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NASA's Occupational Health Program Manager briefed attendees on current Agency initiatives and projects affecting Center Occupational Health personnel. Plans, insight, and expectations for the coming year will be discussed.
Reports of the health effects of handling cytotoxic drugs and compliance with guidelines for handling these agents are briefly reviewed, and studies using analytical and biological methods of detecting exposure are evaluated. There is little conclusive evidence of detrimental health effects from occupational exposure to cytotoxic drugs. Work practices have improved since the issuance of guidelines for handling these drugs, but compliance with the recommended practices is still inadequate. Of 64 reports published since 1979 on studies of workers' exposure to these drugs, 53 involved studies of changes in cellular or molecular endpoints (biological markers) and 12 described chemical analyses of drugs or their metabolites in urine (2 involved both, and 2 reported the same study). The primary biological markers used were urine mutagenicity, sister chromatid exchange, and chromosomal aberrations; other studies involved formation of micronuclei and measurements of urinary thioethers. The studies had small sample sizes, and the methods were qualitative, nonspecific, subject to many confounders, and possibly not sensitive enough to detect most occupational exposures. Since none of the currently available biological and analytical methods is sufficiently reliable or reproducible for routine monitoring of exposure in the workplace, further studies using these methods are not recommended; efforts should focus instead on wide-spread implementation of improved practices for handling cytotoxic drugs.
The authors examine the application of interpersonal human factors training on operating room (OR) personnel. Mortality studies of OR deaths and critical incident studies of anesthesia are examined to determine the role of human error in OR incidents. Theoretical models of system vulnerability to accidents are presented with emphasis on a systems approach to OR performance. Input, process, and outcome factors are discussed in detail.
The NASA policy on environmental health uses medical and environmental concepts to: (1) Determine the health status of employees; (2) prevent illness and promote good health among employees; and (3) identify and control factors that affect the health of personnel and quality of environment. Evaluation and control of physical, chemical, radiological and biological factors surrounding personnel and which represent physiological and psychological stresses and impairment are considered.
The Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC) demonstrated the value and potential of telemedicine using physician's assistants for providing quality health care delivery to people in a remote area. Generally, the program's achievements were to: (1) establish the feasibility of the STARPAHC concept in the delivery of health care; (2) gain information for developing health care systems for future manned spacecraft; (3) determine the constraints and capabilities involved in the interaction between physicians and non-physician health care personnel; (4) determine effectiveness of the STARPAHC technique; and (5) define the additional developments that are needed and/or most valuable to improving telemedicine and its exportable potential.
The purpose of this research was to obtain basic data on ethnic foods by studying dietary patterns and multicultural foods, and to determine nutritional status of multicultural space explorers by evaluating dietary, clinical, biochemical, and socioeconomic factors. The study will plan a significant role in providing nutritional research for space explorers of different ethnic backgrounds. It will provide scientific background information by bringing together cross cultural dietary and nutritional from different ethnic groups. Results will also help the health care personnel including physicians, dietitians, and nutritionists to better understand and assist patients from other cultures illness. Also, the results will provide data which will help in the development of future food plans for long duration flights involving manned exploration to Mars and lunar base colonies.
The Hummer Associates Exposure Control Plan is designed to reduce significant occupational exposure to bloodborne pathogens and infectious materials for Hummer Associates health care personnel. Under universal precautions, all patients and all body fluids are considered potentially infectious for bloodborne pathogens. Medical personnel need not be at increased risk if universal precautions are correctly understood and followed. This program covers all employees who could reasonably anticipate contact with blood or other potentially infectious materials during the performance of their job responsibilities. Although HIV and hepatitis B are mentioned most often, this program applies to all bloodborne diseases. The two main components needed to implement this program are universal precautions and engineering/work practice controls. This program covers all employees who may have occupational exposure to blood or other potentially infectious materials. Other aspects of this program are discussed.
Prolonged rest in bed has been utilized by physicians and other health-care workers to immobilize and confine patients for rehabilitation and restoration of health since time immemorial. The sitting or horizontal position is sought by the body to relieve the strain of the upright or vertical postures, for example during syncopal situations, bone fractures, muscle injuries, fatigue, and probably also to reduce energy expenditure. Most health-care personnel are aware that adaptive responses occurring during bed rest proceed concomitantly with the healing process; signs and symptoms associated with the former should be differentiated from those of the latter. Not all illnesses and infirmities benefit from prolonged bed rest. Considerations in prescribing bed rest for patients-including duration, body position, mode and duration of exercise, light-dark cycles, temperature, and humidity-have not been investigated adequately. More recently, adaptive physiological responses have been measured in normal, healthy subjects in the horizontal or slightly head-down postures during prolonged bed rest as analogs for the adaptive responses of astronauts exposed to the microgravity environment of outer and bed-rest research.
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The six domains that must be addressed in managing fatigue in operational settings are identified, and examples of how the aviation industry is dealing with the problems in each domain are given. Challenges facing healthcare providers in managing fatigue are also discussed.
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.
Physician-monitored central control facility communicating with remote site facilities staffed by paramedical personnel for public health care, based on aerospace experience
A toxicity profile is provided, of 187 toxic substances procured by NASA Lewis Research Center during a 3 1/2 year period, including 27 known or suspected carcinogens. The goal of the program is to assure that the center's health and safety personnel are aware of the procurement and use of toxic substances and to alert and inform the users of these materials as to the toxic characteristics and the control measures needed to ensure their safe use. The program also provides a continuing record of the toxic substances procured, who procured them, what other toxic substances the user has obtained in the past, and where similar materials have been used elsewhere at the center.
Scrubbers required to reduce N2O4 contamination of nitrogen vent gas streams to a safe level to preclude health hazard to personnel and to preclude adverse environmental effects were developed. The scrubber principle involved is to absorb and neutralize the N2O4 component in a closed circuit circulating water/chemical solution in a vertical counter-flow, packed-tower configuration. The operational and performance test requirements for the scrubbers consist of demonstrating that the exit gas contamination level from the scrubbers does not exceed 150 ppm oxidizer under any flow conditions up to 400 scfm with inlet concentrations of up to 100,000 ppm oxidizer. Several problems were encountered during the performance testing that led to a series of investigations and supplementary testing. It was finally necessary to change the scrubber liquors in oxidizer scrubber to successfully achieve performance requirements. The scrubbers, the test configuration, and the various tests performed are described.
This progress report documents research and development efforts performed from August 16, 1993 through August 15, 1994 on NASA Grant NAG8-240, 'Design and Application of Electromechanical Actuators for Deep Space Missions.' Since the submission of our last progress report in February 1994, our efforts have been almost entirely focused on final construction of the test stand and experiment design. Hence, this report is dedicated solely to these topics. However, updates on our research personnel and our health monitoring and fault management efforts are provided in this summary. Following this executive summary are two report sections. The first is devoted to the motor drive being constructed for the test stand. The thrust of the next section is the mechanical and hydraulic design and construction based on the planned experimental requirements. Following both major sections are three appendices.
The potential for buildup .of formaldehyde in closed space environments poses a direct health hazard to personnel. The National Aeronautic Space Agency (NASA) has established a maximum permitted concentration of 0.04 ppm for 7 to 180 days for all space craft. Early detection is critical to ensure that formaldehyde levels do not accumulate. above these limits. New sensor technologies are needed to enable real time,in situ detection in a compact and reusable form factor. Addressing this need,research into the use of reactive fluorescent dyes which reversibly bind to formaldehyde (liquid or gas) has been conducted to support the development of a formaldehyde.sensor. In the presence of formaldehyde the dyes' characteristic fluorescence peaks shift providing the basis for an optical detection. Dye responses to formaldehyde exposure were characterized; demonstrating the optical detection of formaldehyde in under 10 seconds and down to concentrations of 0.5 ppm. To .incorporate the dye .in.an optical sensor device requires. a means of containing and manipulating the dye. Multiple form factors using two dissimilar s~bstrates were considered to determine a suitable configuration. A prototype sensor was demonstrated and considerations for a field able sensor were presented. This research provides a necessary first step toward the development of a compact, reusable; real time optical formaldehyde sensor suitable for use in the U.S. space program,
It will be the responsibility of the long-duration space flight crew to take the actions necessary to maintain their health and well-being and to cope with medical emergencies without direct assistance from support personnel, including maintaining mental health and managing physiological and psychological changes that may impair decision making and performance. The Behavior and Performance Integrated Product Team at Johnson Space Center, working, within the Space Medicine, Monitoring, and Countermeasures Program, has identified critical questions pertaining to long-duration space crew behavioral health, psychological adaptation, human factors and habitability, and sleep and circadian rhythms. Among the projects addressing these questions are: the development of tools to assess cognitive functions during space missions; the development of a model of psychological adaptation in isolated and confined environments; tools and methods for selecting individuals and teams well-suited for long-duration missions; identification of mission-critical tasks and performance evaluation; and measures of sleep quality and correlation to mission performance.
Health and air quality are concerns in environmental justice (EJ) work, as air contaminants and their adverse health effects inequitably impact communities that are often underrepresented in research and litigation. Previously, the NASA DEVELOP National Program partnered with organizations that focus on a variety of health and air quality concerns and is now committed to partnering directly with EJ organizations to address inequities in health and air quality through the application of Earth observations. To support the establishment of future partnerships, DEVELOP is working to identify potential partners for further EJ research in the U.S. regarding health and air quality. This project conducted a needs assessment with EJ organizations to quantify their EJ involvement, geospatial capacity, and interest in collaborating with DEVELOP. A broad literature review identified multiple factors influencing health and air quality for potential DEVELOP projects: agriculture, heat, wildfires, industry and transportation infrastructure, and miscellaneous factors (e.g., burning, urban heat island effect, smoke plumes, truck exhaust, and noise). The needs assessment showed that 22% of the organizations interviewed were primarily concerned with transportation infrastructure, 21% with industry, 19% with heat, 10% with miscellaneous factors (e.g., resource mining, COVID-19), 8% with wildfires, 7% with agriculture, and 6% with resource mining. This will help inform the DEVELOP Program's pursuit of EJ projects relating to health and air quality. The team also created a directory for communities impacted by air pollutants to connect with geospatial resources and NASA Applied Sciences personnel for future EJ health and air quality work.