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NASA NTRS2009

Monitoring Bone Health after Spaceflight: Data Mining to Support an Epidemiological Analysis of Age-related Bone Loss in Astronauts

Through the epidemiological analysis of bone data, HRP is seeking evidence as to whether the prolonged exposure to microgravity of low earth orbit predisposes crewmembers to an earlier onset of osteoporosis. While this collaborative Epidemiological Project may be currently limited by the number of ISS persons providing relevant spaceflight medical data, a positive note is that it compares medical data of astronauts to data of an age-matched (not elderly) population that is followed longitudinally with similar technologies. The inclusion of data from non-ISS and non-NASA crewmembers is also being pursued. The ultimate goal of this study is to provide critical information for NASA to understand the impact of low physical or minimal weight-bearing activity on the aging process as well as to direct its development of countermeasures and rehabilitation programs to influence skeletal recovery. However, in order to optimize these results NASA needs to better define the requirements for long term monitoring and encourage both active and retired astronauts to contribute to a legacy of data that will define human health risks in space.

Baker, K. S,↗
NASA NTRS2009

Nutritional Status Assessment (SMO 016E)

Until 2006, it was not been possible to assess nutritional status of crewmembers on the ISS during flight because blood and urine could not be collected during ISS missions. Postflight observations of alterations in status of several nutrients are troubling, and we require the ability to monitor the status of these nutrients during flight to determine if there is a specific impetus or timeframe for these changes. In addition to the monitoring of crew nutritional status during flight, in-flight sample collection would allow better assessment of countermeasure effectiveness. Collecting samples during flight is one of the objectives of SMO 016E, and it is also designed to expand the current medical requirement for nutritional assessment (MR016L) to include additional normative markers for assessing crew health and countermeasure effectiveness. Additional markers of bone metabolism will be measured to better monitor bone health and the effectiveness of countermeasures to prevent bone resorption. New markers of oxidative damage will be measured to better assess the type of oxidative insults that occur during space flight. The array of nutritional assessment variables will be expanded to include ones that will allow us to better understand changes in folate, vitamin K, and vitamin B6 status, as well as risk factors for cardiovascular and oxidative damage during and after flight. Stress hormones and hormones that affect bone and muscle metabolism will also be measured. Measuring these additional variables will allow us to better monitor the health of crewmembers and make more accurate recommendations for their rehabilitation. Several nutritional assessment variables are altered at landing, but it is not known how long these changes persist. We extended the original protocol to include an additional postflight blood and urine sample collection 30 days after landing. Data are being collected before, during, and after flight. These data will provide a complete survey of how nutritional status and related systems are affected by space flight. Analyzing the data will help us to define nutritional requirements for long-duration missions. This expanded set of measurements will also aid in the identification of nutritional countermeasures to counteract, for example, the deleterious effects of microgravity on bone and muscle and the effects of space radiation.

Smith, S. M.↗
NASA NTRS2008

Robotic Joints Support Horses and Humans

A rehabilitative device first featured in Spinoff 2003 is not only helping human patients regain the ability to walk, but is now helping our four-legged friends as well. The late James Kerley, a prominent Goddard Space Flight Center researcher, developed cable-compliant mechanisms in the 1980s to enable sounding rocket assemblies and robots to grip or join objects. In cable-compliant joints (CCJs), short segments of cable connect structural elements, allowing for six directions of movement, twisting, alignment, and energy damping. Kerley later worked with Goddard s Wayne Eklund and Allen Crane to incorporate the cable-compliant mechanisms into a walker for human patients to support the pelvis and imitate hip joint movement.

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NASA NTRS2009

Neuromuscular Adaptations to Reduced Use

This viewgraph presentation reviews the studies done to reduce neuromuscular strength loss during unilateral lower limb suspension (ULLS). Since there are animals that undergo fairly long periods of muscular disuse without any or minimal muscular atrophy, there is an answer to that might be applicable to human in situations that require no muscular use to diminish the effects of muscular atrophy. Three sets of ULLS studies were reviewed indicated that muscle strength decreased more than the muscle mass. The study reviewed exercise countermeasures to combat the atrophy, including: ischemia maintained during Compound muscle action potential (CMAP), ischemia and low load exercise, Japanese kaatsu, and the potential for rehabilitation or situations where heavy loading is undesirable. Two forms of countermeasures to unloading have been successful, (1) high-load resistance training has maintained muscle mass and strength, and low load resistance training with blood flow restriction (LL(sub BFR)). The LL(sub BFR) has been shown to increase muscle mass and strength. There has been significant interest in Tourniquet training. An increase in Growth Hormone(GH) has been noted for LL(sub BFR) exercise. An experimental study with 16 subjects 8 of whom performed ULLS, and 8 of whom performed ULLS and LL(sub BFR) exercise three times per week during the ULLS. Charts show the results of the two groups, showing that performing LL(sub BFR) exercise during 30 days of ULLS can maintain muscle size and strength and even improve muscular endurance.

Ploutz-Snyder, Lori↗
NASA NTRS2009

Auditory and Vestibular Issues Related to Human Spaceflight

Human spaceflight provides unique opportunities to study human vestibular and auditory systems. This session will discuss 1) vestibular adaptive processes reflected by pronounced perceptual and motor coordination problems during, and after, space missions; 2) vestibular diagnostic and rehabilitative techniques (used to promote recovery after living in altered gravity environments) that may be relevant to treatment of vestibular disorders on earth; and 3) unique acoustical challenges to hearing loss prevention and crew performance during spaceflight missions.

Danielson, Richard W.↗
NASA NTRS2009

Medical Challenges of the First Canadian Long-Duration Space Mission: Lessons Learned

In 2008, Dr. Thirsk was assigned to the crew of Expedition 20/21. This Expedition represented a milestone for the Canadian Space Program since it was the first time that a Canadian would take part in a long-duration mission. Robert Thirsk had the privilege of expanding the boundaries of space exploration by living and working on board the International Space Station for six months. The launch took place on May 27, 2009 aboard a Soyuz rocket from the Cosmodrome in Baikonur, Kazakhstan. This abstract was written before Dr. Thirsk returned to Kazakhstan. Objective: To gather all medically relevant data needed to support the first Canadian long-duration mission in space, and process it to derive lessons learned for presentation and for public disclosure. Methods: Sources of data used for analysis for Expedition 20 on International Space Station included flight selection data, maintenance annual physicals, Flight Medicine Clinic visits, parabolic flight experiments, preflight exams and baseline data collections, daily in-flight exercise countermeasure and science payloads, weekly periodic fitness, nutrition, radiation and payload assessments, postflight medical exams, rehabilitation, and science activities.

Hamilton, Douglas R.↗
NASA NTRS2009

Spinoff 2009

Topics covered include: Image-Capture Devices Extend Medicine's Reach; Medical Devices Assess, Treat Balance Disorders; NASA Bioreactors Advance Disease Treatments; Robotics Algorithms Provide Nutritional Guidelines; "Anti-Gravity" Treadmills Speed Rehabilitation; Crew Management Processes Revitalize Patient Care; Hubble Systems Optimize Hospital Schedules; Web-based Programs Assess Cognitive Fitness; Electrolyte Concentrates Treat Dehydration; Tools Lighten Designs, Maintain Structural Integrity; Insulating Foams Save Money, Increase Safety; Polyimide Resins Resist Extreme Temperatures; Sensors Locate Radio Interference; Surface Operations Systems Improve Airport Efficiency; Nontoxic Resins Advance Aerospace Manufacturing; Sensors Provide Early Warning of Biological Threats; Robot Saves Soldier's Lives Overseas (MarcBot); Apollo-Era Life Raft Saves Hundreds of Sailors; Circuits Enhance Scientific Instruments and Safety Devices; Tough Textiles Protect Payloads and Public Safety Officers; Forecasting Tools Point to Fishing Hotspots; Air Purifiers Eliminate Pathogens, Preserve Food; Fabrics Protect Sensitive Skin from UV Rays; Phase Change Fabrics Control Temperature; Tiny Devices Project Sharp, Colorful Images; Star-Mapping Tools Enable Tracking of Endangered Animals; Nanofiber Filters Eliminate Contaminants; Modeling Innovations Advance Wind Energy Industry; Thermal Insulation Strips Conserve Energy; Satellite Respondent Buoys Identify Ocean Debris; Mobile Instruments Measure Atmospheric Pollutants; Cloud Imagers Offer New Details on Earth's Health; Antennas Lower Cost of Satellite Access; Feature Detection Systems Enhance Satellite Imagery; Chlorophyll Meters Aid Plant Nutrient Management; Telemetry Boards Interpret Rocket, Airplane Engine Data; Programs Automate Complex Operations Monitoring; Software Tools Streamline Project Management; Modeling Languages Refine Vehicle Design; Radio Relays Improve Wireless Products; Advanced Sensors Boost Optical Communication, Imaging; Tensile Fabrics Enhance Architecture Around the World; Robust Light Filters Support Powerful Imaging Devices; Thermoelectric Devices Cool, Power Electronics; Innovative Tools Advance Revolutionary Weld Technique; Methods Reduce Cost, Enhance Quality of Nanotubes; Gauging Systems Monitor Cryogenic Liquids; Voltage Sensors Monitor Harmful Static; and Compact Instruments Measure Heat Potential.

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NASA NTRS2009

Developing a Gap Taxonomy to Address Crew Health Risks in NASA's Human Research Program

The mission of NASA's Human Research Program (HRP) is to understand and reduce the risk to crew health and performance in exploration missions. The HRP addresses 27 specific risks by identifying and then filling gaps in understanding the risks and in the ability to disposition the risks. The primary bases for identifying gaps have been past experience and requirements definition. This approach has been very effective in identifying some important, relevant gaps, but may be inadequate for identifying gaps outside the past experience base. We are exploring the use of a gap taxonomy as a comprehensive, underlying conceptual framework that allows a more systematic identification of gaps. The taxonomy is based on these stages in medical care: prediction, prevention, detection/diagnosis, treatment, monitoring, rehabilitation, and lifetime surveillance. This gap taxonomy approach identifies new gaps in HRP health risks. Many of the new gaps suggest risk reduction approaches that are more cost effective than present approaches. A major benefit of the gap taxonomy approach is to identify new, economical approaches that reduce the likelihood and/or consequence of a risk.

Kundrot, Craig E.↗
NASA NTRS2010

Walking on an Oscillating Treadmill: Two Paths to Functional Adaptation

We mounted a treadmill on top of a six degree-of-freedom motion base platform to investigate and characterize locomotor responses produced by healthy adults when introduced to a novel walking condition. Subjects were classified into two groups according to how their stride times were affected by the perturbation. Our data suggest that a person's choice of adaptation strategy is influenced by the relationship between his unique, natural stride frequency and the external frequency imposed by the motion base. Our data suggest that a person's stride time response while walking on a laterally oscillating treadmill is influenced by the relationship between his unique, natural stride frequency and the imposed external frequency of the motion base. This relationship may be useful for checking the efficacy of gait training and rehabilitation programs. Preselecting and manipulating a person's EST could be one way to draw him out of his preferred "entrainment well" during therapy or training.

Brady, Rachel A.↗
NASA NTRS2010

Real-Time Teleguidance of a Non-Surgeon Crew Medical Officer Performing Orthopedic Surgery at the Amundsen-Scott South Pole Station During Winter-Over

The Amundsen-Scott South Pole Research station located at the geographic South Pole, is the most isolated, permanently inhabited human outpost on Earth. Medical care is provided to station personnel by a non-surgeon crew medical officer (CMO). During the winter-over period from February to October, the station is isolated, with no incoming or outgoing flights due to severe weather conditions. In late June, four months after the station had closed for the austral winter, a 31 year old meteorologist suffered a complete rupture of his patellar tendon while sliding done an embankment. An evacuation was deemed to be too risky to aircrews due to the extreme cold and darkness. A panel of physicians from Massachusetts General Hospital, Johns Hopkins University and the University of Texas Medical Branch were able to assess the patient remotely via telemedicine and agreed that surgery was the only means to restore mobility and prevent long term disability. The lack of a surgical facility and a trained surgical team were overcome by conversion of the clinic treatment area, and intensive preparation of medical laypersons as surgical assistants. The non-surgeon CMO and CMO assistant at South Pole, were guided through the administration of spinal anesthetic, and the two-hour operative repair by medical consultants at Massachusetts General Hospital. Real-time video of the operative field, directions from the remote consultants and audio communication were provided by videoconferencing equipment, operative cameras, and high bandwidth satellite communications. In real-time, opening incision/exposure, tendon relocation, hemostatsis, and operative closure by the CMO was closely monitored and guided and by the remote consultants. The patient s subsequent physical rehabilitation over the ensuing months of isolation was also monitored remotely via telemedicine. This was the first time in South Pole s history that remote teleguidance had been used for surgery and represents a model for real-time guidance of CMO s working at remote duty stations.

Otto, Christian↗
NASA NTRS2011

Kinematics and Kinetics of Squat and Deadlift Exercises with Varying Stance Widths

The primary motion of squat and deadlift exercise involves flexion and extension of the hips, knees, and ankles, but each exercise can be performed with variations in stance width. These variations may result in differing kinematics and ground reaction forces (GRF), which may in turn affect joint loading. PURPOSE: The purpose of this investigation was to compare ankle, knee, and hip kinematics and kinetics of normal squat (NS), wide-stance squat (WS), normal deadlift (ND), and sumo deadlift (SD). We hypothesized that hip joint kinematics and work at each joint would differ between exercise variations. METHODS: Six subjects (3 m/3 f; 70.0 plus or minus 13.7 kg; 168 plus or minus 9.9 cm) performed each lift in normal gravity on the ground-based version of the Advanced Resistive Exercise Device (ARED) used on the International Space Station. The ARED provided resistance with a combination vacuum tube/flywheel mechanism designed to replicate the gravitational and inertial forces of free weights. Subjects completed each lift with their 10-repetition maximum load. Kinematic data were collected at 250 Hz by a 12-camera motion-capture system (Smart-D, BTS Bioengineering, Milan, Italy), and GRF data were collected at 1000 Hz with independent force platforms for each leg (Model 9261, Kistler Instruments AG, Winterhur, Switzerland). All data were captured simultaneously on a single workstation. The right leg of a single lift for each motion was analyzed. Modeling software (OpenSim 2.2.0, Simbios, Palo Alto, CA) determined joint kinematics and net positive and negative work at each lower extremity joint. Total work was found as the sum of work across all joints and was normalized by system mass. Effect sizes and their 95% confidence intervals were computed between conditions. RESULTS: Peak GRF were similar for each lift. There were no differences between conditions in hip flexion range of motion (ROM). For hip adduction ROM, there were no differences between the NS, WS, and SD. However, hip adduction ROM was greater during the NS and SD than during the ND. Hip rotation ROM was greater during the WS than during the NS and SD, and was greater during the SD than during the ND. For knee and ankle flexion ROM, the ND, WS, and SD were not different, but ROM was greater during the NS than the ND and greater during the WS than the SD. Total eccentric work was greater during the WS than the SD. Otherwise, there were no differences in eccentric or concentric work between conditions. CONCLUSIONS: Although squat and deadlift exercises consist of similar motions, there are kinematic differences between them that depend on stance width. Total eccentric and concentric work are similar for different lifts, but differing kinematics may require activation of different musculature for each variation. With respect to each condition, in the ND the ROM of each joint tended to be less, and the WS tended to trade knee motion for hip motion. PRACTICAL APPLICATIONS: Knowledge of differences in kinematics and kinetics between different squat and deadlift variations is important for coaches and rehabilitation personnel to understand when prescribing exercise. Our results suggest that each variation of the squat and deadlift should be considered a separate exercise that may induce different long-term training effects.

DeWitt, John K.↗
NASA NTRS2011

Reliability of Upright and Supine Power Measurements Using an Inertial Load Cycle Ergometer

Practical, reliable, and time efficient methods of measuring muscular power are desirable for both research and applied testing situations. The inertial-load cycling method (ILC; Power/Cycle, Austin, TX) requires subjects to pedal as fast as possible against the inertial load of a flywheel for only 3-5 seconds, which could help reduce the time and effort required for maximal power testing. PURPOSE: 1) To test the intramachine reliability of ILC over 3 separate sessions, 2) to compare postural stance (upright vs. supine) during testing, and 3) to compare the maximal power (Pmax) output measured using ILC to that obtained from traditional isokinetic and leg press testing. METHODS: Subjects (n = 12) were tested on 4 non-consecutive days. The following tests were done on the first day of testing: isometric knee extension, isokinetic knee extension at several speeds, isokinetic power/endurance at 180/sec (Biodex System 4), leg press maximal isometric force, and leg press power/endurance. The other 3 days consisted exclusively of ILC testing. Subjects performed 6 ILC tests in an upright position and 6 ILC tests in a supine position on each day. The starting position was counterbalanced. Mixed-effects linear modeling was used to determine if any differences existed between testing days and between upright and supine for Pmax and revolutions per minute at Pmax (RPMpk). Mixed-modeling was also used to calculate intraclass correlation coefficients (ICC) to determine the reliability of the ILC on each testing day for Pmax and RPMpk (ICCs were calculated separately for upright and supine). gKendall fs Tau a h was used to determine the association between ILC Pmax and isokinetic and leg press data. RESULTS: For Pmax, significant differences were found between days 1 and 2 (upright: p = 0.018; supine: p = 0.014) and between days 1 and 3 (upright: p = 0.001; supine: p = 0.002), but not between days 2 and 3 (upright: p = 0.422; supine: p = 0.501). Pmax ICC values were greater than or equal to 0.97 for all days in both positions. Also, no significant differences between upright and supine postures were found for Pmax. No significant differences between days were found for RPMpk; however, there was a significant posture effect (upright greater than supine). Moderate correlations were observed between ILC Pmax and isokinetic and leg press tests (upright: 0.64-0.79, supine: 0.52-0.82). CONCLUSIONS: Overall, ILC is a very reliable test. Since a significant difference was found between day 1 and the other ILC testing days, it is suggested that day 1 of ILC testing should be used as a familiarization session to allow for subject learning. No significant difference in Pmax was seen from test 3 to test 6. However, an increase of 1.3% was observed from test 4 to test 6. Therefore, although 4 tests may be sufficient for most subjects to produce Pmax, in some cases 6 tests may be required. PRACTICAL APPLICATIONS: No differences were seen in Pmax between upright and supine positions despite differing RPMpk. This suggests that ILC testing can be used to provide reliable testing both in an upright position (appropriate for athletes) and in research (e.g., bed rest) or rehabilitation settings where supine testing is necessary. Future research should evaluate whether peak power measurements obtained with the ILC are sensitive to changes such as that observed with training and de-training.

Wickwire, P. J.↗
NASA NTRS2010

Bone Health Monitoring in Astronauts: Recommended Use of Quantitative Computed Tomography [QCT] for Clinical and Operational Decisions

This slide presentation reviews the concerns that astronauts in long duration flights might have a greater risk of bone fracture as they age than the general population. A panel of experts was convened to review the information and recommend mechanisms to monitor the health of bones in astronauts. The use of Quantitative Computed Tomography (QCT) scans for risk surveillance to detect the clinical trigger and to inform countermeasure evaluation is reviewed. An added benefit of QCT is that it facilitates an individualized estimation of bone strength by Finite Element Modeling (FEM), that can inform approaches for bone rehabilitation. The use of FEM is reviewed as a process that arrives at a composite number to estimate bone strength, because it integrates multiple factors.

Sibonga, J. D.↗
NASA NTRS2011

Preflight and In-Flight Exercise Conditions for Astronauts on the International Space Station

The physiological demands of spaceflight require astronauts to have certain physical abilities. They must be able to perform routine and off-nominal physical work during flight and upon re-entry into a gravity environment to ensure mission success, such as an Extra Vehicular Activity (EVA) or emergency egress. To prepare the astronauts for their mission, a Wyle Astronaut Strength Conditioning and Rehabilitation specialist (ASCR) works individually with the astronauts to prescribe preflight strength and conditioning programs and in-flight exercise, utilizing Countermeasure Systems (CMS) exercise hardware. PURPOSE: To describe the preflight and in-flight exercise programs for ISS crewmembers. METHODS: Approximately 2 years before a scheduled launch, an ASCR is assigned to each astronaut and physical training (PT) is routinely scheduled. Preflight PT of astronauts consists of carrying out strength, aerobic and general conditioning, employing the principles of periodization. Exercise programs are prescribed to the astronauts to account for their individual fitness levels, planned mission-specific tasks, areas of concern, and travel schedules. Additionally, astronauts receive instruction on how to operate CMS exercise hardware and receive training for microgravity-specific conditions. For example, astronauts are scheduled training sessions for the International Space Station (ISS) treadmill (TVIS) and cycle ergometer (CEVIS), as well as the Advanced Resistive Exercise Device (ARED). In-flight programs are designed to maintain or even improve the astronauts pre-flight levels of fitness, bone health, muscle strength, power and aerobic capacity. In-flight countermeasure sessions are scheduled in 2.5 h blocks, six days a week, which includes 1.5 h for resistive training and 1 h for aerobic exercise. CONCLUSIONS: Crewmembers reported the need for more scheduled time for preflight training. During flight, crewmembers have indicated that the in-flight exercise is sufficient, but would like more reliable and capable hardware.

Guilliams, Mark E.↗
NASA NTRS2011

Overview of Pre-Flight Physical Training, In-Flight Exercise Countermeasures and the Post-Flight Reconditioning Program for International Space Station Astronauts

International Space Station (ISS) astronauts receive supervised physical training pre-flight, utilize exercise countermeasures in-flight, and participate in a structured reconditioning program post-flight. Despite recent advances in exercise hardware and prescribed exercise countermeasures, ISS crewmembers are still found to have variable levels of deconditioning post-flight. This presentation provides an overview of the astronaut medical certification requirements, pre-flight physical training, in-flight exercise countermeasures, and the post-flight reconditioning program. Astronauts must meet medical certification requirements on selection, annually, and prior to ISS missions. In addition, extensive physical fitness testing and standardized medical assessments are performed on long duration crewmembers pre-flight. Limited physical fitness assessments and medical examinations are performed in-flight to develop exercise countermeasure prescriptions, ensure that the crewmembers are physically capable of performing mission tasks, and monitor astronaut health. Upon mission completion, long duration astronauts must re-adapt to the 1 G environment, and be certified as fit to return to space flight training and active duty. A structured, supervised postflight reconditioning program has been developed to prevent injuries, facilitate re-adaptation to the 1 G environment, and subsequently return astronauts to training and space flight. The NASA reconditioning program is implemented by the Astronaut Strength, Conditioning, and Rehabilitation (ASCR) team and supervised by NASA flight surgeons. This program has evolved over the past 10 years of the International Space Station (ISS) program and has been successful in ensuring that long duration astronauts safely re-adapt to the 1 g environment and return to active duty. Lessons learned from this approach to managing deconditioning can be applied to terrestrial medicine and future exploration space flight missions.

Kerstman, Eric↗
NASA NTRS2011

Post Flight Reconditioning for US Astronauts Returning from the International Space Station

Prior to spaceflight, each astronaut undergoes medical requirement testing to establish a preflight baseline for physiologic functions. Astronauts returning from the International Space Station can experience deficits in all or some of the following areas: aerobic capacity, muscular strength, power, endurance, stamina, bone, balance, agility, coordination, orthostatic tolerances, proprioception, neurovestibular function and flexibility. These losses occur from living in microgravity and are consistent with deficits seen in terrestrial, de-conditioning individuals. Since 2001, the Astronaut Strength, Conditioning and Rehabilitation (ASCR) specialists have administered a reconditioning program, focusing on all deficits, which improves the physical condition of all returning astronauts. In most cases, astronauts have reached or surpassed their preflight physical condition. Purpose: This presentation will describe and explain the postflight reconditioning program for returning astronauts. Methods: The postflight reconditioning program is designed to stress the body systems that affect the following: aerobic capacity, muscular strength, power, endurance, stamina, bone, balance, agility, coordination, orthostatic tolerances, proprioception, neurovestibular function and flexibility. Postflight reconditioning begins on landing day, is scheduled for two hours per day, 7 days a week for 45 days and is tailored to the specific needs of the astronaut. Initially the program focuses on basic ambulation, cardiovascular endurance, strength, balance, flexibility and proprioception. The program advances through 45 days and specific attention is given to each astronaut s overall condition, testing results, medical status, and assigned duties after their mission. Conclusion: Astronauts will experience noticeable deficits in their physical condition after living in microgravity for an extended length of time. After completing postflight reconditioning, it is shown that astronauts have regained, and in most cases improved upon, their preflight baseline condition.

Nieschwitz, Bruce↗
NASA NTRS2011

Prescribed Travel Schedules for Fatigue Management

The NASA Fatigue Management Team is developing recommendations for managing fatigue during travel and for shift work operations, as Clinical Practice Guidelines for the Management of Circadian Desynchrony in ISS Operations. The Guidelines provide the International Space Station (ISS ) flight surgeons and other operational clinicians with evidence-based recommendations for mitigating fatigue and other factors related to sleep loss and circadian desynchronization. As much international travel is involved both before and after flight, the guidelines provide recommendations for: pre-flight training, in-flight operations, and post-flight rehabilitation. The objective of is to standardize the process by which care is provided to crewmembers, ground controllers, and other support personnel such as trainers, when overseas travel or schedule shifting is required. Proper scheduling of countermeasures - light, darkness, melatonin, diet, exercise, and medications - is the cornerstone for facilitating circadian adaptation, improving sleep, enhancing alertness, and optimizing performance. The Guidelines provide, among other things, prescribed travel schedules that outline the specific implementation of these mitigation strategies. Each travel schedule offers evidence based protocols for properly using the NASA identified countermeasures for fatigue. This presentation will describe the travel implementation schedules and how these can be used to alleviate the effects of jet lag and/or schedule shifts.

Whitmire, Alexandra↗
NASA NTRS2011

DCS: A Case Study of Identification of Knowledge and Disposition Gaps Using Principles of Continuous Risk Management

The Human Research Program (HRP) is formulated around the program architecture of Evidence-Risk-Gap-Task-Deliverable. Review of accumulated evidence forms the basis for identification of high priority risks to human health and performance in space exploration. Gaps in knowledge or disposition are identified for each risk, and a portfolio of research tasks is developed to fill them. Deliverables from the tasks inform the evidence base with the ultimate goal of defining the level of risk and reducing it to an acceptable level. A comprehensive framework for gap identification, focus, and metrics has been developed based on principles of continuous risk management and clinical care. Research towards knowledge gaps improves understanding of the likelihood, consequence or timeframe of the risk. Disposition gaps include development of standards or requirements for risk acceptance, development of countermeasures or technology to mitigate the risk, and yearly technology assessment related to watching developments related to the risk. Standard concepts from clinical care: prevention, diagnosis, treatment, monitoring, rehabilitation, and surveillance, can be used to focus gaps dealing with risk mitigation. The research plan for the new HRP Risk of Decompression Sickness (DCS) used the framework to identify one disposition gap related to establishment of a DCS standard for acceptable risk, two knowledge gaps related to DCS phenomenon and mission attributes, and three mitigation gaps focused on prediction, prevention, and new technology watch. These gaps were organized in this manner primarily based on target for closure and ease of organizing interim metrics so that gap status could be quantified. Additional considerations for the knowledge gaps were that one was highly design reference mission specific and the other gap was focused on DCS phenomenon.

Norcross, Jason↗