Index

A

Abscesses, 82, 84, 127

Accidents and injury, see Trauma

Aerospace Medical Association, 34

Age factors, 11, 58, 64, 77, 78

breast cancer, 89

medical events in space, 81

Agency for Healthcare Research and Quality, 205

Airway management, 111, 118–119

Alimentary system, see Gastrointestinal system

Ambient lighting, see Lighting in spacecraft

American College of Surgeons, 192

American Medical Association, 34

Ames Research Center, 193

Analog environments, 12, 13, 28, 30, 73, 80, 195, 249, 256–260, 262

see also Antarctic stations;

International Space Station

behavioral issues, 12, 13, 139, 140–141, 142, 145, 149, 152, 159–160, 162, 164, 165–167, 170

group interactions, 145–146, 152, 156, 159–160, 162, 164, 165–167

mental illness, 80–81, 82, 85, 86

bone mineral density loss, 40

confidentiality issues, 177–178

emergency and continuing care, 117– 118, 126–127, 131, 132–133, 134

gastrointestinal medical events, 85, 86

infections, 82, 84, 85, 105, 126

longitudinal studies, 82, 83–86

microgravity, 76

neurological effects, 53

pharmacokinetics and pharmacodynamics, 91

respiratory disorders, 82, 84, 85, 86

submarines, 76, 80–83, 84, 85, 106, 140–141, 152, 162, 205, 256– 257, 259

surgery, 126–127

urinary system, 82

Anemia, 39, 105, 106, 113

Anesthesia, see Pain management and anesthesia

Animal models

behavioral, 150



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Safe Passage: Astronaut Care for Exploration Missions Index A Abscesses, 82, 84, 127 Accidents and injury, see Trauma Aerospace Medical Association, 34 Age factors, 11, 58, 64, 77, 78 breast cancer, 89 medical events in space, 81 Agency for Healthcare Research and Quality, 205 Airway management, 111, 118–119 Alimentary system, see Gastrointestinal system Ambient lighting, see Lighting in spacecraft American College of Surgeons, 192 American Medical Association, 34 Ames Research Center, 193 Analog environments, 12, 13, 28, 30, 73, 80, 195, 249, 256–260, 262 see also Antarctic stations; International Space Station behavioral issues, 12, 13, 139, 140–141, 142, 145, 149, 152, 159–160, 162, 164, 165–167, 170 group interactions, 145–146, 152, 156, 159–160, 162, 164, 165–167 mental illness, 80–81, 82, 85, 86 bone mineral density loss, 40 confidentiality issues, 177–178 emergency and continuing care, 117– 118, 126–127, 131, 132–133, 134 gastrointestinal medical events, 85, 86 infections, 82, 84, 85, 105, 126 longitudinal studies, 82, 83–86 microgravity, 76 neurological effects, 53 pharmacokinetics and pharmacodynamics, 91 respiratory disorders, 82, 84, 85, 86 submarines, 76, 80–83, 84, 85, 106, 140–141, 152, 162, 205, 256– 257, 259 surgery, 126–127 urinary system, 82 Anemia, 39, 105, 106, 113 Anesthesia, see Pain management and anesthesia Animal models behavioral, 150

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Safe Passage: Astronaut Care for Exploration Missions bone mineral loss, 45–46 injury, responses to, 121 muscle loss, 48 nervous system, 53 rehabilitation measures, 127 surgical wounds, 121, 123 Antarctic stations, 12, 30, 76, 80, 83–86, 100, 195, 256–259 behavioral issues, 139, 140–141, 142, 159–160, 162 emergency and continuing care, 117– 118, 126, 131, 132–133 infections, 105, 126 surgical wounds, 126, 127 Appendicitis, 29, 82, 85, 88, 102, 104, 127 Astronaut Medical Evaluation Requirements Document, 97 Ataxia, 39, 48 Atraumatic restorative treatment, 100 Attitudes and beliefs, see Public opinion/ education Auditory perception, 77 noise effects and controls, 8, 28, 93, 95 Australian National Antarctic Research Expeditions, see Antarctic stations Authority, NASA organization, 20, 21, 192, 193, 194–195, 198–199 see also Leadership B Baroreceptors, 49, 50 Behavioral health, 28, 76, 137–172, 190, 249, 251, 262 see also Cultural issues; Group interactions; Mental health and illness ; Mood effects; Screening, selection and training analog environments, 12, 13, 139, 140– 141, 142, 145, 149, 152, 159– 160, 162, 164, 165–167, 170 Antarctic stations, 139, 140–141, 142, 159–160, 162 group interactions, 145–146, 152, 156, 159–160, 162, 164, 165–167 mental illness, 80–81 animal models, 150 clinical trials, 66 committee methodology, xii, 3 committee recommendations, 1, 11–13, 14, 15, 16, 21 computer applications, behavioral adaptation, 151, 154–155, 163– 164, 165, 166 confined environments, 138, 140, 142, 168, 170 countermeasures, 107, 108–110, 142, 156–157, 164–165, 169 databases, 139, 142, 165–166 disruptive crew interactions, 14, 108, 154–155, 168, 170 end-of-life care, 9, 130, 134, 211 genetic factors, 162–163 ground support personnel, 108–109, 140, 164, 166, 168 health care personnel, 150 international authorities, cooperation on, 138, 140 international crews, 107, 137, 145, 170, 168 International Space Station (ISS), 150, 152–153, 159 medical events in space, 80–81 Mir space station, 140, 141, 153 NASA efforts, 138, 139, 141, 143, 146, 147, 148, 150–151, 154, 156– 159, 160, 162, 164–165, 170 astronaut esprit as a problem, 174– 175, 182–183 neurological factors, 162, 163 organizational factors, 20, 193 physiological monitoring of, 154, 155– 156, 169 screening, 12, 77, 86, 107, 108 group interactions, 146–147, 148, 149, 158–165, 169, 170 underreporting of problems, 174– 175, 183, 187 sexual behavior, 138, 142, 149; see also Contraceptives and contraception sleep and circadian rhythm, 5, 39, 53– 55, 64, 72, 78, 139, 142, 143–144

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Safe Passage: Astronaut Care for Exploration Missions space crew/ground personnel interactions, 108–109, 140, 152– 158, 166, 168 space shuttle program, 140, 155 Behavioral self-management, 145 see also Self-assessment; Self-monitoring Bioastronautics Institute, 192, 196, 251 Bioavailabilities, 104, 113 Bioregenerative systems, 89, 143, 145 Blood, see Cardiovascular system; Hematology Body mass, 90, 127, 128 Bone, see Musculoskeletal system Bone mineral density, 3, 5, 9, 26–27, 39, 40, 42–47, 62, 64, 66, 77, 123, 127, 128, 129, 153 analog environments, 40 animal models, 45–46 biomarkers, 5, 43, 45, 46 bone resorption, 43, 259 calcium absorption, 43, 259 calcium excretion, 43, 60, 259 clinical research, 5, 46–47, 72 countermeasures, 27, 44, 46, 47, 60– 61, 72, 127–128 gender factors, 43, 58, 59 genetic factors, 5, 43, 45, 47, 72 medications, 5, 44, 46, 47, 72 metabolic processes, 43, 44–46, 47, 60– 61, 87, 259 Mir space station, 43, 44, 128 nutrition, 44 osteoporosis, 45, 47, 64, 212 real-time measurements, 46, 72 Bone resorption, 43, 259 Bowel sounds, 52, 87 Breast cancer, 86–89 C Calcium absorption, 43, 259 Calcium excretion, 43, 60, 259 Carcinogenesis and cancer, 78, 86–89 breast, 86–89 gastrointestinal system, 103 prostate, 112 radiation effects, 65, 88–89, 212 Cardiovascular system, 8, 49–50, 77, 78 anesthesia and pain management, 118 central venous pressure, 49–51 clinical research, 5, 48–49, 50, 62, 64, 66, 72 end-of-life care, resuscitation considerations, 9, 130, 249 health care practice, 97–98 historical perspectives, 97 hydrostatic pressure, 39 injury, responses to, 121–122 medical events in space, 81, 113, 212 medical events in submarines, 82, 85 microgravity, 8, 49–50, 97 neurovestibular adaptation, 67 orthostatic hypotension, 5, 39, 48–49, 50, 97, 102 physical examinations in space, 87 renal system, vascular resistance, 50 screening, 97, 98, 113 Catastrophic illness and death, 6, 29, 114, 130, 138, 218 end-of-life care, 9, 130, 134, 211 historical perspectives, 78, 79 suicidal and homicidal ideation, 108, 154 triage, 118, 134, 211–212 Cell-mediated immunity, 105, 258 Chemicals, hazardous, see Hazardous substances Central nervous system anaesthesia, 120 closed-head injuries, 111 orthostasis, 110 psychomotor functions, 55 radiation effects, 65 sleep and circadian rhythm, 53 Central venous pressure, 49–51 Circadian rhythm, see Sleep and circadian rhythm Clinical Care Capability Development project, 209, 250 Clinical practice guidelines, 8, 9, 31, 134, 204–205, 208, 217, 218 end-of-life considerations, 9, 130, 134

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Safe Passage: Astronaut Care for Exploration Missions multiple casualties, 118, 134 rehabilitation measures, 127–128 standards, 7, 97, 113, 210–212 Clinical research, 3, 4, 6–7, 9–10, 24, 38, 40, 41, 62–73 see also Clinical Research Opportunities; Ethical issues behavioral health, 66 bone mineral density, 5, 9–10, 42–43, 45, 46–47, 62, 64, 66, 72 cardiovascular effects, 5, 48–49, 50, 62, 64, 66, 72 committee methodology, xii, 3, 30, 31– 32 Critical Path Roadmap project, 4, 62– 69 defined, 69 gender factors, 5, 60, 72 hazardous substances, 65 hematology, 9, 62, 64, 106, 113 historical perspectives, 6, 10 immune system, 9, 62, 64, 66, 106, 113 infections, 9, 62, 64, 66 International Space Station (ISS), 41, 73 medications, 5, 55, 204 microgravity, 5, 6, 9–10, 17, 42–43, 45, 46–47, 62–69 musculoskeletal system, 5, 9–10, 42–43, 45, 46–47, 62, 64, 66, 72 neurological, 5, 10, 66, 72, 111, 113 neurovestibular function, 53, 62, 65, 67 nutrition, 5, 62, 63, 65 organizational requirements, 70, 193, 197–198, 199, 207–208 pharmacokinetics and pharmacodynamics, 5, 72, 90 physiological monitoring, 5, 61, 63, 68 radiation exposure, 28, 65 renal stones, 66 reproductive system, 5, 57, 59, 72 space motion sickness, 5, 52, 72 trauma, 63, 65 various body systems and processes, 5, 64–67, 72 wounds, 9, 106 Clinical Research Opportunities, 5, 72 bone mineral density, 5, 46–47, 72 gender factors, general, 60 nervous system, 5, 72 orthostatic hypotension, 5, 48–49, 72 physiological monitoring, 5, 62, 72 reproductive system, 5, 57, 59, 72 sleep and circadian rhythm, 5, 54–55, 64, 72 space motion sickness (SMS), 5, 52, 72 Clinical Research Plan, 202 Closed-head injuries, 111 Communication and communications technology, 2, 6, 11, 13, 142, 143, 151 see also Isolation computer analysis of verbal communication, 154–155 emergency and continuing care, 118, 132, 204–205 family and friends, 14, 151, 152, 168 group interactions, 147, 154, 166 monitoring, 15, 151, 169 robotics, 24, 123–124, 262 surgical procedures, 123–124 time delays, 25, 109 Comprehensive health care system (NASA), 7, 9, 21, 40, 70–71, 190–191, 195, 196, 197, 198, 199, 200, 201, 208–209, 216, 218–219 Computer-aided design/computer-aided manufacturing (CAD-CAM) , 124 Computer applications, other see also Databases behavioral adaptation, 151, 154–155, 163–164, 165, 166 informatics, 9, 24, 61, 208, 212–214, 217 recreational software, 151 robotics, 24, 123–124, 262 self-assessment software, 109 verbal communication analysis, 154– 155 Confidentiality and privacy, 13, 16, 173, 174, 175–187, 195, 196, 201 analog environments, 177–178

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Safe Passage: Astronaut Care for Exploration Missions crew onboard space vessels, privacy, 138, 142, 144 Confined environments, 26, 29, 189 anesthesia and pain management, 118 behavioral problems, 138, 140, 142, 168, 170 neurological effects, 53 privacy onboard spacecraft, 138, 142, 144 Contraception and contraceptives, 60, 104 Cosmic particles, 27, 96, 113 Counter Measure Development and Validation Project, 195–196 Countermeasures, 40–42, 250 see also Medications behavioral problems, 107, 108–110, 142, 156–157, 164–165, 169 bone mineral density, 27, 44, 46, 47, 60–61, 72, 127–128 closed-head and spinal cord injuries, 111 Critical Path Roadmap project, 4, 62– 69, 200, 211, 250 decompression sickness, 92 exercise, 48, 58, 127–128, 129, 142 hazardous materials exposure, 8, 94, 113 hormonal contraceptive agents, 60, 104 hormone replacement therapy, 9, 58– 59, 104, 113 International Space Station (ISS), 41– 42, 68 microgravity effects, 40–42, 48, 56, 62– 69, 72, 127–128 artificial gravity, 5, 72, 251 muscle loss, 48, 56, 72, 127–128 NASA programs, general, 27, 68, 193, 195–194 behavioral, 156–157 bone mineral loss, 40–42, 46 noise effects and controls, 8, 28, 93, 95 organizational requirements, 195–196 peripheral nervous system, 56 recreation and leisure activities, 14, 128–129, 142, 144, 151 rehabilitation measures, 7, 8, 11, 28, 67, 71, 73, 127–130, 190, 250 surgical wound healing, 123 underreporting of problems, 175, 183, 187 urinary system, 60–61, 112 Crew selection and composition, see Ethnicity; International crews; Screening, selection and training Crew Status and Support Tracker, 14, 168 Critical Path Roadmap project, 4, 62–69, 200, 211, 250 Cultural issues see also Ethnicity; International crews; Public opinion astronaut esprit as a problem, 174–175, 182–183 committee methodology, xii, 3 committee recommendations, 11, 21 ethical issues, 174–175, 182 food preparation 88 group interactions, 149, 156, 164–165, 169 language factors, 107, 140, 164–165, 169 mental health, 107, 149, 156, 158 D Databases, 9, 11, 73 behavioral issues, 139, 142, 165–166 bone mineral density, genetics, 47 emergency and continuing care, 132– 133, 134 pharmacokinetics and pharmacodynamics, 8, 91, 113 Decisionmaking, general see also Ethical issues; Organizational factors emergency and continuing care, 117, 118, 130, 134 group, 147 individual astronauts, 4, 21, 31, 194 informatics, 9, 24, 61, 208, 212–214, 217

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Safe Passage: Astronaut Care for Exploration Missions leadership, crew, 10, 108, 147, 148 NASA organization, 20, 21, 192, 193, 194–195, 198–199 triage, 118, 134, 211–212 Death and dying, see Catastrophic illness and death Decompression sickness, 59, 67, 92–93 Dehydration, 51, 52, 60, 90, 111–112, 212 Dental care, 8, 84, 85, 98–101, 113, 252–255 gingivitis, 105 Department of Defense, 194, 200, 203, 204, 205 Department of Health and Human Services, see Agency for Healthcare Research and Quality; terms beginning “National Institute…” Department of Veterans Affairs, 204, 205 Diagnostic and Statistical Manual, 159 Diarrhea, 102 Diet, see Nutrition Digestive system, see Gastrointestinal system Dual agency, 175 Dying, see Catastrophic illness and death Dysbarism, 51, 189, 261 E Electrical stimulation, 128, 129 Emergency and continuing care, 25, 30, 117–136, 169 see also Pain management and anesthesia; Surgery; Trauma analog environments, 117–118, 126– 127 , 131, 132–133, 134 databases, 132–133, 134 decompression sickness, 92 microgravity, 121–123, 125, 127, 128, 129 NASA efforts, 126, 129–130, 134–135 organizational factors, 190, 192, 210–212 triage, 118, 134, 211–212 End of life considerations, see Catastrophic illness and death Endocrine function, 258 contraceptives, 60, 104 exogenous hormone therapy, 9 gametes, female, 57 growth hormone, neurological effects, 5 injury, responses to, 121, 123 medical events in space, 81, 101 neurohormonal, 49 reproductive, 9, 57, 58, 72 replacement therapy, 9, 58–59, 104, 113 testosterone, 57 Endotracheal intubation, 118, 119 Environmental Protection Agency, 194 Epidemiological data, 1, 9, 59, 197 see also Analog environments; Clinical research; Longitudinal studies Ergonomics, 95–96, 113 Erythropoietin, 40, 105 Ethical issues, 77, 173–187, 249 see also Confidentiality and privacy committee methodology, xii, 30 flight surgeon, 174, 175, 180–181, 215 international crews, 174, 186 NASA efforts, 174, 175, 181–187 risk assessment, 4, 30, 31, 114, 206–207 public education, 6, 31, 114, 124, 131, 205–207 Ethnicity, 11, 13, 88 see also Cultural issues; International crews Exercise countermeasures, 48, 127–128, 129, 142 female reproductive physiology, 58 Extravehicular activity (EVA), 77, 116, 189, 190, 191 decompression sickness, 92 gender factors, suits, 60 medical events in space, 79 space motion sickness (SMS), 52 Extreme environments, 1–2, 4, 6, 11–12, 13, 14, 28, 170, 189, 256–257 see also Analog environments; Confined environments; Isolation; Microgravity; Radiation exposure

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Safe Passage: Astronaut Care for Exploration Missions group interactions, 145, 170 Mars exploration, 23, 24–25, 30 medical events, 78–86 space medicine defined, 34 Eye-hand coordination, 55, 125 F Facial and periorbital edema, 26, 87, 90 Fatigue, 53, 55, 66, 106, 107, 153, 155, 212, 259 Federal Aviation Administration, 203–204 Females, see Gender factors Food, see Nutrition Fractures, 42, 45, 46, 64, 72, 79, 123, 124 Freedom of Information Act, 201 Funding, 10, 20, 31, 141, 202, 203, 262 G Galactic cosmic rays, see Cosmic particles; Radiation exposure Galvanic stimulation, 128 Gametes, 56, 58 Gastrointestinal system see also Nutrition; Space motion sickness absorption factors, 39 bowel infections, 111 bowel sounds, 52, 87 cancer, 103 ileus, 39, 123 medical events in Antarctica, 85, 86 medical events in space, 78, 81, 102– 103; see also “space motion sickness” infra medical events in submarines, 82 medications, 5, 52, 102 space motion sickness (SMS), 5, 39, 51– 52 , 72, 78, 87, 91, 102, 138, 140 Gender factors, 5, 11, 59–60, 77 see also Reproductive system bone mineral loss, 43, 58, 59 breast cancer, 86–89 clinical research, 5, 60, 72 data collection and access, 13 extravehicular activity, suits, 60 group interactions, 156, 170 immune system, 59 orthostatic hypotension, 59 radiation effects, 5, 59, 88–89 sexual behavior, 138, 142, 149; see also Contraception and contraceptives General living conditions, see Living conditions, general Genetic factors behavioral effects, 162–163 bone mineral density, 5, 43, 45, 47, 72 databases, 47 informatics, 213 musculoskeletal system, 5, 43, 45, 47 radiation exposure, 5, 56–57, 67, 72 reproductive system effects of radiation, 5, 56–57 risk assessment, general, 86–89 Goldin, Daniel, 189, 261–262 Gravity see also Microgravity artificial, 5, 72, 251 exposure to gravity following missions, 30, 48, 97–98, 129 Ground support personnel, 77, 148, 252 behavioral issues, 108–109, 140, 164, 166, 168 emergency and continuing care, 118 mission control, 108, 136, 140, 150– 151 space crew interactions with, 108–109, 140, 152–158, 166, 168 Group interactions, 2, 21, 28, 142, 145– 157, 160–161, 164–168, 170 analog environments, 145–146, 152, 156, 159–160, 162, 164, 165–167 cultural factors, 149, 156, 164–165, 169 disruptive, 14, 108, 154–156, 168, 170 gender factors, 156, 170 leadership, 10, 108, 147, 148 privacy while onboard spacecraft, 138, 142, 144

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Safe Passage: Astronaut Care for Exploration Missions screening, selection, and training, 77, 146–147, 148, 149, 158–165, 169, 170 Growth, height, 26 Gynecologic health issues, 5, 103–105 contraception and contraceptives, 60, 104 menstruation effects, 5, 43, 58–59, 72, 103, 104 pelvic examinations, 88 H Habitability, see Living conditions, general Hazardous substances, 92, 93–94 anesthesia and pain management, 118, 119–120 clinical research, 65 countermeasures, 8, 94, 113 spacecraft maximum allowable concentrations (SMAC), 93–94, 143 Headaches, 110, 140 Health care personnel, 131–133, 255–256 anesthesia and pain management, 118 behavioral factors, 150 emergency and continuing care, 118 flight surgeon, 174, 175, 180–181, 215 organizational requirements, 193–194 training of, 30, 34, 214–216 Health registers, 83, 141 Hearing, see Auditory perception Height, see Growth, height Hematology, 61, 105–106 anemia, 39, 105, 106, 113 bone density markers, 43, 45, 46 clinical research, 9, 62, 64, 106, 113 erythropoietin, 40, 105 surgery, 121, 122, 125 High-energy particle radiation, see Radiation exposure Historical perspectives, 3, 18, 26, 38, 137, 197 see also Analog environments cardiovascular care, 97 clinical data collection, 6, 10 confidentiality, doctor-patient, 175–176 crew selection, 12 injury, responses to, 121 Mars exploration, 23 medical events, 78, 81 microgravity effects, 37 Hormonal contraceptive agents, 60, 104 Hormone replacement therapy, 9, 58–59, 104, 113 Hormones, see Endocrine function Hubble Space Telescope, 202 Human Exploration of Mars: The Reference Mission of the NASA Mars Exploration Study Team, 24 Hydration, see Dehydration Hydrostatic pressure, 39 Hypercalciuria, 44 I Ileus, 39, 123 Immune system, 39, 153, 212 cell-mediated immunity, 105, 258 clinical research, 9, 62, 64, 66, 106, 113 gender factors, 59 injury, responses to, 121, 126 medical events in space, 81, 212 surgery, 121, 126 Infections, 127 abscesses, 82, 84, 127 analog environments, 82, 84, 85, 105, 126 bowel, 111 cell-mediated immunity, 105 clinical research, 9, 62, 64, 66 medical events in Antarctica, 85, 86 medical events in space, 9, 81, 105, 111 medications, 127 preflight isolation, 105 urinary, 111 wounds, 9, 105, 106, 113, 126 Informatics, 9, 24, 61, 208, 212–214, 217 Infrastructure, see Organizational factors

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Safe Passage: Astronaut Care for Exploration Missions Injury, see Trauma Institutional factors, see Organizational factors Integration, 193–194, 197, 198, 218 comprehensive health care system (NASA), 7, 9, 21, 40, 70–71, 190–191, 195–199 (passim) interagency coordination, 31, 73, 175, 193, 194, 195–196, 198, 199, 200, 203–208, 217 International cooperation, 198, 207, 217, 251 behavioral health problems, 138, 140 committee charge, 31 ethical issues, 174, 186, 187 risk assessment, 114 screening, selection and training, 158– 159 standards, general, 8, 16, 17, 107, 219 International crews, 11, 24, 25, 149 behavioral issues, 107, 137, 145, 170, 168 ethical issues, 174, 186 International Space Station (ISS), 2, 3, 11, 17, 34, 38, 73, 77, 188, 190, 191, 202, 207, 212, 249, 251 behavioral issues, 150, 152–153, 159 bone mineral density, microgravity, 3, 40 clinical research, 41, 73 countermeasures research, 41–42, 68 emergency and continuing care, 117, 190 ethical issues, 181–186, 186, 187 informatics, 213 injury, responses to, 121 launches from, 25 mental health screening, 108 radiation exposure, 96 rehabilitation measures, 129–130, 190 space motion sickness (SMS), 52 Intestines, see Gastrointestinal system Isolation, 3, 10, 11, 13, 14, 25, 28, 29, 138, 140, 142, 168, 189, 258–259 see also Communication and communications technology neurological effects, 53 preflight, infection rates, 105 J Johnson Space Center (JSC), 173, 183, 190, 192, 193, 195, 196, 248, 252 K Kidneys, see Renal system L Language factors, 107, 140, 164–165, 169 computer analysis of verbal communication, 154–155 Laproscopic surgery, 104, 124, 125 Laryngeal mask, 119 Leadership crew, 10, 108, 147, 148 NASA organization, 20, 21, 192, 193, 194–195, 198–199 Legislation, 201–202 see also Regulatory issues Freedom of Information Act, 201 Privacy Act, 16, 175–176, 187, 201 Life on the Screen: Identity in the Age of the Internet, 109 Lighting in spacecraft, 5, 28, 142 sleep and circadian rhythm, 53, 55, 144 Living conditions, general, 15, 65, 77, 134, 138, 142–143, 145, 161, 167 see also Confined environments; Isolation; Lighting in spacecraft noise effects and controls, 8, 28, 93, 95 paired transport vehicles, 149 privacy onboard spacecraft, 138, 142, 144 Longitudinal studies, 15 bone mineral loss, 45 death, 78 epidemiological data, 1, 9, 59, 197 medical events in Antarctica, 83–86 medical events in space, 78–79 medical events in submarines, 82 mental health issues, 109–110, 157–158

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Safe Passage: Astronaut Care for Exploration Missions Longitudinal Study of Astronaut Health, 176, 209, 212, 249 Lucid, Shannon, 26 Lungs, see Respiratory system M Males, see Gender factors Malnutrition, 65, 89 Mars missions, 11, 23–25, 28, 30, 38, 75, 137 bone mineral density loss, 27, 44–45 countermeasures, 68 emergency and continuing care, 123– 125, 132 mental health issues, 107 orthostatic hypotension, 49 surgical procedures, 123–125 Medical devices, 19, 112, 129 see also Robotics anesthesia and pain management, 118– 119, 120 electrical stimulation, 128, 129 laryngeal mask, 119 nanotechnology, 24, 61–62, 194 surgery, 124–125 Medications see also Pain management and anesthesia bone mineral loss, 5, 44, 46, 47, 72 clinical research, general, 5, 55, 204 committee charge, 31 databases, 8, 91, 113 gastrointestinal system, 5, 52, 102 hormonal contraceptive agents, 60, 104 hormone replacement therapy, 9, 58– 59, 104, 113 infections, 127 medical events in space, 79, 102 mental illness treatment, 108 muscle loss, 48, 72 organizational requirements, 204, 217 orthostatic hypotension, 49, 72 pancreatitis prevention, 103 pharmacodynamics, 59, 60, 65, 86, 90– 91, 113 pharmacokinetics, 5, 72, 90–91, 110, 113 psychomotor functions, 55 sleep, 53–54, 55 space motion sickness, 5, 52 Melatonin, 54 Menstruation effects, 5, 43, 58–59, 72, 103, 104 Mental health and illness, 15, 28, 30, 64, 77, 106–110, 113, 138–139 see also Behavioral health; Isolation; Mood effects; Screening, selection and training analog environment data, 80–81, 82, 85, 86 cultural issues, 107, 149, 156, 158 disruptive crew interactions, 14, 108, 154–155, 168, 170 end-of-life care, 9, 130, 134 intramission/postmission problems, 106, 107, 108–110, 153–154, 157–158 longitudinal studies, 109–110, 157–158 mission control, 108, 136, 140, 150–151 NASA efforts, 106–107, 109–110 suicidal and homicidal ideation, 108, 154 Metabolic processes see also Endocrine function bone mineral density, 43, 44–46, 47, 60–61, 87, 259 injury, responses to, 121, 123 medical events in space, 81 nutrient absorption in microgravity, 89–90 pharmacokinetics, 5, 72, 90–91, 110, 113 renal stones, 61, 111–112 Microbiology see also Immune system; Infection anesthesia and pain management, 118, 119, 120 contamination, 94–95, 113 dental care, 99 Microgravity, 3, 6, 26, 29, 37–39, 40, 138, 189, 191, 249, 261, 262 see also Bone mineral density

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Safe Passage: Astronaut Care for Exploration Missions airway management during anaesthesia, 119 analog environments and, 76 artificial gravity, 5, 72, 251 body mass, 90, 127, 128 cardiovascular system, 8, 49–50, 97 clinical research, 5, 6, 9–10, 17, 42–43, 45, 46–47, 62–69 countermeasures, 40–42, 48, 56, 62–69, 72, 127–128; see also “artificial gravity” supra decompression sickness, 59, 67, 92–93 emergency and continuing care, 121– 123, 125, 127, 128, 129 ergonomic issues, 95–96, 113 exposure to gravity following, 30, 48, 97–98, 129 injury, responses to, 121, 122 menstruation effects, 5, 43, 58–59, 72, 103, 104 muscle loss, 9–10, 39, 47–48, 55–56, 62, 64, 66, 77, 127, 212 animal models, 48 countermeasures, 48, 56, 72, 127– 128 neurological effects, 53, 56, 67 nutrient absorption, 89–90 orthostatic hypotension, 5, 39, 48–49, 50, 53, 59, 72, 97, 102, 110, 190 peripheral nervous system, 56 pharmacodynamics, 59, 60, 65, 86, 90– 91 pharmacokinetics, 5, 72, 90–91, 110 physical examinations in, 87–88 radiation, synergistic effects, 65 reproductive system, 5, 8, 56 menstruation effects, 5, 43, 58–59, 72, 103, 104 space motion sickness (SMS), 5, 39, 51–52, 72, 78, 87, 91, 102, 138, 140 standards, 8, 113 surgery, 121–123, 125 urinary system, 39, 42, 44, 50, 60–61; see also Renal system Mir space station, 249 behavioral problems, 140, 141, 153 bone mineral loss, 43, 44, 128 medication usage, 84 mental health issues, 106, 107 rehabilitation measures, 129 sleep and circadian rhythm, 53 surgical wounds, 122–123 Mission control, 108, 136, 140, 150–151 Model Trauma Care System Plan, 192 Mood effects, 8, 14, 86, 106, 113, 139– 142, 155, 259 sleep and circadian rhythm, 53 Moon missions, 34, 38 Motion sickness, see Space motion sickness Motor functions, see Psychomotor functions Musculoskeletal system, 203 see also Bone mineral density ataxia, 39, 48 body mass, 90, 127, 128 clinical research, 5, 9–10, 42–43, 45, 46–47, 62, 64, 66, 72 fractures, 42, 45, 46, 64, 72, 79, 123, 124 gender factors, 43, 58, 59 genetic factors, 5, 43, 45, 47 medical events in Antarctica, 85, 86 medical events in space, 79, 81 muscle loss, 9–10, 39, 47–48, 55–56, 62, 64, 66, 77, 127, 212 animal models, 48 countermeasures, 48, 56, 72, 127– 128 pain management, 48 nutrition, 48 peripheral nervous system, 55–56 surgical wound healing, 122–123 N Nanotechnology, 61, 194 sensors, 24, 61–62 National Aeronautics and Space Administration (NASA), 24, 189–191 see also Organizational factors

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Safe Passage: Astronaut Care for Exploration Missions Ames Research Center, 193 behavioral issues, 138, 139, 141, 143, 146, 147, 148, 150–151, 154, 156–159, 160, 162, 164–165, 170 astronaut esprit as a problem, 174– 175, 182–183 cardiovascular effects of microgravity, 50 committee charge and methodology, xi–xiii, 2–3, 29–33, 247–260 committee recommendations, 1, 6–21, 40, 69–73, 114, 135, 170, 187, 191, 202–219 (passim) comprehensive health care system, 7, 9, 21, 40, 70–71, 190–191, 195, 196, 197, 198, 199, 200, 201, 208–209, 216, 218–219 countermeasures, general, 27, 68, 193, 194–195 behavioral, 156–157 bone mineral loss, 40–42, 46 Critical Path Roadmap project, 4, 62–69, 200, 211, 250 emergency and continuing care, 126, 129–130, 134–135, 190, 192, 210–212 ethical issues, 174, 175, 181–187 funding, 10, 20, 31, 141, 202, 203, 262 gamete preservation, 57 Johnson Space Center (JSC), 173, 183, 190, 192, 193, 195, 196, 248, 252 leadership, crews, 148 leadership, NASA organization, 20, 21, 192, 193, 194–195, 198–199 major health and medical events, 76– 77 mental health of crew, 106–107, 109– 110 neurological clinical program, 111 neurovestibular function, 53 physical training and rehabilitation, 129–130 physiological monitoring, 61–62 pulmonary system, 51 radiation exposure, 96 risk assessment, general, 3–4, 38 space medicine defined, 34 surgical procedures, 126 National Cancer Institute, 62 National Institute of Arthritis and Musculoskeletal and Skin Diseases, 203 National Institute on Aging, 203 National Institutes of Health, 194, 199, 200, 203, 204, 208 National Science Foundation, 195 National Space Biomedical Research Institute, 10, 143, 156–157, 193, 196, 202, 250 Nausea, see Space motion sickness Nephrolithiasis, 60, 111–112 Nervous system, 5, 39, 49, 110–111 see also Pain management and anesthesia; Psychomotor functions; Sleep and circadian rhythm; Space motion sickness analog environments, 53 animal models, 53 ataxia, 39 baroreceptors, 49, 50 behavioral factors, 162, 163 central nervous system, 53, 55, 65, 110, 111, 120 clinical research, 5, 10, 66, 72, 111, 113 closed-head injuries, 111 confined environments, 53 injury, responses to, 121, 123 isolation effects, 53 medical events in Antarctica, 85, 86 medical events in space, 81, 110–111, 212 microgravity, 53, 56, 67 peripheral nervous system, 55–56 space motion sickness (SMS), 5, 39, 51– 52, 72, 78, 87, 91, 102, 138, 140 Neurovestibular function, 10, 53, 62, 65, 67, 77, 81, 110 Noise effects and controls, 8, 28, 93, 95 Nutrition, 11, 51, 88–90, 138, 142, 143, 251 bioregenerative systems, 89, 143, 145 bone mineral loss, 44

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Safe Passage: Astronaut Care for Exploration Missions clinical research, 5, 62, 63, 65 injuries, recovery from, 123 malnutrition, 65, 89 medical events in space, 81 muscle protein, 48 O Occupational health model, 1, 16–17, 92– 97, 178–180, 187, 201, 203–204 ergonomics, 95–96, 113 Office of Naval Research, 194 Oocytes, 57, 58 Organizational factors, 2, 6–7, 10, 19–20, 29–30, 191–219, 262 see also International cooperation authority, 20, 21, 194–195 behavioral health, 20, 193 comprehensive health care system (NASA) , 7, 9, 21, 40, 70–71, 190–191, 195–199 (passim), 200, 201, 208–209, 216, 218–219 ethical issues, 174–175, 182, 187 group functioning, 147, 158, 168 health care personnel, 193–194 integration, 193–194 interagency coordination, 31, 73, 175, 193, 194, 195–196, 198, 199, 200, 203–208, 217 leadership, crew, 10 leadership, NASA, 20, 21, 194–195 neurological clinical program, 111 standards, 191, 192, 193, 195, 200 international cooperation, 8, 16, 17, 107, 219 systems development, 199–200 Orthostasis, 5, 39, 48–49, 50, 53, 59, 72, 97, 102, 110, 190 Osteoporosis, 45, 47, 64, 212 P Pain management and anesthesia, 9, 118– 122, 129, 134 backaches, 79 endotracheal intubation, 118, 119 headaches, 110, 140 medical devices, 118–119, 120 muscle loss and, 48 screening, selection and training, 118, 120 Pancreas, 103 Parathyroid hormone, 258, 259 Performance, see Behavioral health; Task performance Peripheral nervous system, 55–56 Pharmaceuticals, see Medications Pharmacodynamics, 59, 60, 65, 86, 90–91 analog environments, 91 databases, 8, 91, 113 Pharmacokinetics, 5, 72, 90–91, 110 databases, 8, 91, 113 Phenotypes, bone mineral loss, 43, 47, 72 Physiological monitoring, 39, 61–62, 68, 207 behavioral adaptation, 154, 155–156, 169 bone mineral density markers, 5, 43, 45, 46 clinical research, 5, 61, 62, 63, 68, 72 Pituitary gland, 57, 58 Polar tri-idothyronine (T3) syndrome, see Tri-iodothyronine (T3) Poliakov, Valeri, 26 Post-flight support and reintegration, 106, 107, 108–110, 153–154, 157–158 Pregnancy, 60, 103 see also Contraception and contraceptives Preventive measures, 28, 40, 99, 189–190, 210, 211, 213 see also Screening, selection, and training surgical infections, 126 underreporting of problems, 175, 183, 187 Privacy, see Confidentiality and privacy Privacy Act, 16, 175–176, 187, 201 Prostate gland, 112 Protocols see also Clinical practice guidelines; Standards

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Safe Passage: Astronaut Care for Exploration Missions confidentiality, 182–186 end-of-life considerations, 9, 130, 134 mental health, 108 organizational requirements, 200 physical exercise, 48 Psychomotor functions, 9, 39, 55, 64, 65, 134, 138, 212 computerized assessment, 155 medications, 55 recreational activities, 128–129 Public opinion/education, 6, 31, 114, 124, 131, 205–207 Pulmonary system, see Respiratory system Q Quality control, 8, 208, 217 see also Clinical practice guidelines; Ethical issues; Protocols; Regulatory issues; Standards expert oversight, 8, 219 R Race/ethnicity, see Ethnicity Radiation exposure, 8, 27–28, 29, 62, 77, 92, 96, 113, 189, 249, 261 cancer and, 65, 88–89, 212 central nervous system, 65 clinical research, 28, 65 cosmic particles, 27, 96, 113 gender factors, general, 5, 59, 88–89 genetic factors, 5, 56–57, 67, 72 microgravity effects, synergies, 65 neurovestibular adaptation, 67 reproductive health, 5, 56–57, 67, 72 Real-time measurements, 5, 18, 134 bone mineral density, 46, 72 group interactions, 148 neurological effects, 52–53 surgical procedures, 123–124 Recovery systems, see Support and recovery systems Recreation and leisure activities, 14, 128– 129, 142, 144, 151 Regulatory issues, 1, 17, 182, 187 see also Legislation; Occupational health model; Standards Rehabilitation practices, 7, 8, 11, 28, 67, 71, 73, 127–130, 190, 250 animal models, 127 International Space Station (ISS), 129– 130, 190 Renal system calculi, 39, 42, 44, 60–61, 66, 85, 111– 112, 212 nephrolithiasis, 60, 111–112 vascular resistance, 50 Reproductive system, 56–60, 111–112 clinical research, 5, 57, 59, 72 exercise, 58 gametes, 56, 58 genetic factors, 5, 56–57 gynecological issues hormones, 9, 57, 58, 72 replacement therapy, 9, 58–59, 104, 113 testosterone, 57 medical events in submarines, 82 microgravity, gynecological health issues, 5, 8, 43, 56, 58–59, 72, 103, 104 oocytes, 57, 58 pelvic examinations, 88 prostate gland, 112 radiation effects, 5, 56–57, 67, 72 sperm production, 56 Resources for the Optimal Care of the Injured Patient, 192 Respiratory system, 39, 51 airway management, 111, 118–119 endotracheal intubation, 118, 119 laryngeal masks, 119 medical events in Antarctica, 85, 86 medical events in space, 78, 81 medical events in submarines, 82, 84 nasal congestion, 78, 87 orthostatic hypotension, 5, 39, 48–49, 50 pulmonary function tests, 36 Reticulocytes, 105

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Safe Passage: Astronaut Care for Exploration Missions Review of NASA’s Biomedical Research Program, 38 Robotics, 262 Mars exploration, 24 surgery, 123–124 S Sagan, Carl, 137 Screening, selection, and training, 28, 86, 158–165, 169, 170, 250, 256– 257, 259 anesthesia and pain management, 118, 120 behavioral factors, 12, 77, 86, 107, 108 group interactions, 146–147, 148, 149, 158–165, 169, 170 underreporting of problems, 174– 175, 183, 187 bone mineral density, 45, 63 cardiovascular health, 97, 98, 113 committee charge and recommendations, 8, 12, 13, 15, 29, 32, 170 computerized assessment, 154–155 crew diversity, 77 Critical Path Roadmap project, 63 emergency and continuing care, 123– 125, 127, 131–132 ethical issues, 182–183, 187 gastrointestinal system, 102 group interactions, 77, 146–147, 148, 149, 158–165, 169, 170 health care personnel, 30, 34, 214–216 international cooperation, 158–159 Mars exploration, 25 mental health issues, 107, 108 organizational requirements, 189, 210, 214–216 paired transport vehicles, 149 prostate cancer, 112 rehabilitation measures, 127, 134 surgical skills, 123–125 Self-assessment, 108, 109, 139–140, 145, 164, 169 Self-monitoring, 145 Sex differences, see Gender factors Sexual behavior, 138, 142, 149 see also Contraception and contraceptives Shaw, Chuck, 75 Shuttle program, see Space shuttles Skeletal system, see Musculoskeletal system Skin diseases, 78–79, 81, 82, 84, 85, 86, 203 cell-mediated immunity, 105 preflight isolation, 105 Skylab, 27, 74 Sleep and circadian rhythm, 5, 39, 53–55, 64, 72, 78, 139, 142, 143–144 lighting in spacecraft, 53, 55, 144 medications, 53–54, 55 Small Clinical Trials: Issues and Challenges , 70, 207 Small n problem, 214–215 Social issues, 2, 21, 28, 64 see also Behavioral factors; Cultural factors; Group interactions; Public opinion analog environment data, 80–81 gender factors, 59 group interactions, 2, 21, 28, 138–142, 145–149, 156 Socrates, 23 Solar particle events (SPEs), 27, 96, 113 Space Behavioral Assessment Tool, 14, 155, 168 Space Flight Cognitive Assessment Tool, 14, 155 Space Flight Fatigue Assessment Tool, 155 Space motion sickness (SMS), 5, 39, 51– 52, 72, 78, 87, 91, 102, 138, 140 medications, 5, 52 Space shuttle program, 36, 77, 102, 116, 136, 190, 207, 248, 252 behavioral issues, 140, 155 bone mineral loss, 43 dehydration, 112 sleep and circadian rhythms, 144 toxic chemical exposure, 93

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Safe Passage: Astronaut Care for Exploration Missions Space suits, 93 decompression sickness, 92–93 females, 60 Spacecraft maximum allowable concentrations (SMAC), 93–94, 143 Sperm production, 56 Standards, 9 see also Ethical issues; Protocols cardiovascular health screening, 97 clinical care, 7, 97, 113, 210–212; see also Clinical practice guidelines ergonomic, 95–96, 113 group interaction monitoring, 156 health status measures database, 133 international cooperation, 8, 16, 17, 107, 219 mental health, 107 microgravity effects, 8, 113 occupational health model, 1, 16–17, 92–97, 178–180, 187, 201, 203– 204 organizational requirements, 191, 192, 193, 195, 200 international cooperation, 8, 16, 17, 107, 219 toxic substance concentrations (SMAC), 93–94, 143 A Strategy for Research in Space biology and Medicine in the New Century, 38, 139 Submarines, 76, 80–83, 84, 85, 106, 140– 141, 152, 162, 205, 256–257, 259 Suicide, 108, 154 Suits, see Space suits Support and recovery systems, 14, 26, 138, 147, 149–158, 161, 164, 168–169 see also Ground support personnel intramission/postmission problems, 106, 107, 108–110, 153–154, 157–158 mental health, 106, 107, 108–110, 153– 154, 157–158 mission control, 108, 136, 140, 150–151 psychomotor functions, 55 Surgery, 28, 30, 80, 102, 103, 121, 122, 123–127, 136, 215 see also Wounds analog environments, 126–127 anesthesia and pain management, 118– 119, 123 animal models, 121, 123 appendicitis, 29, 82, 85, 88, 102, 104, 127 cholecystectomy, 102, 103 communications technology and, 123– 124 ethical issues, flight surgeon, 174, 175, 180–181, 215 gynecological, 103 hematological considerations, 121, 122, 125 immune system effects, 121, 126 laproscopic, 104, 124, 125 medical devices, 124–125; see also Robotics medical events in submarines, 83–86 microgravity during, 121–123, 125 musculoskeletal system, 122–123 robotic, 123–124 Systemic Multiple Level Observation of Groups, 156 Systems development bioregenerative systems, 89, 143 complex adaptive systems, 148 organizational, 199–200 triage, 118, 134, 211–212 T Task performance, 62, 64, 66, 68, 198, 249, 251 behavioral issues and, 137–172 gender factors, 60 mental health factors, 106–107 neurovestibular adaptation, 67 psychomotor functions, 9, 39, 55 sleep and circadian rhythm, 53 Telecommunications, see Communication and communications technology

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Safe Passage: Astronaut Care for Exploration Missions Temperature factors, 5, 129 Mars, 23 sleep and, 55 Testosterone, 57 Titov, Vladimir, 26 To Err Is Human, Building a Safer Health System, 217 Toxic chemicals, see Hazardous substances Training requirements, see Screening, selection, and training Trauma, 29, 63, 65, 78, 79–80, 81, 121– 123, 127 see also Surgery anesthesia and pain management, 118– 119, 123 animal models, 121 cardiovascular response, 121–122 clinical research, 63, 65 closed-head and spinal cord injuries, 111 emergency and continuing care, 118 fractures, 42, 45, 46, 72, 79 immune system, 121, 126 medical events in Antarctica, 85, 86 medical events in submarines, 82, 84, 85 microgravity, response effects, 121, 122 multiple casualties, 118, 134 nutrition, recovery from, 123 organizational factors, 192 wounds Triage, 118, 134, 211–212 Tri-iodothyronine (T3), 101 U Urinary system, 60–61 see also Renal system bone mineral density markers, 5, 43, 45, 46, 60 clinical research, 5 countermeasures, 60–61, 112 infections, 111 medical events in space, 81, 111–112 medical events in submarines, 82 microgravity, 39, 42, 44, 50, 60–61 urinalysis, other than density markers, 61 V Vestibular function, see Neurovestibular function Visual perception, 53 Vomiting, see Space motion sickness W Weight, see Body mass Weightlessness, see Microgravity Windows Space Flight Cognitive Assessment, 14, 155, 168 Women, see Gender factors Wounds, 42, 84, 105, 113, 122–123 see also Surgery analog environments, 126, 127 animal models, 121, 123 clinical research, 9, 106 infections, 9, 105, 106, 113, 126 Wyle Laboratories, 195–196