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At least 19 records
All sourcesNASA NTRSDOE OSTI
NASA NTRS2008

Space Adaptation Back Pain: A Retrospective Study

Back pain is frequently reported by astronauts during the early phase of space flight as they adapt to the microgravity environment. However, the epidemiology of space adaptation back pain has not been well defined. The purpose of this retrospective study was to develop a case definition of space adaptation back pain, determine the incidence of space adaptation back pain, and determine the effectiveness of available treatments. Medical records from the Mercury, Apollo, Apollo-Soyuz Test Project (ASTP), Skylab, Mir, International Space Station (ISS), and Shuttle programs were reviewed. All episodes of in-flight back pain that met the criteria for space adaptation back pain were recorded. Pain characteristics, including intensity, location, and duration of the pain were noted. The effectiveness of specific treatments also was recorded. The incidence of space adaptation back pain among astronauts was determined to be 53% (384/722). Most of the affected astronauts reported mild pain (85%). Moderate pain was reported by 11% of the affected astronauts and severe pain was reported by only 4% of the affected astronauts. The most effective treatments were fetal positioning (91% effective) and the use of analgesic medications (85% effective). This retrospective study aids in the development of a case definition of space adaptation back pain and examines the epidemiology of space adaptation back pain. Space adaptation back pain is usually mild and self-limited. However, there is a risk of functional impairment and mission impact in cases of moderate or severe pain that do not respond to currently available treatments. Therefore, the development of preventive measures and more effective treatments should be pursued.

Kerstman, E. L.↗
NASA NTRS1994

A retrospective study of promethazine and its failure to produce the expected incidence of sedation during space flight

Since March 1989, intramuscular (IM) promethazine has been successfully used to treat the symptoms of space motion sickness. The incidence of sedation associated with promethazine administration on the ground is large and may result in operational impact. The authors undertook a retrospective study to quantify the incidence of sedation from promethazine use during Space Shuttle flights. Crew medical debriefings from 14 shuttle missions were reviewed for crew members who had been treated with IM promethazine and their corresponding symptoms were identified. Twenty-one crew members received IM promethazine (25-50 mg), and only one experienced any associated sedation with no operational impact. This sedation incidence of less that 5% is in stark contrast to the 60 to 73% incidence of sedation seen in ground-based studies. The incidence of sedation during space flight from IM promethazine is substantially less than that seen on the ground and does not present an operational problem during Space Shuttle flights. Future investigations of environmental stressors and pharmacodynamic changes associated with space flight may explain the huge disparity between the space-flight and ground-based data.

short duration↗
DOE OSTI2023

Joint Analysis of the Epidemic Evolution and Human Mobility During the First Wave of COVID-19 in Spain: Retrospective Study

Background The initial wave of the COVID-19 pandemic placed a tremendous strain on health care systems worldwide. To mitigate the spread of the virus, many countries implemented stringent nonpharmaceutical interventions (NPIs), which significantly altered human behavior both before and after their enactment. Despite these efforts, a precise assessment of the impact and efficacy of these NPIs, as well as the extent of human behavioral changes, remained elusive. Objective In this study, we conducted a retrospective analysis of the initial wave of COVID-19 in Spain to better comprehend the influence of NPIs and their interaction with human behavior. Such investigations are vital for devising future mitigation strategies to combat COVID-19 and enhance epidemic preparedness more broadly. Methods We used a combination of national and regional retrospective analyses of pandemic incidence alongside large-scale mobility data to assess the impact and timing of government-implemented NPIs in combating COVID-19. Additionally, we compared these findings with a model-based inference of hospitalizations and fatalities. This model-based approach enabled us to construct counterfactual scenarios that gauged the consequences of delayed initiation of epidemic response measures. Results Our analysis demonstrated that the pre–national lockdown epidemic response, encompassing regional measures and heightened individual awareness, significantly contributed to reducing the disease burden in Spain. The mobility data indicated that people adjusted their behavior in response to the regional epidemiological situation before the nationwide lockdown was implemented. Counterfactual scenarios suggested that without this early epidemic response, there would have been an estimated 45,400 (95% CI 37,400-58,000) fatalities and 182,600 (95% CI 150,400-233,800) hospitalizations compared to the reported figures of 27,800 fatalities and 107,600 hospitalizations, respectively. Conclusions Our findings underscore the significance of self-implemented prevention measures by the population and regional NPIs before the national lockdown in Spain. The study also emphasizes the necessity for prompt and precise data quantification prior to enacting enforced measures. This highlights the critical interplay between NPIs, epidemic progression, and human behavior. This interdependence presents a challenge in predicting the impact of NPIs before they are implemented.

Public, Environmental & Occupational Health↗
DOE OSTI2024

Health Care Usage During the COVID-19 Pandemic and the Adoption of Telemedicine: Retrospective Study of Chronic Disease Cohorts

Background: The COVID-19 pandemic accelerated telehealth adoption across disease cohorts of patients. For many patients, routine medical care was no longer an option, and others chose not to visit medical offices in order to minimize COVID-19 exposure. In this study, we take a comprehensive multidisease approach in studying the impact of the COVID-19 pandemic on health care usage and the adoption of telemedicine through the first 12 months of the COVID-19 pandemic. Objective: We studied the impact of the COVID-19 pandemic on in-person health care usage and telehealth adoption across chronic diseases to understand differences in telehealth adoption across disease cohorts and patient demographics (such as the Social Vulnerability Index [SVI]). Methods: We conducted a retrospective cohort study of 6 different disease cohorts (anxiety: n=67,578; depression: n=45,570; diabetes: n=81,885; kidney failure: n=29,284; heart failure: n=21,152; and cancer: n=35,460). We used summary statistics to characterize changes in usage and regression analysis to study how patient characteristics relate to in-person health care and telehealth adoption and usage during the first 12 months of the pandemic. Results: We observed a reduction in in-person health care usage across disease cohorts (ranging from 10% to 24%). For most diseases we study, telehealth appointments offset the reduction in in-person visits. Furthermore, for anxiety and depression, the increase in telehealth usage exceeds the reduction in in-person visits (by up to 5%). We observed that younger patients and men have higher telehealth usage after accounting for other covariates. Patients from higher SVI areas are less likely to use telehealth; however, if they do, they have a higher number of telehealth visits, after accounting for other covariates. Conclusions: The COVID-19 pandemic affected health care usage across diseases, and the role of telehealth in replacing in-person visits varies by disease cohort. Understanding these differences can inform current practices and provides opportunities to further guide modalities of in-person and telehealth visits. Critically, further study is needed to understand barriers to telehealth service usage for patients in higher SVI areas. A better understanding of the role of social determinants of health may lead to more support for patients and help individual health care providers improve access to care for patients with chronic conditions.

60 APPLIED LIFE SCIENCES↗
NASA NTRS1976

Retrospective studies of operating problems in air transport

An epidemiological model for the study of human errors in aviation is presented. In this approach, retrospective data are used as the basis for formulation of hypotheses as to system factors which may have contributed to such errors. Prospective experimental studies of aviation operations are also required in order to prove or disprove the hypotheses, and to evaluate the effectiveness of intervention techniques designed to solve operational problems in the aviation system.

Billings, C. E.↗
NASA NTRS2009

Space Adaptation Back Pain: A Retrospective Study

Astronaut back pain is frequently reported in the early phase of space flight as they adapt to microgravity. The epidemiology of space adaptation back pain (SABP) has not been well established. This presentation seeks to determine the exact incidence of SABP among astronauts, develop a case definition of SABP, delineate the nature and pattern of SABP, review available treatments and their effectiveness in relieving SABP; and identify any operational impact of SABP. A retrospective review of all available mission medical records of astronauts in the U.S. space program was performed. It was revealed that the incidence of SABP has been determined to be 53% among astronauts in the U.S. space program; most cases of SABP are mild, self-limited, or respond to available treatment; there are no currently accepted preventive measures for SABP; it is difficult to predict who will develop SABP; the precise mechanism and spinal structures responsible for SABP are uncertain; there was no documented evidence of direction operational mission impact related to SABP; and, that there was the potential for mission impact related to uncontrolled pain, sleep disturbance, or the adverse side effects pf anti-inflammatory medications

Kerstman, Eric↗
DOE OSTI2022

Analysis of implant loss risk factors after simultaneous guided bone regeneration: A retrospective study of 5404 dental implants

Abstract Purpose The purpose was to analyze the risk factors for implant loss after simultaneous guided bone regeneration (GBR). Materials and Methods Patients who underwent implant placement with simultaneous GBR between January 2011 and December 2018 were screened for this study. The cumulative survival rate (CSR) was calculated using the life table method. Log‐rank test and Kaplan–Meier survival estimates were used to identify potential risk factors for implant loss. The association between the investigated variables and implant loss was determined using hazard ratios (HRs) obtained from a multivariate Cox regression analysis. Results A total of 3973 patients with 5404 implants were included in this study. The CSRs of the implants at 1, 5, and 10 years were 99.6%, 98.9%, and 98.7%, respectively. Male patient (HR = 2.94, 95% CI: 1.41–6.14), periodontitis (HR = 4.26, 95% CI: 2.05–9.86), tissue‐level implants (HR = 3.02, 95% CI: 1.30–6.98), narrow implants (HR = 2.71, 95% CI: 1.12–6.57), and implant length ≤10 mm (HR = 2.91, 95% CI: 1.41–6.02) significantly increased the risk of implant loss ( p < 0.05). The risk of implant loss was significantly higher in the maxillary posterior region (HR = 2.26, 95% CI: 1.04–4.90) than in the maxillary anterior region ( p < 0.05). Compared to Straumann, Nobel (HR = 4.07, 95% CI: 1.75–9.44) and other implant systems (HR = 14.23, 95% CI: 4.32–46.85) showed a significantly higher risk of implant loss ( p < 0.05). Conclusion Male patient, periodontitis, maxillary posterior region, Nobel implant system, other implant systems, tissue‐level implants, narrow implants, and implant length ≤10 mm were considered risk factors for implant loss after simultaneous GBR.

Shen, Xiaoting↗
DOE OSTI2022

Variable wildfire impacts on the seasonal water temperatures of western US streams: A retrospective study

Recent increases in the burn area and severity of wildfires in the western US have raised concerns about the impact on stream water temperature–a key determinant of cold-water fish habitats. However, the effect on seasonal water temperatures of concern, including winter and summer, are not fully understood. In this study, we assessed the impact of wildfire burns at Boulder Creek (Oregon), Elk Creek (Oregon), and Gibbon River (Wyoming) watersheds on the downstream winter and summer water temperatures for the first three post-fire years. To obtain results independent of the choice of the analytical method, we evaluated the consequence of each burn using three different statistical approaches that utilize local water temperature data. Our results from the three approaches indicated that the response of water temperatures to wildfire burns varied across seasons and sites. Wildfire burns were associated with a median increase of up to 0.56°C (Standard Error; S.E. < 0.23°C) in the summer mean water temperatures (MWT) and 62 degree-day Celsius (DDC; S.E. < 20.7 DDC) in the summer accumulated degree days (ADD) for the three subsequent years across studied stream sites. Interestingly, these burns also corresponded to a median decrease of up to 0.49°C (S.E. < 0.45°C) in the winter MWT and 39 DDC (S.E. < 40.5 DDC) in the winter ADD for the same period across sites. Wildfire effects on the downstream water temperatures diminished with increasing site distance from the burn perimeter. Our analyses demonstrated that analytical methods that utilize local watershed data could be applied to evaluate fire effects on downstream water temperatures.

54 ENVIRONMENTAL SCIENCES↗
NASA NTRS1988

Hydrologic models for land-atmosphere retrospective studies of the use of LANDSAT and AVHRR data

The use of a Geographic Information System (GIS) and LANDSAT analysis in conjunction with the Simulator for Water Resources on a Rural Basin (SWRRB) hydrologic model to examine the water balance on the Little Washita River basin is discussed. LANDSAT analysis was used to divide the basin into eight non-contiguous land covers or subareas: rangeland, grazed range, winter wheat, alfalfa/pasture, bare soil, water, woodland, and impervious land (roads, quarry). The use of a geographic information system allowed for the calculation of SWRRB model parameters in each subarea. Four data sets were constructed in order to compare SWRRB estimates of hydrologic processes using two methods of maximum LAI and two methods of watershed subdivision. Maximum LAI was determined from a continental scale map, which provided a value of 4.5 for the entire basin, and from its association with the type of land-cover (eight values). The two methods of watershed subdivision were determined according to drainage subbasin (four) and the eight land-covers. These data sets were used with the SWRRB model to obtain daily hydrologic estimates for 1985. The results of the one year analysis lead to the conclusion that the greater homogeneity of a land-cover subdivision provides better water yield estimates than those based on a drainage properties subdivision.

Duchon, Claude E.↗
NASA NTRS1988

Hydrologic models for land-atmosphere retrospective studies of the use of LANDSAT and AVHRR data

The use of a Geographic Information System (GIS) and LANDSAT analysis in conjunction with the Simulator for Water Resources on a Rural Basin (SWRRB) hydrologic model to examine the water balance on the Little Washita River basin is discussed. In the research completed to date LANDSAT analysis was used to divide the basin into eight non-contiguous land covers or sub areas. The use of a geographic informatin system allowed for the calculation of SWRRB model parameters in each subarea. Four data sets were constructed in order to compare SWRRB estimates of hydrologic processes using two methods of maximum LAI and two methods of watershed division. These data sets were used with the SWRRB model to obtain daily hydrologic estimates for 1985.

Duchon, Claude E.↗
NASA NTRS1992

Secular Variation Across the Oceans: a Retrospective Study from 35 Years of Shipboard Total Field Measurements in the NE Atlantic

This is a pilot study to determine whether secular variation information can be retrieved from underway shipboard total field measurements with sufficient accuracy to complement geomagnetic data from land-based observatories. Applying the various new techniques described in this report, we extracted values of the total field at 42,677 crossovers or ship track intersection points contained in data sets collected between 18 degrees N and 50 degress N in the NE Atlantic, and extending temporally from 1955 to 1990. We used an edited subset of these total field values to derive the secular variation at 30,140 different locations in the study area, and compared the results with DGRF secular variation over the study area, calculated at 5 year intervals. The derived and DGRF values agree well, showing that indeed marine data can be a source for secular variations. However the analysis demonstrated that due to inherent noise in the marine data, only minor improvements on the DGRF values for the secular variation can be achieved.

Williams, C. A.↗
NASA NTRS2011

Retrospective Study of Serum Sclerostin Measurements in Bed Rest Subjects

Animal models and human studies suggest that osteocytes regulate the skeleton s response to mechanical unloading at the cellular level in part by an increase in sclerostin, an inhibitor of the anabolic Wnt pathway. However, few studies have reported changes in serum sclerostin in humans exposed to reduced mechanical loading. Thus, we determined changes in serum sclerostin and bone turnover markers in healthy adult men who participated in a controlled bed rest study. Seven healthy adult men (31 +/- 3 yrs old) underwent 90-day six-degree head down tilt bed rest at the University of Texas Medical Branch in Galveston's Institute for Translational Sciences - Clinical Research Center (ITS-CRC). Serum sclerostin, PTH, serum markers of bone turnover (bone specific alkaline phosphatase, RANKL/OPG, and osteocalcin), urinary calcium and phosphorus excretion, and 24 hour pooled urinary markers of bone resorption (NTX, DPD, PYD) were evaluated pre-bed rest (BL), bed rest day 28 (BR-28), bed rest day 60 (BR-60), and bed rest day 90 (BR-90). In addition, bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry (DXA) at BL, BR-60, and post bed rest day 5 (BR+5). Data are reported as mean +/- standard deviation. We used repeated measures ANOVA to compare baseline values to BR-28, BR-60, and BR-90. RESULTS Consistent with prior reports, BMD declined significantly (1-2% per month) at weight-bearing skeletal sites (spine, hip, femur neck, and calcaneus). Serum sclerostin levels were elevated above BL at BR-28 (+29% +/- 20%, p = 0.003), BR-60 (+42% +/- 31%, p < 0.001), and BR-90 (22% +/- 21%, p = 0.07). Serum PTH levels were reduced at BR-28 (-17% +/- 16%, p = 0.02), BR-60 (-24% +/- 14%, p = 0.03), and returned to baseline at BR-90 (-21% +/- 21%, p = 0.14). Serum bone turnover markers did not change, however urinary bone resorption markers and calcium were significantly elevated following bed rest (p < 0.01). CONCLUSION We observed an increase of serum sclerostin associated with decreased serum PTH and elevated bone resorption markers in otherwise healthy men subjected to long-term immobilization.

Spatz, J. M.↗
NASA NTRS2016

Analysis by NASA's VESGEN Software of Retinal Blood Vessels Before and After 70-Day Bed Rest: A Retrospective Study

Significant risks for visual impairment associated with increased intracranial pressure (VIIP) are incurred by microgravity spaceflight, especially long-duration missions. Impairments include decreased near visual acuity, posterior globe flattening, choroidal folds, optic disc edema and cotton wool spots. We hypothesize that microgravity-induced fluid shifts result in pathological changes within the retinal blood vessels that precede development of visual and other ocular impairments. Potential contributions of retinal vascular remodeling to VIIP etiology are therefore being investigated by NASAs innovative VESsel GENeration Analysis (VESGEN) software for two studies: (1) head-down tilt in human subjects before and after 70 days of bed rest, and (2) U.S. crew members before and after ISS missions. VESGEN analysis in previous research supported by the US National Institutes of Health identified surprising new opportunities to regenerate retinal vessels during early-stage, potentially reversible progression of the visually impairing and blinding disease, diabetic retinopathy.

Vascular↗
DOE OSTI2022

NSAID use and clinical outcomes in COVID-19 patients: a 38-center retrospective cohort study

Abstract Background Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain, fever, and inflammation but have been associated with complications in community-acquired pneumonia. Observations shortly after the start of the COVID-19 pandemic in 2020 suggested that ibuprofen was associated with an increased risk of adverse events in COVID-19 patients, but subsequent observational studies failed to demonstrate increased risk and in one case showed reduced risk associated with NSAID use. Methods A 38-center retrospective cohort study was performed that leveraged the harmonized, high-granularity electronic health record data of the National COVID Cohort Collaborative. A propensity-matched cohort of 19,746 COVID-19 inpatients was constructed by matching cases (treated with NSAIDs at the time of admission) and 19,746 controls (not treated) from 857,061 patients with COVID-19 available for analysis. The primary outcome of interest was COVID-19 severity in hospitalized patients, which was classified as: moderate, severe, or mortality/hospice. Secondary outcomes were acute kidney injury (AKI), extracorporeal membrane oxygenation (ECMO), invasive ventilation, and all-cause mortality at any time following COVID-19 diagnosis. Results Logistic regression showed that NSAID use was not associated with increased COVID-19 severity (OR: 0.57 95% CI: 0.53–0.61). Analysis of secondary outcomes using logistic regression showed that NSAID use was not associated with increased risk of all-cause mortality (OR 0.51 95% CI: 0.47–0.56), invasive ventilation (OR: 0.59 95% CI: 0.55–0.64), AKI (OR: 0.67 95% CI: 0.63–0.72), or ECMO (OR: 0.51 95% CI: 0.36–0.7). In contrast, the odds ratios indicate reduced risk of these outcomes, but our quantitative bias analysis showed E-values of between 1.9 and 3.3 for these associations, indicating that comparatively weak or moderate confounder associations could explain away the observed associations. Conclusions Study interpretation is limited by the observational design. Recording of NSAID use may have been incomplete. Our study demonstrates that NSAID use is not associated with increased COVID-19 severity, all-cause mortality, invasive ventilation, AKI, or ECMO in COVID-19 inpatients. A conservative interpretation in light of the quantitative bias analysis is that there is no evidence that NSAID use is associated with risk of increased severity or the other measured outcomes. Our results confirm and extend analogous findings in previous observational studies using a large cohort of patients drawn from 38 centers in a nationally representative multicenter database.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2023

Incidence and predictors of tuberculosis among children receiving antiretroviral therapy in the Wolaita Zone: A retrospective cohort study

Tuberculosis is the leading cause of morbidity and mortality among children living with the human immunodeficiency virus (HIV), mainly in sub-Saharan Africa, including Ethiopia. Tuberculosis remains a significant health concern for HIV-positive children in Ethiopia. There is a paucity of data on the incidence and predictors of tuberculosis among children living with HIV on antiretroviral therapy in the Wolaita zone. Hence, this study aimed to assess the incidence and predictors of tuberculosis among children living with HIV on antiretroviral therapy in the Wolaita zone between January 2010 to December 2020. A retrospective cohort study was conducted among 389 children receiving antiretroviral therapy in Wolaita zone health facilities between January 2010 to December 2020. The checklist was adapted from the standardized antiretroviral treatment (ART) follow-up form currently used by the institutions’ ART clinics. The Kaplan-Meier survival function and Log-rank were used to estimate the survival for each categorical variable to compare the survival between different exposure groups. Both bivariable and multivariable parametric survival Gompertz models were fitted to identify predictors of tuberculosis among HIV-positive children. The association was summarized using an adjusted hazard ratio (AHR), and statistical significance was declared at 95% CI and p-value < 0.05. The goodness of the model fit was assessed using a Cox-Snell residual plot. The incidence rate of tuberculosis among children living with HIV was 3.5 (95% CI 2.7–4.5) per 100 child years. World Health Organization clinical stage III or IV (AHR = 2.31, 95% CI [1.26, 4.22]), hemoglobin level <10 g/dL (AHR = 2.87, 95% CI [1.51, 5.45]), fair or poor ART adherence (AHR = 4.4, 95% CI[2.18, 9.05]), underweight (AHR = 2.55, 95% CI [1.45, 4.51]), age >10 years (AHR = 3.62; 95% CI [1.29, 10.0]), and cotrimoxazole preventive therapy (AHR = 0.23; 95% CI [0.08, 0.60]) were among the independent predictors of TB occurrence. The incidence of tuberculosis among children on ART was high. HIV-positive children presenting with advanced disease staging (III and IV), anemia, “fair” and “poor” ART adherence, underweight, age above ten years, and not receiving cotrimoxazole preventive therapy were at higher risk of TB. Therefore, counseling on ART adherence, early diagnosis, and prompt treatment of anemia and malnutrition are recommended to avert tuberculosis.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2024

Incidence and predictors of loss to follow-up among adult patients receiving antiretroviral therapy in Central Ethiopia: a multi-center retrospective cohort study

Background: Globally, loss to follow-up (LTFU) remains a significant public health concern despite the rapid expansion of antiretroviral medication programs. It is a significant cause of treatment failure and threatens the enhancement of HIV treatment outcomes among patients on antiretroviral therapy (ART). However, there is a paucity of evidence on its incidence and predictors in Ethiopia. Thus, this study aimed to examine the incidence and predictors of LTFU among adult HIV patients receiving ART at hospitals in Central Ethiopia. Methods: A multi-centered facility-based retrospective cohort study was conducted among 432 randomly selected adult patients who received antiretroviral therapy. Data were entered into EpiData version 3.1 and exported to Stata version 14 for analysis. The Kaplan–Meier failure function was employed to determine the overall failure estimates, and the log-rank test was used to compare the probability of failure among the different categories of variables. The Cox proportional hazard model was used to identify independent predictors of LTFU. Results: Overall, 172 (39.8%) study participants were lost to follow-up over the 10-year follow-up period with an incidence rate of 8.12 (95% CI: 7.11, 9.09) per 1,000 person-months. Undisclosed HIV status (AHR: 1.96, 95% CI: 1.14, 3.36), not able to work (AHR: 1.84, 95% CI: 1.13, 2.22), opportunistic infections (AHR: 3.13, 95% CI: 2.17, 4.52), CD4 < 200 cell/mL (AHR: 1.95, 95% CI: 1.18, 3.21), not receiving isoniazid preventive therapy (IPT) (AHR: 2.57, 95% CI: 1.62, 4.06), not participating in clubs (AHR: 1.68, 95% CI: 1.10, 2.22), side effects of drugs (AHR: 1.44, 95% CI: 1.02, 2.04), and high viral load (AHR: 3.15, 95% CI: 1.81, 5.47) were identified as significant predictors of loss to follow-up. Conclusion: In this study, the incidence of LTFU was high. The focus should be on creating awareness and prevention programs that aim to reduce loss to follow-up by continuing counseling, especially on the negative effects of loss to follow-up and the benefits of ART care.

60 APPLIED LIFE SCIENCES↗
NASA NTRS2017

Mapping by VESGEN of Blood Vessels in the Retinas of Astronauts Pre- and Post-Flight to the ISS

Research by NASA [1] established that significant risks for visual and ocular impairments associated with increased intracranial pressure (VIIP) are incurred by microgravity spaceflight, especially long-duration missions. It is well established in physiology and pathology that a fundamental role of the microvasculature is to mediate fluid transfers and remodel actively in response to environmental, immune and other stresses. We therefore hypothesize that remodeling of retinal blood vessels necessarily occurs during accommodation of microgravity-induced fluid shifts prior to subsequent development of visual and ocular impairments. Potential contributions of retinal vascular remodeling to VIIP etiology are therefore being investigated by NASA's innovative VESsel GENeration Analysis (VESGEN) software for two studies: (1) U.S. crew members before and after ISS missions, and (2) head-down tilt in human subjects before and after 70 days of bed rest. We anticipate that results of the two studies will be complete by the Investigators Workshop (January 22, 2017). METHODS: For the 2013 NASA NRA award, we are concluding the analysis of 30 degree infrared (IR) Heidelberg Spectralis images of retinal blood vessels by VESGEN (patents pending), a mature, automated software developed as a translational and basic vascular research discovery tool, particularly for retinal vascular disease. Subjects of our retrospective study include eight ISS crew members monitored for routine occupational surveillance pre- and post-flight, who provided their study consents to NASAs Lifetime Surveillance of Astronaut Health (LSAH) in coordination with approval of the VESGEN retrospective study protocol by NASAs Institutional Review Board (IRB). The ophthalmic retinal images (average image resolution, approximately 5.6 microns per pixel) are blinded as to pre and post ISS status until the second portion of our study, when VESGEN results will be correlated with other ophthalmic and medical findings for the crew members. Due to image resolution challenges, a novel Matlab tool was developed for aligning pre and post images, and comparing (querying) the two images for differences in the morphology of small vessels. RESULTS: During the past year, LSAH approved the release of all astronaut retinal images to our study for VESGEN analysis. Substantial progress on the initial blinded portion of the study is in place. We anticipate that VESGEN analysis of the 32 Spectralis IR retinal images will be complete for presentation at the 2017 IWS meeting. CONCLUSIONS: Modified retinal vascular patterning may offer early-stage predictions of ocular changes resulting in decreased visual acuity for the VIIP syndrome. Novel insights provided by VESGEN into progressively pathological and blinding vascular remodeling in the human retina currently help to guide other NIH- and NASA-supported therapeutic studies of retinal disease and modeling of the VIIP risk. Results of our vascular investigation of the retinas of astronauts pre- and post-flight may help advance the understanding of both healthy and pathological adaptations to fluid shifts in microgravity associated with the VIIP syndrome. Preliminary results indicate that imaging of higher resolution, such as the new OCT angiography (OCT-A) technology, will be required to determine conclusively the role of the smaller retinal and choroidal vessels in VIIP etiology.

VESGEN↗