HPS Flashcards
What is the World-Health-Organization (WHO) Definition of “Health”
Status of complete physical, mental and social well-being and not only absence of disease or infirmity
Define “Space Life Sciences” and describe the three objectives of Space Life Sciences
Space life sciences are the study of these in space:
- Microorganisms (e.g. bacteria)
- Fungi
- Plants
- Animals
Objectives
- Enhance fundamental knowledge in cell biology and human physiology
- Understand the risks associated to living organisms while in space and how to protect the health of astronauts
- Develop advanced technological, pharmacological and physiological countermeasures for improving crew health
List the objectives of Operational and Life Science Research
Objectives of Operational Research
- Closing operational gaps and deficiencies
- Preparing for extended space-flights in changing environments
- Enhance the health care provisions pre-, in-, and post-flight
- Develop advanced technology and applications for health care
Objectives of Life Science Research
Life Sciences are especially devoted to the working of the living world - from bacteria and plants to animals and humans
Describe the risks associated with human space flight
- Bone and muscle loss
- Cardiovascular deconditioning
- Neurovestibular deconditioning
- Fluid redistribution
- Living in confinement
- Psychiatric/psychological Issues
- Microgravity
- Radiation
- Closed environmental system (oxygen/carbon dioxide, water, preserved food)
- Confined environment
- Separation from loved ones
- Dangerous environment
- Distance/time from safety
Identify the roles, functions and responsibilities of Life Sciences, Space Physiology and Space Medicine
Life Sciences
- Are especially devoted to the working of the living world -from bacteria and plants to animals and humans
- On earth, all living organisms have developed under constant exposure to 1 g gravity
- Space life sciences open the door to understanding ourselves, our evolution without the constraining barrier of gravity
- Space life sciences include physiology, medicine and biology
- Space life science explores questions about the role of gravity in the formation, evolution, maintenance and aging processes of life on Earth
- Besides microgravity, living organisms are also affected by radiation, isolation, confinement, and chronobiological aspects during spaceflight
Space Physiology
- To characterize the response to the space environment, 0-g or fractional g
- Looks at system levels in humans
- Knowledge base and foundation for Space Medicine
- Focus is investigational, from standpoint of operational deliverables
Space Medicine
- To solve medical problems encountered in space-flight and during an astronaut’s career: suggest solutions/countermeasures to those problems.
- Includes some adaptive changes, such as space motion sickness and environmental exposures
- Includes some non-pathologic changes, which become maladaptive upon return to Earth, e.g. bone-loss
- Focus is operational, from standpoint of mission impact
Define key terms in human medicine
Human Anatomy
Is the scientific study of the body’s structures
-
Gross Anatomy
Is the study of the larger structures and of the body, those visible without the aid of magnification -
Microscopic (histological) anatomy
Is the study of structures that can only be observed with the use of a microscope or other magnification devices
Human Physiology
Is the scientific study of the chemistry and physics of the structures of the body and the ways in which they work together to support the functions of life
Homeostasis
Is the state of steady internal conditions, such as body temperature, heart rate, blood pressure, blood volume…
Human Pathology
Is the scientific study of the cause, origin and nature of human disease or human sickness or system malfunctions
Human Medicine
Is the science of the diagnosis, treatment, and prevention of disease
Human Psychology
Is the scientific study of human behavior and mind, embracing all aspects of conscious and unconscious experience as well as though
Define applied research & basic research, and understand the Difference
Applied research
Research aimed at solving a specific problem, without necessarily including the cause or mechanism of the problem. Often used interchangeably with operational research. Usually conducted by space agencies themselves, often with the aid of external subject matter experts who submit proposals for projects that could help solve the problem, after the problem in need of solution is made public. Funded by the space agencies.
Fundamental or basic research
Investigation of fundamental life science questions in space. Could be physiology, biochemistry, microbiology, plants, any living organism or organ system or cell type. May not immediately relate to any particular spaceflight medical issue. Usually conducted by researchers at universities – may be funded by space agencies, or by agencies that fund other fundamental biomedical research, like the US National Institute of Health or the National Science Foundation. E.g animal research/in vivo
From internet:
“Applied research is primarily defined by its focus on providing a practical solution to a defined problem while basic research is primarily defined by its focus on expanding knowledge. In other words, basic research is theory-oriented, applied research is practical-oriented”
List the objectives of applied and operational research
Operational/applied research
- Based on results and developments of research activities
- Application oriented
- Operational Research enhances the medical services provided to humans living and working in space
Objectives
- Closing operational gaps and deficiencies
- Preparing for extended space-flights in changing environments
- Enhance the health care provisions pre-, in-, and post-flight
- Develop advanced technology and applications for health care
Describe the risks associated with human research in space
Medical risks related to technical systems
✓ mitigate risk through technical measures
Medical risks related to the space- and microgravity environment
✓ mitigate risk through countermeasures, monitoring
Medical risks related to the biological system
✓ mitigate risk through selection and preventive medical program
make sure astronauts are screened properly e.g. for cardiovascular health
Describe the use of applied research results
Objectives
- Enhance fundamental knowledge in biology and human physiology
- Understand the risks associated to living organisms while in space and how to protect the health of astronauts
- Advance technological, pharmacological and physiological countermeasures for improving crew health
Research activities
- Life Sciences (fundamental research)
- Non-human life sciences
- Human Life Sciences
- Space Physiology
- Effects of Space Environment
- Technical R&D to support science
Clinical Activities
- Use in Occupational Medicine
- Use in (Operational) Space Medicine
- Risk Mitigation
- Technical R&D to support operations
Describe fundamental cellular structures and their function
Nucleus
Information storage, replication, repair mechanisms
- Contains the DNA
Mitochondria
Metabolizes sugar and oxygen into energy
- *Membrane**
1) Energy storage - Permits electric potential
- Permits osmotic potentials
2) Homeostasis
- Stable internal environment
- Waste removal / excretion
Golgi apparatus
Transporting, modifying, and packaging proteins and lipids.
Also have repair mechanisms.
Ribosomes
Perform protein synthesis and have repair mechanisms
Describe metabolism
Metabolism is the sum of all life-sustaining chemical reactions within the cells of living organisms. Conversion of food into energy, building blocks and elimination of waste.
Aerobic metabolism
Complete Metabolism of glucose into carbon dioxide and water yields 2881 kJ/mol, or 38 total ATP molecules, 2 from glycolysis, 2 from the Krebs cycle, and about 34 from the electron transport system
Glucose + Oxygen > Carbon dioxide + Water + Energy
Anaerobic metabolism - glycolysis
breaks down glucose without oxygen
- Products are 2 pyruvates (carbohydrates) that can be further metabolized anaerobically, to lactate or alcohol
- Overall, 1 glucose produces 2 ATP molecules
- Found in very simple (old) organisms
- Like those that lived on Earth before there was significant oxygen in the atmosphere
List the major physiological systems and subsystems and their functions
Describe the main features of the musculo-skeletal system
Weight-Bearing Structures
Long bones, spinal column, pelvis
Anti-Gravity Muscles
Extension muscles, spinal erectors, inter-vertebral muscles, thigh and calf muscles
Gravity Receptors and Proprioceptors
Gravity acts as a reference for several control systems that provide our body or body-parts’ position in the environment
Skeletal Muscle
Is the largest tissue in the body and accounts for about 40-45% of total body mass
Bone
Is a rather active tissue, which is remodeled every 3-5 months by bone resorption (osteoclasts) and bone formation (osteoblasts)
Describe the main features of the cardiovascular system
As organisms increased in size (number of cells) the resupply of nutrients and elimination of waste became essential and led to the development of a vascular system and a pump mechanism. This system has three main functions: Transport of nutrients, oxygen, and hormones to cells throughout the body and removal of metabolic wastes (carbon dioxide, nitrogenous wastes)
Basic Anatomy
- Arteries
- Veins
- Arterioles/Venules
- Capillaries
- Lung?
The heart
- Heart rate
- Blood pressure
- Systolic pressure
peak pressure in arteries, end of cardiac cycle, ventricles contracting, depends on the strength of the heart muscle - Diastolic pressure
minimum pressure in arteries, beginning of cardiac cycle, ventricles filled with blood, depends on the resistance of the peripheral vessels
Blood flow Parameters
- Blood flow
The transportation of nutrients, hormones, metabolic wastes, O2 and CO2 throughout the body to maintain cell-level metabolism, the regulation of the pH, osmotic pressure and temperature of the whole body, and the protection from microbial and mechanical harms.
- Stroke volume
The volume of blood discharged from the left ventricle with each contraction
- Cardiac Output
The amount of blood pumped by the heart in one minute
Vascular System
- The heart pumps blood through blood vessels to deliver oxygen to and return carbon-dioxide from various organs
- Contraction of leg-muscles helps to pump blood toward the heart (venous return)
- Smooth muscle around vessels maintains blood pressure
Describe the main features of the respiratory system
The respiratory/pulmonary system provides for distribution of gas components “nutrients” (oxygen) and elimination of “waste“ (carbon-dioxide)
- Nasal Cavity
- Pharynx
- Larynx
- Trachea
- Bronchi
- Bronchioles
- Lungs
Explain the role of the autonomic nervous system
The autonomic nervous system is a component of the peripheral nervous system and a control system that acts largely unconsciously and regulates bodily functions, such as the heart rate, blood pressure, digestion, respiration, pupillary response, urination, and sexual arousal. It contains two anatomically distinct divisions:
- Sympathetic: “fight or flight”
- Parasympathetic “rest and digest”
In many cases, both of these systems have “opposite” actions where one system activates a physiological response and the other inhibits it (there are exceptions).
Describe the main features of the ear and vestibular system
- Semicircular Organ
- Otolith Organ
- Middle Ear
- Cochlea
Explain the function of the hearing & vestibular sensory system
Deep inside the ear, positioned just under the brain, is the inner ear. In the inner ear contains the cochlea and the vestibular system
Hearing: Cochlea
- The sound event progresses as a traveling wave through the cochlea from the oval to the round window
- The basilar membrane contains the Organ of Corti, which senses the acoustic event
- The frequency-specific perception is possible through decreasing stiffness of the membrane
Vestibular Organ
In most mammals, it is the sensory system that provides the leading contribution to the sense of balance and spatial orientation for the purpose of coordinating movement with balance
- 3-axis acceleration
- Translational acceleration
- Gravity dependent
- Connection to eye muscles
There are two sets of organs in the inner ear: the semicircular canals, which respond to rotational movements (angular acceleration); and the otolith organs within the vestibule, which respond to changes in the position of the head with respect to gravity (linear acceleration).
Otolith Organ & Function
Small stone-like structures of calcium-carbonate (called otoliths) are layered on top of and within a gel, which embeds the hair-cells. During acceleration, the inertia of the otolith bends the hair-cells and a signal is sent to the brain for further processing. The otolith organs are composed of two chambers that detect acceleration (gravity)
- Utricle chamber: detects horizontal acceleration
- Saccule chamber: detects vertical acceleration
Semicircular Canal Organ & Function
- The three semi-circular canals detect angular motion in three axis
- The canals are filled with a liquid, which is moved through the canal by the corresponding motion
- The detection of this flow is achieved through sensors in the ampulla of each canal
Additional receptors
Information is integrated with visual and vestibular information.
To distinguish different kinds of movement, the brain needs more information, coming from proprioceptors. These are:
- Stretch receptors
- located in muscles, joints and tendons
Describe the main features of the urinary system
Urinary System | Clearance of Waste Products
- The kidney clears the blood from water-soluble waste products
- Preserves most of the initially produced excess water by re-absorption
- Average urine production 1.5-2 L/day
- Some ions and minerals are excreted and may cause kidney stone-formation
Kidney | Filtration in Glomerulus
- ≈180 Lof primary filtrate is produced every day
- Complete plasma volume of 3 Lis filtrated every 25 minutes
- All extra-cellular fluid (14 L) is cleared 12 times per day
Kidney | Loop of Henle
- In order to preserve water and minerals, most of them are reabsorbed and the urine is concentrated
- The kidney produces hormones that signal its status to the rest of the body
Describe processes controlling blood volume and blood pressure
Blood pressure
- Rapid transition from lying down to sitting to upright requires that heart and vessels adjust very quickly
- The baroreceptor reflex is the body’s rapid response system for dealing with changes in blood pressure
- Baroreceptors are mechanosensitive and located in the neck (carotid artery) and in the aorta
- A drop in blood pressure produces a drop in baroreceptor activity, which triggers an increase in sympathetic activity and a decrease in parasympathetic activity, which produces an increase in cardiac output and vessel constriction (total peripheral resistance). When they increase, so does blood pressure – in this case back to normal (the set-point)
- Spaceflight deconditions baroreceptor response, resulting in larger changes in baroreceptor distension needed to induce the same changes in heart rate compared to 1g.
Blood volume
- Increased blood volume increases blood pressure
- Reduction of blood volume is required to normalize the blood pressure
- Blood volume can be easiest reduced by excretion of excess water through the kidneys
- In spaceflight, the initially increased blood volume with subsequent increase of blood pressure due to the fluid shift is compensated by increased urine volume
dynamic motion and microgravity environments
Gain familiarity with effects of barometric pressure on human performance
Increased Barometric Pressure Affects the Central Nervous System
- CNS O2 toxicity
Oxygen can cause blurred vision, nausea, vomiting, twitching, irritability, incoordination, ataxia and seizures - Nitrogen Narcosis
Nitrogen is inert at 1 Atmosphere (sea level). N2is a depressant at 4 ATA, anesthetic > 6 ATA
High-Pressure Nervous Syndrome (Helium Tremors)
Divers at pressures over 150 m/ 500 feet (16 ATA) breathing Helium develops
- decreased alertness
- altered mental status
- tremors
- myoclonic jerks
Barotrauma
Expansion of gas filled cavities. The worst situation is pulmonary over inflation syndrome with collapsed lungs, arterial gas embolism within seconds and air under chest, skin and in blood vessels
Hypoxia (hypoxic)
Reduced oxygen delivery to tissues within seconds to minutes: inadequate blood flow, inability to use oxygen at the molecular level, reduced oxygen carrying capacity, Ineffective gas exchange at lungs
- Fatigue
- Dizziness
- Rapid breathing
- Poor judgment
- Poor coordination
- visual field turns gray
- Euphoria
- Tingling
- etc.
Decompression Illness (DCI) aka DCS
With pressure reduction, evolved gas bubble from dissolved nitrogen can cause pain, pulmonary or nervous system damage within minutes to hours
- Type I DCI – Limb or Joint Pain (bends), cutaneous manifestations such as itching and rash (niggles)
- Type II DCI – Neurologic (headache, weakness, paralysis), cardiopulmonary “chokes”
Ebullism
Is the formation of gas bubbles in bodily fluids due to reduced environmental pressure, for example at high altitude. Example: Gas evolved from water (vapor pressure) below 47 mm Hg causes severe lung damage within minutes
Understand the adaptive responses and countermeasures used in aerospace environments
The human adaptive responses and countermeasures can mitigate most challenges in aerospace environments
In-flight Countermeasures
In-flight exercise and Low Body Negative Pressure (LBNP) have a protective effect on the increase in heart rate and fall in blood pressure during standing after flight
- Exercise Countermeasure Systems for the International Space Station (treadmill etc)
Reentry and Landing
- Fluid and salt loading
- Anti-G garment (lower body compression suit)
- Liquid cooling garment
- Recumbent seating during re-entry for flights > 30 days
Recognize physiologic challenges of extreme environments
Physiologic challenges of extreme environments vary with the specific environment and the individual adaptive traits
- The term ‘extreme’ refers to insufficiency or excess of one or more stressors, such as thermal energy, fluid availability, oxygen, pressure, hydrostatic pressure, gravity or environmental toxins
- Some environments are dangerous because they can incapacitate suddenly or in a subtle harmful way, or we lack receptors for detection or lack perception of their effect on the central nervous system
- Most dangers occur during exposures in artificial environments, unfamiliar circumstances, or with rapid excursions (ascents and descents)
Types of Extreme Environments
- Altered Barometric or Hydrostatic Pressure
- Hyperbaric
- Hypobaric
- Altered Atmospheric Composition
- Oxygen, Carbon Dioxide, Environmental Toxins
- Altered Thermal Environments
- Altered Gravito-Inertial Environments
- Microgravity
- Hypergravity
- Dynamic Motion Environments
- Remote, Isolated, and Confined Environments
Gain familiarity with effects of dynamic motion and microgravity environments on human performance
Dynamic motion
Acceleration can cause blackout, confusion and unconsiousness
- Transient accelerations, linear or rotational, are events with duration of less than 0.5 seconds
- Sustained accelerations, linear or rotational, are events > than or = to 0.5 seconds duration
Microgravity
After 1.5 month organs adapt to microgravity
- Fluid shift
On Earth, gravity exerts a downward force to keep fluids flowing to the lower body. In space, the fluids tend to redistribute toward the chest and upper body. This is responsible for the face congestion. At this point, the body detects a “flood” in and around the heart. The body rids itself of this perceived “excess” fluid. The body functions with
less fluid and the heart becomes smaller.
understand the NASA HRP risk structure
Answer certain questions
1) How long is the mission?
2) How far away are we traveling?
3) How many crew members?
Then risks are ranked. If there are gaps in the knowledge in the risks NASA will advertise a ‘call for proposals’ to fill the gaps. These results then feedback into the cycle
- Current major concerns for Mars flyby
- NASA’s Human Research Program periodically evaluates potential health risks to astronauts
- Physiologists, physicians, life support experts and crew determine the likelihood and consequence of particular negative health outcomes
- Mission design is a factor
- Risks are ranked to help guide research and funding priorities
- NASA has someone to manage each individual risk - monitor and give recommendations/evaluations. Then a board discusses and approves.
Explain the source and characteristics of space radiation
Space radiation is composed of atoms whose electrons have been stripped away as the atom accelerated in interstellar space to speeds approaching the speed of light –eventually, only the nucleus of the atom remains.
3 kinds of ionizing radiation
- Particles trapped in the Earth’s magnetic field from the sun
- Solar particle events (SPE), which are highly energetic particles (mostly protons from the Sun) shot into space during solar flares. Travel at near the speed of light and arrive at Earth in ~ 10 min of the event on the Sun
- Galactic cosmic rays (GCR), which are high energy protons and heavy ions from outside our solar system
What is meant by “ionization?”
Enough energy to completely remove an electron from its orbit, thus leaving behind a more positively charged atom
Examples of ionizing radiation
- alpha particles (a helium atom nucleus moving at very high speeds),
- beta particles (a high-speed electron or positron)
- gamma rays, x-rays
- galactic cosmic radiation (GCR) from space
Less energetic, non-ionizing radiation does not have enough energy to remove electrons from the material it crosses.
Examples of non-ionizing radiation
- Radio frequencies
- microwaves
- infrared
- visible light
- ultraviolet (UV)
Shielding isn’t the answer to space radiation. At the moment limiting exposure via ‘time exposed’ the only way to mitigate
Describe the major physiological effects of radiation exposure
DNA damage
- Cell death
- DNA mutations that alter protein function (somatic cells)
- DNA mutations that get passed to the next generation (germ cells)
- May result in cancer
Ocular damage
Such as cataracts
Cell death
Mostly, dead cells will get replaced by stem cells. Replacement is quick in tissues that have fast cell turnover (GI, blood) but very slow in the brain.
Radiation is being studied to determine its role in:
- Reduction-oxidation homeostasis (redox)
- Cognitive and sleep difficulties
- Bone, muscle & joint degeneration
- Immune system changes
- Effects of the microbiome
- Long-term – risk of cancer? cardiovascular disease?
Describe the microbiome and effects of the spaceflight environment on it
- Are communities of microorganisms that live on or in humans
- They are protective and have immune functions
- Each person has a unique microbiome profile
Because microbes may behave differently in micro-g, these ratios can change in spaceflight. Dysregulation in the gut microbiome can result in digestive problems, and/or abdominal pain. Lastly, radiation can kill off these microbes entirely, and we need them to be healthy
Explain effects of the spaceflight environment on the immune system
- Cold sores
- Bad Rashes
- Gene Expression
Spaceflight may also impact the lymphatic system, responsible for the body’s waste removal and transport of white blood cells.
Immune system can be dysregulated in space. We know there are changes but not all are bad…we don’t know yet
Explain effects of the spaceflight environment on skin
Dysregulation of the skin microbiome and microgravity can cause rashes, or skin to slough off entirely. This is typically happening on the feet because thick calluses are present. Feet also are used to hold astronauts in place, and these can get banged up or overused, so skin gets lost.
- Gene expression studies show significant changes in astronauts skin and hair follicles
- Skin calluses fall off, could be due to changes in pressure
- Gene profile is similar to oxidative stress that can be caused by environmental pollution, psychosocial stress, bad diet, etc.
Describe changes in astronaut vision on long missions
Astronaut vision changes during flights, this can result in Spaceflight Associated Neuro-ocular Syndrome (SANS)
*Astronauts are typically over 40, so their vision is already beginning to decline.
Homocysteine
- Methionine is an essential amino acid in mammals, necessary for protein synthesis and carbon metabolism
- Methionine synthase reductase (MTRR) converts homocysteine into methionine
- In some astronauts, homocysteine is a little high, even before they fly. These are the astronauts that get the worst SANS symptoms
Genetic components
- There are naturally occurring genetic variants of MTRR. So in some people, it doesn’t get broken down as completely
- Can lead to DNA methylation (problems with gene expression)
Elevated pressure in head
- Spaceflight induced visual impairment and globe deformations in astronauts are linked to orbital cerebrospinal fluid volume increase
- MRI shows brains shift up slightly
- Fluid pressure causes optic nerve compression, flattening of the back of the eyeball and optic disc swelling
CO2 related
- High CO2 may be behind this as well (on ISS its 10x higher than Earth)
- But there’s no clear evidence that SANS is caused by CO2.
SANS countermeasures
- Artificial gravity
- Negative pressure pants (LBNP)
Describe sleep problems reported by astronauts
- People generally have 24H sleep-wake cycles
- In the absence of a normal 24 hour cycle on the ISS, our bodies will shift our circadian rhythm
- No circadian cues and hard to sleep
- Pre-launch and during missions seep is always too short for astronauts
- Sleep increases post launch, indicating a sleep deficit
- If you look out the window right before you try to sleep, it’s even worse
78% of shuttle astronauts used sleep meds 52% of nights
On Earth, healthy adults use meds on 7% of nights
Solutions
Change lighting on board with variable wavelengths
Explain circadian rhythms and their relationship to health
Reasons to Sleep
- Restorative
repair damage & remove metabolic waste accumulated during the day - Evolutionary survival
encourage animals to remain hidden when their predators are active and encourage animals to conserve energy when they are unlikely to find their prey - Learning
transfer of short term memory to long term happens during sleep
Circadian rhythms have to do with our “body clock.” They have adapted to make us alert during important times of the day, and to fall asleep when we need it. Dysregulation can result in:
- Irritability
- Increased stress
- Behavioral problems
- Issues retaining information
- Appetite problemS
- Risk of making mistakes
- Injury
Describe risks to behavioral health and performance in space
Risks studied from Analogs environments to look at behavioral health/performance
Isolated, confined, controlled (ICC)
Local environment, simulated mission, research is the purpose, experimental control, crew selected to meet astronaut criteria
Isolated, confined and extreme (ICE)
In actual extreme environments, real mission, research is a part of the mission, crew selected for fieldwork or training
Risks
- Isolation
- Bad sleep can lead to increased mistakes
- Irritability being around the same people
- Relationship with your own tools and environment can be compromised
Describe the purposes of EVAs and what physical tasks they may include
The first Extravehicular activities (EVAs) were performed as a proof of concept. Much attention went to ground training. Then, equipment testing, protocol testing were key.
With safe equipment and procedures and good training practices established, EVAs became a way to do work in space.
Purpose
- Spacecraft inspection & maintenance could be performed
- Inspection, maintenance & repair could be performed on satellites & telescopes
- Items could be stored in exterior compartments and retrieved by EVA when needed
- Experiments were placed outside the spacecraft for exposure
- Space Stations were built (ISS)
Physical tasks
- Walking
- Most is stationary light work e.g. observations, sampling, setup/storage of equipment
- Stationary heavy work e.g. hammering, shoveling
- Mobile heavy work e.g. hill climbing, sample/equipment transfer
EVA suits are a small spacecraft
- Must supply O2 and remove CO2
- Must protect from vacuum of space
- Must permit required movement
- Must remove metabolic heat
Explain physiological stressors associated with typical extravehicular activities and potential countermeasures
Physiological stressors
- Bruising, and shoulder injuries because of the lack of range of movement
- Hypoxia (not enough O2) and hypercapnia (too much CO2)
- Radiation exposure
- Internal suit pressure
- Humidity
- Bringing dust into the spacecraft
Countermeasure
EVA suit design can reduce injury.
- New designs permit the arms to be raised above the shoulder
- Having spacesuits outside the craft (suit ports) is an operational countermeasure
Describe the likelihood and consequences of exposure to planetary or indoor dust
Exposure is moderate in the ISS but high on places like Mars or the Moon. Dust floats in a craft, and then gets in the eyes and lungs, is toxic when inhaled in large amounts over time
- Lunar dust is spiky, due to no weather or erosion
- A lot of dust builds up inside the craft from paint flakes, skin cells, food particles, fabric lint etc
- Animal experiments
Describe recent results indicating inflight VTEs, potential countermeasures, and physiological impacts
Venous Thromboembolism (VTE)
Are ‘blood clots’, 3rd most common cardiovascular issue. Is a problem because blood flow stagnates, and sometimes even flows backward
Risks
- Hypoxia
- Heart attack
**Countermeasures** Blood thinners (anti-coagulants)
In the NASA Human Research Program Architecture, there are categories of Evidence, Risks, Gaps, Tasks, and Deliverables. Give three examples of risks here. What is a Gap?
Risks during spaceflight include
- Radiation exposure
- Space-induced cardiovascular disease
- Altered immune function.
A Gap is a gap in knowledge about the risk and a gap in knowledge about how to mitigate that risk
List the three phases of mission support operations
Crew and support get assigned 2 yrs before flight
Baseline measurements are taken from astronauts before flight, during and after e.g. bloodwork, health checks
What is a Likelihood and Consequence rating for risks during spaceflight?
These LxC ratings are based on research that determines the likelihood of a risk during spaceflight and the consequence of that risk to the astronaut or the mission. High numbers in the matrix for L or C indicate high likelihood or high consequences
List medical support personnel and related responsibilities in mission operations
Physicians
Including crew surgeon
- Is the “family physician” for the ESA astronauts
- Is the point of contact to the ISS medical group of the ESA astronauts
- Responsible for all ESA astronauts’ medical matters in all mission’s phases, i.e. pre-flight, Launch, in-flight, landing and post-flight
- Monitors and coordinates the implementation of the physical exercise countermeasures programs for ESA astronauts
Flight Nurse
- Supports Flight Surgeons in all of their primary tasks to provide ESA Astronauts with excellent health care
- Manages all medical data from ESA Astronauts pre-, in- and post-flight
- Reviews all in-flight science experiments and their need of medical monitoring
- Interfaces with international flight medicine clinics and medical operations support teams
- Assists Biomedical Engineers with tracking the life science experiments database
- Maintains the Crew Medical Support Office Medical examination facility and medical equipment
Biomedical engineers
“eyes and ears” of flight surgeon on console
- Represents ESA Medical Operations on console during ISS real-time operations
- Trains Flight Controllers about medical operations and its impact on operations overall
- Works with the Columbus Flight Control Team and the different IP Medical Operations Teams
- Provides specialist knowledge regarding all US and Russian Medical Hardware onboard ISS
- Continuously trains, certifies and retains the qualifications of the ESA BME Flight Controller
- Functions as the eyes and ears of the ESA Surgeons on console to maintain medical-related awareness
- Supports all ISS environmental health related issues
- Performs and implements all the pre-mission coordination with the different operational teams
- Supports medical projects and specific tasks to enhance biomedical engineering services to ESA Astronauts
- Maintains the ESA Medical Operations console infrastructure at the European Astronaut Center
Medical Projects and Technology staff (IT)
- Supports Flight Surgeons and Biomedical Engineers with specialist skills (Information Technology, Hardware Engineering, Exercise & Rehabilitation, Project Management)
- Manages ESA Astronaut health hardware projects (e.g. health assessment devices, exercise devices, medical data collection systems)
- Provides Information Technology support (e.g., operations console infrastructure, web-based organization tools, secured medical databases, etc.)
- Liaises with the ESA Life Sciences Division to coordinate health-related projects
- Coordinates and manages medical staff continuing education and certification
Exercise Team / Psychologists
- Provides countermeasure exercise support to ESA Astronauts during long-duration space missions
- Plans and implements post-flight rehabilitation after a long-duration space mission
- Plans and supports physical exercise concept and individual training sessions for ESA Astronauts
- Provides fitness training recommendations and remote exercise support to ESA Astronauts (e.g., while training for a mission at another space agency)
- Performs fitness assessment tests on ESA Astronauts
- Represents ESA in several ISS Multilateral Operational Medicine committees and working groups
- Supports any fitness and exercise related activity of ESA Astronauts
Describe the principles of the daily on-orbit schedule for astronauts
Astronauts have a mimicked 7 day week. 5 days work then half a day on Saturday and full free day on Sunday
- Working time 10 hrs
- System time 4 hrs
Inflight operations
- Science program
- Technical program
- Medical program
- private conference
- Routine medical test
- Briefings
- Public relations & education
- Housekeeping
- Personal events
- Task List
List the current in-flight countermeasures
- Cardiovascular fitness
- treadmill
- bicycle ergometer
- Strength
- Weight lifting/resistance exercises
- Gravity Simulation
- Penguin-Suit / Skin-Suit
- Centrifuge
- Nutrition
- Vitamin D Supplementation
- Sodium Balance
- Radiation
- shelter, anti-oxidants, protection
- Pre-Landing Preparation
- Lower Body Negative Pressure (LBNP; Russian Tschibis)
- Fluid-Loading
- Anti-g Suit
List the post-flight objectives of astronaut rehabilitation
Objective 1: Prevent injuries
Objective 2: Recover from 0-gravity effects
Objective 3: Science program
Objective 4: De-briefings
Objective 5: Public relations
List the involved medical boards and panels in the ISS program
- Multilateral Medical Policy Board (MMPB)
- Multilateral Space Medicine Board (MSMB)
- Multilateral Medical Operations Panel (MMOP)
Describe the responsibilities of the involved ISS medical boards and panels: MMPB
The MMPB is made up of one physician from each of the international partners. It is the top-level medical policy board, which oversees the Multilateral Medical Operations Panel (MMOP) and the Multilateral Space Medicine Board (MSMB)
- Establishes medical policies that guide all crew health issues related to human spaceflight in the ISS program
- Serves as a forum for resolving conflict among partner agencies
- gives top level policies on astronaut certification and data requirements
Describe the responsibilities of the involved ISS medical boards and panels: MSMB
Responsible for certifying that ISS crew meets the medical certification requirements. It also ensures that mission-assigned flight surgeons selected by the MMOP have completed the established credential standards. After reviewing and approving the MMOP’s findings and recommendations, the MSMB forwards its recommendations to the MMPB
- Final medical certification of crew and oversight of the implementation of medical operations
- Oversight of the implementation of medical operations
- Provides findings and recommendations to the ISS Crew Surgeons on clinical matters and to the MMOP matters concerning the health of ISS crew-members, ISS visitors and other personnel on matters related to flight medical operation
- Oversight of the development of training requirements
- Credentialing and Certification of physicians for duties as ISS Flight Surgeons
Describe the responsibilities of the involved ISS medical boards and panels: MMOP
- establishes common medical standards
- preventive medicine guidelines
- certification criteria
- operational countermeasures
- clinical care
- medical hardware responsibilities
- operational procedures
- and environmental monitoring requirements
- training certification guidelines for ISS flight surgeons and recommends mission-assigned flight surgeons to the MSMB.
The MMOP receives and evaluates input from various working groups to solve key medical issues and presents its findings to both the MMPB and the MSMB
Describe the review process of experiments involving humans as test subjects
NASA, RSA and the other partners will establish a Human Research Multilateral Review Board (HRMRB). This Board will have the responsibility for assuring that human research protocols do not endanger the health, safety, and well-being of human research subjects on the Space Station while ensuring ethical conduct of experiment operations. The HRMRB will review and approve, prior to their implementation, human research protocols for the Space Station proposed by the partners. The HRMRB will operate on the principle of consensus
Review process
- Agency Specific Board or IRB of originating experiment evaluates the experiment
- Agency Board (s) participating in a study evaluates experiment
- HRMRB evaluates experiment and mission complement
- cumulative effects
- combination-hazards
- operational constraints
Describe the historic evolution of human space flight programs
(From the place in the lecture, he is asking what is the evolution of human research in human space flight programs? No other history given in his lecture)
Principles of the Helsinki Declaration (1964) and Nuremberg Trial Code of Conduct (1947) gave the guiding principles of respect for research subjects to prevent the abuses experienced before their creation, such as those in WWII
