HPS Flashcards

Question

Gain familiarity with effects of dynamic motion and microgravity environments on human performance

Answer 1

**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. ![]()

Answer 2

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.

Answer 3

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

Answer 4

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

Answer 5

**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?

Answer 6

* 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

Answer 7

1. Cold sores 2. Bad Rashes 3. 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

Answer 8

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.

Answer 9

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)

Answer 10

* 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

Answer 11

**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

Answer 12

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

Answer 13

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

Answer 14

**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

Answer 15

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

Answer 16

**Venous Thromboembolism (VTE)** Are 'blood clots', 3^rdmost common cardiovascular issue. Is a problem because blood flow stagnates, and sometimes even flows backward **Risks** * Hypoxia * Heart attack ``` **Countermeasures** Blood thinners (anti-coagulants) ```

Answer 17

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

Answer 18

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

Answer 19

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

Answer 20

**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

Answer 21

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

Answer 22

* 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

Answer 23

Objective 1: Prevent injuries Objective 2: Recover from 0-gravity effects Objective 3: Science program Objective 4: De-briefings Objective 5: Public relations

Answer 24

* Multilateral Medical Policy Board (MMPB) * Multilateral Space Medicine Board (MSMB) * Multilateral Medical Operations Panel (MMOP)

Answer 25

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

Answer 26

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

Answer 27

* 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

Answer 28

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

Answer 29

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

HPS Flashcards

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