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Applications of telemedicine in the United States space program

Since the beginning of human space flight, NASA has been placing humans in extreme and remote environments. There are many challenges in maintaining humans in outer space, including the provision of life-support systems, radiation shielding, and countermeasures for minimizing the effect of microgravity. Because astronauts are selected for their health, among other factors, disease and illness are minimized. However, it is still of great importance to have appropriate medical care systems in place to address illness and injury should they occur. With the exception of the Apollo program, exploration of space has been limited to missions that are within several hundred miles of the surface of the Earth. At the drawn of the 21st century and the new millennium, human exploration will be focused on operation of the International Space Station (ISS) and preparation for human missions to Mars. These missions will present inherent risks to human health, and, therefore, appropriate plans must be established to address these challenges and risks. Crews of long-duration missions must become more independent from ground controllers. New systems, protocols, and procedures are currently being perfected. Application of emerging technologies in information systems and telecommunications will be critical to inflight medical care. Application of these technologies through telemedicine will provide crew members access to information, noninvasive procedures for assessing health status, and guidance through the integration of sensors, holography, decision-support systems, and virtual environments. These technologies will also serve as a basis to enhance training and medical education. The design of medical care for space flight should lead to a redesign of the practice of medicine on Earth.

Review, Tutorial

Lunar precursor missions for human exploration of Mars--III: studies of system reliability and maintenance

Discussions of future human expeditions into the solar system generally focus on whether the next explorers ought to go to the Moon or to Mars. The only mission scenario developed in any detail within NASA is an expedition to Mars with a 500-day stay at the surface. The technological capabilities and the operational experience base required for such a mission do not now exist nor has any self-consistent program plan been proposed to acquire them. In particular, the lack of an Abort-to-Earth capability implies that critical mission systems must perform reliably for 3 years or must be maintainable and repairable by the crew. As has been previously argued, a well-planned program of human exploration of the Moon would provide a context within which to develop the appropriate technologies because a lunar expedition incorporates many of the operational elements of a Mars expedition. Initial lunar expeditions can be carried out at scales consistent with the current experience base but can be expanded in any or all operational phases to produce an experience base necessary to successfully and safely conduct human exploration of Mars. Published by Elsevier Ltd.

Moon

How the science and engineering of spaceflight contribute to understanding the plasticity of spinal cord injury

Space programs support experimental investigations related to the unique environment of space and to the technological developments from many disciplines of both science and engineering that contribute to space studies. Furthermore, interactions between scientists, engineers and administrators, that are necessary for the success of any science mission in space, promote interdiscipline communication, understanding and interests which extend well beyond a specific mission. NASA-catalyzed collaborations have benefited the spinal cord rehabilitation program at UCLA in fundamental science and in the application of expertise and technologies originally developed for the space program. Examples of these benefits include: (1) better understanding of the role of load in maintaining healthy muscle and motor function, resulting in a spinal cord injury (SCI) rehabilitation program based on muscle/limb loading; (2) investigation of a potentially novel growth factor affected by spaceflight which may help regulate muscle mass; (3) development of implantable sensors, electronics and software to monitor and analyze long-term muscle activity in unrestrained subjects; (4) development of hardware to assist therapies applied to SCI patients; and (5) development of computer models to simulate stepping which will be used to investigate the effects of neurological deficits (muscle weakness or inappropriate activation) and to evaluate therapies to correct these deficiencies.

Review

Bios-3: Siberian experiments in bioregenerative life support

The Russian experience with the bioregenerative life support system Bios-3 at Krasnoyarsk, Siberia, is reviewed. A brief review of other bioregenerative systems examines Biosphere 2 in Oracle, Arizona, and the Bios-1 and Bios-2 systems that preceded Bios-3. Physical details of the Bios-3 facility are provided. The use of Chlorella and higher plants for gas exchange is examined. Long-term studies of human habitation are discussed. Other topics include microflora in Bios-3, the theory of closed systems, and problems for the future.

Non-NASA Center

Farming in space: environmental and biophysical concerns

The colonization of space will depend on our ability to routinely provide for the metabolic needs (oxygen, water, and food) of a crew with minimal re-supply from Earth. On Earth, these functions are facilitated by the cultivation of plant crops, thus it is important to develop plant-based food production systems to sustain the presence of mankind in space. Farming practices on earth have evolved for thousands of years to meet both the demands of an ever-increasing population and the availability of scarce resources, and now these practices must adapt to accommodate the effects of global warming. Similar challenges are expected when earth-based agricultural practices are adapted for space-based agriculture. A key variable in space is gravity; planets (e.g. Mars, 1/3 g) and moons (e.g. Earth's moon, 1/6 g) differ from spacecraft orbiting the Earth (e.g. Space stations) or orbital transfer vehicles that are subject to microgravity. The movement of heat, water vapor, CO2 and O2 between plant surfaces and their environment is also affected by gravity. In microgravity, these processes may also be affected by reduced mass transport and thicker boundary layers around plant organs caused by the absence of buoyancy dependent convective transport. Future space farmers will have to adapt their practices to accommodate microgravity, high and low extremes in ambient temperatures, reduced atmospheric pressures, atmospheres containing high volatile organic carbon contents, and elevated to super-elevated CO2 concentrations. Farming in space must also be carried out within power-, volume-, and mass-limited life support systems and must share resources with manned crews. Improved lighting and sensor technologies will have to be developed and tested for use in space. These developments should also help make crop production in terrestrial controlled environments (plant growth chambers and greenhouses) more efficient and, therefore, make these alternative agricultural systems more economically feasible food production systems. c2002 COSPAR. Published by Elsevier Science Ltd. All rights reserved.

Review

The biomedical challenges of space flight

Space medicine has evolved considerably through past U.S. missions. It has been proven that humans can live and work in space for long durations and that humans are integral to mission success. The space medicine program of the National Aeronautics and Space Administration (NASA) looks toward future long-duration missions. Its goal is to overcome the biomedical challenges associated with maintaining the safety, health, and optimum performance of astronauts and cosmonauts. This program investigates the health effects of adaptation to microgravity: the nature of their pathologies, the effects of microgravity on pathophysiology, and the alterations in pharmacodynamics and treatment. A critical capability in performing research is the monitoring of the health of all astronauts and of the spacecraft environment. These data support the evidence-based approach to space medicine, incorporating past studies of microgravity-related conditions and their terrestrial counterparts. This comprehensive approach will enable safe and effective exploration beyond low Earth orbit.

Mir Project

Crucial factor: human. Safely extending the human presence in space

The concept of advanced manned space missions has captured the interest and imagination of spacefaring nations. However, the physiological and psychological effects of space flight increase in magnitude and significance in the 'extended time-in-space' context. The unencumbered weightless condition enjoyed during short flights might compromise crew productivity upon return to a gravity field and extremely effective countermeasures may be essential. Missions remote from Earth require careful consideration of the medical facilities, psychological support and life support needed. The author discusses pressing issues that must be resolved before the visions of bolder human missions can be realistically fulfilled.

NASA Discipline General Space Life Sciences

Lessons learned studying design issues for lunar and Mars settlements

In a study of lunar and Mars settlement concepts, an analysis was made of fundamental design assumptions in five technical areas against a model list of occupational and environmental health concerns. The technical areas included the proposed science projects to be supported, habitat and construction issues, closed ecosystem issues, the "MMM" issues (mining, material processing, and manufacturing), and the human elements of physiology, behavior, and mission approach. Four major lessons were learned. First it is possible to relate public health concerns to complex technological development in a proactive design mode, which has the potential for long-term cost savings. Second, it became very apparent that prior to committing any nation or international group to spending the billions to start and complete a lunar settlement, over the next century, that a significantly different approach must be taken from those previously proposed, to solve the closed ecosystem and "MMM" problems. Third, it also appears that the health concerns and technology issues to be addressed for human exploration into space are fundamentally those to be solved for human habitation of the Earth (as a closed ecosystem) in the 21st century. Finally, it is proposed that ecosystem design modeling must develop new tools, based on probabilistic models as a step up from closed circuit models.

Life Support Systems

Medical considerations for extending human presence in space

The prospects for extending the length of time that humans can safely remain in space depend partly on resolution of a number of medical issues. Physiologic effects of weightlessness that may affect health during flight include loss of body fluid, functional alterations in the cardiovascular system, loss of red blood cells and bone mineral, compromised immune system function, and neurosensory disturbances. Some of the physiologic adaptations to weightlessness contribute to difficulties with readaptation to Earth's gravity. These include cardiovascular deconditioning and loss of body fluids and electrolytes; red blood cell mass; muscle mass, strength, and endurance; and bone mineral. Potentially harmful factors in space flight that are not related to weightlessness include radiation, altered circadian rhythms and rest/work cycles, and the closed, isolated environment of the spacecraft. There is no evidence that space flight has long-term effects on humans, except that bone mass lost during flight may not be replaced, and radiation damage is cumulative. However, the number of people who have spent several months or longer in space is still small. Only carefully-planned experiments in space preceded by thorough ground-based studies can provide the information needed to increase the amount of time humans can safely spend in space.

Review, Tutorial

Assessment of the efficacy of medical countermeasures in space flight

Changes in body fluids, electrolytes, and muscle mass are manifestations of adaptation to space flight and readaptation to the 1-g environment. The purposes of this paper are to review the current knowledge of biomedical responses to short- and long-duration space missions and to assess the efficacy of countermeasures to 1-g conditioning. Exercise protocols, fluid hydration, dietary and potential pharmacologic measures are evaluated, and directions for future research activities are recommended.

NASA Discipline General Space Life Sciences

Conversations: with Carl Pilcher [interview by Johan Benson]

An interview with Carl Pilcher, science program director for solar system exploration at NASA, examines NASA's past, present, and planned missions to explore the solar system. Specific questions relate to the status of current and planned missions, science results of the Pathfinder mission to Mars, cooperation with the Japanese space agency, the status of the search for extraterrestrial life in solar system meteoroids and asteroids, mission size for more in-depth exploration, reports of water on the moon, and the exploration of near-Earth objects.

Interview

Preparing for Mars: the physiologic and medical challenges

As the twentieth century closes, retrospectives cite the Apollo moon missions as one of the important events of the past 100 years. A trip to Mars, however, would be even more challenging and significant. A round-trip Mars journey would require nearly three years away from Earth, a significant leap in complexity compared to the two week long Moon trips or the record-breaking fourteen-month flight on Mir. What would be the physiologic and medical challenges of a Mars flight? Two key areas of physiology present the greatest potential problems--calcium metabolism and radiation exposure. Data from Mir missions show that bone loss continues in space despite an aggressive countermeasure program. Average losses were 0.35% per month, but some load bearing areas lost >1% per month. A 1% loss rate, if it continued unabated for 30 months, could produce osteoporosis. Smaller losses could still increase fracture risk. Some bone loss can be well tolerated, particularly if the bone can be regained after the mission. But the effectiveness of post-flight rehabilitation to restore the density and quality of bone after spaceflight is not well known. Bone loss estimates are based on continuous weightlessness exposure, but this is not a requirement for a Mars trip. Most of the time on a Mars trip will be spent in the 1/3 Earth's gravity environment on Mars, and either intermittent or continuous artificial gravity can be provided for the transit between planets (although at an engineering cost). The dosing of the gravity exposure (e.g. the level and duration), however, has not been established. Radiation protection also requires a balance between engineering cost and human health. Excessive shielding could add billions of dollars to the cost of a mission. Trips in interplanetary space, however, expose the crew to heavy high-energy particles from cosmic rays (HZE particles), which have a high linear energy transfer. This high energy leads to significant biological damage (e.g. chromosomal aberrations, cancer induction). A recent report from the Committee on Space Biology and Medicine notes that only one systematic study of cancer induction from high-energy particles has been conducted (using the mouse Harderian gland). Predictions of cancer risk and acceptable radiation exposure in space are extrapolated from minimal data. Other areas of physiology also present problems, such as muscle loss, cardiovascular deconditioning, and vestibular adaptation. Despite all the issues, however, a focussed, aggressive research program that uses the resources of the International Space Station should pave the way for mankind's greatest adventure--a trip to Mars.

STS-90 Shuttle Project