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Tropical medicine: Telecommunications and technology transfer

The potential for global outbreaks of tropical infectious diseases, and our ability to identify and respond to such outbreaks is a major concern. Rapid, efficient telecommunications is viewed as part of the solution to this set of problems - the means to link a network of epidemiological field stations via satellite with U.S. academic institutions and government agencies, for purposes of research, training in tropical medicine, and observation of and response to epidemic emergencies. At a workshop, telecommunications and technology transfer were addressed and applications of telecommunications technology in long-distance consultation, teaching and disaster relief were demonstrated. Applications in teaching and consultation in tropical infectious diseases is discussed.

Legters, Llewellyn J.↗

Risk of Performance and Behavioral Health Decrements Due to Inadequate Cooperation, Coordination, and Psychosocial Adaptions within a Team

The Risk of Performance and Behavioral Health Decrements Due to Inadequate Cooperation, Coordination, Communication, and Psychosocial Adaptation within a Team (the Team Risk) is primarily performance-focused, with a secondary emphasis on behavioral health outcomes resulting from team performance and interpersonal interactions. Monitoring tools, measures, and countermeasures are aimed at enhancing team processes and team composition configurations to optimize team performance and functioning. Long-duration exploration missions (LDEMs) will include major challenges that could affect team performance, including social isolation, physical confinement, a small and diverse crew, communication delays between crew and ground, limited or no crew rotation or evacuation options, limited or no resupply, and a high-consequence environment. Each of these conditions will affect the crew’s coordination, cooperation, psychological well-being, and performance. Although the International Space Station (ISS) remains important for studies that require spaceflight testing and validation, the current conditions on the ISS do not adequately mimic the exploration environment that is required for National Aeronautics and Space Administration (NASA) teams research, and thus access to terrestrial or ground-based analogs of LDEM conditions is paramount. The emphasis on analogs for research is reflected in this updated evidence review of the Team Risk, and includes data from studies conducted at isolated, confined, extreme (ICE) environments (e.g., Antarctic stations), and from several mission simulation analogs such as the Human Exploration Research Analog (HERA) (HERA Experiment Information Package, 2014), also known as isolated, confined, controlled (ICC) environments. These studies have characterized many team factors regarding LDEMs, and the Team Risk has now matured from risk characterization to focusing more on countermeasure development. Because spaceflight evidence for team-level research is lacking, no reliable data is available to quantify the impact of team-level variables on individual and team-level outcomes during spaceflight missions. Until recently, no systematic attempt had been undertaken to measure the performance effects of team cohesion, team composition, team training, or team-related psychosocial adaptation during spaceflight. The Team Risk is a relatively young research area for NASA, with substantial growth only since the 2000s, and with limited access to spaceflight performance data. As a result, spaceflight evidence is lacking to identify specifically what team composition, level of training, amount of cohesion, or quality of psychosocial adaptation is necessary to reduce the risk of performance errors in space. However, astronaut journals and interviews and reports from spaceflight subject matter experts (SMEs) provide testimonies that team performance during spaceflight is important for mission success and to maintain crew health. Team spaceflight data is now being collected as part of the Spaceflight Standard Measures task (Clement, 2021)—a set of core measurements related to many human spaceflight risks that are collected from astronauts before, during, and after long-duration missions. The team-related standard measures focus on team cohesion, team performance, group living, team climate, and team processes. Collection of standard measures data is ongoing and published data is not yet available. Finally, although spaceflight evidence is lacking, evidence gleaned from ground studies and spaceflight analog studies will help close the gaps outlined in the Team Risk. Ground-based studies provide quantitative evidence for team functioning in ICE environments. Academic research on teams has produced dozens of meta-analyses that can be used to understand the general relationships among team inputs (e.g., team member characteristics and skills, job context), team processes, and emergent states (e.g., coordination, communication, cooperation, cohesion, trust, shared cognition), and team outcomes (e.g., effectiveness, errors, adaptation). Teams are complex, incorporating individual characteristics of team members, but also existing at a level that is greater than the sum of its parts. Therefore, the Team Risk must be integrated with other individual-focused NASA Human Research Program (HRP) risks, including Behavioral Medicine (BMed), Sleep, and Human-Systems Integration Architecture (HSIA), and emerging research indicates more integration may needed between the Team Risk and the physiologically oriented risks. Much of this integration occurs through the Human Systems Risk Board (HSRB). A lack of team functioning may be a stressor in some circumstances, but the team often acts as a countermeasure. For example, support for team leaders and teammates can facilitate individual functioning and encourage psychological and physically healthy behaviors and attitudes. However, more research is needed regarding teams during LDEMs and the remaining gaps in the research are described in the current report.

Lauren Blackwell Landon↗

Space Biotech: Hindsight, Insight, Foresight

Over the past forty years, microgravity has inspired and enabled applications in a wide range of sectors including medicine, materials, computers, communications, and national defense. Trends show that demand for high-tech solutions is increasing in these sectors, solutions that require higher resolution, greater precision, novel materials, innovative processes, and more sophisticated tools. These are areas where microgravity can offer unique capabilities for innovation. The Emerging Space Office (ESO) has engaged in multiple studies over the past year that have found that microgravity RD is one of the most promising technology areas for contributing to economic growth and to NASAs mission. The focus of these studies was on terrestrial markets rather than NASA applications, applied research rather than basic research, and commercial rather than academic investigators. There have been more success stories than are generally appreciated and there are significant areas of promising future potential. Many of the problems that have limited commercial microgravity development in the past are being solved. Microgravity research and development (RD) requires iteration and learning, as rapidly as possible. New technologies enable high throughput and rapid data collection in increasingly small payloads. The International Space Station is in orbit and provides a laboratory that is available 247 at least until 2024. Frequent flights by commercial space providers to and from the ISS now enable the fast learning cycles needed by high-tech industries. Launch costs are decreasing and the ability to return payloads to Earth is increasing. New commercial space laboratories, such as those being developed by SpaceX and Bigelow Aerospace, are in the final stages of development and testing. This ecosystem for microgravity RD has never been available before. These are game-changer conditions for attracting high-tech industries to space for terrestrial, as well as NASA, applications. However, few know that these capabilities are available or how to use them. In aggregate, the potential value for new applications from microgravity RD over the next ten years could add billions of dollars per year in terrestrial applications to the future economy, create new jobs, and generate a wide range of public benefits in medical advances, while broadening the customer base for the emerging space industry.

biotech↗

International Telemedicine/Disaster Medicine Conference: Papers and Presentations

The first International Telemedicine/Disaster Medicine Conference was held in Dec. 1991. The overall purpose was to convene an international, multidisciplinary gathering of experts to discuss the emerging field of telemedicine and assess its future directions; principally the application of space technology to disaster response and management, but also to clinical medicine, remote health care, public health, and other needs. This collection is intended to acquaint the reader with recent landmark efforts in telemedicine as applied to disaster management and remote health care, the technical requirements of telemedicine systems, the application of telemedicine and telehealth in the U.S. space program, and the social and humanitarian dimensions of this area of medicine.

Source record↗

Microbial Genomes Multiply

The publication of the first complete sequence of a bacterial genome in 1995 was a signal event, underscored by the fact that the article has been cited more than 2,100 times during the intervening seven years. It was a marvelous technical achievement, made possible by automatic DNA-sequencing machines. The feat is the more impressive in that complete genome sequencing has now been adopted in many different laboratories around the world. Four years ago in these columns I examined the situation after a dozen microbial genomes had been completed. Now, with upwards of 60 microbial genome sequences determined and twice that many in progress, it seems reasonable to assess just what is being learned. Are new concepts emerging about how cells work? Have there been practical benefits in the fields of medicine and agriculture? Is it feasible to determine the genomic sequence of every bacterial species on Earth? The answers to these questions maybe Yes, Perhaps, and No, respectively.

Doolittle, Russell F.↗

Cases in Space Medicine: Right Lower Quadrant Abdominal Pain in a Female Crewmember on the International Space Station

A case study of a medical emergency aboard the International Space Station is reviewed. The case involves a female crewmember who is experiencing acute abdominal pain. The interplay of the Crew Medical Officer (CMO) and the NASA Flight Surgeon is given. Possible diagnoses, and advised medical actions are reviewed. Along the case study questions are posed to the reader, and at the end answers are given.

Hamilton, Douglas R.↗

Clinical and Educational Support for Space Flight via Telemedicine

Session MP3 includes short reports on: (1) Telemedicine: A User's Perspective; (2) Health Care in Extreme Environments; (3) Integration of Emerging Technologies in Information and Telecommunications in Health Care Systems for Space; (4) Telemedicine and Environmental Medicine in Russia: A First Step in Basic Medical Education; and (5) Clinical Utility of Internet Telemedicine.

Source record↗

Legacy of Operational Space Medicine During the Space Shuttle Program

The Johnson Space Center s Medical Science Division branches were involved in preparing astronauts for space flight during the 30 year period of the Space Shuttle Program. These branches included the Flight Medicine Clinic, Medical Operations and the Behavioral Health Program. The components of each facet of these support services were: the Flight Medicine Clinic s medical selection process and medical care; the Medical Operations equipment, training, procedures and emergency medical services; and the Behavioral Health and Performance operations. Each presenter will discuss the evolution of its operations, implementations, lessons learned and recommendations for future vehicles and short duration space missions.

Stepaniakm, P.↗

Innovations in Medicine

NASA is planning now toward the day of long-duration flight-manned interplanetary missions for example-wherein routine health care and emergency treatment must be accomplished on-board the spacecraft over periods of months or perhaps even years. Since spacecraft design limits crew size, the medical assignment may be handled by a single astronaut-physician or by a crew member trained as a physician's assistant. In a space emergency demanding surgery, for instance, sophisticated communications equipment, backed by a computerized data processing system, would make it possible for a surgeon on Earth to "examine" the patient. He could study X-rays and other data, specify an in-flight surgical procedure, and guide the astronaut-medic step-by-step through the operation. Such a system is being evaluated now. It is called STARPAHC (Space Technology Applied to Rural Papago Health Care). NASA technology in space communications and data processing is being applied to remote health services for the Papago tribe. STARPAHC is administered by the NASA Life Sciences Directorate in the Office of Space Sciences. It is a joint program involving NASA's Johnson Space Center, the Indian Health Service of the Department of Health, Education & Welfare, and the Papago's Executive Health Council. Lockheed Missiles & Space Co. is NASA's systems support contractor.

Source record↗

A life-saving device for ships

A life-saving device is described which can be used on either ships or airplanes. The device consists of an airtight container for passengers equipped with elements needed for survival (oxygen, food, medicines, etc.), an energy source, and a parachute. This device can be ejected from the plane or ship when an emergency arises.

Converti, P.↗

Overview and Results of ISS Space Medicine Operations Team (SMOT) Activities

The Space Medicine Operations Team (SMOT) was created to integrate International Space Station (ISS) Medical Operations, promote awareness of all Partners, provide emergency response capability and management, provide operational input from all Partners for medically relevant concerns, and provide a source of medical input to ISS Mission Management. The viewgraph presentation provides an overview of educational objectives, purpose, operations, products, statistics, and its use in off-nominal situations.

Johnson, H. Magee↗

Space Biology and Medicine: Space and Its Exploration - Volume I

Perhaps one of the greatest gifts that has been given to the people of the world in the last few hundred years has been an emerging sense of the place of our planet and its inhabitants within the context of the vast universe. Our knowledge of the rest of the universe has not come quickly, nor was the process of attaining it only recently begun; however, the unprecedented acceleration of that process has benefitted from a fundamental new aspect of our species that has only manifested itself in the last 30 years or so, the ability to travel in space. Before the space age, the Universe was studied only through observations from the Earth. All that has changed with the beginning of the space age. Machines built by humans have flown to all but one of the nine planets that revolve around our Sun, have ventured billions of miles from the Earth and looked back, and have landed on three other worlds. Spacecraft in orbit around the Earth have viewed the sky at a vast number of electromagnetic wavelengths, detecting the shape of the galaxy and the universe, and even measuring the remnants of the universe's beginning. Human explorers have ventured forth, first for short stays in orbit, then, later, walking upon the Moon and living for long periods in space. As they did so, billions of people on the Earth came to view the Earth in a fundamentally different way, not just as the familiar day to- day backdrop for their lives, but as a small oasis suspended in the night sky above an alien landscape. It is this new view of the Earth that is the true gift of space exploration. Space exploration has at once given us a new perspective on the value of our world, and a new perspective from which to understand how it operates. It has shown us that the Earth is by far the most precious place in the solar system in terms of supporting human life, while revealing that other destinations may still be compelling. The exploration of space has at once become a challenge for humanity to overcome and a path to our common future. But for humanity to embark on this path, we need to understand ourselves in a new environment. As such, an understanding of the biological consequences of and opportunities in space flight is essential. In this, the first volume of a joint U.S./Russian series on space biology and medicine, we describe the current status of our understanding of space and present general information that will prove useful when reading subsequent volumes. Since we are witnesses to the beginning of a new era of interplanetary travel, a significant portion of the first volume will concentrate on the physical and ecological conditions that exist in near and outer space, as well as heavenly bodies from the smallest ones to the giant planets and stars. While space exploration is a comparatively recent endeavor, its foundations were laid much more than 30 years ago, and its history has been an eventful one. In the first part of this volume, Rauschenbach, Sokolskiy, and Gurjian address the "Historical Aspects of Space Exploration" from its beginnings to a present-day view of the events of the space age. The nature of space itself and its features is the focus of the second section of the volume. In the first chapter of the part, "Stars and Interstellar Space," the origin and evolution of stars, and the nature of the portions of space most distant from Earth are described by Galeev and Marochnik. In Chapter 2, Pisarenko, Logachev, and Kurt in "The Sun and Interplanetary Space" bring us to the vicinity of our own solar system and provide a description and discussion of the nearest star and its influence on the space environment that our Earth and the other planets inhabit. In our solar system there are many fascinating objects, remnants of the formation of a rather ordinary star in a rather obscure portion of the galaxy. Historical accident has caused us to be much more curious (and knowledgeable) about "The Inner Planets of the Solar System" than about any of these other objects. In Chapter 3, Marov describes the planets Mercury, Venus, Earth, and Mars, their history and origin, and their environmental conditions, and in Chapter 4 Owen provides similar information about Jupiter, Saturn, Uranus, Neptune, and Pluto, "The Outer Planets of the Solar System." Morrison provides a thorough discussion of "Asteroids, Comets, and Other Small Bodies" in Chapter 5. The understanding of these relics of the formation of the solar system may form the center of our ability to understand the origin of solar systems in general, and of the critical role that the beginning of the solar system had on the prospects for the origin of life and its continued survival and evolution in the face of their recurrent impacts on Earth. In Chapter 6, the first chapter of the third part, Rummel describes the area of "Exobiology," the study of the origin, evolution, and distribution of life in the context of the origin and evolution of the universe. The same processes that have given rise to life on Earth may have given rise to life elsewhere. In Chapter 7, the "Earth and the Biosphere," the nature and function of the Earth are discussed as a specific instance of planetary and biological evolution. The effects of biological processes on the Earth under the influence of human activities are also addressed by Moore and Bartlett in Chapter 7. The final chapter in this section concerns the prospects that life in the universe may be widespread; "SETI," the Search for Extraterrestrial Intelligence, by Billingham and Tarter, presents the arguments for conducting a search for evidence of life elsewhere in the galaxy, and describes the various methods proposed for conducting such a search. While SETI has a distinctly exploration al character, more direct means are available for exploring the solar system around us. The fourth part of the volume addresses this subject of space exploration. Considering the prospects for research on space biology and medicine, the means of providing "Access to Space" are described by Feoktistov and Briggs in Chapter 9. This chapter addresses carriers and launch systems, the unmanned and manned spacecraft that they loft into space, and the task of mission operations by which these precious vessels are monitored, navigated, and controlled. Despite the successes of the past and the capabilities of the present, it is clear that the study of space biology and medicine will be even more rewarding in the future than it has been to date. The work of the next few years that will be undertaken by the U.S. and Russia, both independently and jointly, will focus first on enabling greater capabilities in the exploration of space, and then on using the unique characteristics of the space environment to provide insight and greater understanding into biological systems, their behavior, development, and origin. The chapters of the first volume were written by leaders in their fields from the U.S. and Russia. The material presented summarizes our current understanding of space and its exploration. We understand that the first volume will be of interest not only to medical personnel and biologists, but also to general readers who want information about space beyond their own particular fields of expertise.

Nicogossian, Arnauld E.↗

Earth benefits from space life sciences

Contributions of space exploration which are widely recognized are those dealing with the impact of space technology on public health and medical services in both urban and remote rural areas. Telecommunications, image enhancement, 3-dimensional image reconstructions, miniaturization, automation, and data analysis, have transformed the delivery of medical care and have brought about a new impetus to the field of biomedicine. Many areas of medical care and biological research have been affected. These include technological breakthroughs in such areas as: (1) diagnosis, treatment, and prevention of cardiovascular diseases, (2) new approaches to the understanding of osteoporosis, (3) early detection of genetic birth defects, (4) emergency medical care, and (5) treatment of chronic metabolic disorders. These are but a few examples where technology originally developed to support space medicine or space research has been applied to solving medical and health care delivery problems on Earth.

NASA Center HQS↗

Anaphylaxis, Intra-Abdominal Infections, Skin Lacerations, and Behavioral Emergencies: A Literature Review of Austere Analogs for a near Earth Asteroid Mission

As space exploration is directed towards destinations beyond low-Earth orbit, the consequent new set of medical risks will drive requirements for new capabilities and more resources to ensure crew health. The Space Medicine Exploration Medical Conditions List (SMEMCL), developed by the Exploration Medical Capability element of the Human Research Program, addresses the risk of "unacceptable health and mission outcomes due to limitations of in-flight medical capabilities". It itemizes 85 evidence-based clinical requirements for eight different mission profiles and identifies conditions warranting further research and technology development. Each condition is given a clinical priority for each mission profile. Four conditions -- intra-abdominal infections, skin lacerations, anaphylaxis, and behavioral emergencies -- were selected as a starting point for analysis. A systematic literature review was performed to understand how these conditions are treated in austere, limited-resource, space-analog environments (i.e., high-altitude and mountain environments, submarines, military deployments, Antarctica, isolated wilderness environments, in-flight environments, and remote, resource-poor, rural environments). These environments serve as analogs to spaceflight because of their shared characteristics (limited medical resources, delay in communication, confined living quarters, difficulty with resupply, variable time to evacuation). Treatment of these four medical conditions in austere environments provides insight into medical equipment and training requirements for exploration-class missions.

Chough, Natacha G.↗

Algorithms for Haptic Rendering of 3D Objects

Algorithms have been developed to provide haptic rendering of three-dimensional (3D) objects in virtual (that is, computationally simulated) environments. The goal of haptic rendering is to generate tactual displays of the shapes, hardnesses, surface textures, and frictional properties of 3D objects in real time. Haptic rendering is a major element of the emerging field of computer haptics, which invites comparison with computer graphics. We have already seen various applications of computer haptics in the areas of medicine (surgical simulation, telemedicine, haptic user interfaces for blind people, and rehabilitation of patients with neurological disorders), entertainment (3D painting, character animation, morphing, and sculpting), mechanical design (path planning and assembly sequencing), and scientific visualization (geophysical data analysis and molecular manipulation).

Basdogan, Cagatay↗

Organization, Management and Function of International Space Station (ISS) Multilateral Medical Operations

Long duration crews have inhabited the ISS since November of 2000. The favorable medical outcomes of its missions can be largely attributed to sustained collective efforts of all ISS Partners medical organizations. In-flight medical monitoring and support, although crucial, is just a component of the ISS system of Joint Medical Operations. The goal of this work is to review the principles, design, and function of the multilateral medical support of the ISS Program. The governing documents, which describe the relationships among all ISS partner medical organizations, were evaluated, followed by analysis of the roles, responsibilities, and decision-making processes of the ISS medical boards, panels, and working groups. The degree of integration of the medical support system was evaluated by reviewing the multiple levels of the status reviews and mission assurance activities carried out throughout the last six years. The Integrated Medical Group, consisting of physicians and other essential personnel in the mission control centers represents the front-line medical support of the ISS. Data from their day-to-day activities are presented weekly at the Space Medicine Operations Team (SMOT), where known or potential concerns are addressed by an international group of physicians. A broader status review is conducted monthly to project the state of crew health and medical support for the following month, and to determine measures to return to nominal state. Finally, a comprehensive readiness review is conducted during preparations for each ISS mission. The Multilateral Medical Policy Board (MMPB) issues medical policy decisions and oversees all health and medical matters. The Multilateral Space Medicine Board (MSMB) certifies crewmembers and visitors for training and space flight to the Station, and physicians to practice space medicine for the ISS. The Multilateral Medical Operations Panel (MMOP) develops medical requirements, defines and supervises implementation of operational countermeasures, environmental monitoring, medical care, and emergency medical services. MMOP assures the medical readiness of the Station for each subsequent mission or critical event. All boards and panels have functioned effectively and without interruptions even in various challenging circumstances. Based on the experience of the authors, consensus has prevailed as the primary nature of decisions made by all ISS medical groups, at all levels. The six first years of piloted operation have demonstrated the ability of the ISS medical authority groups and the medical infrastructure to implement medical policies and requirements, effectively interface with non-medical groups, and maintain the health and productivity of the crew in an integrated, multilaterally coordinated fashion. The medical support system appears to be mature and ready for further expansion of all Partners roles, and for the anticipated increase in the size of ISS crews.

Duncan, James M.↗

Oxygen Candle Background for Subs and Space

"At any time and without warning, a submarine may have to remain submerged for several days on account of the presence of the enemy, or rough weather, or serious accident to the machinery. Fortunately such occurrences are rare; but every commanding officer must be prepared to meet such an emergency that will afford his men the greatest possible chance of survival." Reference (1) This quotation is taken from a review of submarine air purification technology published by the Bureau of Medicine and Surgery in 1919. At that time, the U.S. Navy had just begun to experiment with possible air purification devices and supplies of oxygen that might permit submarines to remain submerged longer that the untreated closed atmosphere would allow. Submariners were exposed to elevated levels of carbon dioxide and reduced levels of oxygen that would be considered completely unacceptable by current standards. It was a different world, but humans are still humans, and the requirements for safe and effective functioning in a self-contained environment are really unchanged. The maximum submergence time for submarines as published in that work was approximately 48 hours, reference (1) In early submarines, the preferred supply of oxygen was 1800 psig compressed gas bled into the boat as needed, references (1,2). The need for added oxygen was occasionally "measured" by the physiological impact on the crew rather than a reliable instrument, reference (1). The design of submarine oxygen supply was limited to approximately 25 day submerged operation, reference (2). It was not until 1958 that U.S. submarines were able to carry out dives beyond that period and necessitated new sources of oxygen, reference (2). A curious second source of oxygen at the time was compressed air vessels that were bled into the boat while "vitiated" air (air with reduced oxygen and elevated carbon dioxide) from the opposite end of the boat was compressed into waiting empty vessels, reference (1). The periodic use of pressurized air to control oxygen caused swings in ambient pressure that was uncomfortable to the crew, reference (1). As early as 1919, liquid oxygen was a commercially available product and its use on submarines was contemplated, reference (1). It is interesting that even at this date, 1919, the danger of oils or greases when exposed to compressed or liquid oxygen was recognized: "One precaution must be always taken. No oil or grease should be used in the gauge or fittings or a dangerous explosion may result."

Graf, John↗