HPS

Explain the principles of the "Hippocratic Oath"

(modern version / abridged) -I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. - I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of over-treatment and therapeutic nihilism. - I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. -I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. -I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. -I will prevent disease whenever I can, for prevention is preferable to cure. -I will, according to my ability and judgment, prescribe a regimen for the health of the sick; but I will utterly reject harm and mischief First: Do no harm

List some astronaut specific medical risks

- Cancer - radiation dependent (Leucemia , Lymphoma, Genetic risks: oocytes and spermatocytes) - Cardio-Vascular Diseases (Orthostatic Intolerance, Arrhythmia) - Infectious Diseases - Viral,Bacterial, Fungal ( Dermatitis in space, due to lack of convection and thus human cooling/sweating altered, Latent virus activation: Hepatitis, Epstein-Barr, and Varicella/Herpes) - Degenerative Musculo-Skeletal (Shoulder Joint (EVA suit), Back-Pain , Osteoporosis) - Mental Health ( Altered bio-rhythms / jet lag, Family issues) - Urology - Increased risk of Kidney Stones -Trauma ( Eye injuries, due to dirt free floating, Crush-injuries, mass not changed and thus injuries occur with collisions) - VIIP: Visual Impairment and Intracranial Pressure

Describe the main principles of the vestibular organ

-combined hearing and vestibular system -3-axis acceleration - translational acceleration -gravity dependent -connection to eye muscles

List some common medical issues

-Cancer ( Breast Cancer , Prostate Cancer, Lung Cancer) -Cardio-Vascular Diseases (Coronary-Heart-Disease, Hypertonus , Arrhythmia, Thrombosis) -Infectious Diseases: Viral and Bacterial (Gastro-Intestinal , Airway, Skin, Hepatitis, HIV) -Metabolic Diseases (Diabetes, Lipid Metabolism) -Degenerative Musculo-Skeletal -Mental Health (Depression , Burn-Out) -Allergies -Endocrinology (Thyroid Gland ) -Urology (Kidney Stones ) -Trauma -Drugs & Alcohol

List the current in-flight countermeasures

-Cardio-Vascular Fitness: Treadmill , Bicycle Ergometer -Strength : Weight-Lifting -Gravity Simulation: Penguin-Suit / Skin-Suit, Centrifuge (long-arm (station), short-arm) -Nutrition : Vitamin D Supplementation, Sodium Balance -Radiation: shelter, anti-oxidants, protection -Pre-Landing Preparation: LBNP (Russian Tschibis), Fluid-Loading, Anti-g Suit

Describe the changes to human physiology in varying altitudes

-Hemoglobin is sufficiently saturated (96% to 84%) in altitudes of usual human inhabitation (sea-level to 3000m/10000m) -Sensor System: O2 in abundance therefore no sensors, but CO2 sensors to protect from environmental and metabolic hazards -Time of Useful Consciousness (TUC) is defined as the amount of time an individual is able to perform (flying) duties efficiently in an environment of inadequate oxygen supply -Ebullism is the formation of gas bubbles in bodily fluids due to reduced environmental pressure. It occurs because liquids reach their boiling point at reduced ambient pressure. -Partial Pressure Gradient depending on Altitude -reduced ppO2 gradient with altitude increase

Describe the principles of the daily on-orbit schedule for astronauts

-Science Program: scheduling, according to approved protocols , hazards -Technical Program: hazards -Medical program : routine medical tests (nutritional status, weight in weightlessness), private conferences , environmental monitoring -Briefings -Public Relations & Education -Personal Events -Task List - Housekeeping

Recall the World-Health-Organisation (WHO) Definition of "Health"

-Status of complete physical, mental and social well-being and not only absence of disease or infirmity -physical well being: it is the soundness of the body, freedom from disease or abnormality, and the condition of optimal well-being. It is when the body is functioning as it was designed to function. -mental well being: a person's condition with regard to their psychological, behavioural and emotional well-being. -social well being: context in which we are working and living (employer, family, friends) *there is not a perfectly healthy individual

Describe the symptoms and possible treatment of Space Motion Sickness

-appears in about 70% of first time-space-flyers and varies in level of symptoms - is most likely caused by contradictory sensory inputs coming from the vestibular, visual systems and the proprioceptive receptors - most symptoms disappear within 24 to 48 hours - may re-appear upon landing and re-adaptation to the 1-g environment -is accepted in the space community as a given fact - is no big issue in long-duration space-flights, but has been in short missions - can be prevented or symptoms reduced by medication (promethazine), behaviourally and operationally

Explain the purposes of an inflight timeline

-initial planning of science activities - integrated with vehicle, comm and other constraints -iterative fine-tuning -dependencies and exclusions - medical and crew aspects Importance and purpose: -scheduling of day and night -of data rates (gaps, data being dumped from other satellites and crafts), ability to have family conference for example might not be possible -not wanting to bother crew all the time -physiological issues with flight controllers (coffee/bathroom breaks) -timeline begins development 6-8 months before flight (more elements added as time nears to launch) -various parameters and factors considered -loss of signal=LOS

List the objectives of Operational and Life Science Research

-objectives of Life Sciences research: 1) enhance fundamental knowledge in biology and human physiology 2) protect the health of astronauts 3) develop advanced technology and applications for space & ground research -objectives of operations research 1) closing operational gaps and deficiencies 2) preparing for extended space-flights in changing environments 3) enhance the health care provisions pre/in/post-flight 4) develop advanced technology and applications for health care

Describe the structure and hierarchy of a flight control team

-the commander is responsible for the crew and the implementation of the mission objectives -the flight director has the overall authority and is supported by subject mafer experts (flight controllers) Chain of Authority Surgeon in MCC-H (Houston) has medical authority for whole crew -in contingencies, consultation with Partners if time available -Partner Surgeon represents Partner astronauts - Partner medical teams support MCC-H Surgeon in a backroom function -assigned to dedicated issue-solving or agency specific topics *The surgeon answers to the flight director who is also being briefed from various bodies (EVA, Payload, Spacecraft communicator, flight activities officer, etc.) Primary Mission Control Center: Houston Backup Mission Control Center: Moscow Partner Control Centers: CSA (Montreal), JAXA (Tsukuba), Munich (Cologne and Munich, GER) Payload control centres are dedicated and distributed

List the gas laws relevant to human physiology

1) Boyle's / Mariotte's Law: or the pressure-volume law states that the volume of a given amount of gas held at constant temperature varies inversely with the applied pressure when the temperature and mass are constant (when pressure goes up, volume goes down - when volume goes up, pressure goes down). —> P1 /P2 =V2 /V1 -or - P1 *V1 =P2 *V2 —> gas-expansion in digestive system, teeth cavities, sinuses, ear, baro-trauma —> valsalva maneuvre 2) Dalton's Law: the pressure of a mixture of gases is the sum of the partial pressures of the individual components (e.g. 21% O2 = 160 mmHg, where 760mmHg is the total pressure) —> Ptotal =Pa +Pb +Pc +... —> Hypoxia 3) Henry's Law: at constant temperature, the amount of a given gas dissolved in a given type and volume of liquid is directly proportional to the partial pressure of that gas in equilibrium with that liquid —>Q1 /Q2 =P1 /P2 —> bubbles in blood and tissues - bends, chokes, paraesthesia, nervous system damage —> Decompression sickness (caisson disease, built Brooklyn bridge and saw death of divers constructing foundation) describes a condition arising from dissolved gases coming out of solution into bubbles inside the body on depressurisation

Explain the concept of "Evidence Based Medicine"

=is an approach to medical practice intended to optimize decision- making by emphasising the use of evidence from well designed and conducted research. -combines the following: clinical judgments, patients values and preferences, relevant scientific evidence

Explain the principles of medical risk analysis

A Risk Matrix: - is a table that has several categories of likelihood for rows and several categories of consequence for columns -partitions hazards into distinct categories corresponding to different risk levels or colors of the matrix cells -provides an approximate qualitative representation of quantitative risks Weak Consistency: The highest risk category (red) is assigned to hazards that actually do have higher quantitative risk values than hazards assigned to the lowest risk category (green) Betweenness: Intermediate risk categories (yellow) have quantitative risk values between the highest risk categories (red) and the lowest risk categories (green) Consistent Coloring: Equal quantitative risk values should ideally be assigned to the same qualitative risk category (color) Probabilistic Risk Assessment (PRA): Risk = Likelihood x Consequence What can go wrong? Medical event How likely is it to occur? Probability of occurrence What is the consequence? Functional impairment (evacuation, loss of crew life)

Explain the principles and goals of "Longitudinal Studies"

A longitudinal study is an observational research method in which data is gathered for the same subjects repeatedly over a period of time. Longitudinal research projects can extend over years or even decades. In a longitudinal cohort study, the same individuals are observed over the study period. -In medicine, the design is used to uncover predictors of certain diseases. - Longitudinal studies are open used in psychology, to study developmental trends across the life span, and in sociology, to study life events throughout lifetimes or generations. - to detect profession/task/duty specific cumulative pathologies -Derived Occupational Exposure standards (OSHA) - Spaceflight Standards, such as "Shukle Maximum Allowable Concentration" SMAC -often based on longitudinal study results -Medical Requirements and Standards to perform a specific job or duty -Professional Diver Certification -Aviator Certification -Astronaut Medical Standards Focus: keep astronauts medically qualified to fly a long career

List medical support personnel and related responsibilities in mission operations

Crew Surgeon -Is the "family physician" for the ESA astronauts -Responsible for all astronaut medical matters in all mission's phases, i.e. pre-flight, Launch, in-flight, landing and post-flight -Monitors and coordinates the implementa?on of the physical exercise countermeasures programs f Flight Nurse -Supports Flight Surgeons in all of their primary tasks -Manages all medical data from Astronauts pre-, in- and post-flight. -Reviews all in-flight science experiments and their need of medical monitoring -Assists Biomedical Engineers with tracking the life science experiments database Biomedical engineers -Represents Medical Operations on console during ISS real-time operations -Trains Flight Controllers about medical opera?ons and its impact on opera?ons overall -Continuously trains, certifies and retains the qualifications of the BME Flight Controller -Supports all ISS environmental health related issues Project, IT, Education Staff -deals with scientific and research and educational aspects -Supports Flight Surgeons and Biomedical Engineers with specialist skills (Informa?on Technology, Hardware Engineering, Exercise & Rehabilita?on, Project Management) -Coordinates and manages medical staff continuing education and certification Fitness/Exercise Team and Psychologists -provide physical and mental support -Provides countermeasure exercise support to Astronauts during long duration space missions -Plans and implements post-flight rehabilita?on arer a long dura?on space mission -Performs fitness assessment tests Technologies -Ground Segment Infrastructure - Flight Surgeon Communicator -Web-based technologies

List the medical staff involved in real time mission operations

Crew Surgeon Flight Surgeon Deputy Surgeon Biomedical Engineer (BME) Crew Psychologist Countermeasure & Fitness Experts Space Radiation Advisory Group (SRAG) Partner Medical Personnel

Describe the changes to the neuro-vestibular system in micro-gravity

Effects of Changing Gravity -Fluid dynamics are affected by gravity : detection of rotary motion by the semi-circular canals will be affected -Weight is affected by gravity : detection of linear motion by the otolith organs will be altered -When we loose the ability to properly determine our motion, we also loose our spatial orientation and the ability to maintain balance Spatial Orientation -Before adaptation to a change in gravity occurs, the astronauts may experience spatial disorientation -the crew may loose the ability to differentiate "up" from "down" -sensory mismatch (visual-vestibular) may trigger physiological reactions -the crew may lose the ability to differentiate "up" and "down" -on earth the pull of gravity on the otoliths defines "down" -during spaceflight this reference point is gone -Humans rely on the visual system and clues in the environment to align with information originating from the vestibular system -vehicle design can help, by providing an "up" and "down" reference -crew timeline should accommodate for adaptation period -Body posture is affected, as sensory input from muscle, tendon and joint sensors requires adaptation due to the missing g-vector - free-floating body shows "neutral-0" joint-position -crew may have issues pointing or "hijng" a switch or object

List the primary mission operations documents and explain its purpose

Flight Rules =collected wisdom of history of spaceflight -Flight Rules can be if the flight director deems it warranted, -they inform and guide MCC decisions. -EX: during visiting vehicle rendezvous, there is a flight rule called the GO/NO-GO Matrix. It describes the minimum acceptable capabilities of the ISS and visiting vehicle throughout the timeline. The matrix will dictate when an abort must be called because the system failure tolerance is lower than deemed safe. -generic: applicable to all flights -flight specific: applicable to a particular mission only. The Generic Ground Rules and Constraints (GGRC) -ground rule is an assumption or guideline that provides direction for an approved method of performing an operation. -constraint is a limitation placed on operations by the vehicle, medical community, transportation vehicle design, system operations, trajectory etc. Ex: ppCO2 Constraint, Crew Awake Time, Soyuz vehicle certified lifetime (constraint) Medical Checklist -book astronauts pull out, providing description of all medical conditions alphabetically, all medical procedures -Ex: Allergic reaction warnings, response procedures, where it can be found, symptoms -Ex: list of pharmacy drug list on board (amounts, location, dosage)

Describe the changes to the cardiovascular system in micro-gravity

Launch Conditions -The crew is placed in the Shufle and Soyuz approximately 1 hour prior to expected launch -Crew can be in the Shufle for as long as 4 hours before mission control considers a launch scrub -Supine position with 90° hip and knee flexion in order to limit launch acceleration to the +Gx direction -The effect is that significant blood volume is placed above the heart, increasing load to the heart, central venous pressure, cardiac volumes and cardiac output - The body compensates for this by reducing blood volume through urination and reduced thirst -The astronauts sometimes prefer to restrict their fluid intake prior to launch and "fly dry" -Reduction in blood volume on the launch pad may impair the ability to emergency egress (syncope upon standing) Acceleration -g-loc = g-induced loss of consciousness Adaption in Phases of Spaceflight -The rapid transition between upright, sitting, and lying down postures requires that the heart and blood vessels adjust very quickly -However, the control centers are not stimulated in microgravity -These de-conditioned control centers do not respond appropriately to orthostatic challenge aler space flight. Situation Upon Landing -Both heart rate and arterial pressure increase during reentry and just aler landing (in the seated posiAon) 2g - HAC -After Shuttle missions, about one out of four astronauts (27%) is unable to complete a 10-minute stand test on landing day, and is forced to sit down to prevent syncope (loss of consciousness) -Syncope is due to a decreased blood flow (less than 30 ml/min per 100 g of brain tissue) Anaemia of Spaceflight -Erythropoietin is a hormone which stimulates Red Cell production for blood. -The loss of fluid in the vascular space concentrates Red Blood Cells. -The body responds by decreasing Erythropoietin. -Upon landing, the Red Blood Cell is diluted when the fluid lost during space flight, is replaced. -This causes the phenomena called the "Anaemia of Spaceflight" -The body responds to this by increasing Erythropoietin

List major medical concerns in context of human space flight

Major Areas of Concerns -Visual System: Eye Sight —> Ophthalmologist -Cardio-Vascular System: Coronary Heart Disease, High Blood Pressure —> Internal Medicine -Kidney: Kidney Stones —> Urologist -Musculo-Skeletal System: Back-Pain, Joint-Wear —> Orthopedic Surgeon - Immune System: Infectious Diseases, Latent Virus Activation —> Microbiologist, Virologists, Epidemiologist -Bio-Rhythm: Jet-lag, Fatigue, Human Errors —> Psychologist, Chrono-Biologist -Radiation: Cancer —> Radiation Biologist and Physicist, Hematologist

List and explain the purpose of private conferences

Non-Encrypted, dedicated comm-systems, secured by procedure or physical means -Private Medical Conference - routinely scheduled or upon request by crew or surgeon -internal medical report (confidential) - report to Flight Director: no, uncertain, definite mission impact -Private Psychological Conference -routinely scheduled or upon request by crew or surgeon or psychologist -internal psychological report (confidential) - report to Surgeon: no, uncertain, definite mission impact / recommendations -Private Family Conference - on weekends, duration ad lib -2-way audio/video any location world-wide -Management Conferences -Flight Directors, Agency Management

List the post-flight objectives of astronaut rehabilitation

Objective 1: prevent injuries Objective 2: recover from 0-g effects, recertification for daily life, aviation and spaceflight activities Objective 3: science program Objective 4: de-briefings Objective 5: public relations Direct Return: Quick Return from Landing Site Immediate scientific evaluations Immediate medical tests Immediate start of rehabilitation Fast Family Reunion PR and Briefings

List preventative and supportive services provided to the astronauts

Preventative Services -Fitness Program (initial and repetitive fitness assessment, individualised fitness program, pre/in/post-flight, mental fitness) -Rehabilitation (post-mission rehab , post-medical intervention) -Life Style ( habits, nutritional aspects, other health risks) -Radiation (personal dosimetry , environmental dosimetry, somatic and genetic risk evaluation) Support Services -Training (hazardous training (baro-chamber, vacuum- chamber, EVA) , science training, Basic Medical Training, HBP training) -Science Activities (Baseline-Data-Collection, science hazard evaluation, ethical and medical safety review) -Mental Health (contingency planning , circadian physiology, work-load, family support , career and non-assignment planning

Describe measures to monitor and research space radiation

Radiation - Dosimetry (calculation and assessment of the radiation dose received by the human body) *equivalent to approximately 10 x rays/day -Passive Dosimetry : TLD (Thermo-Luminescent-Dosimetry) -Active Dosimetry: EuCPAD (European-Crew-Personal-Active-Dosimeter) - reads in real time what radiation is, to inform if environment's radiation levels are too high for example and requiring shielding or abort -Research: Matryoshka (ressembles a human torso, in which human tissue and bones are embedded in a segmented fashion as well as detectors, radiation tracked through, as well as damage taken) -used to study cosmic radiation dose types and rates that relate to the health of space travellers on long duration missions. -the doll has measured the radiation doses of the separate components of the ionizing cosmic radiation at the skin surface and at different locations inside a realistic human torso, in order to establish the relation between skin doses and organ doses.

Identify the roles, functions and responsibilities of Life Sciences, Space Physiology and Space Medicine

Space Medicine - to solve medical problems encountered in space-flight and astronaut career - to keep an astronaut healthy and in space and able to recover after a flight - includes some adaptive changes, such as space motion sickness and environmental exposures - includes some non-pathologic changes, which become maladaptive upon return to Earth, e.g. bone-loss -Focus is OPERATIONAL, from standpoint of MISSION IMPACT Space Physiology -understanding of different human systems and how they are connected in the weightlessness environment -to characterise response to space environment, especially 0-g -knowledge base and foundation for Space Medicine -Focus is INVESTIGATIONAL, from standpoint of SCIENTIFIC RETURN Life Sciences -entity that provides the basic/fundamental research activities form a molecular/biochemical level to the animal/plant/human -are especially devoted to the working of the living world - from bacteria and plants to animals and humans -on earth, all living organisms have developed under constant exposure to 1-g gravity -Space Life Sciences help us to understanding ourselves,our evolution without the constraining barrier of gravity -besides microgravity, living organisms are also affected by radiation, isolation, confinement, and chronobiological aspects during space flight Life Sciences (With humans as test subjects): -peer reviewed experiments on the basis of public announcements and gap analysis -follows common legal & ethical rules (e.g. Helsinki Declaration, Institutional Review Boards) -requires informed consent and participation is voluntary -implementation follows scientific objectives supporting a mission goal -sharing of scientific data following agreed data-sharing rules -publication of results required Space Medicine -implements evidence based (terrestrial) medical processes -follows common physician ethics and medical privacy rules (e.g. US Privacy Act, EU Directive on Data Protection) -occupational medicine as a job-requirement with limited consent -implementation follows internationally agreed operational rules -sharing of clinical data follows rules of medical secrecy -publication of data limited

Describe the risks of human spaceflight to the astronaut health and mitigation strategies

The Risks: Context -Medical risks related to technical systems: mitigate risk through technical measures -Medical risks related to the space and microgravity environment : mitigate risk through countermeasures, monitoring -Medical risks related to the biological system: mitigate risk through selection and preventive medical program -In case of an incidence: Provision of adequate on-board and terrestrial medical resources and capabilities Medical Challenges: Eye Injuries (foreign bodies) . Genito-Urinary Tract (Urolithiasis), Dermatologic Infections , Hypothermia (EVA) , Infections , Radiation induced impairments , Psychiatric/Psychological Issues Risk Mitigation: -Strict Selection Criteria -Intensive Annual Medical Check -Preventive Measures -Medical Check 10 days prior to mission -Quarantine 8 days prior launch -Training of 2 Crew Medical Officers to operate as Paramedics -On-Board Medical Infrastructure -Routine Private Medical and Psychological Conferences -Routine Private Family Voice/Video Conferences -Ground Control -Monitoring Technical Systems -Timeline & Scheduling

Explain the differences in medical support between professional and tourist astronauts

The Space-Tourists: - one flight - no career-astronaut -expected medical issues (older population with age-related medical problems , young and rich population with possible life-style issues) - reduced and less stringent medical and psychological standards - reduce risk to impact taxpayer program by sick tourists - participation in science, or own science program and education program disclosure of tourist medical standards (MED Volume C, published in AsMA Journal) -exceptional publication of medical issues (multiple and recurrent bullae with pneumothorax, large liver hemangioma) -Ex: Guy Liberté, Denis Tito, Mark Shuttleworth, Gregory Olsen

Describe the main principles of the vestibular organ

Vestibular Organ -combined hearing and vestibular system -3 axis acceleration -provides us with information on linear acceleration (not speed!) -translational acceleration -gravity dependent -connection to eye muscles Otolith Organ & Function • Otolith organs are composed of two chambers : Utricle chamber and Saccule chamber • Small stone-like structures of calcium-carbonate (called otoliths) are layered on top of and within a gel, which embeds the hair-cells • the 2 chambers detect linear acceleraAon horizontally and vertically • during acceleration, the inertia of the otolith bends the hair-cells and a signal is send to the brain for further processing • the saccule detects vertical and the utricle horizontal acceleration Semicircular Canal Organ & Function • the three semi-circular canals detect angular motion in three axis • the canals are filled with a liquid, which is moved through the canal by the corresponding motion • the detection of this flow is achieved through sensors in the ampulla of each canal Proprioception -to distinguish different kinds of movement, the brain needs more information. This information comes from proprioceptive receptors -these receptors are stretch receptors located in muscles, joints and tendons -information is integrated with visual and vestibular information Motion - Orientation - Balance The Nervous System evaluates: Motion - using primarily the vestibular system, aided by sight Spatial Orientation - using the vestibular system and sight Balance - using primarily the vestibular system and proprioception, aided by sight Spatial Orientation -Orientation: a sense of knowing where you are in space and time -Disorientation: not knowing where you are in space and time, or thinking you know where you are in space and time, but being wrong

Describe the purpose and function of reflexes

What is a Reflex ? -a reflex is an involuntary and nearly instantaneous movement in response to a sensory input -cannot be controlled voluntarily -self-protection -a reflex response is a very simple system that has: -a sensor afached to a sensing nerve -central processing (spinal cord or brain) -a response nerve stimulating a muscle -examples are pulling away the hand from a hot plate, knee-tendon reflex -Acoustic Reflex (Stapedius Reflex): small muscle that pulls a little bone back to protect ear from loud sounds Vestibulo-Ocular-Reflex (VOR) -the "sensor" of the VOR is the vesAbular system - however, if the vestibular system is not operating properly during spaceflight -VOR also does not operate as expected -the problems with the VOR are attributed to problems with the vestibular system -reflex provides for a stable and focussed image on the retina during head movements