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At least 19 records

Relationship Between Carbon Dioxide Levels and Reported Congestion and Headaches on the International Space Station

Congestion is commonly reported during spaceflight, and most crewmembers have reported using medications for congestion during International Space Station (ISS) missions. Although congestion has been attributed to fluid shifts during spaceflight, fluid status reaches equilibrium during the first week after launch while congestion continues to be reported throughout long duration missions. Congestion complaints have anecdotally been reported in relation to ISS CO2 levels; this evaluation was undertaken to determine whether or not an association exists. METHODS: Reported headaches, congestion symptoms, and CO2 levels were obtained for ISS expeditions 2-31, and time-weighted means and single-point maxima were determined for 24-hour (24hr) and 7-day (7d) periods prior to each weekly private medical conference. Multiple imputation addressed missing data, and logistic regression modeled the relationship between probability of reported event of congestion or headache and CO2 levels, adjusted for possible confounding covariates. The first seven days of spaceflight were not included to control for fluid shifts. Data were evaluated to determine the concentration of CO2 required to maintain the risk of congestion below 1% to allow for direct comparison with a previously published evaluation of CO2 concentrations and headache. RESULTS: This study confirmed a previously identified significant association between CO2 and headache and also found a significant association between CO2 and congestion. For each 1-mm Hg increase in CO2, the odds of a crew member reporting congestion doubled. The average 7-day CO2 would need to be maintained below 1.5 mmHg to keep the risk of congestion below 1%. The predicted probability curves of ISS headache and congestion curves appear parallel when plotted against ppCO2 levels with congestion occurring at approximately 1mmHg lower than a headache would be reported. DISCUSSION: While the cause of congestion is multifactorial, this study showed congestion is associated with CO2 levels on ISS. Data from additional expeditions could be incorporated to further assess this finding. CO2 levels are also associated with reports of headaches on ISS. While it may be expected for astronauts with congestion to also complain of headaches, these two symptoms are commonly mutually exclusive. Furthermore, it is unknown if a temporal CO2 relationship exists between congestion and headache on ISS. CO2 levels were time-weighted for 24hr and 7d, and thus the time course of congestion leading to headache was not assessed; however, congestion could be an early CO2-related symptom when compared to headache. Future studies evaluating the association of CO2-related congestion leading to headache would be difficult due to the relatively stable daily CO2 levels on ISS currently, but a systematic study could be implemented on-orbit if desired.

Cole, Robert↗

The head and neck discomfort of autonomic failure: an unrecognized aetiology of headache

Information concerning the frequency, severity, character, location, duration, diurnal pattern of headache and ancillary symptoms were obtained in 25 patients with autonomic failure and 44 control subjects. Precipitating and ameliorating factors were identified. Autonomic failure patients had more head and neck discomfort than controls. Their discomfort was much more likely to localize in the occiput, nape of the neck and shoulder, compared with controls. There was a greater tendency for the discomfort to occur in the morning and after meals. It was sometimes less than 5 min in duration and was often associated with dimming, blurring, or tunnelling of vision. It was provoked by upright posture and relieved by lying down. Patients with severe autonomic failure and orthostatic hypotension often present with a posture-dependent headache or neck pain. Because the relationship of these symptoms to posture is often not recognized, the fact that these findings may signal an underlying autonomic disorder is underappreciated, and the opportunity to consider this aetiology for the headache may be missed.

NASA Discipline Regulatory Physiology↗

Safety and efficacy of peripheral nerve blocks to treat refractory headaches after aneurysmal subarachnoid hemorrhage – A pilot observational study

Objectives: Headache after aneurysmal subarachnoid hemorrhage (HASH) is common, severe, and often refractory to conventional treatments. Current treatment standards include medications including opioids, until the pain is mitigated. Peripheral nerve blocks (PNBs) may be an effective therapeutic option for HASH. We conducted a small before-and-after study of PNBs to determine safety, feasibility, and efficacy in treatment of HASH. Methods: We conducted a pilot before-and-after observational study and collected data for 5 patients in a retrospective control group and 5 patients in a prospective intervention PNB group over a 12-month period. All patients received a standard treatment of medications including acetaminophen, magnesium, gabapentin, dexamethasone and anti-spasmodics or anti-emetics as needed. Patients in the intervention group received bilateral greater occipital, lesser occipital, and supraorbital PNBs in addition to medications. The primary outcome was pain severity, measured by Numeric pain rating scale (NPRS). All patients were followed for 1 week following enrollment. Results: The mean ages in the PNB group and control group were 58.6 and 57.4, respectively. One patient in the control group developed radiographic vasospasm. Three patients in both groups had radiographic hydrocephalus and IVH, requiring external ventricular drain (EVD) placement. The PNB group had an average reduction in mean raw pain score of 2.76 (4.68, 1.92 p = 0.024), and relative pain score by 0.26 (0.48, 0.22 p = 0.026), compared to the control group. The reduction occurred immediately after PNB administration. Conclusion: PNB can be a safe, feasible and effective treatment modality for HASH. Further investigations with a larger sample size are warranted.

60 APPLIED LIFE SCIENCES↗

The Headache of Carbon Dioxide Exposures

Carbon dioxide (CO2), a natural product of human metabolism, accumulates quickly in sealed environments when humans are present, and can induce headaches, among other symptoms. Major resources are expended to control CO2 levels to concentrations that are tolerable to the crews of spacecraft and submersible craft. It is not practical to control CO2 levels to those found in the ambient environment on earth. As NASA looks ahead to long-duration missions conducted far from earth, difficult issues arise related to the management and effects of human exposure to CO2. One is the problem of pockets of CO2 in the habitat caused by excess generation of the gas in one location without a mechanism to purge the area with fresh air. This results in the crew rebreathing CO2 from their exhaled breath, exposing them to a much higher concentration of CO2 than whole-module measurements would suggest. Another issue is the potential increased sensitivity to CO2 in microgravity. For example, based on anecdotal information, it appears that space crews may be more susceptible than submarine crews to some of the subtle, yet adverse effects of CO2 exposure. Another issue, not unique to spaceflight, is the possibility of inter-individual differences in the susceptibility of crewmembers to CO2 exposure. Again, anecdotal reports from the International Space Station (ISS) crews suggest that certain individuals may experience a greater susceptibility. The implications associated with these issues are extremely important as NASA sets CO2 exposure limits that protect the crew from this compound s subtle adverse effects, without causing an unwarranted expenditure of resources to scrub CO2 from the habitat atmosphere.

James, John T.↗

Evaluation of Transient Pin-Stress Requirements for Spacecraft Launching in Lightning Environments. Pain Free Analysis to Alleviate Those Pin Stress Headaches

Spacecraft are generally protected from direct lightning attachment by encapsulation within the payload fairing of a launch vehicle and the ground structures that exist at the launch site. Regardless of where lightning strikes, potentially damaging indirect effects prevail from the coupling of electromagnetic fields into a loop created by outer shield of the payload umbilical. The energy coupled into individual spacecraft circuits is dependent on the umbilical current drive, the cable transfer impedance and the source/ load circuitry, and the reference potential used. Lightning induced transient susceptibility of the spacecraft avionics needs to be fully understood in order to define realistic re-test criteria in the event of a lightning occurrence during the launch campaign. Use of standards such as RTCA/DO-160 & SAE 5412 has some applicability but do not represent the indirect environment adequately. This paper evaluates the launch pad environments, the measurement data available, and computer simulations to provide pain-free analysis to alleviate the transient pin-stress headaches for spacecraft launching in Lightning environments.

Induced Transient↗

Programs, projects, and headaches

The role of the individual NASA space centers in the space science program is examined. The relationship between the space centers and the NASA headquarters is discussed.

Source record↗

Independent Validation of Specifications: A Coordination Headache

Large, complex projects face significant barriers to coordination and communication due to continuous, rapid changes during a project's life cycle. Such changes must be tracked, analyzed, and reconciled to ensure high quality in the end product, otherwise problems may get lost or ignored in the overall complexity. We report on 'work-in-progress' in the study of coordination problems between two independent, separate groups: software development and software analysis. We have begun to construct a taxonomy of coordination problems, which we illustrate with two scenarios. We briefly describe current attempts to introduce incremental improvements to coordination problems in such projects via World Wide Web tools. Based on actual project experiences, we plan to deploy such tools in a non-intrusive fashion to improve coordination and communication between software development groups.

Easterbrook, Steve↗

The Value of Data and Metadata Standardization for Interoperability in Giovanni Or: Why Your Product's Metadata Causes Us Headaches!

Giovanni is a data exploration and visualization tool at the NASA Goddard Earth Sciences Data Information Services Center (GES DISC). It has been around in one form or another for more than 15 years. Giovanni calculates simple statistics and produces 22 different visualizations for more than 1600 geophysical parameters from more than 90 satellite and model products. Giovanni relies on external data format standards to ensure interoperability, including the NetCDF CF Metadata Conventions. Unfortunately, these standards were insufficient to make Giovanni's internal data representation truly simple to use. Finding and working with dimensions can be convoluted with the CF Conventions. Furthermore, the CF Conventions are silent on machine-friendly descriptive metadata such as the parameter's source product and product version. In order to simplify analyzing disparate earth science data parameters in a unified way, we developed Giovanni's internal standard. First, the format standardizes parameter dimensions and variables so they can be easily found. Second, the format adds all the machine-friendly metadata Giovanni needs to present our parameters to users in a consistent and clear manner. At a glance, users can grasp all the pertinent information about parameters both during parameter selection and after visualization.

interoperability↗

The Relationship Between CO2 Levels and CO2 Related Symptoms Reported on the ISS

Medical Operations, Toxicology, and the Lifetime Surveillance of Astronaut Health collaborated to assess the association of CO2 levels on board the International Space Station and USOS crew reported symptoms inflight, i.e. headache and vision changes. Private Medical Conference (PMC) documents and the weekly Space Medicine Operations Team (SMOT) Notes were used to provide a robust data set of inflight medical events. All events and non‐events were documented independent of CO2 levels and other potential contributors. Average (arithmetic mean) and single point maximum ppCO2 was calculated for the 24 hours and 7 days prior to the PMC or SMOT date and time provided by LSAH. Observations falling within the first 7 days of flight (147) were removed from the datasets analyzed to avoid confounding with Space Adaptation Syndrome. The final analysis was based on 1716 observations. For headache, 46 headaches were observed. CO2 level, age at launch, time inflight, and data source were all significantly associated with headache. In particular, for each 1 mmHg increase in CO2, the odds of a crewmember reporting a headache doubled. For vision changes, 29 reports of vision changes were observed. These observations were not found to be statistically associated with CO2 levels as analyzed. While the incidence of headache has was not high (~3%), headaches may be an indicator of underlying increases in intracranial pressure, which may result likely from the synergy between CO2‐induced cerebral vasodilatation and decreased venous drainage in microgravity. Vision changes were inconsistently reported and as a result did not align appropriately with the CO2 levels. Further analysis is needed. Our results support ongoing efforts to lower the CO2 exposure limits in spacecraft.

VanBaalen, M.↗

Effects of Acute Exposures to Carbon Dioxide Upon Cognitive Functions

Large quantities of carbon dioxide (CO2) originate from human metabolism and typically, within spacecraft, remain about 10-fold higher in concentration than at the earth's surface. There have been recurring complaints by crew members of episodes of "mental viscosity" adversely affecting their performance, and there is evidence from the International Space Station (ISS) that associates CO2 levels with reports of headaches by crewmembers. Additionally, there is concern that CO2 may contribute to vision impairment and intracranial pressure that has been observed in some crewmembers. Consequently, flight rules have been employed to control the level of CO2 below 4 mm Hg, which is well below the existing Spacecraft Maximum Allowable Concentration (SMAC) of 10 mm Hg for 24-hour exposures, and 5.3 mm Hg for exposures of 7 to 180 days. However, the flight rule imposed limit, which places additional demands upon resources and current technology, still exceeds the lower bound of the threshold range for reportable headaches (2 - 5 mm Hg). Headaches, while sometime debilitating themselves, are also symptoms that can provide evidence that physiological defense mechanisms have been breached. The causes of the headaches may elicit other subtle adverse effects that occur at CO2 levels well below that for headaches. The concern that CO2 may have effects at levels below the threshold for headaches appears to be substantiated in unexpected findings that CO2 at concentrations below 2 mm Hg substantially reduced some cognitive functions that are associated with the ability to make complex decisions in conditions that are characterized by volatility, uncertainty, complexity, ambiguity, and delayed feedback. These are conditions that could be encountered by crews in off-nominal situations or during the first missions beyond low earth orbit. If findings of the earlier study are confirmed in crew-like subjects, our findings would provide additional evidence that CO2 may need to be controlled at levels that are well below current spacecraft limits. Our study will extend the earlier study to determine if crew-like subjects are similarly effected by CO2. In addition to employing the Strategic Management Simulation tool, we will use the Cognition battery of psychometric measures that are being utilized aboard the ISS. It will be important to learn, by using Cognition, if additional cognitive domains are sensitive to concentrations of CO2 at or below limits currently controlled by flight rules. While spaceflight Cognition data will greatly enhance the knowledge base related to inflight behavioral health and performance, some of the measures may be influenced by fatigue (related to sleep deprivation and or workload) and changes in circadian rhythms. Therefore our use of this battery of tests in a well-controlled, ground-based study that is free of these potential confounding influences will establish a baseline terrestrial data set against which Cognition data collected in flight may be assessed. The findings from this study will be useful to the NASA Toxicology Office and the National Research Council Committee on Toxicology, which assists NASA in setting environmental standards, for revision of the SMAC for CO2, and for designing further studies on effects of CO2 upon cognitive functions.

Scully, R. R.↗

Missing Data and Multiple Imputation: An Unbiased Approach

The default method of dealing with missing data in statistical analyses is to only use the complete observations (complete case analysis), which can lead to unexpected bias when data do not meet the assumption of missing completely at random (MCAR). For the assumption of MCAR to be met, missingness cannot be related to either the observed or unobserved variables. A less stringent assumption, missing at random (MAR), requires that missingness not be associated with the value of the missing variable itself, but can be associated with the other observed variables. When data are truly MAR as opposed to MCAR, the default complete case analysis method can lead to biased results. There are statistical options available to adjust for data that are MAR, including multiple imputation (MI) which is consistent and efficient at estimating effects. Multiple imputation uses informing variables to determine statistical distributions for each piece of missing data. Then multiple datasets are created by randomly drawing on the distributions for each piece of missing data. Since MI is efficient, only a limited number, usually less than 20, of imputed datasets are required to get stable estimates. Each imputed dataset is analyzed using standard statistical techniques, and then results are combined to get overall estimates of effect. A simulation study will be demonstrated to show the results of using the default complete case analysis, and MI in a linear regression of MCAR and MAR simulated data. Further, MI was successfully applied to the association study of CO2 levels and headaches when initial analysis showed there may be an underlying association between missing CO2 levels and reported headaches. Through MI, we were able to show that there is a strong association between average CO2 levels and the risk of headaches. Each unit increase in CO2 (mmHg) resulted in a doubling in the odds of reported headaches.

Foy, M.↗

Assessing the Health and Performance Risks of Reduced Carbon Dioxide Exposures and Resource Utilization

There have been a cluster of anecdotal reports that ISS crews are experiencing adverse health effects from on orbit exposure to CO2 levels well below the current Spacecraft Maximum Allowable Concentration (SMAC), which is 5.3 mmHg for 180 days of exposure. Developing evidence that this standard should be reduced to protect crew health is not a simple process. Dr. John James' team looked at the reports of headaches by the crew during private medical conferences and matched these with CO2 levels around the time of these reports. They then compared these to CO2 levels when there were no reports of headache. Using benchmark dose modeling, they found that the risk of headache could be predicted in concentration ranges from 2 to 5 mmHg. However, the data are incomplete because there were insufficient data when crews were exposed to concentrations below 2 mmHg. James' team also asked whether neuro-cognitive effects could be identified with CO2 exposure levels and found that these could not be associated with CO2 levels. Finally, they addressed the question of resource use to meet various levels of CO2 control if the SMACs were lowered. They estimated that CO2 restrictions approaching 2 mmHg would require substantial increases in power use and up-mass resources. They are refining their data on CO2 and headaches, and are looking at potential interactions of intracranial pressure and CO2 levels in eliciting ocular effects.

James, John T.↗

Effects of Acute Exposures to Carbon Dioxide upon Cognitive Functions

Carbon dioxide (CO2) originates from human metabolism and typically remains about 10-fold higher in concentration on the International Space Station (ISS) than at the earth's surface. There have been recurring complaints by crew members of episodes of "mental viscosity" adversely affecting their performance, and there is evidence from the ISS that associates CO2 levels with reports of headaches by crewmembers. Consequently, flight rules have been employed to control CO2 below 3 mm Hg, which is well below the existing Spacecraft Maximum Allowable Concentration (SMAC) of 10 mm Hg for 24-hour exposures, and 5.3 mm Hg for exposures of 7 to 180 days. Headaches, while sometime debilitating themselves, are also symptoms that can provide evidence that physiological defense mechanisms have been breached, and there is evidence that CO2 has effects at levels below the threshold for headaches. This concern appears to be substantiated in reports that CO2 at concentrations below 2 mm Hg substantially reduced some cognitive functions that are associated with the ability to make complex decisions in conditions that are characterized by volatility, uncertainty, complexity, ambiguity, and delayed feedback. These are conditions that could be encountered by crews in off-nominal situations or during the first missions beyond low earth orbit. Therefore, we set out to determine if decision-making under volatile, uncertain, confusing and ambiguous circumstances, where feedback is delayed or absent, is correlated with low levels of CO2 during acute exposures (several hours) in crew-like subjects and to determine if additional cognitive domains are sensitive to concentrations of CO2 at, or below, current ISS levels by using a test battery that is currently available onboard ISS. We enrolled 22 volunteers (8 females, 14 males) between the ages of 30-55 (38.8 +/- 7.0) years whose training and professional experience reflect that of the astronaut corps. Subjects were divided among 4 study groups. Exposures occurred in the 20-foot environmental chamber in Bldg 7 at JSC. Each group was exposed to each of four concentrations of CO2 (600, 1200, 2500, and 5000 ppm), and the exposure order was balanced across the groups which were randomly assigned to 4 possible complete exposure orders. Study participants and investigators were blinded to the exposure order. Each exposure lasted 4 hours and occurred on the same day each week for 4 consecutive weeks. Testing included the Strategic Management Simulation (SMS) methodology and the Cognition battery of psychometric measures that are being utilized aboard the ISS. Subjects participated in a familiarization session one week prior to the start of exposure sessions. Each exposure session followed the schedule noted in Figure 1 below. On the morning of each exposure, subjects completed the Cognition battery in a conference room at indoor ambient CO2 levels. Subjects then entered the exposure chamber and were acclimated to the environment for 15 minutes before completing another round of the Cognition battery. After a 20 minute rest, subject completed the approx.80 minute SMS. Subjects were allowed another 20 minute rest period before completing the final Cognition test battery in the exposure chamber. Subjects then returned to the conference room where they completed one final round of Cognition. Data from both testing methodologies are currently being analyzed and will be presented. Study investigators have not yet been unblinded to the coded exposure concentrations, but preliminary results suggest differences.

Ryder, V. E.↗

Visibility and annoyance of the phantom array effect varies with age and history of migraine

The phantom array effect (PAE) is a series of repeated images that may be perceived when a person moves their eyes in large saccades across a light source (or a specular reflection of that light source) that is modulating in output over time. Fifty-five people, including a group of 25 who experience migraine, evaluated the visibility and annoyingness of phantom arrays produced by 85 unique temporal light modulation waveforms (including sine, rectangular, complex and DC waveforms) generated using an LED placed against a black background. Those with migraine exhibited higher average visibility compared to those without migraine ( p = 0.019) and were relatively more sensitive at higher frequencies ( p < 0.001). Younger participants also found more stimuli to be visible ( p < 0.001). The threshold sensitivity function was similar to that developed for the phantom array visibility measure (PAVM), and PAVM was effective in predicting visibility ( R 2 = 0.87 for the relevant region of PAVM < 3). While those in the migraine group did not report seeing the PAE more often in everyday life at a statistically significant level, they reported being more annoyed by it and having more unwanted physiological responses (headaches, eye fatigue and distraction/disorientation). Members of the migraine group were also more likely to have changed their behaviour in architectural spaces (such as leaving a restaurant with ‘flickering’ lights). In the four hours after completing the experiment, 64% of the migraine group (vs. 19% of the non-migraine group) reported experiencing discomfort or an adverse reaction. In particular, 41% reported experiencing a headache (vs. 8% for those in the non-migraine group).

60 APPLIED LIFE SCIENCES↗