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NASA NTRS2015

NASA Astronaut Occupational Surveillance Program and Lifetime Surveillance of Astronaut Health, LSAH, Astronaut Exposures and Risk in the Terrestrial and Spaceflight Environment

United States Astronauts have a very unique occupational exposure profile. In order to understand these risks and properly address them, the National Aeronautics and Atmospheric Administration, NASA, originally created the Longitudinal Study of Astronaut Health, LSAH. The first LSAH was designed to address a variety of needs regarding astronaut health and included a 3 to 1 terrestrial control population in order to compare United States "earth normal" disease and aging to that of a microgravity exposed astronaut. Over the years that program has been modified, now termed Lifetime Surveillance of Astronaut Health, still LSAH. Astronaut spaceflight exposures have also changed, with the move from short duration shuttle flights to long duration stays on international space station and considerable terrestrial training activities. This new LSAH incorporates more of an occupational health and medicine model to the study of occupationally exposed astronauts. The presentation outlines the baseline exposures and monitoring of the astronaut population to exposures, both terrestrial, and in space.

Keprta, Sean R.↗
NASA NTRSDate not supplied

Watching Without Seeing a Tool to Surveil Astronaut Health Outcomes While Maintaining Astronaut Medical Privacy

BACKGROUND The Privacy Act of 1974 regulates the use a nd disclosure of personally identifiable information by US Federal agencies. The Act applies to biographical, financial, a nd other identity-linked information, a s well a s personal health information (PHI). As such, the use of astronaut PHI is limited to authorized personnel for preapproved uses, with data reporting often limited to aggregated information about groups. These limitations on the use a nd reporting of astronaut PHI complicates surveillance efforts, wherein epidemiologists a t the National Aeronautics and Space Administration (NASA)monitor the incidence of targeted health conditions in the astronaut population, or to discover emerging trends of aging and disease. Stratification on one or more covariates –particularly time-period, sex, a nd mission participation –can lead to extremely small datasets such that the reporting of results is potentially attributable to individuals. An additional challenge is the small size of the astronaut population, both in terms of numbers of individuals a s well a s in terms of density of exposure time. Such small datasets yield volatile rate estimates that are difficult to interpret. To a id the epidemiological surveillance efforts, a surveillance tool is required that can (a) satisfy the need for rapid computation of condition-specific incidence and mortality rates; (b) improve the statistical estimates of these estimated rates; and (c) maintain astronaut privacy. Here we describe a nd demonstrate such a tool. METHODS We devised a system that models incidence a nd mortality rates rather than calculating them directly. This ha s the advantage of using all the available data to derive the estimates, lea ding to rates that a re not attributable to any one individual, a nd a re a s numerically stable a s they can be given the extremely limited data. The system models disease endpoints using a Poisson regression model with exposure density (measured in person-years) a s a n offset term. By doing so the model is estimating event counts per person-year, equivalent to modeling the rates directly. It uses a standard (pre-specified)set of covariates; the system does not engage in “model-building” as model parsimony is not the goa l. Instead, it is explicitly recognized that if a covariate is not statistically significant a nd not a confounder then it will likely have very little effect on the estimate of the incidence a nd mortality rates. Users are able to specify the disease endpoint of interest and the covariates over which they would like to stratify. The system then uses the resulting model to compute the estimated rates for the user-chosen configuration of variables as visualizes those either over an age range within a specified time-period, or over time for astronauts with a specified age range. RESULTS The first iteration of the tool computes incidence a nd mortality rates for cardiovascular conditions and cancers. Code ha s been developed to retrieve the appropriate data from the IMPALA analysis platform, compute the models for incidence a nd mortality, a nd then use those models to generate the corresponding rate curves. A companion graphical user interface allows the user to specify the curves and visualize the results. CONCLUSIONS It is important to note that the rapid surveillance tool described here is neither meant to be a definitive assessment of the incidence or mortality of any particular disease or condition in the astronaut population, nor is it meant to be used for research purposes. Rather, it is meant as an early indicator that in-depth investigation may be warranted. By automating a repetitive process and leveraging carefully curated astronaut health outcomes, the tool makes possible a rapid “first look” into known areas of concern, and, if used judiciously, may surface new areas of concern for long-term astronaut health. This work is supported in part by the Translational Research Institute for Space Health (TRISH) through NASA Cooperative Agreement NNX16AO69A.

R J Reynolds↗
NASA NTRS2000

Monitoring Astronaut Health at the Nanoscale Cellular Level Through the Eye

A user friendly goggles-like head-mounted device equipped with a suite of instruments for several non-invasive and quantitative medical evaluation of the eye, skin, and brain is desired for monitoring the health of astronauts during space travel and exploration of neighboring and distant planets. Real-time non-invasive evaluation of the different structures within the above organs can provide indices of the health of not just these organs, but the entire body. The techniques such as dynamic light scattering (for the early detection of uveitis, cholesterol levels, cataract, changes in the vitreous and possibly Alzheimer's disease), corneal autofluorescence (to assess extracellular matrix biology e.g., in diabetes), optical activity measurements (of anterior ocular fluid to evaluate blood-glucose levels), laser Doppler velocimetry (to assess retinal, optic nerve, and choroidal blood flow), reflectometry/oximetry (for assessing ocular and central nervous system oxygen metabolism), optical coherence tomography (to determine retinal tissue microstructure) and possibly scanning laser technology (for intraocular tissue imaging and scanning) will he integrated into this compact device. Skin sensors will also be mounted on the portion of the device in contact with the periocular region. This will enable monitoring of body temperature, EEG, and electrolyte status. This device will monitor astronaut health during long-duration space travel by detecting aberrations from pre-established "nonns", enabling prompt diagnosis and possibly the initiation of early preventative/curative therapy. The non-invasive nature of the device technologies permits frequent repetition of tests, enabling real-time complete crew health monitoring. This device may ultimately be useful in tele-medicine to bring modern healthcare to under-served areas on Earth as well as in so-called "advanced" care settings (e.g. diabetes in the USA).

Ansari, Rafat R.↗
NASA NTRS1993

The value and potential of animal research in enabling astronaut health - Transition from Spacelab to Space Station Freedom

Maintaining astronaut health is a critical aspect of human space exploration. Three decades of space research have demonstrated that microgravity produces significant physiological changes in astronauts. For long-duration missions, the possibility exists that these changes may prevent the achievement of full health and safety and may therefore require countermeasures. Meeting this goal depends on a strong biomedical foundation. Although much research is conducted with humans, some of the most critical work involves a necessary in-depth look into complex problem areas requiring invasive procedures using animals. Much of this research cannot be performed in humans within the bounds of accepted medical practice. A large portion of knowledge and experience in flying animals and applying the data to astronaut health has been obtained through the Spacelab experience and can be applied to a space station situation (expanded to accommodate necessary standardization and flexibility). The objectives of this paper are to (a) discuss the value and potential of animal research in answering critical questions to enable astronaut health for advanced missions, (b) discuss how previous Spacelab operational experience in animal studies can be applied to facilitate transition into a space station era, and (c) review capabilities of biological facilities projected for Space Station Freedom.

Garshnek, V.↗
NASA NTRS2011

The Lifetime Surveillance of Astronaut Health Newsletter

The June 2010 LSAH newsletter introduced the change from the Longitudinal Study of Astronaut Health research study to the new Lifetime Surveillance of Astronaut Health program (An Overview of the New Occupational Surveillance Program for the Astronaut Corps). Instead of performing research-focused retrospective analyses of astronaut medical data compared to a JSC civil servant control population, the new program is focused on prevention of disease and prospective identification and mitigation of health risks in each astronaut due to individual exposure history and the unique occupational exposures experienced by the astronaut corps. The new LSAH program has 5 primary goals: (1) Provide a comprehensive medical exam for each LSAH participant; (2) Conduct occupational surveillance; (3) Improve communication, data accessibility, integrity and storage; (4) Support operational and healthcare analyses; and (5) Support NASA research objectives. This article will focus primarily on the first goal, the comprehensive medical exam. Future newsletters will outline in detail the plans and processes for addressing the remaining program goals.

Lee, Lesley↗
NASA NTRS2013

The Lifetime Surveillance of Astronaut Health (LSAH) Project

From 1989-2010 NASA conducted a research study, the Longitudinal Study of Astronaut Health, to investigate the incidence of acute and chronic morbidity and mortality in astronauts and to determine whether their occupational exposures were associated with increased risk of death or disability. In 2004, the Institute of Medicine recommended that NASA convert the longitudinal study into an occupational health surveillance program and in 2010, NASA initiated the Lifetime Surveillance of Astronaut Health project. The new program collects data on astronaut workplace exposures, especially those occurring in the training and space flight environments, and conducts operational and health care analyses to look for trends in exposure and health outcomes. Astronaut selection and retention medical standards are rigorous, requiring an extensive clinical testing regimen. As a result, this employee population has contributed to a large set of health data available for analyses. Astronauts represent a special population with occupational exposures not typically experienced by other employee populations. Additionally, astronauts are different from the general population in terms of demographic and physiologic characteristics. The challenges and benefits of conducting health surveillance for an employee population with unique occupational exposures will be discussed. Several occupational surveillance projects currently underway to examine associations between astronaut workplace exposures and medical outcomes will be described.

Bopp, Eugenia↗
NASA NTRSDate not supplied

Using A Guided Interview to Create an Individual Exposure Profile for The Lifetime Surveillance of Astronaut Health (LSAH)

BACKGROUND To support NASA’s Lifetime Surveillance of Astronaut Health (LSAH) project, Individual Exposure Profiles (IEPs) were developed to record an astronaut’s pre-, in-, and post-NASA exposures. NASA astronauts were invited to participate in a one-time guided interview to review known hazard exposures and medical history documented in NASA records and to add new information not otherwise reported. The purpose of the IEP project was to determine if any significant information was gained from these interviews and identify potential trends in long-term health. METHODOLOGY The pre-filled exposure profile data was extracted from several sources including medical records, biographies, and LSAH records. The information that was pre-filled before the interview included occupational exposures prior to selection to the Astronaut Corps, during active astronaut career (e.g., EVA and ground-based training, on-orbit exposures), and after active career. The IEPs also contained relevant medical history (e.g., audiometry, illnesses, injuries) and significant non-occupational exposures. 189 interviews were conducted from 2012-2014. A Microsoft Access database was created to store the information collected in the IEPs before and after the interviews. The database houses the information from the IEPs to track the updates made to the original data. By analyzing which astronauts supplied additional information and which kinds of data were consistently added, potential gaps and trends in missing data may be identified. In designing the database, an efficient structure was implemented for ease of inputting data and to create variables that would generate quantifiable data. Creating standardized variables within the structure helped ease the process of inputting, organizing data, and analyzing data. Additional updates/data were denoted and were categorized by type of update. The categories identified were “Confirmed”, “Confirmed & Supplemented”, “Supplemented”, “Denied”, “Denied & Supplemented”, and “Other”. STATISTICAL ANALYSIS AND RESULTS To assess frequency of exposure updates, descriptive statistics will be generated and stratified by relevant factors such as astronaut selection decade, age at selection, and program/era. Hypothesis testing will be performed to understand the associations between updates to exposure information and population characteristics.

Astronaut health↗
NASA NTRS2011

Astronaut Health Participant Summary Application

The Longitudinal Study of Astronaut Health (LSAH) Participant Summary software captures data based on a custom information model designed to gather all relevant, discrete medical events for its study participants. This software provides a summarized view of the study participant s entire medical record. The manual collapsing of all the data in a participant s medical record into a summarized form eliminates redundancy, and allows for the capture of entire medical events. The coding tool could be incorporated into commercial electronic medical record software for use in areas like public health surveillance, hospital systems, clinics, and medical research programs.

Johnson, Kathy↗
NASA NTRS2023

The Effects of Space Flight and Microgravity Exposure on Female Astronaut Health and Performance

Over the past half century, our understanding of the physiological effects of space exploration and microgravity exposure have improved immensely. Microgravity causes incredible changes to the human body that increase risk of injury upon return to Earth and lunar/planetary egress scenarios. This is due to deconditioning of the cardiovascular and skeletal muscle systems that reduce aerobic capacity and muscular strength. With upcoming exploration class missions, such as NASA’s Artemis lunar exploration program which aims to send the first female astronaut to the lunar surface by 2030, as well as a long-term goal of Martian exploration, maintaining astronaut health during extended-duration space flight is critical for achieving mission objectives. However, our understanding of these physiological implications due to microgravity are based primarily on flight studies of male astronauts and 1g bed rest analog study participants, with few investigations focusing specifically on females. Innate physiologic differences in endocrine signaling and reproductive function impact sex-dependent responses to various health conditions, treatments, and environmental factors in nearly every system in the body. Therefore, to assume comparable alterations in females in response to microgravity exposure may be inappropriate and consequentially, could lead to lasting impacts on female astronaut health and impact mission success. Moreover, differences in sex hormones may also influence the regulation of cardiovascular control during egress activity after space flight-induced deconditioning and blood volume loss (i.e., risk for orthostatic intolerance). Other potential physiological systems and factors related to musculoskeletal health and aerobic capacity that warrant investigation with respect to microgravity include endocrine/reproductive function, vascular control, bone mineral density/microarchitecture, and soft-tissue health. The purpose of this investigation is two-fold: 1) to summarize the data available from space flight and simulated bed rest analog exposures to begin addressing these gaps in knowledge regarding impacts to female astronaut health, and 2) to describe differences in demographic health characteristics, injury prevalence, and aerobic capacity and muscular strength in NASA female and male astronauts. Female astronauts make up 50% of Artemis-specific astronaut corps and the extent to which microgravity exposure impacts female cardiovascular and musculoskeletal health, and whether these alterations are consistent with their male counterparts, is inconclusive. With the growing inclusion of female astronauts in the NASA space program and the increased duration of missions beyond low Earth orbit, a greater understanding of the sex-specific adaptation to space travel will help determine the development of appropriate countermeasures for minimizing risk and maintaining health of all astronauts.

Female Astronaut↗
NASA NTRSDate not supplied

The Effects of Space Flight and Microgravity Exposure on Female Astronaut Health and Performance

Over the past half century, our understanding of the physiological effects of space exploration and microgravity exposure have improved immensely. Microgravity causes incredible changes to the human body that increase risk of injury upon return to Earth and lunar/planetary egress scenarios. This is due to deconditioning of the cardiovascular and skeletal muscle systems that reduce aerobic capacity and muscular strength. With upcoming exploration class missions, such as NASA’s Artemis lunar exploration program which aims to send the first female astronaut to the lunar surface by 2030, as well as a long-term goal of Martian exploration, maintaining astronaut health during extended-duration space flight is critical for achieving mission objectives. However, our understanding of these physiological implications due to microgravity are based primarily on flight studies of male astronauts and 1g bed rest analog study participants, with few investigations focusing specifically on females. Innate physiologic differences in endocrine signaling and reproductive function impact sex-dependent responses to various health conditions, treatments, and environmental factors in nearly every system in the body. Therefore, to assume comparable alterations in females in response to microgravity exposure may be inappropriate and consequentially, could lead to lasting impacts on female astronaut health and impact mission success. Moreover, differences in sex hormones may also influence the regulation of cardiovascular control during egress activity after space flight-induced deconditioning and blood volume loss (i.e., risk for orthostatic intolerance). Other potential physiological systems and factors related to musculoskeletal health and aerobic capacity that warrant investigation with respect to microgravity include endocrine/reproductive function, vascular control, bone mineral density/microarchitecture, and soft-tissue health. The purpose of this investigation is two-fold: 1) to summarize the data available from space flight and simulated bed rest analog exposures to begin addressing these gaps in knowledge regarding impacts to female astronaut health, and 2) to describe differences in demographic health characteristics, injury prevalence, and aerobic capacity and muscular strength in NASA female and male astronauts. Female astronauts make up 50% of Artemis-specific astronaut corps and the extent to which microgravity exposure impacts female cardiovascular and musculoskeletal health, and whether these alterations are consistent with their male counterparts, is inconclusive. With the growing inclusion of female astronauts in the NASA space program and the increased duration of missions beyond low Earth orbit, a greater understanding of the sex-specific adaptation to space travel will help determine the development of appropriate countermeasures for minimizing risk and maintaining health of all astronauts.

Female Astronaut↗
NASA NTRSDate not supplied

The Effects of Spaceflight and Microgravity Exposure on Female Astronaut Health and Performance

Over the past half century, our understanding of the physiological effects of space exploration and microgravity exposure have improved immensely. Microgravity causes incredible changes to the human body that increase risk of injury upon return to Earth and lunar/planetary egress scenarios. This is due to deconditioning of the cardiovascular and skeletal muscle systems that reduce aerobic capacity and muscular strength. With upcoming exploration class missions, such as NASA’s Artemis lunar exploration program which aims to send the first female astronaut to the lunar surface by 2030, as well as a long-term goal of Martian exploration, maintaining astronaut health during extended-duration space flight is critical for achieving mission objectives. However, our understanding of these physiological implications due to microgravity are based primarily on flight studies of male astronauts and 1g bedrest analog study participants, with few investigations focusing specifically on females. Innate physiologic differences in endocrine signaling and reproductive function impact sex-dependent responses to various health conditions, treatments, and environmental factors in nearly every system in the body. Therefore, to assume comparable alterations in females in response to microgravity exposure may be inappropriate and consequentially, could lead to lasting impacts on female astronaut health and impact mission success. Moreover, differences in sex hormones may also influence the regulation of cardiovascular control during egress activity after space flight-induced deconditioning and blood volume loss (i.e., risk for orthostatic intolerance). Other potential physiological systems and factors related to musculoskeletal health and aerobic capacity that warrant investigation with respect to microgravity include endocrine/reproductive function, vascular control, bone mineral density/microarchitecture, and soft-tissue health. The purpose of this investigation is two-fold: 1) to summarize the data available from space flight and simulated bedrest analog exposures to begin addressing these gaps in knowledge regarding impacts to female astronaut health, and 2) to describe differences in demographic health characteristics, injury prevalence, and aerobic capacity and muscular strength in NASA female and male astronauts. Female astronauts make up 50% of Artemis-specific astronaut corps and the extent to which microgravity exposure impacts female cardiovascular and musculoskeletal health, and whether these alterations are consistent with their male counterparts, is inconclusive. With the growing inclusion of female astronauts in the NASA space program and the increased duration of missions beyond low Earth orbit, a greater understanding of the sex-specific adaptation to space travel will help determine the development of appropriate countermeasures for minimizing risk and maintaining health of all astronauts.

Nicole Christine Strock↗
NASA NTRS2018

Neutrophil to Lymphocyte Ratio: A Prognostic Indicator for Astronaut Health

Short-term and long-term spaceflight missions can cause immune system dysfunction in astronauts. Recent studies indicate elevated white blood cells (WBC) and polymorphonuclear neutrophils (PMN) in astronaut blood, along with unchanged or reduced lymphocyte counts, and reduced T cell function, during short-(days) and long-(months) term spaceflight. A high PMN to lymphocyte ratio (NLR) can acts as a strong predictor of poor prognosis in cancer, and as a biomarker for subclinical inflammation in humans and chronic stress in mouse models, however, the NLR has not yet been identified as a predictor of astronaut health during spaceflight. For this, complete blood cell count data collected from astronauts and rodents that have flown for short- and long-term missions on board the International Space Station (ISS) was repurposed to determine the NLR pre-, in-, and post-flight. The results displayed that the NLR progressively increased during spaceflight in both human and mice, while a spike in the NLR was observed at post-flight landing, suggesting stress-induced factors may be involved. In addition, the ground-based chronic microgravity analog, hindlimb unloading in mice, indicated an increased NLR, along with induced myeloperoxidase expression, as measured by quantitative (q)PCR. The mechanism for increased NLR was further assessed in vitro using the NASA-developed rotating wall vessel (RWV) cell culture suspension system with human WBCs. The results indicated that simulated microgravity led to increased mature PMN counts, NLR profiles, and production of reactive oxygen species (ROS). Collectively, these studies show that an increased NLR is observed in spaceflight missions, and in chronic microgravity-analog simulation in mice, and that this effect may be potentiated by the oxidative stress response in blood cells under microgravity conditions. Furthermore, these results suggest that a disrupted NLR profile in spaceflight may further disrupt immune homeostasis, potentially causing chronic immune-mediated inflammatory diseases. Thus, we propose that the health status of astronauts during short- and long-term space missions can be monitored by their NLR profile, in addition to utilizing this measurement as a tool for interventions and countermeasure development to restore homeostatic immunity.

biomarker↗
NASA NTRS2023

The Lifetime Surveillance of Astronaut Health Newsletter

Welcome to the October 2023 issue of the Lifetime Surveillance of Astronaut Health (LSAH) Newsletter! This issue will showcase our Space Radiation Analysis Group (SRAG), highlighting their contributions towards keeping our astronauts safe during spaceflight.

Ronnie Rafanan↗
NASA NTRS2024

The Lifetime Surveillance of Astronaut Health Newsletter

Welcome to the October 2024 issue of the Lifetime Surveillance of Astronaut Health (LSAH) Newsletter. In this issue, we will introduce you to the outgoing LSAH/LSDA lead, Mary Van Baalen, PhD; share with you the history of the NASA Electronic Medical Record (EMR) Project, as well as provide you with additional information on the consent to re-use your Astronaut data and the application of the TREAT Act. Be sure to check out the Clinic Corner, HRP Corner, the Publications Corner, and a special Formers Corner where we share Travel Tips for your LSAH Exam travels!

Ronnie Rafanan↗
NASA NTRS2023

The Lifetime Surveillance of Astronaut Health Newsletter

Welcome to the April 2023 issue of the Lifetime Surveillance of Astronaut Health (LSAH) Newsletter! Along with the familiar subjects in previous issues, this issue will introduce two new sections: Clinic Corner, where Dr. Tim LaVan shares a brief status of the Flight Medicine Clinic, and Formers Corner, where we share images and captions submitted by you and your fellow crewmates!

Tim Lavan↗
NASA NTRS2024

Lifetime Surveillance of Astronaut Health Newsletter

Welcome to the April 2024 issue of the Lifetime Surveillance of Astronaut Health (LSAH) Newsletter. In this issue, we celebrate LSAH lead, Dr. Mary Wear’s retirement, inform you of the Apollo Records Synthesis Project (ARSP), and recap information shared at the 2024 Human Research Program (HRP) Investigators’ Workshop (IWS) by our LSAH Epidemiologists and NASA HRP team.

Anna C. Morgenthaler-Cejka↗