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NASA NTRS2002

Bioastronautics: optimizing human performance through research and medical innovations

A strategic use of resources is essential to achieving long-duration space travel and understanding the human physiological changes in space, including the roles of food and nutrition in space. To effectively address the challenges of space flight, the Bioastronautics Initiative, undertaken in 2001, expands extramural collaboration and leverages unique capabilities of the scientific community and the federal government, all the while applying this integrated knowledge to Earth-based problems. Integral to the National Aeronautics and Space Administration's missions in space is the reduction of risk of medical complications, particularly during missions of long duration. Cumulative medical experience and research provide the ability to develop evidence-based medicine for prevention, countermeasures, and treatment modalities for space flight. The early approach applied terrestrial clinical judgment to predict medical problems in space. Space medicine has evolved to an evidence-based approach with the use of biomedical data gathered and lessons learned from previous space flight missions to systematically aid in decision making. This approach led, for example, to the determination of preliminary nutritional requirements for space flight, and it aids in the development of nutrition itself as a countermeasure to support nutritional mitigation of adaptation to space.

Nutritional Requirements↗
NASA NTRS1969

Experience factors in performing periodic physical evaluations

The lack of scientific basis in the so-called periodic health examinations on military personnel inclusive of the Executive Health Program is outlined. This latter program can well represent a management tool of the company involved in addition to being a status symbol. A multiphasic screening technique is proposed in conjunction with an automated medical history questionnaire for preventive occupational medicine methodology. The need to collate early sickness consultation or clinic visit histories with screening techniques is emphasized.

Hoffman, A. A.↗
NASA NTRS2000

Monitoring on the Move

The MyoMonitor EMG system was developed by Delsys, Inc. under SBIR funding from Johnson Space Center. It is a wearable four-channel device that can monitor muscle performance. Presently, its application include rehabilitative therapy, injury prevention, sports medicine, exercise training, and various other muscle monitoring activities. The MyoMonitor uses a two-bar single differential electrode. Due to the electrode-skin interface in traditional EMG equipment, during rigorous muscular activity, the movement of the skin causes the electrode detection surfaces to become compromised. The MyoMonitor eliminates this problem, enabling a wide array of applications and experiments during intense muscular activity. The ability to make such recordings, for example, enables novel experiments aboard the International Space Station for investigating the effect of microgravity on muscle performance. Product still commercially available as of March 2002.

Source record↗
NASA NTRS1969

The relationship of NASA occupational medicine and environmental health with the Advisory Center on Toxicology

Preventive measures of occupational medicine and industrial hygiene are coordinated to identify toxicities of industrial products and safety standards in manned space flight applications. Emphasized is the off-gassing of construction materials in spacecraft with the resulting contamination of the cabin atmosphere and the establishment of criteria for the quality of drinking water for astronauts during Gemini and Apollo programs.

Wands, R. C.↗
NASA NTRS1975

Flight crew health stabilization program

The flight crew health stabilization program was developed to minimize or eliminate the possibility of adverse alterations in the health of flight crews during immediate preflight, flight, and postflight periods. The elements of the program, which include clinical medicine, immunology, exposure prevention, and epidemiological surveillance, are discussed briefly. No crewmember illness was reported for the missions for which the program was in effect.

Bennie C. Wooley↗
NASA NTRSDate not supplied

Sweating the Small Stuff: A Sensor for Real-Time Neuro-Immune Axis Monitoring

Although manageable with certain precautions, circadian rhythm misalignment and sleep disturbances pose a potential threat to astronaut health. It is well-known that sleep is essential for proper immunological and neurological functioning, while impairments in these functions result in risks for spaceflight success. Neuropeptides and hormones are involved in regulating the circadian clock and are used as biomarkers for circadian alignment. However, in-flight monitoring of these biomarkers is limited due to the lack of real-time sensor systems and sample collection/processing confines. Therefore, real-time measurements of biomarkers in-flight are necessary for mission success and crew health. For this, a robust biomarker involved in the neuro-immune axis of circadian rhythm cycling, physiological stress responses, and inflammation would be well-received as a viable biomarker for assessing physiological health for crew during long-duration missions, as these are currently NASA Human Research Program defined risks. Therefore, this paper describes the development of a wearables we at biosensor to measure the biological clock neuropeptide, orexin/hypocretin. Additionally, potential for implementation of a user-friendly sensor of orexin/hypocretin to be telemetrically reported in real-time, is proposed. In brief, the proposed system has the possibility to be used as a biomarker monitor to support preventive and personalized medicine.

Amber M Paul↗
NASA NTRS2011

Astronaut Medical Selection and Flight Medicine Care During the Shuttle ERA 1981 to 2011

The NASA Shuttle Program began with congressional budget approval in January 5, 1972 and the launch of STS-1 on April 12, 1981 and recently concluded with the landing of STS-135 on July 21, 2011. The evolution of the medical standards and care of the Shuttle Era Astronauts began in 1959 with the first Astronaut selection. The first set of NASA minimal medical standards were documented in 1977 and based on Air Force, Navy, Department of Defense, and the Federal Aviation Administration standards. Many milestones were achieved over the 30 years from 1977 to 2007 and the subsequent 13 Astronaut selections and 4 major expert panel reviews performed by the NASA Flight Medicine Clinic, Aerospace Medicine Board, and Medical Policy Board. These milestones of aerospace medicine standards, evaluations, and clinical care encompassed the disciplines of preventive, occupational, and primary care medicine and will be presented. The screening and retention standards, testing, and specialist evaluations evolved through periodic expert reviews, evidence based medicine, and Astronaut medical care experience. The last decade of the Shuttle Program saw the development of the International Space Station (ISS) with further Space medicine collaboration and knowledge gained from our International Partners (IP) from Russia, Canada, Japan, and the European Space Agencies. The Shuttle Program contribution to the development and implementation of NASA and IP standards and waiver guide documents, longitudinal data collection, and occupational surveillance models will be presented along with lessons learned and recommendations for future vehicles and missions.

Johnston, S.↗
NASA NTRS2000

Clinical Space Medicine Panel

The practice of space medicine is diverse. It includes routine preventive medical care of astronauts and pilots, the development of inflight medical capability and training of flight crews as well as the preflight, inflight, and postflight medical assessment and monitoring. The Johnson Space Center Medical Operations Branch is a leader in the practice of space medicine. The papers presented in this panel will demonstrate some of the unique aspects of space medicine.

Baisden, Denise L.↗
NASA NTRS1989

Workshop on Exercise Prescription for Long-Duration Space Flight

The National Aeronautics and Space Administration has a dedicated history of ensuring human safety and productivity in flight. Working and living in space long term represents the challenge of the future. Our concern is in determining the effects on the human body of living in space. Space flight provides a powerful stimulus for adaptation, such as cardiovascular and musculoskeletal deconditioning. Extended-duration space flight will influence a great many systems in the human body. We must understand the process by which this adaptation occurs. The NASA is agressively involved in developing programs which will act as a foundation for this new field of space medicine. The hallmark of these programs deals with prevention of deconditioning, currently referred to as countermeasures to zero g. Exercise appears to be most effective in preventing the cardiovascular and musculoskeletal degradation of microgravity.

Harris, Bernard A., Jr.↗
NASA NTRS2007

Clinical Core Competency Training for NASA Flight Surgeons

Introduction: The cohort of NASA flight surgeons (FS) is a very accomplished group with varied clinical backgrounds; however, the NASA Flight Surgeon Office has identified that the extremely demanding schedule of this cohort prevents many of these physicians from practicing clinical medicine on a regular basis. In an effort to improve clinical competency, the NASA FS Office has dedicated one day a week for the FS to receive clinical training. Each week, an FS is assigned to one of five clinical settings, one being medical patient simulation. The Medical Operations Support Team (MOST) was tasked to develop curricula using medical patient simulation that would meet the clinical and operational needs of the NASA FS Office. Methods: The MOST met with the Lead FS and Training Lead FS to identify those core competencies most important to the FS cohort. The MOST presented core competency standards from the American Colleges of Emergency Medicine and Internal Medicine as a basis for developing the training. Results: The MOST identified those clinical areas that could be best demonstrated and taught using medical patient simulation, in particular, using high fidelity human patient simulators. Curricula are currently being developed and additional classes will be implemented to instruct the FS cohort. The curricula will incorporate several environments for instruction, including lab-based and simulated microgravity-based environments. Discussion: The response from the NASA FS cohort to the initial introductory class has been positive. As a result of this effort, the MOST has identified three types of training to meet the clinical needs of the FS Office; clinical core competency training, individual clinical refresher training, and just-in-time training (specific for post-ISS Expedition landings). The MOST is continuing to work with the FS Office to augment the clinical training for the FS cohort, including the integration of Web-based learning.

Polk, J. D.↗
NASA NTRS2014

Introduction

The 2014 SPIE Sensing Technologies for Global Health, Military Medicine and Environmental Monitoring conference embraced a wealth of state-of-the-art information in basic and applied science. This event covered the latest developments in the following areas: Non-invasive Disease Diagnostics for Global Health- This opening series of two consecutive sessions focused on oral biospecimen based rapid assays and point-of-care devices for the detection of pathogens causing infectious diseases, biomarkers for cancer, and analytes for noncommunicable diseases such as diabetes. They also covered presentations on the human proteasome and microbiome with linkage to human diseases and diagnostic approaches. The sessions were built on the past experience and expertise of the National Institutes of Health, National Institutes of Dental and Craniofacial Research. Military Medicine I: Traumatic Brain Injury and PTSD-This assembly covered oral-biomarker based diagnostics for brain damage and TBI as well as prevention and rehabilitation technologies. Neurorehabilitation and noninvasive neuromodulation were also discussed as critical approaches for effective functioning. Military Medicine II: Physiology and Medicine of Extreme Environments and Spaceflight-This scientific segment showcased physiological, pharmacological and diagnostic sensing methodologies during spaceflight per the National Aeronautics and Space Administration as well as military-relevant toxicans and future sensing trends per the Department of Defense. It also included latest technologies to determine hydration status in warfighters, eye surgery using the latest laser technologies, and sensing tools for blood analysis.  Sensing Technologies for Disease Diagnostics and Environmental Monitoring-This closing series of two consecutive sessions provided the venues to learn and discuss more results on the next generation of diagnostic tools and field technologies for diseases, including biomarker detection by digital imaging, multiplex technologies, capillary electrophoresis and molecular platforms serving as labs-on-chips. This conference allowed cross-fertilization of ideas, projects and collaborative work by a multidisciplinary audience of national and international colleagues from the academia, industry and federal government: The National Institutes of Health, National Aeronautics and Space Administration, and the Department of Defense.

Wotring, Virginia E.↗
NASA NTRS2001

The Role of Space Medicine in Management of Risk in Spaceflight

The purpose of Space Medicine is to ensure mission success by providing quality and comprehensive health care throughout all mission phases to optimize crew health and performance and to prevent negative long-term health consequences. Space flight presents additional hazards and associated risks to crew health, performance, and safety. With an extended human presence in space it is expected that illness and injury will occur on orbit, which may present a significant threat to crew health and performance and to mission success. Maintaining crew health, safety and performance and preventing illness and injury are high priorities necessary for mission success and agency goals. Space flight health care should meet the standards of practice of evidence based clinical medicine. The function of Space Medicine is expected to meet the agency goals as stated in the 1998 NASA Strategic Plan and the priorities established by the Critical Path Roadmap Project. The Critical Path Roadmap Project is an integrated NASA cross-disciplinary strategy to assess, understand, mitigate, and manage the risks associated with long-term exposure to the space flight environment. The evidence based approach to space medicine should be standardized, objective process yielding expected results and establishing clinical practice standards while balancing individual risk with mission (programmatic) risk. The ability to methodically apply available knowledge and expertise to individual and mission health issues will ensure appropriate priorities are assigned and resources are allocated. NASA Space Medicine risk management process is a combined clinical and engineering approach. Competition for weight, power, volume, cost, and crew time must be balanced in making decisions about the care of individual crew with competing agency resources.

Clark, Jonathan B.↗
NASA NTRS2006

Johnson Space Center Flight Medicine Clinic Experience

Being a member of the Flight Medicine Clinic (FMC) Staff is a great experience. I joined the FMC staff 2 years ago when I became part of the Kelsey-Seybold team. The FMC staff consists of Flight Surgeons, Family Clinic Physician, Nursing staff, Wellness Coordinator and Support staff. We serve as the Primary Care Physicians for the astronauts and their families and provide annual physicals for the retired astronauts. We have approximately 800 patients in the FMC. As the Family Clinic Physician, I care for the astronaut spouses and children and provide annual physicals for the retired astronauts. Since we have a small patient population, we have the opportunity to spend increased personal time with our patients, which I enjoy. We have a pretty healthy patient population, who are very interested in their overall health and preventive care. In preparation for a shuttle launch, our nursing staff assists the flight surgeons with the astronaut physical exams, which occur 10 days prior to launch and again 3 days after their return. We also provide Primary Contact physicals for the families and guests, who will be in close contact with shuttle crew members. During these physicals, we provide education, emphasizing the importance of preventing the spread of communicable diseases to shuttle crew members. Being a part of the Space Medicine Program is an honor. To know that you contribute in some way to our nation s Space Program is very special. (This article was prepared by Dr. Trela Landry, M.D. for inclusion in a Kelsey-Seybold newsletter on 25 OCT 2006.)

Landry, Trela↗
NASA NTRS1993

Autogenic-Feedback Training (AFT) as a preventive method for space motion sickness: Background and experimental design

Finding an effective treatment for the motion sickness-like symptoms that occur in space has become a high priority for NASA. The background research is reviewed and the experimental design of a formal life sciences shuttle flight experiment designed to prevent space motion sickness in shuttle crew members is presented. This experiment utilizes a behavioral medicine approach to solving this problem. This method, Autogenic-Feedback Training (AFT), involves training subjects to voluntarily control several of their own physiological responses to environmental stressors. AFT has been used reliably to increase tolerance to motion sickness during ground-based tests in over 200 men and women under a variety of conditions that induce motion sickness, and preliminary evidence from space suggests that AFT may be an effective treatment for space motion sickness as well. Proposed changes to this experiment for future manifests are included.

Cowings, Patricia S.↗
NASA NTRS1988

Answering the Space Medicine Challenge

The development of the Space Station Health Maintenance Facility (HMF) is featured. The HMF will provide necessary inflight medical care, including prevention, diagnosis, treatment, and care during transport if the patient must be evacuated from Space Station.

Source record↗
NASA NTRS2004

Pharmacotherapeutic Aspects of Space Medicine

Medications are used for a wide variety of indications during space flight. For example, astronauts have taken drugs in flight to ameliorate or prevent symptoms of space motion sickness, headache, sleeplessness, backache, nasal congestion, and constipation. Russian cosmonauts reportedly take medications to prevent metabolic disturbances of the myocardium and intestinal flora, and to optimize their work capacity. Although the discomfort associated with some acute responses to microgravity (e.g., space motion sickness) is expected to diminish with length of time in flight, other responses that have delayed onset (e.g., maintaining nutritional status, bone and muscle strength, and perhaps immune response) may affect health and quality of life during longer missions. Therefore, as the duration of space flights increases, the need for treatment with medications is expected to increase accordingly. Medications carried on Space Shuttle missions have varied somewhat from flight to flight, depending on the individual needs of the crewmembers. Medications use during Shuttle flights seems to be more prevalent than during earlier programs, perhaps because drugs are provided in easy-to-use forms. In fact, nearly all medications taken to date have been ingested orally in tablet form. However, given that the oral route may not be ideal for those suffering motion-sickness symptoms, intramuscular and intranasal preparations are being tested. For example, intramuscular administration of promethazine hydrochloride (Phenergan(Registered TradeMark)) has been reported to be more effective in alleviating motion-sickness symptoms. The difficulties involved in conducting definitive studies of drug efficacy during U.S. space flights have been compounded by the absence of a systematic approach to determining which drugs were taken by whom and under what circumstances. The use of some drugs in space has been less efficacious than expected. The onset, intensity, and duration of the response produced by any drug depend upon rates of absorption, distribution, metabolism, and elimination of the drug; space flight-induced changes in blood flow and the function of the gastrointestinal (GI) tract, liver, or kidneys may alter these processes. Another important aspect of clinical efficacy of medications in space is the stability of pharmaceuticals. As the U.S. space program is moving toward extended Space Shuttle flights and beyond, to space station missions and planetary explorations, understanding how space flight affects organ systems and clinical pharmacology is necessary to optimize pharmacotherapeutics in space and ensure adequate safety and health of crewmembers.

Putcha, Lakshmi↗