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NASA NTRS2017

Intracranial Fluid Redistribution During a Spaceflight Analog

The neural correlates of spaceflight-induced sensorimotor impairments are unknown. Head down-tilt bed rest (HDBR) serves as a microgravity analog because it mimics the headward fluid shift and limb unloading of spaceflight. We investigated focal brain white matter (WM) changes and fluid shifts during 70 days of 6 deg HDBR in 16 subjects who were assessed pre (2x), during (3x), and post-HDBR (2x). Changes over time were compared to those in control subjects (n=12) assessed four times over 90 days. Diffusion MRI was used to assess WM microstructure and fluid shifts. Free-Water Imaging, derived from diffusion MRI, was used to quantify the distribution of intracranial extracellular free water (FW). Additionally, we tested whether WM and FW changes correlated with changes in functional mobility and balance measures. HDBR resulted in FW increases in fronto-temporal regions and decreases in posterior-parietal regions that largely recovered by two weeks post-HDBR. WM microstructure was unaffected by HDBR. FW decreased in the post-central gyrus and precuneus. We previously reported that gray matter increases in these regions were associated with less HDBR-induced balance impairment, suggesting adaptive structural neuroplasticity. Future studies are warranted to determine causality and underlying mechanisms.

Koppelmans, Vincent↗
NASA NTRS1987

Physiologic adaptation of man in space; Proceedings of the Seventh International Man in Space Symposium, Houston, TX, Feb. 10-13, 1986

Topics discussed in this volume include space motion sickness, cardiovascular adaptation, fluid shifts, extravehicular activity, general physiology, perception, vestibular response modifications, vestibular physiology, and pharmacology. Papers are presented on the clinical characterization and etiology of space motion sickness, ultrasound techniques in space medicine, fluid shifts in weightlessness, Space Shuttle inflight and postflight fluid shifts measured by leg volume changes, and the probability of oxygen toxicity in an 8-psi space suit. Consideration is also given to the metabolic and hormonal status of crewmembers in short-term space flights, adaptive changes in perception of body orientation and mental image rotation in microgravity, the effects of a visual-vestibular stimulus on the vestibulo-ocular reflex, rotation tests in the weightless phase of parabolic flight, and the mechanisms of antimotion sickness drugs.

Holland, Albert W.↗
NASA NTRS2011

Comparison of Ocular Outcomes in Two 14-Day Bed Rest Studies

Reports of astronauts visual changes raised concern about ocular health during long-duration spaceflight. Some of these findings included hyperopic shifts, choroidal folds, optic disc edema, retinal nerve fiber layer (RNFL) thickening, and cotton wool spots. While the etiology remains unknown, hypotheses speculate that hypertension in the brain caused by cephalad fluid shifts during spaceflight is a possible mechanism for these ocular changes. Head-down tilt (HDT) bed rest is a spaceflight analog that induces cephalad fluid shifts. In addition, previous studies of the HDT position demonstrated body fluid shifts associated with changes in intraocular pressure (IOP). For these reasons, vision monitoring of HDT bed rest subjects was implemented for NASA bed rest studies. Subjects selected for these studies were healthy adults (14 males and 5 females). Average age was 37.5 plus or minus 9.1 years, weight was 77.4 plus or minus 11.3 Kg, and height was 173.4 plus or minus 7.2 14 cm. Controlled conditions followed for all NASA bed rest studies were implemented. These conditions included factors such as eating a standardized diet, maintaining a strict sleep wake cycle, and remaining in bed for 24 hours each day. In one study, subjects maintained a horizontal (0 degree) position while in bed and were exercised six days per week with an integrated resistance and aerobic training (iRAT) program. In the other study, subjects were placed at 6 degrees HDT while in bed and did not engage in exercise. All subjects underwent pre- and post bed rest vision testing. While the battery of vision tests for each study was not identical, measures common to both studies will be presented. These measures included IOP and measures that provided an indication of optic disc swelling as derived from optical coherence tomography (OCT) testing: average retinal nerve fiber layer (RNFL) thickness (millimeters), disc area (square millimeters), rim area (square millimters), and average cup to disc (C/D) ratio. For all measures, there was no significant difference between subject groups for pre-bed rest testing. Post bed rest values also remained similar between groups. Comparison of pre- to post bed rest testing within each group did not demonstrate any statistical differences. These preliminary results from 14-day bed rest studies suggest that the combination of exercise and horizontal bed rest as compared to 6 degrees HDT bed rest did not produce differences in the ocular response with regard to IOP and optic disc parameters. The ocular measures reported here only included pre- and post bed rest time points. Further investigation is needed to examine both the acute response and long term adaptation of structural and functional ocular parameters in the bed rest platform and determine its usefulness for studying spaceflight phenomena. From a clinical perspective, the ability to study ocular responses in the controlled environment of the bed rest platform can provide valuable information for the care of patients restricted to bed rest.

Cromwell, R. L.↗
NASA NTRS2012

Comparison of Ocular Outcomes in Two 14-Day Bed Rest Studies

Reports of astronauts' visual changes have raised concern about ocular health during long-duration spaceflight. Some of these findings include globe flattening with hyperopic shifts, choroidal folds, optic disc edema, retinal nerve fiber layer (RNFL) thickening, and cotton wool spots. While the etiology remains unknown, it is hypothesized that, in predisposed individuals, hypertension in the brain may follow cephalad fluid shifts during spaceflight. This possible mechanism of ocular changes may also apply to analogous cases of idiopathic intracranial hypertension (IIH) or pseudotumor cerebri on Earth patients. Head-down t ilt (HDT) bed rest is a spaceflight analog that induces cephalad fluid shifts. Previous studies of the HDT position demonstrated body fluid shifts associated with changes in intraocular pressure (IOP) but the conditions of bed rest varied among experiments, making it difficult to compare data and draw conclusions. For these reasons, vision evaluation of bed rest subjects was implemented for NASA bed rest studies since 2010, in an attempt to monitor vision health in subjects subjected to bed rest. Vision monitoring is thus currently performed in all NASA-conducted bed rest campaigns

Cromwell, Ronita L.↗
NASA NTRS2008

Human Space Flight Challenges: Get a Leg Up

This viewgraph presentation reviews some of the challenges that spaceflight imposes on the Human system. It describes four of the signs and symptoms of fluid shift in the astronaut when they fly in low earth orbit. It describes how the leg muscles influence blood flow It also outlines the four phases of "fluid shift" and where the majority of the central volume of blood is located in the body And it reviews other changes to the body systems as a result of Fluid Shift

Lloyd, Charles W.↗
NASA NTRS1980

Fluid-electrolyte shifts and thermoregulation - Rest and work in heat with head cooling

The effects of head cooling on thermoregulation and associated plasma fluid and electrolyte shifts during rest and submaximal exercise in the heat are investigated. Thermoregulatory responses and plasma volume were measured in four male subjects fitted with liquid-cooled neoprene headgear during 60 min of rest, 60 min of ergometer exercise at 45% maximal oxygen uptake and 30 min of recovery in the supine position at 40.1 C and 40% relative humidity. It is found that, compared to control responses, head cooling decreased thigh sweating and increased mean skin temperature at rest and attenuated increases in thigh sweating, heart rate, rectal temperature and ventilation during exercise. During recovery, cooling is observed to facilitate decreases in sweat rate, heart rate, rectal temperature and forearm blood flow and enhance the increase in average temperature. Cooling had no effect on plasma protein, osmotic or electrolyte shifts, and decreased plasma volume losses. The findings indicate the effectiveness of moderate head cooling for the improvement of human performance during exercise in heat.

Greenleaf, J. E.↗
NASA NTRS2011

CO2 Effects in Space: Relationship to Intracranial Hypertension

This slide presentation reviews the effects of enhanced exposure to CO2 on Earth and in space. The effects of enhanced exposure to CO2 are experienced in almost all bodily systems. In space some of the effects are heightened due to the fluid shifts to the thorax and head. This fluid shift results in increased intracranial pressure, congested cerebral circulation, increased Cerebral Blood Flow (CBF) and Intravenous dilatation. The mechanism of the effect of CO2 on CBF is diagrammed, as is the Cerebrospinal Fluid (CSF) production. A listing of Neuroendocrine targets is included.

Alexander, David J.↗
NASA NTRS2014

Focal Gray Matter Plasticity as a Function of Long Duration Head Down Tilted Bed Rest: Preliminary Results

Long duration spaceflight (i.e., 22 days or longer) has been associated with changes in sensorimotor systems, resulting in difficulties that astronauts experience with posture control, locomotion, and manual control. The microgravity environment is an important causal factor for spaceflight induced sensorimotor changes. Whether these sensorimotor changes are solely related to peripheral changes from reduced vestibular stimulation, body unloading, body fluid shifts or that they may be related to structural and functional brain changes is yet unknown. However, a recent study reported associations between microgravity and flattening of the posterior eye globe and protrusion of the optic nerve [1] possibly as the result of increased intracranial pressure due to microgravity induced bodily fluid shifts [3]. Moreover, elevated intracranial pressure has been related to white matter microstructural damage [2]. Thus, it is possible that spaceflight may affect brain structure and thereby cognitive functioning. Long duration head down tilt bed rest has been suggested as an exclusionary analog to study microgravity effects on the sensorimotor system [4]. Bed rest mimics microgravity in body unloading and bodily fluid shifts. In consideration of the health and performance of crewmembers both in- and post-flight, we are conducting a prospective longitudinal 70-day bed rest study as an analog to investigate the effects of microgravity on brain structure [5]. Here we present results of the first six subjects. Six subjects were assessed at 12 and 7 days before-, at 7, 30, and ~70 days in-, and at 8 and 12 days post 70 days of bed rest at the NASA bed rest facility in UTMB, Galveston, TX, USA. At each time point structural MRI scans (i.e., high resolution T1-weighted imaging and Diffusion Tensor Imaging (DTI)) were obtained using a 3T Siemens scanner. Focal changes over time in gray matter density were assessed using the voxel based morphometry 8 (VBM8) toolbox under SPM. Longitudinal processing in VBM8 includes linear registration of each scan to the mean of the subject and subsequently transforming all scans in to MNI space by applying the warp from the mean subject to MNI to the individual gray matter segmentations. Modulation was applied so that all images represented the volume of the original structure in native space. Voxel wise analysis was carried out on the gray matter images after smoothing, using a flexible factorial design with family wise error correction. Focal changes in white matter microstructural integrity were assessed using tract based spatial statistics (TBSS) as part of FMRIB software library (FSL). TBSS registers all DTI scans to standard space. It subsequently creates a study specific white matter skeleton of the major white matter tracts. For each subject, for each DTI metric (i.e. fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD)), the maximum value in a line perpendicular to the skeleton tract is projected to the skeleton. Non-parametric permutation based t-tests and ANOVA's were used for voxel-wise comparison of the skeletons. For both VBM and TBSS, comparison of pre bed rest measurements did not show significant differences. VBM analysis revealed decreased gray matter density in bilateral areas including the frontal medial cortex, the insular cortex and the caudate (see Figure) from 'pre to in bed rest'. Over the same time period, there was an increase in gray matter density in the cerebellum, occipital-, and parietal cortex, including the precuneus (see Figure). The majority of these changes did not recover from 'during to post bed rest'. TBSS analysis did not reveal significant changes in white matter microstructural integrity after correction for multiple comparisons. Uncorrected analyses (p<.015) revealed an increase in RD in the cerebellum and brainstem from pre bed rest to the first week in bed rest that did not recover post bed rest. Extended bed rest, which is an analog for microgravity, can result in gray matter changes and potentially in microstructural white matter changes in areas that are important for neuro motor behavior and cognition. These changes did not recover at two weeks post bed rest. Whether the effects of bed rest wear off at longer times post bed rest, and if they are associated with behavior are important questions that warrant further research.

Koppelmans, V.↗
NASA NTRS1987

Early Fluid and Protein Shifts in Men During Water Immersion

High precision blood and plasma densitometry was used to measure transvascular fluid shifts during water immersion to the neck. Six men (28-49 years) undertook 30 min of standing immersion in water at 35.0 +/- 0.2 C; immersion was preceded by 30 min control standing in air at 28 +/- 1 C. Blood was sampled from an antecubital catheter for determination of Blood Density (BD), Plasma Density (PD), Haematocrit (Ht), total Plasma Protein Concentration (PPC), and Plasma Albumin Concentration (PAC). Compared to control, significant decreases (p less than 0.01) in all these measures were observed after 20 min immersion. At 30 min, plasma volume had increased by 11.0 +/- 2.8%; the average density of the fluid shifted from extravascular fluid into the vascular compartment was 1006.3 g/l; albumin moved with the fluid and its albumin concentration was about one-third of the plasma protein concentration during early immersion. These calculations are based on the assumption that the F-cell ratio remained unchanged. No changes in erythrocyte water content during immersion were found. Thus, immersion-induced haemodilution is probably accompanied by protein (mainly albumin) augmentation which accompanies the intra-vascular fluid shift.

Hinghofer-Szalkay, H.↗
NASA NTRS1977

Heat Acclimation and Water-Immersion Deconditioning: Fluid Electrolyte Shifts with Tilting

One of the major problems encountered by astronauts exposed to space flight is a reduction of orthostatic tolerance on return to earth. Many studies have been performed in an attempt to define the physiologic mechanism of orthostatic intolerance and to develop some remedial treatment. Exercise training does not appear to enhance orthostatic tolerance . In contrast, heat acclimation (i.e., exercise training in the heat) has been reported to enhance orthostatic tolerance. Since plasma volume increases with both exercise training and heat acclimation, it is not clear what role fluid and electrolytes play in determining tolerance to hydrostatic pressure. The purpose of this study was to compare the effects of exercise training in a cool environment and heat acclimation on resting plasma volume (PV) and the ensuing fluid and electrolyte shifts which occur during head-up tilting before and after water immersion deconditioning.

Conertino, V. A.↗
NASA NTRS2001

Changes in gene expression and signal transduction in microgravity

Studies from space flights over the past three decades have demonstrated that basic physiological changes occur in humans during space flight. These changes include cephalic fluid shifts, loss of fluid and electrolytes, loss of muscle mass, space motion sickness, anemia, reduced immune response, and loss of calcium and mineralized bone. The cause of most of these manifestations is not known and until recently, the general approach was to investigate general systemic changes, not basic cellular responses to microgravity. This laboratory has recently studied gene growth and activation of normal osteoblasts (MC3T3-El) during spaceflight. Osteoblast cells were grown on glass coverslips and loaded in the Biorack plunger boxes. The osteoblasts were launched in a serum deprived state, activated in microgravity and collected in microgravity. The osteoblasts were examined for changes in gene expression and signal transduction. Approximately one day after growth activation significant changes were observed in gene expression in 0-G flight samples. Immediate early growth genes/growth factors cox-2, c-myc, bcl2, TGF beta1, bFGF and PCNA showed a significant diminished mRNA induction in microgravity FCS activated cells when compared to ground and 1-G flight controls. Cox-1 was not detected in any of the samples. There were no significant differences in the expression of reference gene mRNA between the ground, 0-G and 1-G samples. The data suggest that quiescent osteoblasts are slower to enter the cell cycle in microgravity and that the lack of gravity itself may be a significant factor in bone loss in spaceflight. Preliminary data from our STS 76 flight experiment support our hypothesis that a basic biological response occurs at the tissue, cellular, and molecular level in 0-G. Here we examine ground-based and space flown data to help us understand the mechanism of bone loss in microgravity.

manned↗
NASA NTRS1998

Effects of microgravity on osteoblast growth

Studies from space flights over the past two decades have demonstrated that basic physiological changes occur in humans during space flight. These changes include cephalic fluid shifts, loss of fluid and electrolytes, loss of muscle mass, space motion sickness, anemia, reduced immune response, and loss of calcium and mineralized bone. The cause of most of these manifestations is not known and until recently, the general approach was to investigate general systemic changes, not basic cellular responses to microgravity. Recently analyzed data from the 1973-1974 Skylabs disclose that there is a rise in the systemic hormone, cortisol, which may play a role in bone loss in flight. In two flights where bone growth was measured (Skylabs 3 and 4), the crew members had a significant loss of calcium accompanied by a rise in 24 hour urinary cortisol during the entire flight period. In ground-based work on osteoblasts, we have demonstrated that equivalent amounts of glucocorticoids can inhibit osteoblast cell growth. In addition, this laboratory has recently studied gene growth and activation of mouse osteoblasts (MC3T3-E1) during spaceflight. Osteoblast cells were grown on glass coverslips, loaded in the Biorack plunger boxes 18 hours before launch and activated 19 hours after launch in the Biorack incubator under microgravity conditions. The osteoblasts were launched in a serum deprived state, activated and collected in microgravity. Samples were collected at 29 hours after sera activation (0-g, n=4; 1-g, n=4). The osteoblasts were examined for changes in gene expression and cell morphology. Approximately one day after growth activation, remarkable differences were observed in gene expression in 0-g and 1-g flight samples. The 0-g activated cells had increased c-fos mRNA when compared to flight 1-g controls. The message of immediate early growth gene, cox-2 was decreased in the microgravity activated cells when compared to ground or 1-g flight controls. Cox-1 was not detected in any of the samples. There were no significant differences in the expression of actin mRNA between the 0-g and 1-g samples. These data indicate that quiescent osteoblasts are slower to enter the cell cycle in microgravity, suggesting that the force of gravity itself may be a significant factor in bone loss in spaceflight. Preliminary data from our STS 76 flight experiment support our hypothesis that a basic biological response occurs at the tissue, cellular, and molecular level in 0-g. Here we examine ground-based and space flown data on osteoblast growth in ground-based experiments mimicking space flight conditions and in microgravity to simulate lack of gravity stress to help us understand the mechanism of bone loss by experiments.

NASA Experiment Number 9403056↗
NASA NTRS1993

Review of the biological effects of weightlessness on the human endocrine system

Studies from space flights over the past two decades have demonstrated that there are basic physiological changes in humans during space flight. These changes include cephalad fluid shifts, loss of fluid and electrolytes, loss of muscle mass, space motion sickness, anemia, reduced immune response, and loss of calcium and mineralized bone. The cause of most of these manifestations is not known but the general approach has been to investigate systemic and hormonal changes. However, data from the 1973-1974 Skylabs, Spacelab 3 (SL-3), Spacelab D-I (SL-DI), and now the new SLS-1 missions support a more basic biological response to microgravity that may occur at the tissue, cellular, and molecular level. This report summarizes ground-based and SLS-1 experiments that examined the mechanism of loss of red blood cell mass in humans, the loss of bone mass and lowered osteoblast growth under space flight conditions, and loss of immune function in microgravity.

STS-40 Shuttle Project↗
NASA NTRS2016

Bringing Gravity to Space

This panel will present NASA's plans for ongoing and future research to define the requirements for Artificial Gravity (AG) as a countermeasure against the negative health effects of long-duration weightlessness. AG could mitigate the gravity-sensitive effects of spaceflight across a host of physiological systems. Bringing gravity to space could mitigate the sensorimotor and neuro-vestibular disturbances induced by G-transitions upon reaching a planetary body, and the cardiovascular deconditioning and musculoskeletal weakness induced by weightlessness. Of particular interest for AG during deep-space missions is mitigation of the Visual Impairment Intracranial Pressure (VIIP) syndrome that the majority of astronauts exhibit in space to varying degrees, and which presumably is associated with weightlessness-induced fluid shift from lower to upper body segments. AG could be very effective for reversing the fluid shift and thus help prevent VIIP. The first presentation by Dr. Charles will summarize some of the ground-based and (very little) space-based research that has been conducted on AG by the various space programs. Dr. Paloski will address the use of AG during deep-space exploration-class missions and describe the different AG scenarios such as intra-vehicular, part-of-vehicle, or whole-vehicle centrifugations. Dr. Clement will discuss currently planned NASA research as well as how to coordinate future activities among NASA's international partners. Dr. Barr will describe some possible future plans for using space- and ground-based partial-G analogs to define the relationship between physiological responses and G levels between 0 and 1. Finally, Dr. Stenger will summarize how the human cardiovascular system could benefit from intermittent short-radius centrifugations during long-duration missions.

Norsk, P.↗
NASA NTRS1977

Comparison of susceptibility to motion sickness during rotation at 30 rpm in the earth-horizontal, 10 deg head-up, and 10 deg head-down positions

Normal persons rotated about an earth-horizontal axis vary in their susceptibility to motion sickness. An experimental study was conducted to measure intraindividual differences in susceptibility in 12 subjects when rotated 10 deg head up and 10 deg head down as well as in the horizontal position. Subjects assumed the test-position 60 min prior to rotation, thus providing an opportunity for translocation of body fluids. Physiological and psychological measurements were conducted throughout the experiment. There were no intraindividual differences in susceptibility to motion sickness in the three positions tested, although there were significant differences in vital capacity, demonstrating the expected fluid shifts. It was concluded that, in the sample of subjects tested, short-term effects of fluid shifts greater than those that would be manifested in zero gravity had no definite effect on motion sickness susceptibility.

Graybiel, A.↗
NASA NTRS2015

The Visual Impairment Intracranial Pressure Syndrome in Long Duration NASA Astronauts: An Integrated Approach

The Visual Impairment Intracranial Pressure (VIIP) syndrome is currently NASA's number one human space flight risk. The syndrome, which is related to microgravity exposure, manifests with changes in visual acuity (hyperopic shifts, scotomas), changes in eye structure (optic disc edema, choroidal folds, cotton wool spots, globe flattening, and distended optic nerve sheaths). In some cases, elevated cerebrospinal fluid pressure has been documented postflight reflecting increased intracranial pressure (ICP). While the eye appears to be the main affected end organ of this syndrome, the ocular affects are thought to be related to the effect of cephalad fluid shift on the vascular system and the central nervous system. The leading hypotheses for the development of VIIP involve microgravity induced head-ward fluid shifts along with a loss of gravity-assisted drainage of venous blood from the brain, both leading to cephalic congestion and increased ICP. Although not all crewmembers have manifested clinical signs or symptoms of the VIIP syndrome, it is assumed that all astronauts exposed to microgravity have some degree of ICP elevation in-flight. Prolonged elevations of ICP can cause long-term reduced visual acuity and loss of peripheral visual fields, and has been reported to cause mild cognitive impairment in the analog terrestrial population of Idiopathic Intracranial Hypertension (IIH). These potentially irreversible health consequences underscore the importance of identifying the factors that lead to this syndrome and mitigating them.

Otto, C. A.↗
NASA NTRS1984

Physiological responses to prolonged bed rest and fluid immersion in humans

For many centuries, physicians have used prolonged rest in bed and immersion in water in the treatment of ailments and disease. Both treatments have positive remedial effects. However, adverse physiological responses become evident when patients return to their normal daily activities. The present investigation is concerned with an analysis of the physiological changes during bed rest and the effects produced by water immersion. It is found that abrupt changes in body position related to bed rest cause acute changes in fluid compartment volumes. Attention is given to fluid shifts and body composition, renal function and diuresis, calcium and phosphorus metabolism, and orthostatic tolerance. In a discussion of water immersion, fluid shifts are considered along with cardiovascular-respiratory responses, renal function, and natriuretic and diuretic factors.

Greenleaf, J. E.↗
NASA NTRS2016

A Year in Space: Early Results and Lessons Learned from the First Year-Long Expedition Aboard the International Space Station

Two ISS crewmembers recently completed the first year-long orbital stay in two decades. International cooperation was central to the success of Mikhail Kornienko from Russia and Scott Kelly from the United States. Their expedition leveraged current mission experience and capitalized on recent advances in health monitoring technology. This unique effort began in 2012 when the program managers of the ISS partner nations adopted two separate goals: greater multilateral cooperation to increase efficiency of inflight research and a year-long expedition to gain familiarity with in-flight durations approaching that required for a Mars mission. These goals were unified when a set of bilateral Russian and American human research investigations was assigned to the year-long mission, augmented by additional investigations from Europe and Japan. For example, Kelly was assigned 18 investigations (twice the complement on standard six-month missions) including two joint U.S.-Russian studies, and two Russian and two Japanese studies. The core set of American investigations was a repetition of six studies Kelly had done on his previous six-month ISS mission, to allow a direct comparison of physiological and behavioral responses of the longer and shorter durations in this single individual. The remainder of his assignments plus those of Kornienko were drawn from currently active national investigations documenting human adaptation to long-duration spaceflight factors or effectiveness of countermeasures against known deleterious adaptations. The two joint U.S.-Russian investigations were the flagship biomedical studies of the year-long expedition. The "Fluid Shifts" study collocated American research equipment alongside a Russian operational stressor device to document the pattern and impacts of the headward fluid shift long known to occur in weightlessness, including its role in ocular changes recently observed in some astronauts. The "Field Test" study investigated the ability of the astronaut and cosmonaut to perform rudimentary tasks requiring sensorimotor coordination immediately after landing to define human capabilities soon after landing on Mars after an extended transit. Both investigations were highly successful in large part to the thorough integration of the implementation processes of the two partners. Kelly's assignment as the one-year crewmember also provided a serendipitous opportunity for the "Twins Study" comparing changes in his body at the genetic level with those occurring on Earth in his identical twin brother Mark Kelly. Data analysis from this expedition will commence in earnest after frozen in-flight samples are delivered to Earth in May aboard a commercial cargo spacecraft. Detailed results are expected in early 2017. Preliminary results and implementation improvements will be reviewed in this presentation.

Charles, J. B.↗