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Mason, Sara

Publications and source records attributed to Mason, Sara.

Relationship Between Carbon Dioxide Levels and Reported Congestion and Headaches on the International Space Station

Congestion is commonly reported during spaceflight, and most crewmembers have reported using medications for congestion during International Space Station (ISS) missions. Although congestion has been attributed to fluid shifts during spaceflight, fluid status reaches equilibrium during the first week after launch while congestion continues to be reported throughout long duration missions. Congestion complaints have anecdotally been reported in relation to ISS CO2 levels; this evaluation was undertaken to determine whether or not an association exists. METHODS: Reported headaches, congestion symptoms, and CO2 levels were obtained for ISS expeditions 2-31, and time-weighted means and single-point maxima were determined for 24-hour (24hr) and 7-day (7d) periods prior to each weekly private medical conference. Multiple imputation addressed missing data, and logistic regression modeled the relationship between probability of reported event of congestion or headache and CO2 levels, adjusted for possible confounding covariates. The first seven days of spaceflight were not included to control for fluid shifts. Data were evaluated to determine the concentration of CO2 required to maintain the risk of congestion below 1% to allow for direct comparison with a previously published evaluation of CO2 concentrations and headache. RESULTS: This study confirmed a previously identified significant association between CO2 and headache and also found a significant association between CO2 and congestion. For each 1-mm Hg increase in CO2, the odds of a crew member reporting congestion doubled. The average 7-day CO2 would need to be maintained below 1.5 mmHg to keep the risk of congestion below 1%. The predicted probability curves of ISS headache and congestion curves appear parallel when plotted against ppCO2 levels with congestion occurring at approximately 1mmHg lower than a headache would be reported. DISCUSSION: While the cause of congestion is multifactorial, this study showed congestion is associated with CO2 levels on ISS. Data from additional expeditions could be incorporated to further assess this finding. CO2 levels are also associated with reports of headaches on ISS. While it may be expected for astronauts with congestion to also complain of headaches, these two symptoms are commonly mutually exclusive. Furthermore, it is unknown if a temporal CO2 relationship exists between congestion and headache on ISS. CO2 levels were time-weighted for 24hr and 7d, and thus the time course of congestion leading to headache was not assessed; however, congestion could be an early CO2-related symptom when compared to headache. Future studies evaluating the association of CO2-related congestion leading to headache would be difficult due to the relatively stable daily CO2 levels on ISS currently, but a systematic study could be implemented on-orbit if desired.

Cole, Robert

OCT Expanded Clinical Data Analysis

Vision changes identified in long duration space fliers has led to a more comprehensive clinical monitoring protocol. Optical Coherence Tomography (OCT) was recently implemented on board the International Space Station in 2013. NASA is collaborating with Heidelberg Engineering to expand our current OCT data analysis capability by implementing a volumetric approach. Volumetric maps will be created by combining the circle scan, the disc block scan, and the radial scan. This assessment may provide additional information about the optic nerve and further characterize changes related microgravity exposure. We will discuss challenges with collection and analysis of OCT data, present the results of this reanalysis and outline the potential benefits and limitations of the additional data.

Van Baalen, Mary

The Effects of Spaceflight on Neurocognitive Performance: Extent, Longevity, and Neural Bases

Spaceflight effects on gait, balance, & manual motor control have been well studied; some evidence for cognitive deficits. Rodent cortical motor & sensory systems show neural structural alterations with spaceflight. We found extensive changes in behavior, brain structure & brain function following 70 days of HDBR. Specific Aim: Aim 1-Identify changes in brain structure, function, and network integrity as a function of spaceflight and characterize their time course. Aim 2-Specify relationships between structural and functional brain changes and performance and characterize their time course.

Seidler, Rachael D.

NASA Astronaut Urinary Conditions Associated with Spaceflight

INTRODUCTION: Spaceflight is associated with many factors which may promote kidney stone formation, urinary retention, and/or Urinary Tract Infection (UTI). According to ISS mission predictions supplied by NASA's Integrated Medical Model, kidney stone is the second and sepsis (urosepsis as primary driver) the third most likely reason for emergent medical evacuation from the International Space Station (ISS). METHODS: Inflight and postflight medical records of NASA astronauts were reviewed for urinary retention, UTI and kidney stones during Mercury, Gemini, Apollo, Mir, Shuttle, and ISS expeditions 1-38. RESULTS: NASA astronauts have had 7 cases of kidney stones in the 12 months after flight. Three of these cases occurred within 90 to 180 days after landing and one of the seven cases occurred in the first 90 days after flight. There have been a total of 16 cases (0.018 events per person-flights) of urinary retention during flight. The event rates per mission are nearly identical between Shuttle and ISS flights (0.019 vs 0.021 events per person-flights). In 12 of the 16 cases, astronauts had taken at least one space motion sickness medication. Upon further analysis, it was determined that the odds of developing urinary retention in spaceflight is 3 times higher among astronauts who took promethazine. The female to male odds ratio for inflight urinary retention is 11:14. An astronaut with urinary retention is 25 times more likely to have a UTI with a 17% infection rate per mission. There have been 9 reported UTIs during spaceflight. DISCUSSION: It is unclear if spaceflight carries an increased post-flight risk of kidney stones. Regarding urinary retention, the female to male odds ratio is higher during flight compared to the general population where older males comprise almost all cases due to prostatic hypertrophy. This female prevalence in spaceflight is even more concerning given the fact that there have been many more males in space than females. Terrestrial medications with a known side effect of urinary retention are also associated with urinary retention during flight. However, not all cases of urinary retention surrounded medication use inflight. It is also known that UTI is a terrestrial cause of urinary retention. Furthermore, the treatment of urinary retention with a urinary catheter may be more likely to initiate a UTI in space than on the ground, as aseptic techniques can be particularly challenging with an inexperienced provider in a free-floating environment. Inflight urinary retention and UTI have proven to be highly associated and urinary risks should be considered collectively when planning for space flight.

Law, Jennifer

Optic Nerve Sheath Diameter: Translating a Terrestrial Focused Technique into a Clinical Monitoring Tool for Spaceflight

Ultrasonography is increasingly used to quickly measure optic nerve sheath diameter (ONSD) when increased intracranial pressure (ICP) is suspected. NASA Space and Clinical Operations Division has been using ground and on‐orbit ultrasound since 2009 as a proxy for ICP in non‐acute monitoring for space medicine purposes. In the terrestrial emergency room population, an ONSD greater than 0.59 cm is considered highly predictive of elevated intracranial pressure. However, this cut‐off limit is not applicable to the spaceflight setting since over 50% of US Operating Segment (USOS) astronauts have an ONSD greater than 0.60 cm even before launch. Crew Surgeon clinical decision‐making is complicated by the fact that many astronauts have history of previous spaceflights. Our data characterize the distribution of baseline ONSD in the astronaut corps, its longitudinal trends in long‐duration spaceflight, and the predictive power of this measure related to increased ICP outcomes.

Mason, Sara

Evidence Based Medicine in Space Flight: Evaluation of Inflight Vision Data for Operational Decision-Making

Due to recently identified vision changes associated with space flight, JSC Space and Clinical Operations (SCO) implemented broad mission‐related vision testing starting in 2009. Optical Coherence Tomography (OCT), 3 Tesla Brain and Orbit MRIs, Optical Biometry were implemented terrestrially for clinical monitoring. While no inflight vision testing was in place, already available onorbit technology was leveraged to facilitate in‐flight clinical monitoring, including visual acuity, Amsler grid, tonometry, and ultrasonography. In 2013, on‐orbit testing capabilities were expanded to include contrast sensitivity testing and OCT. As these additional testing capabilities have been added, resource prioritization, particularly crew time, is under evaluation.

Van Baalen, Mary

Changes in Near Visual Acuity of Over Time in the Astronaut Corps

We hypothesized that visual impairment due to intracranial pressure (VIIP) would increase the rate of which presbyopia would occur in the astronaut population, with long durations flyers at an especially high risk. Presbyopia is characterized as the gradual loss of near visual acuity overtime due to a loss in ability to accommodate. It generally develops in the mid‐40s and progresses until about age 65. This analysis considered annual vision exams conducted on active NASA astronauts with spaceflight experience currently between the ages of 40 to 60 years of age. Onset of presbyopia was characterized as a shift of at least 20 units on the standard Snellen test from one annual exam to the next. There were 236 short duration and 48 long duration flyers, the majority of whom did experience onset of presbyopia between age 40 and 60. This shift however, did not necessarily come after spaceflight. In comparing the short and long duration flyers the mean age of onset was 47 years old (SD+/-3.7). The mean of onset within the general population is 45 to 47 years old [1, 2]. The mean age of the onset of presbyopia as compared to the general population indicates that space flight does not induce early development of presbyopia.

Taiym, Wafa

Combining Epidemiologic Information Across Space Agencies

Space flight is a very unique occupational exposure with potential hazards that are not fully understood. A limited number of individuals have experienced the exposures incurred during space flight, and epidemiologic research would benefit from shared information across space agencies. However, data sharing can be problematic due to agency protection policies for personally identifiable information as well as medical records. Compliance with these protocols in the astronaut population is particularly difficult given the small, high-profile population under study. Creativity in combining data is necessary in order to overcome these difficulties and improve statistical power in research. This study presents methods in meta-analysis that may be used to combine non-attributable data across space agencies so that meaningful conclusions may be drawn about study interests. Methods for combining epidemiologic data across space agencies are presented, and the processes are demonstrated using life-time mortality data in U.S. astronauts and Russian cosmonauts. This proof of concept was found to be an acceptable way of sharing data across agencies, and will be used in the future as more relevant research interests are identified.

Minard, Charles G.

Intraocular Pressure Dynamics in Microgravity and Terrestrial Analogues: A Systematic Review and Qualitative Analysis

Spaceflight-Associated Neuro-ocular Syndrome (SANS) presents risk to expeditionary spaceflight. Related ocular findings carry poorly understood pathophysiology, including relationship to intraocular pressure (IOP) dynamics in microgravity. The study objectives were to conduct a systematic literature review and pool available IOP data from terrestrial microgravity analogs plus published spaceflight measures for comparison and qualitative analysis.

Elkhatib, Wiaam