Wow…what a great 93rd Annual Scientific Meeting we had together in New Orleans this year! I wish to share some perspectives, provide a meeting recap of some key items, and share gratitude for the professionalism and hard work of so many that made the meeting a success. We had a final total registration of 1,630 attendees. An AsMA record and wonderful return coming out of the Pandemic era! A total of 55 countries were represented by our International colleagues. The Opening Night Reception in the Exhibits area set a great tone to rekindle friendships and make new
INTRODUCTION: Prior study has indicated that individuals of varied age, medical history, and limited-to-no experience tolerate spaceflight conditions. We sought to expand upon the understanding of layperson response to hypergravity conditions expected in commercial spaceflight by exposing subjects, following minimal training, to centrifuge-simulated, high-fidelity commercial spaceflight profiles. We further explored how these individuals perform in simulated operational activities during and following hypergravity.
METHODS: Volunteer subjects participated in up to five centrifuge runs (maximum +4.0 Gz, +4.5 Gx, 6.1 G resultant; onset rate <0.5 Gz · s−1, ≤1 Gx · s−1). Profiles included two winged spacecraft simulations with sequential and combined +Gx/+Gz and two capsule simulations representing nominal +Gx launch and reentry. The final profile simulated a capsule launch abort, with a more dynamic cycling of +Gx exposures and oscillatory multi-axis exposures simulating parachutes and water motion. Touchscreen tablets were used to administer pattern-replication tasks during and after profiles.
RESULTS: A total of 46 subjects participated, including 4 diabetics and 9 with cardiac disease. There was increased frequency of motion sickness, subjectively associated with capsule-type profiles, and increased termination of participation compared to prior studies. There was no association between medical history, age, sex, or motion sickness history and tolerance or noncompletion. Tablet test errors were common; accuracy and time to completion were associated with age. There was no association between any time metric or accuracy and sex.
DISCUSSION: This study improves understanding of layperson tolerance in commercial spaceflight analog conditions, and the capsular profiles broaden the applicability of the findings. The frequency of task errors highlights the potential for mistakes in operational activities when performed by laypersons.
Blue RS, Ong KM, Ray K, Menon A, Mateus J, Auñón-Chancellor S, Shah R, Powers W. Layperson physiological tolerance and operational performance in centrifuge-simulated spaceflight. Aerosp Med Hum Perform. 2023; 94(8):584–595.
BACKGROUND: Critical care for exploration space missions may require intravenous (IV) fluid resuscitation therapy. Resource constraints may limit availability of standard, Earth-based infusion technologies. The effect of variable acceleration on infusion flow rates using simple fluid resuscitation supplies was investigated.
METHODS: Infusions of water or blood analog (40% glycerol) from a 1 L IV bag were performed using pressure bag augmentation at 0, 150, or 300 mmHg. The solution bag rested on an adjustable mount, configured to different heights to simulate relevant gravitational accelerations (1 G, Martian G, lunar G, and 0 G). The bag emptied through an IV line with a 14- or 20-gauge angiocath into a 3-mmHg venous pressure reservoir. Flow rates were measured using an in-line flow probe. Three determinations were made for each test condition.
RESULTS: Temporal flow rate data for all test conditions displayed one-phase exponential decay. At 300 mmHg pressurization, maximum infusion rates ranged from 92–222 mL ⋅ min−1 for water and from 21–49 mL ⋅ min−1 for blood analog. All reduced gravity conditions had significantly longer infusion times in comparison to 1 G for both test solutions.
DISCUSSION: Reduced acceleration significantly altered flow rates and infusion times for fluid resuscitation. Fluid resuscitation protocols specify a desired volume to infuse for a target time (e.g., 20–30 mL ⋅ min−1 for a 75-kg adult). This data demonstrates that this protocol parameter can be achieved with infusion pressure bag augmentation alone and provides information for the refinement of fluid resuscitation protocols for exploration space missions.
Pantalos GM, Heidel JS, Jain IM, Warner SE, Barefoot TL, Baker RO, Hailey M. Intravenous fluid resuscitation capabilities in simulated reduced gravity. Aerosp Med Hum Perform. 2023; 94(8):596–603.
BACKGROUND: Due to the increased overweight and obesity prevalence in Colombia, the aim of this study is to determine the frequency of metabolic syndrome (MetS) among Colombian Air Force military aviators, crews, remote piloted aircraft operators, and air traffic controllers and relationships with clinical markers.
METHODS: Operationally active Columbian Air Force military personnel examined periodically at the Colombian Air Force Aerospace Medical Directorate were chosen for a cross-sectional study performed among 2179 subjects. Medical history, anthropometrics, and laboratory results were analyzed and frequencies, correlations, and odds ratios were calculated.
RESULTS: Overall prevalence of MetS was 21.7%; in subjects with BMI ≥25, frequency increased to 36% vs. those with BMI <25. Hypertriglyceridemia was present in 31%, impaired fasting glucose 12.5%, hypertension (≥130/85 mmHg) 14.4%, low HDL-C 35.2%, and increased waist circumference 46.2%. Those with three criteria were 14.6%, four criteria 5.8%, and five criteria 1.2%. Pilots had a significantly lower prevalence of MetS at 17.7% and an adjusted OR of 0.61 (0.49–0.76) than other crew; hyperuricemia was three times more likely (3.2–5.1) and hypercholesterolemia OR was 2.3 (1.9–2.9). Subjects with MetS had a significantly higher fat percentage, waist circumference, low-density lipoprotein, very low-density lipoprotein, non-high-density lipoprotein cholesterol, atherogenic index of plasma (AIP), uric acid, and white blood cell (leukocyte) count, and a lower estimated glomerular filtration rate. There is a linear relationship of the AIP and waist circumference, BMI, uric acid, and white blood cell count.
DISCUSSION: MetS prevalence among Colombian Air Force aviators is lower than the general population, higher than other countries, and displays worse lipid profiles that increase cardiovascular and diabetes mellitus risk within the military.
Malpica D. Metabolic syndrome, hyperlipidemias, and associated clinical markers among military airmen. Aerosp Med Hum Perform. 2023; 94(8):604–609.
INTRODUCTION:During future interplanetary space missions, a number of health conditions may arise, owing to the hostile environment of space and the myriad of stressors experienced by the crew. When managing these conditions, crews will be required to make accurate, timely clinical decisions at a high level of autonomy, as telecommunication delays and increasing distances restrict real-time support from the ground. On Earth, artificial intelligence (AI) has proven successful in healthcare, augmenting expert clinical decision-making or enhancing medical knowledge where it is lacking. Similarly, deploying AI tools in the context of a space mission could improve crew self-reliance and healthcare delivery.
METHODS: We conducted a narrative review to discuss existing AI applications that could improve the prevention, recognition, evaluation, and management of the most mission-critical conditions, including psychological and mental health, acute radiation sickness, surgical emergencies, spaceflight-associated neuro-ocular syndrome, infections, and cardiovascular deconditioning.
RESULTS: Some examples of the applications we identified include AI chatbots designed to prevent and mitigate psychological and mental health conditions, automated medical imaging analysis, and closed-loop systems for hemodynamic optimization. We also discuss at length gaps in current technologies, as well as the key challenges and limitations of developing and deploying AI for space medicine to inform future research and innovation. Indeed, shifts in patient cohorts, space-induced physiological changes, limited size and breadth of space biomedical datasets, and changes in disease characteristics may render the models invalid when transferred from ground settings into space.
Cheung HC, De Louche C, Komorowski M. Artificial intelligence applications in space medicine. Aerosp Med Hum Perform. 2023; 94(8):610–622.
INTRODUCTION:Aerobic exercise within the habitable volume of small spacecraft needed for space exploration beyond low Earth orbit is expected to challenge the capacity of environmental control systems. Moisture control is a primary concern. Crewmembers will contribute moisture to the cabin environment in the form of sweat while exercising. The effects of continuous aerobic exercise for improving and maintaining aerobic capacity is well characterized. Likewise, evidence suggests that high intensity interval exercise for shorter durations is also effective in building and maintaining aerobic capacity.
METHODS: On separate days, measures of sweat and respiratory responses were made for continuous (30 min of steady state exercise at ∼75% of aerobic capacity) and two interval (4 × 4 min, 8 × 30 s) exercise protocols.
RESULTS: We observed that the 4-min and 30-s interval protocols produce 16% and 66% less metabolic water loss vs. the continuous exercise protocol, respectively. These responses were highly correlated with the amount of work performed (R2 = 0.81) and the amount of energy expenditure (R2 = 0.83) during exercise.
DISCUSSION: These results suggest that interval exercise may be a useful alternative to continuous aerobic exercise when metabolic water production is an environmental concern. The results may inform the choices of aerobic exercise countermeasure protocols for use in deep space exploration.
Ryder JW, Crowell JB, Song HJ, Ewert M. Sweat production during continuous and interval aerobic exercise. Aerosp Med Hum Perform. 2023; 94(8):623–628.
BACKGROUND: Aero-otitis media (AOM), also known as aural barotrauma or barotitis media, is categorized into primary AOM and secondary AOM. Because conservative treatment was ineffective, primary AOM was one of the main reasons for grounding. In 2014, the team successfully treated a pilot with primary AOM using balloon Eustachian tuboplasty (BET). Now, this case is reported.
CASE REPORT:The patient was a 40-yr-old male transport pilot who joined a flight after catching a cold. During the descent, the right ear appeared to have stuffiness and hearing loss, accompanied by tinnitus and ear pain. The local hospital’s acoustic immittance test showed an “A” curve in the left ear and a “B” curve in the right ear. According to “secretory otitis media”, right tympanic membrane puncture and drugs were performed. After he recovered, he continued to fly, and the symptoms reappeared again. Then he was transferred to our hospital, and right BET was performed. Equalization of ear pressure in the hypobaric chamber returned to normal 2 mo after the operation. The pilot was found fit to fly. The pilot is still qualified, with more than 6000 h of flight time.
DISCUSSION: AOM is linked to Eustachian tube dysfunction. BET has been a minimally invasive treatment of Eustachian tube lesions in recent years. If conservative treatments for primary AOM are ineffective, BET can be selected. While the postoperative symptoms disappeared, pure tone audiometry, tympanometry, and ear pressure function tests met the standards for the physical examination of pilots, allowing the determination of flight qualification.
Zhang M, Liu X, Wang B, Jin Z, Xu X. Qualification of pilots with aero-otitis media after balloon Eustachian tuboplasty. Aerosp Med Hum Perform. 2023; 94(8):629–633.
INTRODUCTION:In 2022, the National Aeronautics and Space Administration (NASA) began launching missions to establish a sustainable human presence on the Moon. One key to success will be maintaining human health. In preparation for longer missions with more diverse crews, the Spaceflight for Everybody Symposium was held to review currently known human spaceflight biomedical knowledge, the future of exploration space medicine, and the ability of NASA to manage the spaceflight human health risks and enable exploration. The symposium highlighted the future of precision health/personalized medicine, the possible spaceflight health acute and lifetime illnesses, and the challenge of identifying appropriate prevention, treatment, rehabilitation, and autonomous medical systems for long-duration spaceflight. The symposium was organized to look back at NASA exploration, science, and leadership successes, celebrate NASA women’s leadership, and focus on future Artemis activities, including research and development that will benefit both spaceflight and terrestrial life. NASA current preparations for returning to the Moon have led to increased acknowledgment of the importance of workforce diversity, i.e., to use the best candidate in every work position, including the plan for the first woman and person of color to land on the Moon. NASA is developing plans to use commercial spaceflight research opportunities when the International Space Station is no longer available. Astronaut health decisions will consist of individualized health risk determinations and mitigation strategies and increased medical self-care. Research findings include improved exploration cardiovascular, musculoskeletal, and radiation risk reduction and improved interpersonal support for both astronaut crews and mission control personnel.
Schneider V, Siegel B, Allen JR. Human health on the Moon and beyond and the results of the Spaceflight for Everybody Symposium. Aerosp Med Hum Perform. 2023; 94(8):634–643.
Kanas N. Behavioral Health and Human Interactions in Space. Cham (Switzerland): Springer Nature; 2023. Available from https://link.springer.com/book/10.1007/978-3-031-16723-2. Dr. Kanas has recently published his newest book, Behavioral Health and Human Interactions in Space. The book is written primarily as a textbook for students in aerospace medicine, psychiatry, psychology, and the social sciences to provide a broad overview of the psychological and behavioral health issues that can affect astronauts in low Earth orbit and long-duration missions to the Moon and beyond. Dr. Kanas’s book is organized into nine chapters covering multiple domains that impact behavioral
This article was prepared by Natacha Chough, M.D., M.P.H., Moriah Thompson, M.D., M.P.H., and Benjamin Johansen, D.O., M.P.H. You’re the NASA Flight Surgeon for an International Space Station (ISS) mission during the first year of the COVID-19 pandemic. Your crew are among the last unvaccinated individuals to travel to ISS prior to the release of mRNA vaccines. Thanks to NASA and International Partners cooperation, preflight quarantine was successful, and your crew is safely aboard the ISS with no active medical issues. The world’s first mRNA vaccines were released a month ago, and during your most recent weekly Private Medical Conferences
Mayes RS, Keirns CJ, Hicks AG, Menner LD, Lee MS, Wagner JH, Baltzer RL. USAFSAM Aeromedical Consultation Service Medical Risk Assessment and Airworthiness Matrix. Aerosp Med Hum Perform. 2023; 94(7):514–522. DOI: https://doi.org/10.3357/AMHP.6154.2023 In the above article, the authors missed errors in the Methods section, p. 517, left-hand column, first full paragraph, eighth sentence and in the equations about two-thirds of the way down the page. The sentence in question says “For instance, an “occasional” event would occur once every 10,000 (10−4) to 100,000 (10−5) h.” It should read “…an “occasional” event would occur once
This article was prepared by Catherine J. Blasser, D.O., M.P.H., and W. David Smith, M.D. You are the attending flight surgeon when a 28-yr-old male active-duty U.S. Air Force (USAF) intelligence officer on flying class (FC) III status presents to your flight medicine clinic with complaints of fatigue. Over the past few months, he notes difficulty staying awake during long missions, frequently falling asleep while watching television, and a 12-lb weight gain [body mass index (BMI) = 31.2 kg · m−2] that he attributes to feeling too tired to exercise. He had not thought much of his symptoms, as
President John F. Kennedy offered collaboration on the human lunar program with the Union of Soviet Socialist Republics (USSR) while addressing the United Nations on September 20, 1963, but this went unanswered by the Soviets. In April 1970, NASA Administrator Thomas O. Paine suggested, in an informal meeting with Soviet academician Anatoli Blagonravov in New York, that the two nations cooperate on astronaut safety, including compatible docking equipment on space stations and spacecraft to permit rescue operations in space emergencies. The development of the Apollo-Soyuz Test Project (ASTP) began with a letter sent from Thomas Paine to the Soviet Academy
Booze in aviation (Johns Hopkins University, Baltimore, MD; Office of the Chief Medical Examiner, Chapel Hill, NC; University of North Carolina School of Public Health, Chapel Hill, NC): “This study examines the magnitude of and factors related to alcohol involvement in both pilot and non-pilot aviation fatalities. … We analyzed medical examiner data on all victims who died in civilian aircraft crashes in North Carolina during 1985-94, complemented by crash investigation data from the National Transportation Safety Board. … During the 10 yr study period, the North Carolina Medical Examiner Information System recorded 337 aviation-related fatalities includingAugust 1998
