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Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
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OCR for page 31
C
Committee Reviews of the Evidence Books
Sensorimotor
Chapter 1 Impaired Ability to Maintain Control of Vehicles and Other
Complex Systems
Bone
Chapter 2 Accelerated Osteoporosis
Chapter 3 Bone Fracture
Chapter 4 Renal Stone Formation
Chapter 5 Intervertebral Disk Damage
Muscle
Chapter 6 Impaired Performance Errors Due to Reduced Muscle Mass,
Strength, and Endurance
Chapter 7 Operational Impact of Prolonged Daily Required Exercise
Chapter 8 Compromised EVA Performance and Crew Health Due to
Inadequate EVA Suit Systems
Cardiovascular
Chapter 9 Orthostatic Intolerance During Re-Exposure to Gravity
Chapter 10 Cardiovascular Effects on Performance and Operational Limi-
tations
Chapter 11 Cardiac Rhythm Problems
31
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32 REVIEW OF NASA’S HUMAN RESEARCH PROGRAM EVIDENCE BOOKS
Nutrition
Chapter 12 Inadequate Nutrition
Immunology
Chapter 13 Crew Adverse Health Event Due to Altered Immune
Response
Behavioral Health and Performance
Chapter 14 Performance Errors Due to Sleep Loss, Circadian Desynchro-
nization, Fatigue, and Work Overload
Chapter 15 Performance Errors Due to Poor Team Cohesion and Perform-
ance, Inadequate Selection/Team Composition, Inadequate
Training, and Poor Psychosocial Adaptation
Chapter 16 Behavioral and Psychiatric Conditions
Space Radiation
Chapter 17 Acute Radiation Syndromes Due to Solar Particle Events
Chapter 18 Degenerative Tissue or Other Health Effects from Radiation
Exposure
Chapter 19 Acute or Late Central Nervous System Effects from Radiation
Exposure
Chapter 20 Radiation Carcinogenesis
Pharmacology
Chapter 21 Therapeutic Failure Due to Ineffectiveness of Medication
Exploration Medical Capabilities
Chapter 22 Inability to Adequately Treat an Ill or Injured Crew Member
Space Human Factors and Habitability
Chapter 23 Lack of Human-Centered Design
A. Sub-Risk of Reduced Safety and Efficiency Due to Poor
Human Factors Design
B. Sub-Risk of Error Due to Inadequate Information
C. Sub-Risk Associated with Poor Task Design
Chapter 24 Inadequate Food System
Chapter 25 Adverse Health Effects from Lunar Dust Exposure
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33
APPENDIX C
Chapter 1
Impaired Ability to Maintain Control of Vehicles
and Other Complex Systems
Does the evidence book make the case (sufficient evidence) that this risk is
relevant to long-term space missions?
Yes. Experimental and observational findings from prior missions, including
Apollo, aviation, ground-experimental, and patient data are quite thoroughly
described. Additional data and discussions would be helpful to add as described
below.
Is the text of the short description of the health risk provided in the PRD)clear
(it should be Section I of the evidence book)? Provide suggestions of revised
wording.
Yes. However, an additional sentence relating the risk to existing Apollo data
would be helpful.
Does the evidence book make the case for the research gaps presented?
Yes. The paper presents a comprehensive review of the literature. The implica-
tions for future lunar and Mars missions are clearly spelled out. The documenta-
tion in the appendix of apparently all U.S. and Russian neurological and
sensorimotor experiments conducted in space is highly informative.
Additional risks to be considered for review in this paper include the possible
impact of alterations in cortical maps of motor control and somatosensation, and
the physiologically relevant factors associated with cognitive and sensorimotor
adaptations to abnormal force conditions.
Are there any additional gaps in knowledge that should be considered for this
specific risk?
Yes, there should be some discussion of the relationship to the basic perform-
ance measures (reaction time, short-term memory, etc.) in spaceflight. A discus-
sion of fractional g-levels and sensorimotor adaptation is also needed.
Does the evidence book address relevant interactions among risks?
Yes. A consideration of sleep deprivation and stress effects on sensorimotor
performance is indicated.
Comment if relevant to the specific evidence book: Is the merging of some risks
in the Bioastronautics Roadmap into a single risk appropriate? Is the omission
of some risks in the Bioastronautics Roadmap appropriate?
These are not relevant to this evidence book.
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Comment on other issues regarding the evidence book, including:
• Is the author expertise sufficient? Other disciplines needed?
• Literature search: Is the breadth of the search sufficient? Is informa-
tion on the search strategy needed?
• Overall readability: Is it appropriate for a “science professional” who
is not familiar with the specific area covered?
The paper is highly readable, scholarly, and quite comprehensive in its coverage.
The amount of material covered and the implications of the findings for future
lunar and Mars missions are highly informative. The paper clearly specifies the
potential risks in future space activities based on the sensorimotor deficit find-
ings from previous studies. It would be helpful if the paper had a discussion of
the caveats relevant to assessing the reliability of data from these types of space
flight experiments that involve few subjects and lack adequate controls.
A more thorough review of the literature on vestibulo-ocular reflex function
could be added. The committee had concerns that the section on tilt translation
and tilt gain illusions seems exceedingly long given the sparse information actu-
ally available. Discussions of the issues regarding the theories that are proposed
to explain these illusions should be added, as should a discussion of oculogravic
illusions. The section on computer-based simulation information presents a
number of the classic early studies in the field but more recent modeling data
need to be described (data based on more biological considerations than on
analogies with inertial guidance systems). Future reviews would benefit from a
more diverse group of contributors that could add a focus on these additional
topics.
Minor issue:
There is an error in the table of contents in which “Risk of Accelerated Osteopo-
rosis” is listed as the title of the risk.
Overarching comments on the evidence book: Provide a short paragraph
summary of the key issues raised in your review of the paper.
The paper provides a clear and succinct review of the space and other literature
related to sensorimotor problems during and after spaceflight. The extrapolation
of these data to potential risks in vehicle control for lunar and Mars missions is
informative, particularly discussions about landing a vehicle on the Mars sur-
face. The issue of predictors of astronaut performance from preflight measures is
highly relevant.
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35
APPENDIX C
Please note:
• Crosscutting issues and ideas for broader recommendations
• Additional risks that should be added to the list (missing risks)
Space motion sickness should still be considered an unsolved risk, and there is
ample reason to keep it on the gap and critical path lists.
Chapter 2
Accelerated Osteoporosis
Does the evidence book make the case (sufficient evidence) that this risk is
relevant to long-term space missions?
Generally, yes. The evidence book is an excellent review and analysis of the
evidence. Some areas deserve additional comment, at least in part because they
may lead to the identification of more knowledge gaps.
1. Although mentioned, the considerable heterogeneity in the rate of bone loss
is of potentially huge importance, and should be further emphasized. Some
flight personnel apparently experience particularly rapid bone loss, and
these individuals may be at particular risk. Are flights imperiled more by
the astronauts with greatest bone loss rather than the average bone loss of
the crew? As the evidence book notes, there is also heterogeneity in the de-
gree of recovery from bone loss after landing.
2. The evidence book mentions the lack of evidence concerning the effects of
long-term flight (> 6 months) on bone, but fails to discuss the relevant data
concerning long-term spinal cord injury (SCI). One of the potential failings
of the comparison of bone loss in spaceflight to menopause is that it could
lead to the assumption that the bone loss in space is self-limited. On the
other hand, long-term SCI studies suggest that bone loss continues for long
periods after immobilization begins and results in truly dramatic reductions
in bone mass. Moreover, some data indicate that markers of bone resorption
remain elevated for long periods, further raising the concern that accelerated
bone loss could be prolonged with more impressive implications for long-
term flights. These considerations seem important to discuss. See the re-
views of SCI and bone by Giangregorio and Blimkie (2002) and Jiang et al.
(2006).
3. The paper concentrates on the effects of the unloading that accompanies
weightlessness, but little attention is given to known or possible effects of
long-term reduced gravity environments such as those that might be experi-
enced with future lunar missions.
4. A discussion of the potential biomechanical trauma anticipated on bone
during flight and planetary/lunar stays seems important. Although it could
also be presented in the evidence book on fractures (and just referenced in
this section), the current evidence book does a good job of presenting finite
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36 REVIEW OF NASA’S HUMAN RESEARCH PROGRAM EVIDENCE BOOKS
element analyses of the strength of bone, and the corollary of that discus-
sion is that of the load-to-strength ratio (factor of risk). In other words, is
the level of trauma risk anticipated (load) likely to be greater than the ability
of the weakened bone to resist it (strength)? The issue of trauma would
seem relevant given the possibility of flight turbulence, landing, and extra-
vehicular excursions. Are there forms of trauma expected that might affect
specific bones, and are those bones particularly weakened (e.g., hip)? In ad-
dition to the possibility of trauma from factors such as turbulence, it may be
worth mentioning the possibility of physical stresses from tasks requiring
forceful movements and torque (although such tasks might be more likely to
put stress on the upper extremities, where the bone changes are not as
great). Should space suits or in-flight clothes contain force-mitigating pads
during long flights? The degree of concern for in-flight fracture ultimately
rests on the ability of the bones on the flight (and potentially the weakest
bones) to resist the extant trauma.
5. The emphasis on unloading as the etiology of bone loss is necessary and
appropriate, but the other potential causes of bone loss during missions may
deserve more discussion. Although unloading is undoubtedly a dominant
factor, other possible contributors to bone loss could be considered. These
include chronic stress, weight loss, sleep disturbance, gonadal abnormali-
ties, etc. Some of these are suspected to be problems, while others have not
been examined. The possibility that unexpected effects on bone may be en-
countered during spaceflight should not be ignored. More discussion is war-
ranted. This may deserve special attention in light of the interindividual
variation in bone loss. The factors mentioned, such as chronic stress and
sleep disturbance, would be expected to vary substantially from person to
person.
6. In the introduction, the authors appropriately point out that, despite their use
of the menopausal and aging comparisons, that spaceflight is neither of
those things. However, the possibility that spaceflight causes a distinct form
of metabolic bone disease should be more carefully considered. For exam-
ple, spaceflight is not like postmenopausal osteoporosis because there may
be an absolute (or more marked) reduction in bone formation during flight
whereas postmenopausal bone loss is characterized by increased bone for-
mation (with an even more increased rate of resorption). If the nature of
flight-induced bone loss is different from the aging or postmenopausal con-
ditions, perhaps more akin to glucocorticoid-induced bone loss (where—
like spaceflight—there is also a state of increased bone resorption and re-
duced bone formation), it could result in an altered fracture threshold. An-
other example of differences may be that hip bone loss seems to out of
proportion to that seen in postmenopausal women, apparently indicating
distinct pathophysiological mechanisms. Should these and other potential
differences be examined to best understand how to mitigate risk?
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APPENDIX C
7. Bone strength is the result of a number of factors, including the amount of
bone, its structure, and its quality. The evidence book should mention the
possibility that bone material properties could be altered by flight. Some
data from the SCI literature indicate that bone formation is altered, poten-
tially affecting material properties and strength.
8. Efforts undertaken so far to prevent bone loss during flight, and their effec-
tiveness, should be discussed.
9. The recent occurrence of a hip fracture in a previous astronaut is potentially
important, especially because traumatic fractures are highly related to lower
bone mineral density (BMD) (Mackey et al., 2007). Perhaps this should be
presented.
Is the text of the short description of the health risk provided in the PRD clear
(it should be Section I of the evidence book)? Provide suggestions of revised
wording.
1. “…unloading of the skeleton. In moderate-duration flights (6 months) aver-
age loss rates are approximately 1 percent per month, but some individuals
lose at a greater rate. It is unclear whether this bone mineral loss will stabi-
lize at a lower level or continue for the duration of longer flights. The cau-
sation and specific nature of the loss are unknown. Efforts to devise
methods to prevent loss during flight have not been successful. Mission-
related bone loss…”
2. Also, the statement that “mission-related bone loss cannot be corrected
by. . . ” may be too strong. Perhaps “ . . . cannot be reliably . . . ” or “ . . .
cannot be completely . . . ” would be more correct.
Does the evidence book make the case for the research gaps presented?
Yes, there is an excellent presentation of research gaps.
Are there any additional gaps in knowledge that should be considered for this
specific risk?
Additional gaps to be considered include:
1. Does the loss of bone during flight result in structural alterations that
are unique (different from the aging or postmenopausal states) that
have distinct biomechanical implications?
2. Apart from unweighting, the factors that contribute to bone loss are un-
clear.
3. The effects of long-term flight on bone are unknown (the authors
clearly note this, but it is not listed as a gap).
4. The preflight or during-flight factors that affect the rate of bone loss
during flight are unknown.
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38 REVIEW OF NASA’S HUMAN RESEARCH PROGRAM EVIDENCE BOOKS
5. The expected forces (trauma) that may be exerted on bone during flight
or extravehicular activity are unknown. The bones at particular risk are
unknown.
6. The best methods for measuring bone structure and strength are not
known.
7. The usefulness of new bone formation drugs are not known—either
during flight or after return to Earth.
8. In-flight metabolic alterations that could affect bone are not known.
Does the evidence book address relevant interactions among risks?
Some possibilities are as follows:
1. The risk of renal stones from increased bone resorption is noted, but
other possible problems may flow from alterations of bone metabolism.
For instance, there are probably vitamin D reductions during flight, and
muscle strength is reduced by vitamin D insufficiency. The danger of
hypercalcemia is clearly increased in SCI (especially under certain cir-
cumstances, such as dehydration). Hypercalcemia has been linked to
nausea, mental status and mood abnormalities, cardiac arrhythmias, etc.
2. Nutrition is an area of potential overlap.
3. Human Factors Design and Task Design are areas of potential overlap.
Comment if relevant to the specific evidence book: Is the merging of some risks
in the Bioastronautics Roadmap into a single risk appropriate? Is the omission
of some risks in the Bioastronautics Roadmap appropriate?
These are not relevant to this evidence book.
Comment on other issues regarding the evidence book, including:
• Is the author expertise sufficient? Other disciplines needed?
• Literature search: Is the breadth of the search sufficient? Is informa-
tion on the search strategy needed?
• Overall readability: Is it appropriate for a “science professional” who
is not familiar with the specific area covered?
o Author expertise appropriate: The authors are outstanding. An ex-
pert in mineral metabolism and related endocrine issues would be
useful. A bone biomechanic would provide benefit, and an expert
in human factors engineering may be useful.
o Literature presented; generally very good. As noted previously,
additional areas of interest would be the long term effects of SCI
and bone/mineral endocrinology.
o Overall readability: excellent.
Overarching comments on the evidence book: Provide a short paragraph
summary of the key issues raised in your review of the paper.
Key issues raised include:
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APPENDIX C
1. Concern about overreliance on the models of postmenopausal and age-
related bone loss.
2. A minimal emphasis on the heterogeneity of bone loss, and the implica-
tions of the “weakest link” consideration.
3. Need for linking the strength of bone to the trauma expected during
flight.
4. The paucity of good data concerning the metabolic/environmental ab-
normalities potentially contributing to bone loss (apart from unweight-
ing).
Please note:
• Crosscutting issues and ideas for broader recommendations
• Additional risks that should be added to the list (missing risks)
Other risks: The possibility of metabolic disturbances resulting from accelerated
bone remodeling/loss (vitamin D deficiency, hypercalcemia).
REFERENCES CITED
Giangregorio, L., and C. J. Blimkie. 2002. Skeletal adaptations to alterations in
weight-bearing activity: A comparison of models of disuse osteoporosis.
Sports Medicine 32(7):459-476.
Jiang, S. D., L. Y. Dai, and L. S. Jiang. 2006. Osteoporosis after spinal cord
injury. Osteoporosis International 17(2):180-192.
Mackey, D. C., L. Y. Lui, P. M. Cawthon, D. C. Bauer, M. C. Nevitt, J. A.
Cauley, T. A. Hillier, et al. 2007. High-trauma fractures and low bone min-
eral density in older women and men. Journal of the American Medical As-
sociation 298(20):2381-2388.
Chapter 3
Bone Fracture
Does the evidence book make the case (sufficient evidence) that this risk is
relevant to long-term space missions?
Yes. In general the evidence book is a scholarly and complete examination of
the issue. There are additional knowledge gaps that should be considered.
Is the text of the short description of the health risk provided in the PRD clear
(it should be Section I of the evidence book)? Provide suggestions of revised
wording.
Yes, in general the short description is clear and complete. Consider a final sen-
tence “Additional data is needed to understand the alterations in bone biology
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40 REVIEW OF NASA’S HUMAN RESEARCH PROGRAM EVIDENCE BOOKS
that could increase the potential for stress fracture or impaired fracture healing
in flight.”
Does the evidence book make the case for the research gaps presented?
Yes. The research gaps identified are well substantiated.
Are there any additional gaps in knowledge that should be considered for this
specific risk?
Yes. Additional gaps in knowledge to be considered include:
1. The evidence book concentrates on fracture risk during flight. Although
this is an appropriate concern, there is less attention paid to the risks of
fracture after return from flight. As there have been several fractures
now in previous astronauts, and the to-some-extent irreversible bone
loss associated with flight is well known, post-flight fracture risk
should be more prominently considered.
2. Fracture due to severe trauma is prominently considered (as it should
be) but there may be additional mechanisms of potential importance
(particularly in a situation associated with low bone formation). One is
stress fracture due to repetitive lower level force. Unusual stress and
impaired responses to it may be encountered during flight/EVA. An-
other may be static forces and torque or torsional forces during mission
activities such as construction tasks or EVAs.
3. In addition to the biomechanically oriented fracture risks considerations
included in the evidence book, some attention should be paid to frac-
ture healing in space. There is evidence to suggest that remodeling is
altered, but little data concerning the adequacy of healing. Certainly, if
a fracture occurs during flight, inadequate healing would add to the
problem.
Does the evidence book address relevant interactions among risks?
Related risks that were not addressed. They might include:
1. Reduced muscle mass
2. Poor human factors design
3. Bone loss
4. Impact of prolonged exercise
5. Inability to provide clinical treatment
6. Nutrition
7. Poor task design
8. Orthostatic intolerance
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APPENDIX C
Comment if relevant to the specific evidence book: Is the merging of some
risks in the Bioastronautics Roadmap into a single risk appropriate? Is the
omission of some risks in the Bioastronautics Roadmap appropriate?
These are not relevant to this evidence book.
Comment on other issues regarding the evidence book, including:
• Is the author expertise sufficient? Other disciplines needed?
• Literature search: Is the breadth of the search sufficient? Is informa-
tion on the search strategy needed?
• Overall readability: Is it appropriate for a “science professional” who
is not familiar with the specific area covered?
Additional expertise in fracture biology and in human factors engineering (to
give more full attention to the relationship between environmental design and
physical stress on bones and joints) might be helpful. The literature search is
complete. Readability is good.
Overarching comments on the evidence book: Provide a short paragraph
summary of the key issues raised in your review of the paper.
In general the evidence book is excellent. Additional attention should be di-
rected at postflight fracture risk, fracture healing during low-G situations, and
the possibility of stress fracture.
Although there are distinct features of this evidence book on fracture risk, it
could be argued that it could be combined with that on bone loss.
Two minor issues:
1. Figure 3-1 may have an error. The aBMD ascribed to the three bone ge-
ometries is consistently 1, but in fact the aBMD is progressively lower
going left to right.
2. On p. 3-9 it is noted that “ . . . planetary surfaces provide unique scenar-
ios that may:
- reduce the forces applied to bone structures.”
In fact, planetary surfaces may increase forces when considered in comparison
to previous 0 G conditions. That could be a critical consideration regarding frac-
ture risk.
Please note:
• Crosscutting issues and ideas for broader recommendations
• Additional risks that should be added to the list (missing risks)
No additional comments.
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based solely on existing in-mission and analog environment experience is likely
to be insufficiently effective, and should be enhanced by best available synthesis
of the other health risk categories. For example, although altered immunity has
yet to be associated with clinically evident disease, consideration of treatments
of conditions that might result from altered immunity, such as disseminated viral
reactivation, should be included in planning for long-term missions.
Does the evidence book address relevant interactions among risks?
No. Inability to provide treatment is interlinked with “risk of error due to inade-
quate information.”
Comment if relevant to the specific evidence book: Is the merging of some risks
in the Bioastronautics Roadmap into a single risk appropriate? Is the omission
of some risks in the Bioastronautics Roadmap appropriate?
These are not relevant to this evidence book.
Comment on other issues regarding the evidence book, including:
• Is the author expertise sufficient? Other disciplines needed?
• Literature search: Is the breadth of the search sufficient? Is informa-
tion on the search strategy needed?
• Overall readability: Is it appropriate for a “science professional” who
is not familiar with the specific area covered?
The paper is quite readable and well formulated, with adequate citations to pub-
lished and unpublished findings. Author expertise appears to be appropriate to
the task.
Overarching comments on the evidence book: Provide a short paragraph
summary of the key issues raised in your review of the paper.
This evidence book seems to be in an early stage of development. The addition
of a detailed list of gaps will do much to illuminate the directions in which re-
search and development will be going within NASA. As written, it describes a
necessary, but not sufficient, overall approach to the provisioning of autono-
mous health care resources and, at least as importantly, the enumeration of con-
ditions that will be left untreated during exploration-class missions.
Please note:
• Crosscutting issues and ideas for broader recommendations
• Additional risks that should be added to the list (missing risks)
No additional comments.
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APPENDIX C
Chapter 23A
Lack of Human-Centered Design: Sub-Risk of Reduced Safety and Effi-
ciency Due to Poor Human Factors Design
Does the evidence book make the case (sufficient evidence) that this risk is
relevant to long-term space missions?
Yes. The case is made largely on the basis of anecdotal incidents that are con-
vincing, but not a thorough scientific evaluation. The numerous examples are
compelling, but it would be a stronger case if they were limited to the space ac-
cidents rather than the ground-based accidents (e.g., aviation, ship, power plant)
as well. It is far more important to demonstrate the problems that exist in long-
duration spaceflight and the research required to address those problems than it
is to describe the effects of general human accidents in recent history.
Is the text of the short description of the health risk provided in the PRD clear
(it should be Section I of the evidence book)? Provide suggestions of revised
wording.
No. Although the case is strong, the description is inadequate. It is filled with
jargon and is not specific.
Does the evidence book make the case for the research gaps presented?
Yes.
Are there any additional gaps in knowledge that should be considered for this
specific risk?
Yes. Additional gaps in knowledge to be considered include:
1. Manual control
2. Advanced displays
3. Workload assessment
4. Training, both initial and in-mission
5. Use of artificial intelligence for malfunctions
6. Spatial disorientation as it affects performance
Does the evidence book address relevant interactions among risks?
Yes. With human factors, everything is connected to everything else. A fatigued
astronaut will need a redundant checklist. A disoriented one will need a more
compelling display. Further, the authors may wish to address the potential over-
lap associated with the impact of environmental design on psychosocial and
behavioral adjustment issues, e.g., issues discussed in Chapters 15 and 16.
Comment if relevant to the specific evidence book: Is the merging of some risks
in the Bioastronautics Roadmap into a single risk appropriate? Is the omission
of some risks in the Bioastronautics Roadmap appropriate?
These are not relevant to this evidence book.
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Comment on other issues regarding the evidence book, including:
• Is the author expertise sufficient? Other disciplines needed?
• Literature search: Is the breadth of the search sufficient? Is informa-
tion on the search strategy needed?
• Overall readability: Is it appropriate for a “science professional” who
is not familiar with the specific area covered?
The literature should be divided into the specific accounts associated with the
Human Factors examples, and the broader references dealing with space experi-
ences and human factors methodology. The expertise and examples are ade-
quate, though not all are directly applicable. The overall readability is poor
because of too much jargon and too much repetition. The evidence book list of
authors includes many from “inside” the NASA system, and may be improved
with additional external academic perspectives.
Overarching comments on the evidence book: Provide a short paragraph
summary of the key issues raised in your review of the paper.
This section is a full and provocative primer on the general issue of dangers as-
sociated with the various aspects of human-centered design, and what can hap-
pen if the principles are ignored. It suffers from being too long—but especially
in not distinguishing between the dangers associated with the failure to follow
known procedures, and the absence of information about what procedures to
employ for long-duration spaceflight. The first is a matter of training and the
second is the subject for NASA’s Human Research Program (HRP) research.
Please note:
• Crosscutting issues and ideas for broader recommendations
• Additional risks that should be added to the list (missing risks)
1. Manual control
2. Displays
3. Spatial disorientation
4. Fatigue
Chapter 23B
Lack of Human-Centered Design: Sub-Risk of Error
Due to Inadequate Information
Does the evidence book make the case (sufficient evidence) that this risk is
relevant to long-term space missions?
Yes. As discussed below; however, the case could be made more compelling.
Is the text of the short description of the health risk provided in the PRD clear
(it should be Section I of the evidence book)? Provide suggestions of revised
wording.
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APPENDIX C
Yes. It is clear. but incomplete. “Lack of information can be a problem, but so
can too much information if the means of separating the important information
are inadequate or poorly designed.” A suggested revision follows:
“Task errors can be due to lack of, or inadequate ability to dis-
cern, appropriate information, which in turn may be due to any
of the following:
[(a), (b), (c), (d) as shown]
(e) excessive information, with unclear or otherwise inade-
quate demarcation between the information that is important
or useful for the situation and the information that is not.”
Does the evidence book make the case for the research gaps presented?
Yes. The supporting evidence from spaceflight is very strong, and NASA is cer-
tainly one of the world’s leading experts. However, the categorization of the
spaceflight examples could have been more logically presented in some in-
stances. The ground-based supporting evidence is not adequate. For example,
using an occurrence that is nearly 30 years old (the Three Mile Island nuclear
accident in Pennsylvania) as an example of inadequate displays and controls
certainly raises the question of whether there are more recent examples. If so,
these should be cited as examples, and if not, query whether a problem still ex-
ists.
In addition, because the risk definition does not adequately address having too
much information, none of the examples relates to that issue. There is a large
amount of supporting ground-based evidence that is available concerning every
category enumerated in the evidence book, involving both inadequate and too
much information. The evidence book would be stronger if such issues were
also included.
Are there any additional gaps in knowledge that should be considered for this
specific risk?
Yes. There are undoubtedly gaps associated with the issue of too much informa-
tion, which is not adequately discussed in the report.
Does the evidence book address relevant interactions among risks?
Yes.
Comment if relevant to the specific evidence book: Is the merging of some risks
in the Bioastronautics Roadmap into a single risk appropriate? Is the omission
of some risks in the Bioastronautics Roadmap appropriate?
These are not relevant to this evidence book.
Comment on other issues regarding the evidence book, including:
• Is the author expertise sufficient? Other disciplines needed?
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• Literature search: Is the breadth of the search sufficient? Is informa-
tion on the search strategy needed?
• Overall readability: Is it appropriate for a “science professional” who
is not familiar with the specific area covered?
No additional comments.
Overarching comments on the evidence book: Provide a short paragraph
summary of the key issues raised in your review of the paper.
The paper satisfactorily addresses issues associated with inadequate information,
but the paper should also address issues associated with too much information,
which can also lead to undesirable outcomes.
Please note:
• Crosscutting issues and ideas for broader recommendations
• Additional risks that should be added to the list (missing risks)
No additional comments.
Chapter 23C
Lack of Human-Centered Design: Sub-Risk Associated
with Poor Task Design
Does the evidence book make the case (sufficient evidence) that this risk is
relevant to long-term space missions?
Yes. As discussed below, however, the case could be more compelling.
Is the text of the short description of the health risk provided in the PRD clear
(it should be Section I of the evidence book)? Provide suggestions of revised
wording.
Yes. It is clear but incomplete. Focusing solely on reducing operator error is
politically popular, but can result in serious inefficiencies when applied in actual
operation. Moreover, the issue relates to all tasks, not just critical tasks. A sug-
gested revision to the second sentence follows: “All tasks, especially critical
tasks, must be designed to minimize human error in a way that improves effi-
ciency as much as possible, or at least minimally degrades efficiency.”
Does the evidence book make the case for the research gaps presented?
Yes. Similar to Chapter 23B: Inadequate Information, the supporting evidence
from spaceflight is very strong, and NASA is certainly one of the world’s lead-
ing experts. However, the categorization of the spaceflight examples could have
been more logically presented in some instances. The ground-based supporting
evidence is not adequate. For example, using an occurrence that is more than 60
years old (a cargo ship explosion in 1947) as an example of which cargo com-
partments should and should not be adjacent to each other (not to mention the
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issue of why this is an example of poor task design) certainly raises the question
of whether there are better and more recent examples. If so, why aren’t more
recent examples cited, and if not, query whether this is still a problem.
Are there any additional gaps in knowledge that should be considered for this
specific risk?
Yes. There are gaps associated with determining the impact on efficiency of an
error-reducing task design.
Does the evidence book address relevant interactions among risks?
No. The design of tasks that necessitate EVA must consider the physical and
other limitations created by the EVA suit.
Comment if relevant to the specific evidence book: Is the merging of some risks
in the Bioastronautics Roadmap into a single risk appropriate? Is the omission
of some risks in the Bioastronautics Roadmap appropriate?
These are not relevant to this evidence book.
Comment on other issues regarding the evidence book, including:
• Is the author expertise sufficient? Other disciplines needed?
• Literature search: Is the breadth of the search sufficient? Is informa-
tion on the search strategy needed?
• Overall readability: Is it appropriate for a “science professional” who
is not familiar with the specific area covered?
No additional comments.
Overarching comments on the evidence book: Provide a short paragraph
summary of the key issues raised in your review of the paper.
The paper should address not only the error potential of task designs, but also
the impact on efficiency. In addition, task design of activities that involve EVA
must also consider the physical and other limitations of the EVA suit.
Please note:
• Crosscutting issues and ideas for broader recommendations
• Additional risks that should be added to the list (missing risks)
No additional comments.
Chapter 24
Inadequate Food System
Does the evidence book make the case (sufficient evidence) that this risk is
relevant to long-term space missions?
Yes.
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Is the text of the short description of the health risk provided in the PRD clear
(it should be Section I of the evidence book)? Provide suggestions of revised
wording.
No. The last sentence suggests that an allocation of resources for food has al-
ready been made, which is unlikely at this early stage. The following is a sug-
gested replacement for the last sentence: “Furthermore, careful attention must be
paid to the resources allocated to creating a satisfactory food system in order to
avoid unduly depriving other systems of needed resources.”
Does the evidence book make the case for the research gaps presented?
Yes.
Are there any additional gaps in knowledge that should be considered for this
specific risk?
Yes. One gap that is not mentioned is whether acceptable food will grow on
Mars, the Moon, or enroute, given the reduced gravity, reduced sunlight, avail-
able water, radiation, and other aspects of the growing environment. This uncer-
tainty may necessitate carrying enough on-board food to provide adequate and
acceptable nutrition in case biogeneration is not successful. If enough on-board
nutrition has to be carried, as a contingency, a potential query is whether bio-
generation should be part of the overall nutrition plan.
Does the evidence book address relevant interactions among risks?
No. The paper addresses several interactions, most notably the relation between
adequate and acceptable food and the crew’s physical and mental well-being,
but at least one risk interaction is missing. The evidence book on central nervous
system effects from radiation exposure mentions some dietary countermeasures,
but there is no indication in this food system paper regarding giving any special
consideration to those dietary items.
Comment if relevant to the specific evidence book: Is the merging of some risks
in the Bioastronautics Roadmap into a single risk appropriate? Is the omission
of some risks in the Bioastronautics Roadmap appropriate?
These are not relevant to this evidence book.
Comment on other issues regarding the evidence book, including:
• Is the author expertise sufficient? Other disciplines needed?
• Literature search: Is the breadth of the search sufficient? Is informa-
tion on the search strategy needed?
• Overall readability: Is it appropriate for a “science professional” who
is not familiar with the specific area covered?
No additional comments.
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Overarching comments on the evidence book: Provide a short paragraph
summary of the key issues raised in your review of the paper.
The paper provides a good description and analysis of the many difficult issues
involved.
Please note:
• Crosscutting issues and ideas for broader recommendations
• Additional risks that should be added to the list (missing risks)
No additional comments.
Chapter 25
Adverse Health Effects from Lunar Dust Exposure
Does the evidence book make the case (sufficient evidence) that this risk is
relevant to long-term space missions?
No.
1. The evidence book would be strengthened by the addition of a system-
atic introduction to the toxicology of airborne particulates, so that the
reader would have a set of benchmarks against which the evidence re-
garding lunar dust can be considered. As a related consequence, the
document jumps from one topic to another, including some examples
(e.g., Hawks Nest tunnel disaster) that have little relevance for the task
at hand. It makes the assumption that activation/passivation is the key
issue, but does not adequately justify this. The draft does not do an
adequate job of presenting and discussing the potential health effects of
dust exposure. These would include at least fibrogenicity, carcinogenic-
ity, allergic sensitization, and respiratory/dermal irritant properties.
2. This evidence book should include a more complete and systematic
presentation concerning what is known about the characteristics of lu-
nar dust in order to consider adequately the potential health risks. This
is another prerequisite for an evaluation of risk and gaps. The human
health risks from airborne dust exposure vary according to chemical
composition, particle size, physical characteristics (e.g., crystalline
structure, particle shape, fibrous character), and a variety of human fac-
tors (e.g., pre-existing illness, respiratory rate). As an example, the
draft paper seems to presume that lunar dust is respirable (see first sen-
tence of executive summary), but there is no discussion about the parti-
cle size distribution of lunar dust and not all evidence supports this
assumption. More attention is necessary for this important issue.
3. Similarly, the current draft fails to consider potential allergic/immune
consequences of lunar dust. Indeed, terms such as “airborne allergen”
and “IgE” never appear, and the word “immune” (or related) appears
only once. This is despite the evidence that two individuals who were
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exposed to lunar dust reported allergic symptoms or findings. The first,
an Apollo astronaut, described his response as “hay fever” (i.e., pollen
allergy); the second, a ground-based physician-scientist, described an
“allergic-type” reaction, apparently supported by changes in basophil
and eosinophil counts. This oversight should be considered and ad-
dressed to ensure the development of effective countermeasures.
4. The draft offers two Earth-based analogs (silicosis among miners and
volcanic ash exposure) without convincingly explaining how these
compare with possible lunar dust exposures. It fails to explore another
body of evidence that may be relevant—environmental exposure to
PM10 particulate dust (10µM-diameter particulate matter) and its effect
on respiratory and cardiovascular function.
Is the text of the short description of the health risk provided in the PRD clear
(it should be Section I of the evidence book)? Provide suggestions of revised
wording.
No. The text is not an affirmative statement describing the problem. Rather it is
simply a critique of the risk statement in the PRD. It is suggested that it be re-
written, not just revised.
Does the evidence book make the case for the research gaps presented?
Yes. Most of the gaps identified seem reasonable; however, the paper may be
strengthened if it begins to establish relative importance to each.
Are there any additional gaps in knowledge that should be considered for this
specific risk?
Yes. Additional gaps in knowledge to be considered include:
1. Respiratory dynamics under conditions of reduced gravity or weight-
lessness. Does particle distribution and deposition in the respiratory
tract differ from Earth-based conditions?
2. Effectiveness of available control methods to reduce exposure.
3. Role of lunar dust as a possible airborne allergen.
4. Countermeasure development, ranging from physical to pharmaceuti-
cal, to deal with the airborne allergen potential.
Does the evidence book address relevant interactions among risks?
No. Only EVA suits are mentioned. Other topics for consideration include im-
pact of prolonged exercise, poor human factors design, and cognitive errors.
Comment if relevant to the specific evidence book: Is the merging of some risks
in the Bioastronautics Roadmap into a single risk appropriate? Is the omission
of some risks in the Bioastronautics Roadmap appropriate?
These are not relevant to this evidence book.
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Comment on other issues regarding the evidence book, including:
• Is the author expertise sufficient? Other disciplines needed?
• Literature search: Is the breadth of the search sufficient? Is informa-
tion on the search strategy needed?
• Overall readability: Is it appropriate for a “science professional” who
is not familiar with the specific area covered?
See comments above regarding the literature base. The authors seem highly
skilled and knowledgeable in a variety of areas, but the draft suggests the need
for more input from the clinical, epidemiological, and environmental health sci-
entists who are familiar with the occupational and environmental health risks of
long-term, low-level exposures to a variety of airborne particulates.
Overarching comments on the evidence book: Provide a short paragraph
summary of the key issues raised in your review of the paper.
No additional comments.
Please note:
• Crosscutting issues and ideas for broader recommendations
• Additional risks that should be added to the list (missing risks)
No additional comments.
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