Review of NASA's Human Research Program Evidence Books A Letter Report (2008) / Chapter Skim
Currently Skimming:
C Committee Reviews of the Evidence Books
C Committee Reviews of the Evidence Books
Pages 31-90
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From page 31... ...
C Committee Reviews of the Evidence Books Sensorimotor Chapter 1 Impaired Ability to Maintain Control of Vehicles and Other Complex Systems Bone Chapter 2 Accelerated Osteoporosis Chapter 3 Bone Fracture Chapter 4 Renal Stone Formation Chapter 5 Intervertebral Disk Damage Muscle Chapter 6 Impaired Performance Errors Due to Reduced Muscle Mass, Strength, and Endurance Chapter 7 Operational Impact of Prolonged Daily Required Exercise Chapter 8 Compromised EVA Performance and Crew Health Due to Inadequate EVA Suit Systems Cardiovascular Chapter 9 Orthostatic Intolerance During Re-Exposure to Gravity Chapter 10 Cardiovascular Effects on Performance and Operational Limi tations Chapter 11 Cardiac Rhythm Problems 31
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From page 32... ...
Sub-Risk of Error Due to Inadequate Information C Sub-Risk Associated with Poor Task Design Chapter 24 Inadequate Food System Chapter 25 Adverse Health Effects from Lunar Dust Exposure
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From page 33... ...
Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate? Is the omission of some risks in the Bioastronautics Roadmap appropriate?
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From page 34... ...
The amount of material covered and the implications of the findings for future lunar and Mars missions are highly informative. The paper clearly specifies the potential risks in future space activities based on the sensorimotor deficit findings from previous studies.
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From page 35... ...
On the other hand, long-term SCI studies suggest that bone loss continues for long periods after immobilization begins and results in truly dramatic reductions in bone mass. Moreover, some data indicate that markers of bone resorption remain elevated for long periods, further raising the concern that accelerated bone loss could be prolonged with more impressive implications for long term flights.
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From page 36... ...
. If the nature of flight-induced bone loss is different from the aging or postmenopausal con ditions, perhaps more akin to glucocorticoid-induced bone loss (where -- like spaceflight -- there is also a state of increased bone resorption and re duced bone formation)
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From page 37... ...
Efforts to devise methods to prevent loss during flight have not been successful. Mission related bone loss…" 2.
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From page 38... ...
Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate? Is the omission of some risks in the Bioastronautics Roadmap appropriate?
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From page 39... ...
4. The paucity of good data concerning the metabolic/environmental ab normalities potentially contributing to bone loss (apart from unweight ing)
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From page 40... ...
Poor human factors design 3. Bone loss 4.
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From page 41... ...
Additional attention should be directed at postflight fracture risk, fracture healing during low-G situations, and the possibility of stress fracture. Although there are distinct features of this evidence book on fracture risk, it could be argued that it could be combined with that on bone loss.
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From page 42... ...
Consider a change to the final sentence: "Alterations in hydration state (relative dehydration) and accelerated bone loss during exposure to microgravity may contribute to an increase in the risk of kidney stone formation.
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From page 43... ...
Bone loss/fracture risk.
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From page 44... ...
Without comparing the astronaut group with a control population having similar aviation experience except for spaceflight, it is premature to conclude that disk herniation is a risk of spaceflight. The third fact is that weightlessness and the associated absence of normal axial and muscular loading of the spine results in swelling of the intervertebral disks, elongation of the spine, and loss or lordotic curvature.
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From page 45... ...
Reduced muscle mass 2. Poor human factors design 3.
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From page 46... ...
Chapter 6 Impaired Performance Errors Due to Reduced Muscle Mass, Strength, and Endurance Does the evidence book make the case (sufficient evidence) that this risk is relevant to long-term space missions?
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From page 47... ...
Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate? Is the omission of some risks in the Bioastronautics Roadmap appropriate?
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From page 48... ...
Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks) A potential crosscutting issue is the interactive effects of nutrition on skeletal muscle properties with prolonged space travel.
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From page 49... ...
Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate? Is the omission of some risks in the Bioastronautics Roadmap appropriate?
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From page 50... ...
The most effective combinations of exercise and other countermeasures can be studied in bed rest experiments as well as on orbit. As noted in the letter report, the committee suggests that the scope of this evidence book be expanded and changed to "Operational Impact of Countermeasures." Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks)
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From page 51... ...
Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate? Is the omission of some risks in the Bioastronautics Roadmap appropriate?
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From page 52... ...
Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks) No additional comments.
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From page 53... ...
Yes. This is very clear and appropriately emphasizes the importance of developing and evaluating countermeasures to combat orthostatic intolerance during space missions.
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From page 54... ...
To date, an effective countermeasure for orthostatic intolerance has not been fully identified. Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks)
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From page 55... ...
Because benchmarks for cardiovascular performance are not presented, the risk assessment during longterm space travel and planetary exploration cannot be adequately determined. Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate?
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From page 56... ...
The committee suggests that this risk should be redefined to "Physiological Limits on Performance and Operations" to include effects such as cardiovascular, metabolic, strength, and thermal limits that might cause operational tasks to be limited or redefined. Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks)
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From page 57... ...
Not directly, although the evidence book does suggest that in persons with underlying occult heart disease, arrhythmias may be precipitated by the stress of working in space or of microgravity. Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate?
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From page 58... ...
Perhaps most important, the opening material documents in considerable detail evidence from prior space missions to indicate that astronauts often experience reduced dietary intake. Is the text of the short description of the health risk provided in the PRD clear (it should be Section I of the evidence book)
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From page 59... ...
behavioral health. Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate?
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From page 60... ...
An enormous amount of evidence is reviewed regarding nutrition and previous spaceflights, and it seems likely that that information could be condensed and summarized. Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks)
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From page 61... ...
Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate? Is the omission of some risks in the Bioastronautics Roadmap appropriate?
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From page 62... ...
No additional comments. Chapter 14 Performance Errors Due to Sleep Loss, Circadian Desynchronization, Fatigue, and Work Overload Does the evidence book make the case (sufficient evidence)
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From page 63... ...
Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate? Is the omission of some risks in the Bioastronautics Roadmap appropriate?
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From page 64... ...
Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks) A crosscutting issue is the effect of sleep loss and fatigue on psychosocial adaptation.
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From page 65... ...
This information is relevant to the risk of performance errors, particularly if certain types of behavior problems have a specific impact on various team factors, and in turn performance. Moreover, individual adaptation is relevant to team selection and the development of countermeasures.
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From page 66... ...
Editing is required to clarify some of the comments that are vaguely presented or repeat the obvious. The recommendations for research on selection and countermeasures for dealing with the risk of performance errors due to team performance need to be expanded.
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From page 67... ...
Numerous statistical analyses are presented projecting behavioral and psychiatric risks based on data primarily from analog environments. Is the text of the short description of the health risk provided in the PRD clear (it should be Section I of the evidence book)
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From page 68... ...
Yes. The section on personality factors is extremely sparse and does not cover adequately the many personality studies of personnel in extreme environments including simulation studies, as well as data from astronaut selection.
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From page 69... ...
Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate? Is the omission of some risks in the Bioastronautics Roadmap appropriate?
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From page 70... ...
Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks) Missing: prevention and treatment of postflight behavior/psychiatric disorders.
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From page 71... ...
Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks) No additional comments.
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From page 72... ...
Yes. Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate?
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From page 73... ...
Overarching comments on the evidence book: Provide a short paragraph summary of the key issues raised in your review of the paper. The primary concern is a lack of recognition (this is pervasive throughout the evidence books)
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From page 74... ...
Yes. Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate?
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From page 75... ...
Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks) No additional comments.
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From page 76... ...
This comment is a general one, not limited to the specific evidence book: The approach using separate evidence books could be too compartmentalized, unless the next phase is to integrate them. It would make sense to classify risks and risk factors in terms of (1)
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From page 77... ...
The title is somewhat misleading, as the evidence book clearly demonstrates that there are risks related to self-medication, and inaccurate recordkeeping in addition to "ineffectiveness of medication." It is striking that the largest indication for self-medication is pain relief, yet debriefings suggest that pain is inadequately addressed in flight. Similarly, the evidence book appropriately warns against the "un-counseled polypharmacy trend of medication use in space." We suggest changing the title to: "Risk of therapeutic failure or adverse effect due to ineffectiveness of medication, medication interaction, or unanticipated idiosyncratic reaction." Is the text of the short description of the health risk provided in the PRD clear (it should be Section I of the evidence book)
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From page 78... ...
Yes. Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate?
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From page 79... ...
Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks) No additional comments.
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From page 80... ...
As written, it describes a necessary, but not sufficient, overall approach to the provisioning of autonomous health care resources and, at least as importantly, the enumeration of conditions that will be left untreated during exploration-class missions. Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks)
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From page 81... ...
Further, the authors may wish to address the potential overlap associated with the impact of environmental design on psychosocial and behavioral adjustment issues, e.g., issues discussed in Chapters 15 and 16. Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate?
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From page 82... ...
The first is a matter of training and the second is the subject for NASA's Human Research Program (HRP) research.
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From page 83... ...
Yes. Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate?
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From page 84... ...
Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks) No additional comments.
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From page 85... ...
Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks) No additional comments.
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From page 86... ...
The evidence book on central nervous system effects from radiation exposure mentions some dietary countermeasures, but there is no indication in this food system paper regarding giving any special consideration to those dietary items. Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate?
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From page 87... ...
Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks) No additional comments.
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From page 88... ...
Other topics for consideration include impact of prolonged exercise, poor human factors design, and cognitive errors. Comment if relevant to the specific evidence book: Is the merging of some risks in the Bioastronautics Roadmap into a single risk appropriate?
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From page 89... ...
No additional comments. Please note: • Crosscutting issues and ideas for broader recommendations • Additional risks that should be added to the list (missing risks)
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