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NASA NTRS2001

Biomarkers of exposure and dose: state of the art

Biomarkers provide methods to measure changes in biological systems and to relate them to environmental insults and disease processes. Biomarkers can be classified as markers of exposure and dose, markers of sensitivity, and markers of disease. It is important that the differences and applications of the various types of biomarkers be clearly understood. The military is primarily interested in early biomarkers of exposure and dose that do not require high levels of sensitivity but can be used to rapidly triage war fighters under combat or terrorist conditions and determine which, if any, require medical attention. Biomarkers of long-term radiation risk represent the second area of interest for the military. Biomarkers of risk require high sensitivity and specificity for the disease and insult but do not require rapid data turnaround. Biomarkers will help provide information for quick command decisions in the field, characterise long-term troop risks and identify early stages of radiation-induced diseases. This information provides major positive reassurances about individual exposures and risk that will minimise the physical and psychological impact of wartime radiation exposures.

Review, Tutorial↗

NASA NTRS2007

Artificial Gravity as a Multi-System Countermeasure: Effects on Cognitive Function

The Space Flight Cognitive Assessment Tool for Windows (WinSCAT) is a medical requirement on the International Space Station, and its purpose is to evaluate cognitive functioning after physical insult (e.g., head trauma, decompression sickness, exposure to toxic gases, medication side effects). The current objective is to assess cognitive functioning in a long duration space mission analog environment where Artificial Gravity is being applied as a countermeasure in a Bed Rest study. Methods: Fifteen male subjects (8 treatment and 7 control) who participated in 21 days of -6 degree head-down bed rest were assessed. Three practice and three baseline WinSCAT test sessions were administered during the pre-bed rest phase of study participation. During the bed rest phase, the WinSCAT test was scheduled every other day, following the centrifuge, for a total of 10 test sessions. (The treatment group received 60 minutes of centrifugation each day during the 21 days of bed rest. The control subjects were strapped to the centrifuge for the same length of time as the treatment group but were not spun.) During the post-bed rest (reconditioning) phase, the test was administered 4 times. Results: Individual differences were found both within and between the treatment and control groups. After controlling for the number of subjects in each group, the treatment group accounted for more off-nominal WinSCAT scores than the control group. Conclusions:There is some preliminary evidence that centrifuge spinning might negatively impact cognitive functioning. However, due to sample size limitations, it cannot be ascertained whether there were significant differences in cognitive performance between the treatment and control groups. If centrifugation had a negative effect on cognitive functioning, consistent decrements would be expected to be found with all treatment subjects across time. Individual differences in underlying cognitive ability and motivation level are other possible explanations for the results found in this study.

Sipes, Walter E.↗

NASA NTRS2000

Nutritional Biochemistry of Space Flight

Adequate nutrition is critical for maintenance of crew health during and after extended-duration space flight. The impact of weightlessness on human physiology is profound, with effects on many systems related to nutrition, including bone, muscle, hematology, fluid and electrolyte regulation. Additionally, we have much to learn regarding the impact of weightlessness on absorption, m~tabolism , and excretion of nutrients, and this will ultimately determine the nutrient requirements for extended-duration space flight. Existing nutritional requirements for extended-duration space flight have been formulated based on limited flight research, and extrapolation from ground-based research. NASA's Nutritional Biochemistry Laboratory is charged with defining the nutritional requirements for space flight. This is accomplished through both operational and research projects. A nutritional status assessment program is included operationally for all International Space Station astronauts. This medical requirement includes biochemical and dietary assessments, and is completed before, during, and after the missions. This program will provide information about crew health and nutritional status, and will also provide assessments of countermeasure efficacy. Ongoing research projects include studies of calcium and bone metabolism, and iron absorption and metabolism. The calcium studies include measurements of endocrine regulation of calcium homeostasis, biochemical marker~ of bone metabolism, and tracer kinetic studies of calcium movement in the body. These calcium kinetic studies allow for estimation of intestinal absorption, urinary excretion, and perhaps most importantly - deposition and resorption of calcium from bone. The Calcium Kinetics experiment is currently being prepared for flight on the Space Shuttle in 2001, and potentially for subsequent Shuttle and International Space Station missions. The iron study is intended to assess whether iron absorption is down-regulated dUl1ng space flight. This is critical due to the red blood cell changes which occur, and the increase in iron storage that has been observed after space flight. The Iron Absorption and Metabolism experiment is currently planned for long-term flights on the International Space Station.

Smith, Scott M.↗

NASA NTRS2009

The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Space Flight Medical Systems

The Integrated Medical Model (IMM) is a decision support tool that is useful to mission planners and medical system designers in assessing risks and designing medical systems for space flight missions. The IMM provides an evidence based approach for optimizing medical resources and minimizing risks within space flight operational constraints. The mathematical relationships among mission and crew profiles, medical condition incidence data, in-flight medical resources, potential crew functional impairments, and clinical end-states are established to determine probable mission outcomes. Stochastic computational methods are used to forecast probability distributions of crew health and medical resource utilization, as well as estimates of medical evacuation and loss of crew life. The IMM has been used in support of the International Space Station (ISS) medical kit redesign, the medical component of the ISS Probabilistic Risk Assessment, and the development of the Constellation Medical Conditions List. The IMM also will be used to refine medical requirements for the Constellation program. The IMM outputs for ISS and Constellation design reference missions will be presented to demonstrate the potential of the IMM in assessing risks, planning missions, and designing medical systems. The implementation of the IMM verification and validation plan will be reviewed. Additional planned capabilities of the IMM, including optimization techniques and the inclusion of a mission timeline, will be discussed. Given the space flight constraints of mass, volume, and crew medical training, the IMM is a valuable risk assessment and decision support tool for medical system design and mission planning.

Kerstman, Eric↗

NASA NTRS2006

Skeletal Recovery Following Long-Duration Spaceflight Missions as Determined by Preflight and Postflight DXA Scans of 45 Crew Members

Introduction: The loss of bone mineral in astronauts during spaceflight has been investigated throughout the more than 40 years of bone research in space. Consequently, it is a medical requirement at NASA that changes in bone mass be monitored in crew members by measurements of bone mineral density (BMD) with dual-energy x-ray absorptiometry (DXA). This report is the first to evaluate medical data to address the recovery of bone mineral that is lost during spaceflight. Methods: DXA scans are performed before and after flight in astronauts who serve on long-duration missions (4-6 months) to ensure that medical standards for flight certification are met, to evaluate the effects of spaceflight and to monitor the restoration to preflight BMD status after return to Earth. Through cooperative agreements with the Russian Space Agency, the Bone and Mineral Lab at NASA Johnson Space Center (Houston, TX), also had access to BMD data from cosmonauts who had flown on long-duration missions yielding data from a total of 45 individual crew members. Changes in BMD (between 56 different sets of pre- and postflight measurements) were plotted as a function of time (days after landing); plotted data were fitted to an exponential mathematical model that determined i) BMD change at day 0 after landing and ii) the number of days after which 50% of the lost bone was recovered ("Recovery Half-Life"). These fits were performed for BMD of the lumbar spine, trochanter, pelvis, femoral neck and calcaneus. Results: In sum, averaged losses of bone mineral after spaceflight ranged between 2-9% for sites in the axial and appendicular skeleton. The fitted postflight BMD values predicted a 50% recovery of bone loss for all sites within 9 months.

Sibonga, J. D.↗

NASA NTRS2003

Countermeasure Evaluation and Validation Project (CEVP) Database Requirement Documentation

The initial focus of the project by the JSC laboratories will be to develop, test and implement a standardized complement of integrated physiological test (Integrated Testing Regimen, ITR) that will examine both system and intersystem function, and will be used to validate and certify candidate countermeasures. The ITR will consist of medical requirements (MRs) and non-MR core ITR tests, and countermeasure-specific testing. Non-MR and countermeasure-specific test data will be archived in a database specific to the CEVP. Development of a CEVP Database will be critical to documenting the progress of candidate countermeasures. The goal of this work is a fully functional software system that will integrate computer-based data collection and storage with secure, efficient, and practical distribution of that data over the Internet. This system will provide the foundation of a new level of interagency and international cooperation for scientific experimentation and research, providing intramural, international, and extramural collaboration through management and distribution of the CEVP data. The research performed this summer includes the first phase of the project. The first phase of the project is a requirements analysis. This analysis will identify the expected behavior of the system under normal conditions and abnormal conditions; that could affect the system's ability to produce this behavior; and the internal features in the system needed to reduce the risk of unexpected or unwanted behaviors. The second phase of this project have also performed in this summer. The second phase of project is the design of data entry screen and data retrieval screen for a working model of the Ground Data Database. The final report provided the requirements for the CEVP system in a variety of ways, so that both the development team and JSC technical management have a thorough understanding of how the system is expected to behave.

Shin, Sung Y.↗

NASA NTRSDate not supplied

Developing Mission Segment-Specific Clinical Data for Impact

Space exploration missions represent a significant future objective for NASA’s human spaceflight operations for the near and long term. By operating missions during longer periods and over further distances, NASA’s mission planning models, hardware systems, and medical capabilities will be stretched beyond their original design constraints. The necessity of medical training and medical supply manifesting for such missions is likely to become incredibly intricate as trade-space analysis is performed over varying mission profiles. For this purpose, IMPACT was created to extend and improve the Integrated Medical Model (IMM) which is used for International Space Station (ISS) medical predications and consists of a probabilistic risk assessment tool that simulates missions to calculate risks given the constraints on crew complement, mission duration and activity (such as Extravehicular Activities), power, communication, mass, volume, and evacuation consideration as well as to predict mission outcomes. Currently, the medical evidence used to support IMPACT remains static, addressing risks of a medical condition and the impacts of the condition during spaceflight only, but is only calculated for a small number of mission parameters. Extended missions will consist of new and varied living environments, changing gravitational loads, and dynamic working requirements. Medical risks are not typically constant but will change depending upon the physical and physiological environment of the body during all phases of a mission. Risks are likely to shift during different mission segments, and understanding how components of a mission profile change risks will assist mission planners to increase chances for mission success.

Christopher Zahner↗

NASA NTRS2014

A Guideline for the Management of Renal Stones in Astronauts

There are no specific guidelines for the management of renal stones in astronauts. Given the increased risk for bone loss, hypercalcuria, and stone formation due to microgravity, a clinical practice guideline is needed. Methods An extensive review of the literature and current aeromedical standards for the management of renal stones was done. The NASA Flight Medicine Clinic's electronic medical record and Longitudinal Survey of Astronaut Health were also reviewed. This information was used to create an algorithm for the management of renal stones in astronauts. Results Guidelines are proposed based on accepted standards of care, with consideration to the environment of spaceflight. In a usual medical setting, asymptomatic, small stones less than 7 mm are often observed over time. Given the constraints of schedule, and the risks to crew health and mission, this approach is too liberal. An upper limit of 3 mm stone diameter was adopted before requiring intervention, because this is the largest size that has a significant chance of spontaneous passage on its own. Other specific guidelines were also created. Discussion The spaceflight environment requires more aggressive treatment than would otherwise be found with the usual practice of medicine. A small stone can become a major problem because it may ultimately require medical evacuation from orbit. Thus renal stones are a significant mission threat and should be managed in a systematic way to mitigate risks to crew health and mission success.

Reyes, David↗

NASA NTRS2017

Medical Support for ISS Crewmember Training in Star City, Russia

Medical support of spaceflight training operations across international lines is a unique circumstance with potential applications to other aerospace medicine support scenarios. KBRwyle's Star City Medical Support Group (SCMSG) has fulfilled this role since the Mir-Shuttle era, with extensive experience and updates to share with the greater AsMA community. OVERVIEW: The current Soyuz training flow for assigned ISS crewmembers takes place in Star City, Russia. Soyuz training flow involves numerous activities that pose potential physical and occupational risks to crewmembers, including centrifuge runs and pressurized suit simulations at ambient and hypobaric pressures. In addition, Star City is a relatively remote location in a host nation with variable access to reliable, Western-standard medical care. For these reasons, NASA's Human Health & Performance contract allocates full-time physician support to assigned ISS crewmembers training in Star City. The Star City physician also treats minor injuries and illnesses as needed for both long- and short-term NASA support personnel traveling in the area, while working to develop and maintain relationships with local health care resources in the event of more serious medical issues that cannot be treated on-site. The specifics of this unique scope of practice will be discussed. SIGNIFICANCE: ISS crewmembers training in Star City are at potential physical and occupational risk of trauma or dysbarism during nominal Soyuz training flow, requiring medical support from an on-duty aerospace medicine specialist. This support maintains human health and performance by preserving crewmember safety and well-being for mission success; sharing information regarding this operational model may contribute to advances in other areas of international, military, and civilian operational aerospace medicine.

Chough, Natacha↗

NASA NTRS2017

Medical Support for ISS Crewmember Training in Star City, Russia

Chough, Natacha↗

NASA NTRS2010

Cognitive Assessment During Long-Duration Space Flight

The Space Flight Cognitive Assessment Tool for Windows (WinSCAT) is a computer-based, self-administered battery of five cognitive assessment tests developed for medical operations at NASA's Johnson Space Center in Houston, Texas. WinSCAT is a medical requirement for U.S. long-duration astronauts and has been implemented with U.S. astronauts from one NASA/Mir mission (NASA-7 mission) and all expeditions to date on the International Space Station (ISS). Its purpose is to provide ISS crew surgeons with an objective clinical tool after an unexpected traumatic event, a medical condition, or the cumulative effects of space flight that could negatively affect an astronaut's cognitive status and threaten mission success. WinSCAT was recently updated to add network capability to support a 6-person crew on the station support computers. Additionally, WinSCAT Version 2.0.28 has increased difficulty of items in Mathematics, increased number of items in Match-to-Sample, incorporates a moving rather than a fixed baseline, and implements stricter interpretation rules. ISS performance data were assessed to compare initial to modified interpretation rules for detecting potential changes in cognitive functioning during space flight. WinSCAT tests are routinely taken monthly during an ISS mission. Performance data from these ISS missions do not indicate significant cognitive decrements due to microgravity/space flight alone but have shown decrements. Applying the newly derived rules to ISS data results in a number of off-nominal performances at various times during and after flight.. Correlation to actual events is needed, but possible explanations for off-nominal performances could include actual physical factors such as toxic exposure, medication effects, or fatigue; emotional factors including stress from the mission or life events; or failure to exert adequate effort on the tests.

Seaton, Kimberly↗

NASA NTRS2007

Recovery of Spaceflight-induced Bone Loss: Bone Mineral Density after Long-Duration Missions as Fitted with an Exponential Function

The loss of bone mineral in NASA astronauts during spaceflight has been investigated throughout the more than 40 years of space travel. Consequently, it is a medical requirement at NASA Johnson Space Center (JSC) that changes in bone mass be monitored in crew members by measuring bone mineral density (BMD) with dual-energy x-ray absorptiometry (DXA) before and after flight on astronauts who serve on long-duration missions (4-6 months). We evaluated this repository of medical data to track whether there is recovery of bone mineral that was lost during spaceflight. Our analysis was supplemented by BMD data from cosmonauts ( by convention, a space traveler formally employed by the Russia Aviation and Space Agency or by the previous Soviet Union) who had also flown on long-duration missions. Data from a total of 45 individual crew members -- a small number of whom flew on more than one mission -- were used in this analysis. Changes in BMD (between 56 different sets of pre- and postflight measurements) were plotted as a function of time (days after landing). Plotted BMD changes were fitted to an exponential mathematical function that estimated: i) BMD change on landing day (day 0) and ii) the number of days after landing when 50% of the lost bone would be recovered ("50% recovery time") in the lumbar spine, trochanter, pelvis, femoral neck and calcaneus. In sum, averaged losses of bone mineral after long-duration spaceflight ranged between 2-9% across all sites with our recovery model predicting a 50% restoration of bone loss for all sites to be within 9 months.

Sibonga, J. D.↗

NASA NTRS2007

Nutritional Status Assessment (SMO 016E)

It has not been possible to assess nutritional status of crew members on the ISS during flight because blood and urine could not be collected during ISS missions. Postflight observations of alterations in nutritional status for several nutrients are troubling, and we require the ability to monitor the status of these nutrients during flight to determine if there is a specific impetus or timeframe for these changes. In addition to the monitoring of crew nutritional status during flight, in-flight sample collection would allow better assessment of countermeasure effectiveness. SMO 016E is also designed to expand the current medical requirement for nutritional assessment (MR016L) to include additional normative markers for assessing crew health and countermeasure effectiveness. Additional markers of bone metabolism will be measured to better monitor bone health and the effectiveness of countermeasures to prevent bone resorption. New markers of oxidative damage will be measured to better assess the type of oxidative insults that occur during space flight. The array of nutritional assessment parameters will be expanded to include parameters that will allow us to better understand changes in folate and vitamin B6 status, and related cardiovascular risk factors during and after flight. Additionally, stress hormones and hormones that affect bone and muscle metabolism will also be measured. This additional assessment will allow us to better monitor the health of crew members and make more accurate recommendations for their rehabilitation. Several nutritional assessment parameters are altered at landing, but it is not known how long these changes persist. We extended the current protocol to include an additional postflight blood and urine sample collection 30 days after landing. Data are being collected before, during, and after flight. These data will provide a complete survey of how nutritional status and related systems are affected by space flight. Analyzing the data will help us to define nutritional requirements for long-duration missions. This expanded set of measurements will also aid in the identification of nutritional countermeasures to counteract, for example, the deleterious effects of microgravity on bone and muscle and the effects of space radiation.

Smith, S. M.↗

NASA NTRS2009

Nutritional Status Assessment (SMO 016E)

Until 2006, it was not been possible to assess nutritional status of crewmembers on the ISS during flight because blood and urine could not be collected during ISS missions. Postflight observations of alterations in status of several nutrients are troubling, and we require the ability to monitor the status of these nutrients during flight to determine if there is a specific impetus or timeframe for these changes. In addition to the monitoring of crew nutritional status during flight, in-flight sample collection would allow better assessment of countermeasure effectiveness. Collecting samples during flight is one of the objectives of SMO 016E, and it is also designed to expand the current medical requirement for nutritional assessment (MR016L) to include additional normative markers for assessing crew health and countermeasure effectiveness. Additional markers of bone metabolism will be measured to better monitor bone health and the effectiveness of countermeasures to prevent bone resorption. New markers of oxidative damage will be measured to better assess the type of oxidative insults that occur during space flight. The array of nutritional assessment variables will be expanded to include ones that will allow us to better understand changes in folate, vitamin K, and vitamin B6 status, as well as risk factors for cardiovascular and oxidative damage during and after flight. Stress hormones and hormones that affect bone and muscle metabolism will also be measured. Measuring these additional variables will allow us to better monitor the health of crewmembers and make more accurate recommendations for their rehabilitation. Several nutritional assessment variables are altered at landing, but it is not known how long these changes persist. We extended the original protocol to include an additional postflight blood and urine sample collection 30 days after landing. Data are being collected before, during, and after flight. These data will provide a complete survey of how nutritional status and related systems are affected by space flight. Analyzing the data will help us to define nutritional requirements for long-duration missions. This expanded set of measurements will also aid in the identification of nutritional countermeasures to counteract, for example, the deleterious effects of microgravity on bone and muscle and the effects of space radiation.

Smith, S. M.↗

NASA NTRS1990

Biomedical program at Space Biospheres Ventures

There are many similarities and some important differences between potential health problems of Biosphere 2 and those of which might be anticipated for a space station or a major outpost on Mars. The demands of time, expense, and equipment would not readily allow medical evacuation from deep space for a serious illness or major trauma, whereas personnel can easily be evacuated from Biosphere 2 if necessary. Treatment facilities can be somewhat less inclusive, since distance would not compel the undertaking of heroic measures or highly complicated surgical procedures on site, and with personnel not fully trained for these procedures. The similarities are given between medical requirements of Biosphere 2 and the complex closed ecological systems of biospheres in space or on Mars. The major problems common to all these would seem to be trauma, infection, and toxicity. It is planned that minor and moderate degrees of trauma, including debridement and suturing of wounds, x ray study of fractures, will be done within Biosphere 2. Bacteriologic and fungal infections, and possibly allergies to pollen or spores are expected to be the commonest medical problem within Biosphere 2.

Walford, Roy↗

NASA NTRS2007

Autonomous Medical Care for Exploration Class Space Missions

The US-based health care system of the International Space Station (ISS) contains several subsystems, the Health Maintenance System, Environmental Health System and the Countermeasure System. These systems are designed to provide primary, secondary and tertiary medical prevention strategies. The medical system deployed in Low Earth Orbit (LEO) for the ISS is designed to enable a "stabilize and transport" concept of operations. In this paradigm, an ill or injured crewmember would be rapidly evacuated to a definitive medical care facility (DMCF) on Earth, rather than being treated for a protracted period on orbit. The medical requirements of the short (7 day) and long duration (up to 6 months) exploration class missions to the Moon are similar to LEO class missions with the additional 4 to 5 days needed to transport an ill or injured crewmember to a DCMF on Earth. Mars exploration class missions are quite different in that they will significantly delay or prevent the return of an ill or injured crewmember to a DMCF. In addition the limited mass, power and volume afforded to medical care will prevent the mission designers from manifesting the entire capability of terrestrial care. NASA has identified five Levels of Care as part of its approach to medical support of future missions including the Constellation program. In order to implement an effective medical risk mitigation strategy for exploration class missions, modifications to the current suite of space medical systems may be needed, including new Crew Medical Officer training methods, treatment guidelines, diagnostic and therapeutic resources, and improved medical informatics.

Hamilton, Douglas↗

NASA NTRSDate not supplied

Bio-stasis: A Strategy for Survivability and Payload Cost Reduction in Long-duration Space Missions

As humans proceed with long-term space voyages, involving flights with lasting duration of months or years, “adaptation to space” will eventually lead to hard realities resultant physiological and psychological conditions must be realistically estimated and considered before it occurs. It is obvious that humans in their lifespan cannot adopt to spaceflight environment by reversible modification of their complex biochemical reactions and physiological functions without jeopardizing sustainable homeostasis shaped by multiple generations during evolution. In this case Nature offers an evolutionary proven alternative strategy- a coordinative adjustment of metabolism in order to survive. Incorporation of this metabolic adjustment strategy along with the relevant life support system into space flight architecture would protect humans during long term space flight from many irreversible physiological alterations and may dramatically reduce overall cost of space missions. In addition to the harmful space radiation and prolonged weightlessness, incorporation of this strategy may also benefit by solving other major medical unknowns in interplanetary flight such as isolation and psychological stress which still remains a risk. It is one of the priorities of NASA and other space agencies to figure out not only how to keep long-distance travelers alive and in good cognitive health but also how to return them to normal life on Earth with a minimum rehabilitation period after prolonged exposure to space. Presently re-adaptation of astronauts to Earth conditions and recovery from spaceflight exposure may take many months and years and, in some cases, require medical intervention. Therefore, recognizing physiological adjustment of the energy-regulating system as a viable life support strategy for human space exploration beyond LEO is essential.

Bio-stasis;↗

NASA NTRS2014

Effects of Long Duration Spaceflight on Venous and Arterial Compliance

The visual impairment and intracranial pressure syndrome (VIIP) is a newly described space flight-associated medical condition made up of a constellation of symptoms affecting at least 34% of American astronauts who have flown International Space Station (ISS) missions. VIIP is defined primarily by visual acuity deficits and anatomical changes to eye structures, and is thought to be related to elevated intracranial pressure secondary to space flightinduced cephalad fluid shifts. Loss of visual acuity could be a significant threat to crew health and performance and may be suggestive of other adaptations with implications for years post-flight. Our primary objective is to determine whether vascular compliance is altered by space flight and whether such adaptations are related to the incidence of VIIP. In particular, we will measure ocular parameters and vascular compliance in vessels of the head and neck in astronauts who have no space flight experience, in astronauts before, during, and after space flight, and in bed rest subjects with conditions similar to space flight. Additionally, we will analyze astronaut data from the Lifetime Surveillance of Astronaut Health (LSAH) archive to determine which factors might be predictive of the development of VIIP. The project will be conducted in four separate but related parts. To understand the baseline condition of astronauts without any prior space flight experience, we will study 10 astronauts who have never flown in space by performing a comprehensive evaluation of the vasculature of the head, neck and eyes. Hemodynamic data (stroke volume and blood pressure), ocular (tonometry and ocular ultrasound), venous and arterial parameters will be acquired across a range of tilt angles (20, 10, 0, -10, -20 degrees). Vessels to be studied include the temporal, jugular, and vertebral veins and the cerebral, carotid and vertebral arteries. Ophthalmic data from the annual physical will be obtained through data sharing. To examine the relation between vascular compliance in the head and neck and the development of VIIP after a long duration space flight, we will study 10 astronauts before, during, and after long-duration ISS missions. Pre- and post-flight testing will be identical to that described above. During flight, images of the same vessels of interest will be obtained for later analysis. Ophthalmic data including VIIP scores will be obtained through data sharing from medically-required tests. To investigate the effects of age and elevated sodium intake, two potential contributors to VIIP, we will study 24 men (in two age groups: 25-35 and 45-55) during a 14 day 6deg head-down bed rest, a well-accepted analog of space flight. Standard NASA bed rest conditions will be maintained except for dietary sodium. Sodium intake will be similar to that of ISS astronauts, which is higher than consumed in previous bed rest studies. Pre- and post-bed rest testing procedures will be identical to the testing protocol described above for astronauts. Ophthalmic testing (optical coherence tomography, fundoscopy, and tonometry) will be conducted on the same day that vascular compliance measures are obtained. To identify parameters that may relate to an increase in an astronaut's susceptibility to developing VIIP, we will use data mining techniques to evaluate astronaut data obtained from the LSAH. Medical history, family history, space flight history and its related exposures, and history of high performance jet aircraft exposure will be examined for their potential relationship to ocular data. We hypothesize that the cephalad fluid shift induced by space flight will result in structural and functional adaptations in head and neck vessels leading to decreased vascular compliance and related to the development of VIIP symptoms. Further, although VIIP has not been observed in previous bed rest studies, we hypothesize that an elevated sodium intake will increase the incidence of VIIP symptoms in this space flight analog. Finally, we hypothesize that data mining analyses will reveal relationships between health history, previous exposures (including space flight and high performance aircraft), and the development of VIIP in the astronaut population.

Ribeiro, L. C.↗