the groupings of issues related to human factors were clustered in Chapter 23 of a single evidence book, Lack of Human-Centered Design, which addressed three risks related to human factors: inadequate information, poor human factor design, and poor task design. There were no previous recommendations relevant to the specific topics on HARI.
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The report uses the framework of the eight core contributing factors associated with the risk of inadequate HCI (derived from the Human Factors Analysis and Classification System) , and it makes an excellent case for the identified research gaps.
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, and the next iteration could explore those in greater depth. BOX 5 Additional Research Gaps Identified in the Human Research Roadmap: Human-Computer Interaction • SHFE-HCI-01: What are the effects of vibration and acceleration on crew task performance and how can those effects be mitigated?
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(Lee, 2004) ; • war games (e.g., situational awareness-based effective respons es)
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The report makes an excellent case for a systems or integrated approach to addressing the interactions among the risks associated with HCI, HARI, critical task design, and training. It specifically recognizes the relative importance of efficiency, effectiveness, and complexity associated with the various interactions.
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covers a wide range of topics, and the authors were faced with the challenge of deciding where to focus the discussion and how to integrate the discussion with the other evidence reports on human factors (Holden et al., 2013; Marquez et al., 2013) , as well as other closely related evidence reports such as those on risk of injury from dynamic loads (Caldwell et al., 2012)
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This evidence report provides a number of descriptions of anecdotal reports and examples from experiences on the Shuttle, ISS, and Constellation programs. These examples provide the reader with the starting points for understanding the context, but more could be done to identify and analyze the key research gaps that are identified by those accounts.
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The evidence report places considerable emphasis on anthropometry and on noise, without explicit discussion of the consequences of inadequate design in these areas; these limitations of the report are discussed on the next page. The other research gaps (e.g., visual environment, vehicle volume and layout)
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Additional areas in which there are research gaps include • suit effects, including mobility for surface EVAs and energy expenditure; • vehicle effects and biomechanics as related to gravitational and nongravitational environments; • neutral body posture and the impact of anthropometric consid erations, including skeletal build and fat-to-muscle ratio and their impacts on posture; and • restraints (beyond foot holds and hand holds) and their utilization.
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Although human system integration with the habitat/vehicle is discussed throughout the report, there could be further efforts to address the relevant interactions among the various risks described in this evidence report and also among the risks described in other evidence reports. Interactions among risks that are not described include • interactions where changes in human health (such as changes in muscle strength and bone stability caused by vibration and G forces, as well as visual acuity)
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. Throughout the report there is a need for increased attention to health risks and how the various design features affect crew health, rather than paying attention to more general operations issues.
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poor task design. There were no previous recommendations relevant to the specific topics on vehicle and habitat design.
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Among the most salient omissions of the evidence report is the recognition of the enormous responsibilities that ground personnel face in preparing realistic schedules, accurate procedures, and optimum presentation of information to guide task performance in space. The report discusses inadequate task design in general terms and, to illustrate potential consequences, uses examples drawn almost exclusively from aviation.
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The evidence report provides justification for all of the research gaps identified. However, the data provided are almost exclusively summative, based on crew report.
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BOX 7 Additional Research Gaps Identified in the Human Research Roadmap: Critical Task Design • SHFE-TASK-01: How can workload measures and tools be devel oped to unobtrusively monitor and trend workload throughout the mission design and verification cycle in a consistent manner? • SHFE-TASK-02: What model-based Human Factors Tools can as sist with the design and evaluations of spacecraft systems and task procedures?
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Further gaps remain regarding the effect of delayed communications with the ground on task performance during interplanetary expeditions; more needs to be learned about how to write procedures to support autonomous operations. The list of research gaps is generally thoughtful, with the discussion of human-in-the-loop evaluations being particularly appropriate, especially because spacecraft design will continue to evolve and include greater automation.
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• Automated job aids to correct operator errors: Research on task design should include consideration of automated procedures that might be developed that would have the capability of detect ing errors and suggesting mitigating actions, in the same manner
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Links are provided in this evidence report to the NASA evidence reports on inadequate HCI (Holden et al., 2013) , training deficiencies (Barshi, 2012)
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Has the Evidence Report Addressed Previous Recommendations Made by the IOM in the 2008 Letter Report? In the 2008 IOM report, the discussion regarding task design was part of the review of a broad chapter, Chapter 23 in Lack of HumanCentered Design, that addressed three risks: (1)
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and summarizes its response to the key questions below. Does the Evidence Report Provide Sufficient Evidence, as Well as Sufficient Risk Context, That the Risk Is of Concern for Long-Term Space Missions?
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The evidence report needs additional examples taken directly from the field of spaceflight to illustrate the risks of inadequate training. Does the Evidence Report Make the Case for the Research Gaps Presented?
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, as suggested throughout this letter report. BOX 8 Additional Research Gaps Identified in the Human Research Roadmap: Performance Errors Due to Training Deficiencies • SHFE-TRAIN-01: We do not know which validated objective measures of operator proficiency and of training effectiveness should be used for future long-duration exploration missions.
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, this review of training risks fails to include, in its list of research gaps, the need for task analyses of the work to be performed on expedition-class missions. The absence of task analyses for the ISS operations and for future long-duration expeditions handicaps understanding of associated risks and limits discussion to vague and unanchored generalities.
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The evidence report mentions only "inadequate task design" as a related risk. Beyond task design, the most salient training-related risk is inadequate personnel selection, which involves both the initial criteria for selection and the criteria used to select a specific crew composition.
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The evidence report is well-written overall and easily readable, but it could be improved with greater specificity. Is the Breadth of the Cited Literature Sufficient?
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Just-in-time training: The evidence report states that, "contributing factors regarding training deficiencies may pertain to organizational process and training programs for spaceflight, such as when training programs are in adequate or unavailable" (Barshi, 2012, p.
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This research focus is appropriate for the risk. However, this evidence report, as with each of the evidence reports on a broad topic, would benefit from additional perspectives.
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The 2013 evidence report provides significantly expanded coverage on the risk of inadequate training and highlights the research needed on types of training and measurement of its impact, although, as noted in this review, greater specificity is needed, where feasible. SUMMARY This is the second of five letter reports that will review the entire series of NASA's evidence reports on human health risks.
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Masys, Vice Chair Committee to Review NASA's Evidence Reports on Human Health Risks
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