Dynamic Medical Risk Assessment Supported by Inference Networks

L. McIntyre1, L. Leinweber2, J. Myers1

1NASA Glenn Research Center 2ZIN Technologies, Inc.

Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

MEDPRAT -Event Driven -Time Dependent -Stochastic

3 Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

Crew Attributes

Crew Attributes o Gender MEDPRAT o Dental Crowns -Event Driven -Time Dependent o Contacts -Stochastic o Hx abdominal surgery o EVA

4 Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

Crew Attributes

Available Available Resources Resources o Initial quantity MEDPRAT o Consumable -Event Driven -Time Dependent o Essential -Stochastic o Mass o Volume

5 Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

Crew Attributes

Available Treatment Info Resources o Condition MEDPRAT o Resource -Event Driven Treatment Info -Time Dependent o Dose -Stochastic

6 Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

Crew Attributes Medical Condition Available Parameters (RV’s) Resources o Incidence rate (IR) MEDPRAT o Clinical phases -Event Driven Treatment Info -Time Dependent o Best/Worst case -Stochastic o Functional Impairment Medical Condition o Loss of Crew Life (LOCL) Parameters o Removed To Definitive Care (RTDC)

7 Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

Crew Attributes

Available Mission Parameters Resources o # Crew MEDPRAT o Mission duration -Event Driven Treatment Info -Time Dependent o EVA schedule -Stochastic Medical Condition Parameters Mission Parameters

8 Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

Crew Attributes

Available Risk Metrics Resources Risk Metrics o Occurrence (QTL, LOCL, RTDC) MEDPRAT o Condition -Event Driven Treatment Info -Time Dependent o Crew -Stochastic o Trial Medical Condition o Sum, mean, std deviation Parameters o Best/Worst case o Treated/Untreated Mission Parameters

9 Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

Crew Attributes

Available Resource Consumption Resources Risk Metrics o Required quantity (QTL, LOCL, RTDC) MEDPRAT o Resource exhausted -Event Driven Treatment Info -Time Dependent o Peak rate -Stochastic o Min, max, sum, mean, sd Medical Condition Resource o Primary vs alternate Parameters Consumption Mission Parameters

10 Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

Crew Attributes

Available RiskAvailableCrewTreatmentMissionResource Metrics Attributes Parameters ResourcesConsumption Info Resources Risk Metrics oo OccurrenceInitialGenderCondition#Required Crew quantity quantity (QTL, LOCL, RTDC) MEDPRAT oo ConditionConsumableDentalResourceMission Crowns duration exhausted -Event Driven Treatment Info -Time Dependent oo CrewEssentialContactsDoseEVAPeak schedule rate -Stochastic oo TrialMassHMin,x abdominal max, sum, surgery mean, sd Medical Condition Resource oo Sum,VolumeEVAPrimary mean, vs alternate std deviation Consumption Parameters o Best/Worst case o Treated/Untreated Mission Parameters

11 Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

Crew Attributes

12 Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

Crew Attributes

13 Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

Crew Attributes

Given any Medical Equipment List (MEL) what is the level of risk?

14 Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

Crew Attributes

How is my risk impacted if I reduce the overall mass of a capability/resource?

15 Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

Crew Attributes

For a particular “allowable risk”, what is the optimal MEL, given power, mass, and volume requirements?

16 Simulated Medical Events

HIP/PROXIMAL FEMUR FRACTURE NASAL CONGESTION (SAS) NECK SPRAIN/STRAIN MEDICATION OVERDOSE/ADVERSE REACTION APPENDICITIS ELBOW DISLOCATION FINGERNAIL DELAMINATION SEC TO EVA DENTAL FILLING LOSS INFLUENZA HERPES ZOSTER REACTIVATION (SHINGLES) SLEEP DISORDER VIIP (SAS) ACUTE CHOLECYSTITIS/BILIARY COLIC PARESTHESIAS SEC TO EVA HEADACHE (LATE) LOWER EXTREMITY STRESS FRACTURE SPACE MOTION SICKNESS (SAS) HYPERTENSION DECOMPRESSION SICKNESS SECONDARY TO EVA ALTITUDE SICKNESS DENTAL CARIES CARDIOGENIC SHOCK SEC TO MYOCARDIAL INFARCTION ACUTE PROSTATITIS DEPRESSION BAROTRAUMA (EAR/SINUS BLOCK) ALLERGIC REACTION ANXIETY EYE PENETRATION (FOREIGN BODY) ANKLE SPRAIN/STRAIN MOUTH ULCER STROKE (CEREBROVASCULAR ACCIDENT) ELBOW SPRAIN/STRAIN HEARING LOSS ACUTE COMPARTMENT SYNDROME HIP SPRAIN/STRAIN ANAPHYLAXIS ACUTE ANGLE-CLOSURE GLAUCOMA KNEE SPRAIN/STRAIN DIARRHEA ATRIAL FIBRILLATION/ ATRIAL FLUTTER SHOULDER SPRAIN/STRAIN INSOMNIA (SAS) ACUTE COMPARTMENT SYNDROME WRIST SPRAIN/STRAIN EYE CHEMICAL BURN ABNORMAL UTERINE BLEEDING BACK SPRAIN/STRAIN EYE INFECTION SMALL BOWEL OBSTRUCTION CHOKING/OBSTRUCTED AIRWAY GASTROENTERITIS DENTAL AVULSION (TOOTH LOSS) CONSTIPATION (SAS) HEAD INJURY TRAUMATIC HYPOVOLEMIC SHOCK URINARY RETENTION (SAS) ACUTE DIVERTICULITIS ANGINA/MYOCARDIAL INFARCTION WRIST FRACTURE DENTAL CROWN LOSS RETINAL DETACHMENT SUDDEN CARDIAC ARREST ACUTE PANCREATITIS RESPIRATORY INFECTION URINARY TRACT INFECTION HEADACHE (SAS) DENTAL EXPOSED PULP BEHAVIORAL EMERGENCY HEMORRHOIDS EYE IRRITATION/ABRASION EYE CORNEAL ULCER INDIGESTION FINGER DISLOCATION SHOULDER DISLOCATION NEPHROLITHIASIS HEADACHE (CO2 INDUCED) URINARY INCONTINENCE (SAS) NOSE BLEED (SAS) ACUTE ARTHRITIS ACUTE RADIATION SYNDROME OTITIS EXTERNA SMOKE INHALATION LUMBAR SPINE FRACTURE OTITIS MEDIA TOXIC EXPOSURE (AMMONIA) ABDOMINAL WALL HERNIA PHARYNGITIS BURNS SECONDARY TO FIRE VAGINAL YEAST INFECTION SEPSIS NEUROGENIC SHOCK URINARY TRACT INFECTION DENTAL ABSCESS SKIN ABRASION URINARY RETENTION (SAS) ACUTE SINUSITIS SKIN LACERATION BACK PAIN (SAS) SKIN INFECTION ABDOMINAL INJURY SEIZURES SKIN RASH CHEST INJURY

17 Simulated Medical Events

HIP/PROXIMAL FEMUR FRACTURE NASAL CONGESTION (SAS) NECK SPRAIN/STRAIN MEDICATION OVERDOSE/ADVERSE REACTION APPENDICITIS ELBOW DISLOCATION FINGERNAIL DELAMINATION SEC TO EVA DENTAL FILLING LOSS INFLUENZA HERPES ZOSTER REACTIVATION (SHINGLES) SLEEP DISORDER VIIP (SAS) ACUTE CHOLECYSTITIS/BILIARY COLIC PARESTHESIAS SEC TO EVA HEADACHE (LATE) Approximately 100 conditions LOWER EXTREMITY STRESS FRACTURE SPACE MOTION SICKNESS (SAS) HYPERTENSION DECOMPRESSION SICKNESS SECONDARY TO EVA ALTITUDE SICKNESS DENTAL CARIES CARDIOGENIC SHOCK SEC TO MYOCARDIAL INFARCTION ACUTE PROSTATITIS DEPRESSION BAROTRAUMA (EAR/SINUS BLOCK) ALLERGIC REACTION ANXIETY EYE PENETRATION (FOREIGN BODY) ANKLE SPRAIN/STRAIN MOUTH ULCER STROKE (CEREBROVASCULAR ACCIDENT) ELBOW SPRAIN/STRAIN HEARING LOSS ACUTE COMPARTMENT SYNDROME HIP SPRAIN/STRAIN ANAPHYLAXIS ACUTE ANGLE-CLOSURE GLAUCOMA KNEE SPRAIN/STRAIN DIARRHEA ATRIAL FIBRILLATION/ ATRIAL FLUTTER SHOULDER SPRAIN/STRAIN INSOMNIA (SAS) ACUTE COMPARTMENT SYNDROME WRIST SPRAIN/STRAIN EYE CHEMICAL BURN ABNORMAL UTERINE BLEEDING BACK SPRAIN/STRAIN EYE INFECTION SMALL BOWEL OBSTRUCTION CHOKING/OBSTRUCTED AIRWAY GASTROENTERITIS DENTAL AVULSION (TOOTH LOSS) CONSTIPATION (SAS) HEAD INJURY TRAUMATIC HYPOVOLEMIC SHOCK URINARY RETENTION (SAS) ACUTE DIVERTICULITIS ANGINA/MYOCARDIAL INFARCTION WRIST FRACTURE DENTAL CROWN LOSS RETINAL DETACHMENT SUDDEN CARDIAC ARREST ACUTE PANCREATITIS RESPIRATORY INFECTION URINARY TRACT INFECTION HEADACHE (SAS) DENTAL EXPOSED PULP BEHAVIORAL EMERGENCY HEMORRHOIDS EYE IRRITATION/ABRASION EYE CORNEAL ULCER INDIGESTION FINGER DISLOCATION SHOULDER DISLOCATION NEPHROLITHIASIS HEADACHE (CO2 INDUCED) URINARY INCONTINENCE (SAS) NOSE BLEED (SAS) ACUTE ARTHRITIS ACUTE RADIATION SYNDROME OTITIS EXTERNA SMOKE INHALATION LUMBAR SPINE FRACTURE OTITIS MEDIA TOXIC EXPOSURE (AMMONIA) ABDOMINAL WALL HERNIA PHARYNGITIS BURNS SECONDARY TO FIRE VAGINAL YEAST INFECTION SEPSIS NEUROGENIC SHOCK URINARY TRACT INFECTION DENTAL ABSCESS SKIN ABRASION URINARY RETENTION (SAS) ACUTE SINUSITIS SKIN LACERATION BACK PAIN (SAS) SKIN INFECTION ABDOMINAL INJURY SEIZURES SKIN RASH CHEST INJURY

18 Simulated Medical Events

HIP/PROXIMAL FEMUR FRACTURE NASAL CONGESTION (SAS) NECK SPRAIN/STRAIN MEDICATION OVERDOSE/ADVERSE REACTION APPENDICITIS ELBOW DISLOCATION FINGERNAIL DELAMINATION SEC TO EVA DENTAL FILLING LOSS INFLUENZA HERPES ZOSTER REACTIVATION (SHINGLES) SLEEP DISORDER VIIP (SAS) ACUTE CHOLECYSTITIS/BILIARY COLIC PARESTHESIAS SEC TO EVA HEADACHE (LATE) Approximately 100 conditions LOWER EXTREMITY STRESS FRACTURE SPACE MOTION SICKNESS (SAS) HYPERTENSION DECOMPRESSION SICKNESS SECONDARY TO EVA ALTITUDE SICKNESS DENTAL CARIES CARDIOGENIC SHOCK SEC TO MYOCARDIAL INFARCTION ACUTE PROSTATITIS DEPRESSION BAROTRAUMA (EAR/SINUS BLOCK) ALLERGIC REACTION ANXIETY EYE PENETRATION (FOREIGN BODY) ANKLE SPRAIN/STRAIN MOUTH ULCER STROKE (CEREBROVASCULAR ACCIDENT) ELBOW SPRAIN/STRAIN HEARING LOSS ACUTE COMPARTMENT SYNDROME HIP SPRAIN/STRAIN ANAPHYLAXIS ACUTE ANGLE-CLOSURE GLAUCOMA KNEE SPRAIN/STRAIN DIARRHEA IR sampled from specified ATRIAL FIBRILLATION/ ATRIAL FLUTTER SHOULDER SPRAIN/STRAIN INSOMNIA (SAS) probability distributions ACUTE COMPARTMENT SYNDROME WRIST SPRAIN/STRAIN EYE CHEMICAL BURN ABNORMAL UTERINE BLEEDING BACK SPRAIN/STRAIN EYE INFECTION SMALL BOWEL OBSTRUCTION CHOKING/OBSTRUCTED AIRWAY GASTROENTERITIS DENTAL AVULSION (TOOTH LOSS) CONSTIPATION (SAS) HEAD INJURY TRAUMATIC HYPOVOLEMIC SHOCK URINARY RETENTION (SAS) ACUTE DIVERTICULITIS ANGINA/MYOCARDIAL INFARCTION WRIST FRACTURE DENTAL CROWN LOSS RETINAL DETACHMENT SUDDEN CARDIAC ARREST ACUTE PANCREATITIS RESPIRATORY INFECTION URINARY TRACT INFECTION HEADACHE (SAS) DENTAL EXPOSED PULP BEHAVIORAL EMERGENCY HEMORRHOIDS EYE IRRITATION/ABRASION EYE CORNEAL ULCER INDIGESTION FINGER DISLOCATION SHOULDER DISLOCATION NEPHROLITHIASIS HEADACHE (CO2 INDUCED) URINARY INCONTINENCE (SAS) NOSE BLEED (SAS) ACUTE ARTHRITIS ACUTE RADIATION SYNDROME OTITIS EXTERNA SMOKE INHALATION LUMBAR SPINE FRACTURE OTITIS MEDIA TOXIC EXPOSURE (AMMONIA) ABDOMINAL WALL HERNIA PHARYNGITIS BURNS SECONDARY TO FIRE VAGINAL YEAST INFECTION SEPSIS NEUROGENIC SHOCK URINARY TRACT INFECTION DENTAL ABSCESS SKIN ABRASION URINARY RETENTION (SAS) ACUTE SINUSITIS SKIN LACERATION BACK PAIN (SAS) SKIN INFECTION ABDOMINAL INJURY SEIZURES SKIN RASH CHEST INJURY

19 Simulated Medical Events

HIP/PROXIMAL FEMUR FRACTURE NASAL CONGESTION (SAS) NECK SPRAIN/STRAIN MEDICATION OVERDOSE/ADVERSE REACTION APPENDICITIS ELBOW DISLOCATION FINGERNAIL DELAMINATION SEC TO EVA DENTAL FILLING LOSS INFLUENZA HERPES ZOSTER REACTIVATION (SHINGLES) SLEEP DISORDER VIIP (SAS) ACUTE CHOLECYSTITIS/BILIARY COLIC PARESTHESIAS SEC TO EVA HEADACHE (LATE) Approximately 100 conditions LOWER EXTREMITY STRESS FRACTURE SPACE MOTION SICKNESS (SAS) HYPERTENSION DECOMPRESSION SICKNESS SECONDARY TO EVA ALTITUDE SICKNESS DENTAL CARIES CARDIOGENIC SHOCK SEC TO MYOCARDIAL INFARCTION ACUTE PROSTATITIS DEPRESSION BAROTRAUMA (EAR/SINUS BLOCK) ALLERGIC REACTION ANXIETY EYE PENETRATION (FOREIGN BODY) ANKLE SPRAIN/STRAIN MOUTH ULCER STROKE (CEREBROVASCULAR ACCIDENT) ELBOW SPRAIN/STRAIN HEARING LOSS ACUTE COMPARTMENT SYNDROME HIP SPRAIN/STRAIN ANAPHYLAXIS ACUTE ANGLE-CLOSURE GLAUCOMA KNEE SPRAIN/STRAIN DIARRHEA IR sampled from specified ATRIAL FIBRILLATION/ ATRIAL FLUTTER SHOULDER SPRAIN/STRAIN INSOMNIA (SAS) probability distributions ACUTE COMPARTMENT SYNDROME WRIST SPRAIN/STRAIN EYE CHEMICAL BURN ABNORMAL UTERINE BLEEDING BACK SPRAIN/STRAIN EYE INFECTION SMALL BOWEL OBSTRUCTION CHOKING/OBSTRUCTED AIRWAY GASTROENTERITIS DENTAL AVULSION (TOOTH LOSS) CONSTIPATION (SAS) HEAD INJURY TRAUMATIC HYPOVOLEMIC SHOCK URINARY RETENTION (SAS) ACUTE DIVERTICULITIS ANGINA/MYOCARDIAL INFARCTION WRIST FRACTURE DENTAL CROWN LOSS RETINAL DETACHMENT SUDDEN CARDIAC ARREST ACUTE PANCREATITIS IR probability parameters may RESPIRATORY INFECTION URINARY TRACT INFECTION HEADACHE (SAS) vary given crew attributes DENTAL EXPOSED PULP BEHAVIORAL EMERGENCY HEMORRHOIDS EYE IRRITATION/ABRASION EYE CORNEAL ULCER INDIGESTION FINGER DISLOCATION SHOULDER DISLOCATION NEPHROLITHIASIS HEADACHE (CO2 INDUCED) URINARY INCONTINENCE (SAS) NOSE BLEED (SAS) ACUTE ARTHRITIS ACUTE RADIATION SYNDROME OTITIS EXTERNA SMOKE INHALATION LUMBAR SPINE FRACTURE OTITIS MEDIA TOXIC EXPOSURE (AMMONIA) ABDOMINAL WALL HERNIA PHARYNGITIS BURNS SECONDARY TO FIRE VAGINAL YEAST INFECTION SEPSIS NEUROGENIC SHOCK URINARY TRACT INFECTION DENTAL ABSCESS SKIN ABRASION URINARY RETENTION (SAS) ACUTE SINUSITIS SKIN LACERATION BACK PAIN (SAS) SKIN INFECTION ABDOMINAL INJURY SEIZURES SKIN RASH CHEST INJURY

20 Simulated Medical Events

HIP/PROXIMAL FEMUR FRACTURE NASAL CONGESTION (SAS) NECK SPRAIN/STRAIN MEDICATION OVERDOSE/ADVERSE REACTION APPENDICITIS ELBOW DISLOCATION FINGERNAIL DELAMINATION SEC TO EVA DENTAL FILLING LOSS INFLUENZA HERPES ZOSTER REACTIVATION (SHINGLES) SLEEP DISORDER VIIP (SAS) ACUTE CHOLECYSTITIS/BILIARY COLIC PARESTHESIAS SEC TO EVA HEADACHE (LATE) Approximately 100 conditions LOWER EXTREMITY STRESS FRACTURE SPACE MOTION SICKNESS (SAS) HYPERTENSION DECOMPRESSION SICKNESS SECONDARY TO EVA ALTITUDE SICKNESS DENTAL CARIES CARDIOGENIC SHOCK SEC TO MYOCARDIAL INFARCTION ACUTE PROSTATITIS DEPRESSION BAROTRAUMA (EAR/SINUS BLOCK) ALLERGIC REACTION ANXIETY EYE PENETRATION (FOREIGN BODY) ANKLE SPRAIN/STRAIN MOUTH ULCER STROKE (CEREBROVASCULAR ACCIDENT) ELBOW SPRAIN/STRAIN HEARING LOSS ACUTE COMPARTMENT SYNDROME HIP SPRAIN/STRAIN ANAPHYLAXIS ACUTE ANGLE-CLOSURE GLAUCOMA KNEE SPRAIN/STRAIN DIARRHEA IR sampled from specified ATRIAL FIBRILLATION/ ATRIAL FLUTTER SHOULDER SPRAIN/STRAIN INSOMNIA (SAS) probability distributions ACUTE COMPARTMENT SYNDROME WRIST SPRAIN/STRAIN EYE CHEMICAL BURN ABNORMAL UTERINE BLEEDING BACK SPRAIN/STRAIN EYE INFECTION SMALL BOWEL OBSTRUCTION CHOKING/OBSTRUCTED AIRWAY GASTROENTERITIS DENTAL AVULSION (TOOTH LOSS) CONSTIPATION (SAS) HEAD INJURY TRAUMATIC HYPOVOLEMIC SHOCK URINARY RETENTION (SAS) ACUTE DIVERTICULITIS ANGINA/MYOCARDIAL INFARCTION WRIST FRACTURE DENTAL CROWN LOSS RETINAL DETACHMENT SUDDEN CARDIAC ARREST ACUTE PANCREATITIS IR probability parameters may RESPIRATORY INFECTION URINARY TRACT INFECTION HEADACHE (SAS) vary given crew attributes DENTAL EXPOSED PULP BEHAVIORAL EMERGENCY HEMORRHOIDS EYE IRRITATION/ABRASION EYE CORNEAL ULCER INDIGESTION FINGER DISLOCATION SHOULDER DISLOCATION NEPHROLITHIASIS HEADACHE (CO2 INDUCED) URINARY INCONTINENCE (SAS) NOSE BLEED (SAS) ACUTE ARTHRITIS ACUTE RADIATION SYNDROME OTITIS EXTERNA SMOKE INHALATION LUMBAR SPINE FRACTURE OTITIS MEDIA TOXIC EXPOSURE (AMMONIA) ABDOMINAL WALL HERNIA PHARYNGITIS Originally implemented with BURNS SECONDARY TO FIRE VAGINAL YEAST INFECTION SEPSIS probabilistic independence NEUROGENIC SHOCK URINARY TRACT INFECTION DENTAL ABSCESS SKIN ABRASION URINARY RETENTION (SAS) ACUTE SINUSITIS SKIN LACERATION BACK PAIN (SAS) SKIN INFECTION ABDOMINAL INJURY SEIZURES SKIN RASH CHEST INJURY

21 Introducing Dependent Conditions

MEDPRAT provides a means of capturing relationships and dependencies between events being modeled. Urinary Retention These relationships are quantified using a mathematical data structure referred to as the Susceptibility Inference Network (SIN).

The SIN provides MEDPRAT with a “memory” which allows the system to use knowledge of what simulation events have occurred to appropriately alter the representative probability that future simulation events will occur.

22 Introducing Dependent Conditions

The SIN provides MEDPRAT with a Urinary Tract “memory” which allows the system to use Infection knowledge of what simulation events have occurred to appropriately alter the representative probability that future simulation events will occur.

23 Introducing Dependent Conditions

24 Introducing Dependent Conditions

MEDPRAT provides a means of Acute Radiation capturing relationships and Syndrome dependencies between events being modeled. Respiratory Urinary Shingles Infection Retention These relationships are quantified using a mathematical Urinary data structure referred to as the Eye Irritation/ Incontinence Susceptibility Inference Network Skin Rash Abrasion (SIN).

The SIN provides MEDPRAT with a Urinary Tract “memory” which allows the system to use Eye Infection Infection knowledge of what simulation events have Skin occurred to appropriately alter the Infection representative probability that future simulation events will occur. Sepsis

25 Simulation with Independent Events

26 Simulation with Dependent Events

27 Spaceflight Data Assessment

Data request made to and fulfilled by Lifetime Surveillance of Astronaut Health (LSAH) • De-identified • Shuttle/ISS

Pearson Correlation A number between [-1,1] that indicates the extent to which two variables are linearly related.

28 Spaceflight Data Assessment

Condition Condition Correlation P Value Significant? (0.1) Knee Sprain/Strain Shoulder Sprain/Strain 0.701 0.00001 TRUE Wrist Sprain/Strain UTI 0.7 0.0799 TRUE Wrist Sprain/Strain Skin Infection 0.534 0.1728 FALSE Respiratory Infection Indigestion 0.626 0.1326 FALSE UTI Skin Infection 0.506 0.2465 FALSE Data request made to and fulfilled by Gastroenteritis Insomnia (SA) 0.304 0.0049 TRUE Insomnia = 84 Gastroenteritis = 1 Hip Sprain/Strain Headache (Late) 0.339 0.0401 TRUE Lifetime Surveillance of Astronaut Hip Sprain/Strain Shoulder Sprain/Strain 0.403 0.0973 TRUE Health (LSAH) Eye Irritation/Abrasion Headache (Late) 0.339 0.016 TRUE • De-identified Knee Sprain/Strain Skin Rash 0.341 0.0203 TRUE Eye Corneal Ulcer Paresthesias 0.318 0.0991 TRUE Paresthesias = 27 Eye Corneal Ulcer = 1 • Shuttle/ISS Neck Sprain/Strain Skin Laceration 0.302 0.3964 FALSE Neck Sprain/Strain HZR (Shingles) 0.492 0.262 FALSE Indigestion Neck Sprain/Strain 0.49 0.2177 FALSE Back Sprain/Strain Indigestion 0.392 0.0002 TRUE Back S/S = 30 Indigestion = 5 Elbow Sprain/Strain Allergic Reaction (M to M) 0.394 0.0464 TRUE Anxiety Allergic Reaction (M to M) 0.357 0.1746 FALSE VIIP Allergic Reaction (M to M) 0.357 0.1746 FALSE Hip Sprain/Strain Knee Sprain/Strain 0.411 0.0174 TRUE Respiratory Infection Anxiety 0.442 0.7085 FALSE VIIP Respiratory Infection 0.442 0.558 FALSE

29 Spaceflight Data Assessment

• 40 out of ~100 conditions are observed Hip Sprain/Strain Eye Irritation/Abrasion Wrist Sprain/Strain Back Sprain/Strain Elbow Sprain/Strain • 15 conditions observed 20 or more times Knee Sprain/Strain Headache (Late) Urinary Tract Infection Indigestion Allergic Reaction M to M • Of those, 6 are space adaptation conditions Shoulder Sprain/Strain Skin Rash

30 Spaceflight Data Assessment

Conclusion: This data set is not robust enough to inform the SIN. Even with more spaceflight data, we cannot accurately capture the associated risk, particularly to LOCL, without Hip Sprain/Strain Eye Irritation/Abrasion Wrist Sprain/Strain Back Sprain/Strain Elbow Sprain/Strain data for high impact conditions such as sepsis, shock, and Knee Sprain/Strain Headache (Late) Urinary Tract Infection Indigestion Allergic Reaction M to M myocardial infarction.

Shoulder Sprain/Strain Skin Rash In order to obtain a data-driven model, we will need significantly more data, likely in the form of spaceflight data, terrestrial data, and medical literature.

31 Result of Clinician Specified SIN

§ 1078 connections identified § 275 connections as a result of § Anxiety § Atrial Fibrillation/Atrial Flutter § Medication Overdose/Adverse Reaction § Median of 7 connections per condition § Maximum number of parents 97 (Anxiety) § Maximum number of children 43 (Acute Radiation Syndrome)

§ Sufficiently complex to require change in MEDPRAT architecture § May provide roadmap for data acquisition in highly connected or high impact areas

32 Future Work

• MEDPRRAT V1.0 Delivery 3/2020 • Architecture update: calculate incidence rate updates as needed as opposed to during pre- processing to accommodate potentially large numbers of parent conditions • Finalize documentation • Review and deliver to ExMC • MEDPRAT V2.0 • Expand to integrate risks across HRP Elements • Proposed 2 to 3-year development plan • Within 6 Months -Identify and prioritize capabilities to characterize (iPRR) discipline risk • Likely supply intermediate development versions for discipline testing

33 Lauren McIntyre [email protected]