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Suggested Citation:"Index." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Suggested Citation:"Index." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Suggested Citation:"Index." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Suggested Citation:"Index." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Suggested Citation:"Index." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Suggested Citation:"Index." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Suggested Citation:"Index." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Suggested Citation:"Index." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Suggested Citation:"Index." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Suggested Citation:"Index." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Suggested Citation:"Index." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Index A group interactions, 145-146, 152, 156, 159-160, 162, 164, 165-167 Abscesses, 82, 84, 127 mental illness, 80-81, 82, 85, 86 Accidents and injury, see Trauma bone mineral density loss, 40 Aerospace Medical Association, 34 confidentiality issues, 177-178 Age factors, 11, 58, 64, 77, 78 emergency and continuing care, 117- breast cancer, 89 118, 126-127, 131, 132-133, 134 medical events in space, 81 gastrointestinal medical events, 85, 86 Agency for Healthcare Research and infections, 82, 84, 85, 105, 126 Quality, 205 longitudinal studies, 82, 83-86 Airway management, 111, 118-119 microgravity, 76 Alimentary system, see Gastrointestinal neurological effects, 53 system pharmacokinetics and Ambient lighting, see Lighting in pharmacodynamics, 91 spacecraft respiratory disorders, 82, 84, 85, 86 American College of Surgeons, 192 submarines, 76, 80-83, 84, 85, 106, American Medical Association, 34 140-141, 152, 162, 205, 256- Ames Research Center, 193 257, 259 Analog environments, 12, 13, 28, 30, 73, surgery, 126-127 80, 195, 249, 256-260, 262 urinary system, 82 see also Antarctic stations; Anemia, 39, 105, 106, 113 International Space Station Anesthesia, see Pain management and behavioral issues, 12, 13, 139, 140-141, anesthesia 142, 145, 149, 152, 159-160, Animal models 162, 164, 165-167, 170 behavioral, 150 275

276 INDEX bone mineral loss, 45-46 animal models, 150 injury, responses to, 121 clinical trials, 66 muscle loss, 48 committee methodology, xii, 3 nervous system, 53 committee recommendations, 1, 11-13, rehabilitation measures, 127 14, 15, 16, 21 surgical wounds, 121, 123 computer applications, behavioral Antarctic stations, 12, 30, 76, 80, 83-86, adaptation, 151, 154-155, 163- 100, 195, 256-259 164, 165, 166 behavioral issues, 139, 140-141, 142, confined environments, 138, 140, 142, 159-160, 162 168, 170 emergency and continuing care, 117- countermeasures, 107, 108-110, 142, 118, 126, 131, 132-133 156-157, 164-165, 169 infections, 105, 126 databases, 139, 142, 165-166 surgical wounds, 126, 127 disruptive crew interactions, 14, 108, Appendicitis, 29, 82, 85, 88, 102, 104, 127 154-155, 168, 170 Astronaut Medical Evaluation end-of-life care, 9, 130, 134, 211 Requirements Document, 97 genetic factors, 162-163 Ataxia, 39, 48 ground support personnel, 108-109, Atraumatic restorative treatment, 100 140, 164, 166, 168 Attitudes and beliefs, see Public opinion/ health care personnel, 150 education international authorities, cooperation Auditory perception, 77 on, 138, 140 noise effects and controls, 8, 28, 93, 95 international crews, 107, 137, 145, Australian National Antarctic Research 170, 168 Expeditions, see Antarctic International Space Station (ISS), 150, stations 152-153, 159 Authority, NASA organization, 20, 21, medical events in space, 80-81 192, 193, 194-195, 198-199 Mir space station, 140, 141, 153 see also Leadership NASA efforts, 138, 139, 141, 143, 146, 147, 148, 150-151, 154, 156- 159, 160, 162, 164-165, 170 B astronaut esprit as a problem, 174- 175, 182-183 Baroreceptors, 49, 50 neurological factors, 162, 163 Behavioral health, 28, 76, 137-172, 190, organizational factors, 20, 193 249, 251, 262 physiological monitoring of, 154, 155- see also Cultural issues; Group 156, 169 interactions; Mental health and screening, 12, 77, 86, 107, 108 illness; Mood effects; Screening, group interactions, 146-147, 148, selection and training 149, 158-165, 169, 170 analog environments, 12, 13, 139, 140- underreporting of problems, 174- 141, 142, 145, 149, 152, 159- 175, 183, 187 160, 162, 164, 165-167, 170 sexual behavior, 138, 142, 149; see also Antarctic stations, 139, 140-141, Contraceptives and 142, 159-160, 162 contraception group interactions, 145-146, 152, sleep and circadian rhythm, 5, 39, 53- 156, 159-160, 162, 164, 165-167 55, 64, 72, 78, 139, 142, 143-144 mental illness, 80-81

INDEX 277 space crew/ground personnel prostate, 112 interactions, 108-109, 140, 152- radiation effects, 65, 88-89, 212 158, 166, 168 Cardiovascular system, 8, 49-50, 77, 78 space shuttle program, 140, 155 anesthesia and pain management, 118 Behavioral self-management, 145 central venous pressure, 49-51 see also Self-assessment; Self- clinical research, 5, 48-49, 50, 62, 64, monitoring 66, 72 Bioastronautics Institute, 192, 196, 251 end-of-life care, resuscitation Bioavailabilities, 104, 113 considerations, 9, 130, 249 Bioregenerative systems, 89, 143, 145 health care practice, 97-98 Blood, see Cardiovascular system; historical perspectives, 97 Hematology hydrostatic pressure, 39 Body mass, 90, 127, 128 injury, responses to, 121-122 Bone, see Musculoskeletal system medical events in space, 81, 113, 212 Bone mineral density, 3, 5, 9, 26-27, 39, medical events in submarines, 82, 85 40, 42-47, 62, 64, 66, 77, 123, microgravity, 8, 49-50, 97 127, 128, 129, 153 neurovestibular adaptation, 67 analog environments, 40 orthostatic hypotension, 5, 39, 48-49, animal models, 45-46 50, 97, 102 biomarkers, 5, 43, 45, 46 physical examinations in space, 87 bone resorption, 43, 259 renal system, vascular resistance, 50 calcium absorption, 43, 259 screening, 97, 98, 113 calcium excretion, 43, 60, 259 Catastrophic illness and death, 6, 29, 114, clinical research, 5, 46-47, 72 130, 138, 218 countermeasures, 27, 44, 46, 47, 60- end-of-life care, 9, 130, 134, 211 61, 72, 127-128 historical perspectives, 78, 79 gender factors, 43, 58, 59 suicidal and homicidal ideation, 108, genetic factors, 5, 43, 45, 47, 72 154 medications, 5, 44, 46, 47, 72 triage, 118, 134, 211-212 metabolic processes, 43, 44-46, 47, 60- Cell-mediated immunity, 105, 258 61, 87, 259 Chemicals, hazardous, see Hazardous Mir space station, 43, 44, 128 substances nutrition, 44 Central nervous system osteoporosis, 45, 47, 64, 212 anaesthesia, 120 real-time measurements, 46, 72 closed-head injuries, 111 Bone resorption, 43, 259 orthostasis, 110 Bowel sounds, 52, 87 psychomotor functions, 55 Breast cancer, 86-89 radiation effects, 65 sleep and circadian rhythm, 53 Central venous pressure, 49-51 C Circadian rhythm, see Sleep and circadian rhythm Calcium absorption, 43, 259 Clinical Care Capability Development Calcium excretion, 43, 60, 259 project, 209, 250 Carcinogenesis and cancer, 78, 86-89 Clinical practice guidelines, 8, 9, 31, 134, breast, 86-89 204-205, 208, 217, 218 gastrointestinal system, 103 end-of-life considerations, 9, 130, 134

278 INDEX multiple casualties, 118, 134 Clinical Research Opportunities, 5, 72 rehabilitation measures, 127-128 bone mineral density, 5, 46-47, 72 standards, 7, 97, 113, 210-212 gender factors, general, 60 Clinical research, 3, 4, 6-7, 9-10, 24, 38, nervous system, 5, 72 40, 41, 62-73 orthostatic hypotension, 5, 48-49, 72 see also Clinical Research physiological monitoring, 5, 62, 72 Opportunities; Ethical issues reproductive system, 5, 57, 59, 72 behavioral health, 66 sleep and circadian rhythm, 5, 54-55, bone mineral density, 5, 9-10, 42-43, 64, 72 45, 46-47, 62, 64, 66, 72 space motion sickness (SMS), 5, 52, 72 cardiovascular effects, 5, 48-49, 50, 62, Clinical Research Plan, 202 64, 66, 72 Closed-head injuries, 111 committee methodology, xii, 3, 30, 31- Communication and communications 32 technology, 2, 6, 11, 13, 142, Critical Path Roadmap project, 4, 62- 143, 151 69 see also Isolation defined, 69 computer analysis of verbal gender factors, 5, 60, 72 communication, 154-155 hazardous substances, 65 emergency and continuing care, 118, hematology, 9, 62, 64, 106, 113 132, 204-205 historical perspectives, 6, 10 family and friends, 14, 151, 152, 168 immune system, 9, 62, 64, 66, 106, 113 group interactions, 147, 154, 166 infections, 9, 62, 64, 66 monitoring, 15, 151, 169 International Space Station (ISS), 41, robotics, 24, 123-124, 262 73 surgical procedures, 123-124 medications, 5, 55, 204 time delays, 25, 109 microgravity, 5, 6, 9-10, 17, 42-43, 45, Comprehensive health care system 46-47, 62-69 (NASA), 7, 9, 21, 40, 70-71, musculoskeletal system, 5, 9-10, 42-43, 190-191, 195, 196, 197, 198, 45, 46-47, 62, 64, 66, 72 199, 200, 201, 208-209, 216, neurological, 5, 10, 66, 72, 111, 113 218-219 neurovestibular function, 53, 62, 65, Computer-aided design/computer-aided 67 manufacturing (CAD-CAM), nutrition, 5, 62, 63, 65 124 organizational requirements, 70, 193, Computer applications, other 197-198, 199, 207-208 see also Databases pharmacokinetics and behavioral adaptation, 151, 154-155, pharmacodynamics, 5, 72, 90 163-164, 165, 166 physiological monitoring, 5, 61, 63, 68 informatics, 9, 24, 61, 208, 212-214, 217 radiation exposure, 28, 65 recreational software, 151 renal stones, 66 robotics, 24, 123-124, 262 reproductive system, 5, 57, 59, 72 self-assessment software, 109 space motion sickness, 5, 52, 72 verbal communication analysis, 154- trauma, 63, 65 155 various body systems and processes, 5, Confidentiality and privacy, 13, 16, 173, 64-67, 72 174, 175-187, 195, 196, 201 wounds, 9, 106 analog environments, 177-178

INDEX 279 crew onboard space vessels, privacy, rehabilitation measures, 7, 8, 11, 28, 138, 142, 144 67, 71, 73, 127-130, 190, 250 Confined environments, 26, 29, 189 surgical wound healing, 123 anesthesia and pain management, 118 underreporting of problems, 175, 183, behavioral problems, 138, 140, 142, 187 168, 170 urinary system, 60-61, 112 neurological effects, 53 Crew selection and composition, see privacy onboard spacecraft, 138, 142, Ethnicity; International crews; 144 Screening, selection and Contraception and contraceptives, 60, training 104 Crew Status and Support Tracker, 14, 168 Cosmic particles, 27, 96, 113 Critical Path Roadmap project, 4, 62-69, Counter Measure Development and 200, 211, 250 Validation Project, 195-196 Cultural issues Countermeasures, 40-42, 250 see also Ethnicity; International crews; see also Medications Public opinion behavioral problems, 107, 108-110, astronaut esprit as a problem, 174-175, 142, 156-157, 164-165, 169 182-183 bone mineral density, 27, 44, 46, 47, committee methodology, xii, 3 60-61, 72, 127-128 committee recommendations, 11, 21 closed-head and spinal cord injuries, ethical issues, 174-175, 182 111 food preparation 88 Critical Path Roadmap project, 4, 62- group interactions, 149, 156, 164-165, 69, 200, 211, 250 169 decompression sickness, 92 language factors, 107, 140, 164-165, exercise, 48, 58, 127-128, 129, 142 169 hazardous materials exposure, 8, 94, mental health, 107, 149, 156, 158 113 hormonal contraceptive agents, 60, 104 D hormone replacement therapy, 9, 58- Databases, 9, 11, 73 59, 104, 113 behavioral issues, 139, 142, 165-166 International Space Station (ISS), 41- bone mineral density, genetics, 47 42, 68 emergency and continuing care, 132- microgravity effects, 40-42, 48, 56, 62- 133, 134 69, 72, 127-128 pharmacokinetics and artificial gravity, 5, 72, 251 pharmacodynamics, 8, 91, 113 muscle loss, 48, 56, 72, 127-128 Decisionmaking, general NASA programs, general, 27, 68, 193, see also Ethical issues; Organizational 195-194 factors behavioral, 156-157 emergency and continuing care, 117, bone mineral loss, 40-42, 46 118, 130, 134 noise effects and controls, 8, 28, 93, 95 group, 147 organizational requirements, 195-196 individual astronauts, 4, 21, 31, 194 peripheral nervous system, 56 informatics, 9, 24, 61, 208, 212-214, recreation and leisure activities, 14, 217 128-129, 142, 144, 151

280 INDEX leadership, Endocrine function, 258 crew, 10, 108, 147, 148 contraceptives, 60, 104 NASA organization, 20, 21, 192, exogenous hormone therapy, 9 193, 194-195, 198-199 gametes, female, 57 triage, 118, 134, 211-212 growth hormone, neurological effects, Death and dying, see Catastrophic illness 5 and death injury, responses to, 121, 123 Decompression sickness, 59, 67, 92-93 medical events in space, 81, 101 Dehydration, 51, 52, 60, 90, 111-112, 212 neurohormonal, 49 Dental care, 8, 84, 85, 98-101, 113, 252-255 reproductive, 9, 57, 58, 72 gingivitis, 105 replacement therapy, 9, 58-59, 104, Department of Defense, 194, 200, 203, 113 204, 205 testosterone, 57 Department of Health and Human Endotracheal intubation, 118, 119 Services, see Agency for Environmental Protection Agency, 194 Healthcare Research and Epidemiological data, 1, 9, 59, 197 Quality; terms beginning see also Analog environments; Clinical “National Institute...” research; Longitudinal studies Department of Veterans Affairs, 204, 205 Ergonomics, 95-96, 113 Diagnostic and Statistical Manual, 159 Erythropoietin, 40, 105 Diarrhea, 102 Ethical issues, 77, 173-187, 249 Diet, see Nutrition see also Confidentiality and privacy Digestive system, see Gastrointestinal committee methodology, xii, 30 system flight surgeon, 174, 175, 180-181, 215 Dual agency, 175 international crews, 174, 186 Dying, see Catastrophic illness and death NASA efforts, 174, 175, 181-187 Dysbarism, 51, 189, 261 risk assessment, 4, 30, 31, 114, 206-207 public education, 6, 31, 114, 124, 131, 205-207 E Ethnicity, 11, 13, 88 see also Cultural issues; International Electrical stimulation, 128, 129 crews Emergency and continuing care, 25, 30, Exercise countermeasures, 48, 127-128, 117-136, 169 129, 142 see also Pain management and female reproductive physiology, 58 anesthesia; Surgery; Trauma Extravehicular activity (EVA), 77, 116, analog environments, 117-118, 126- 189, 190, 191 127, 131, 132-133, 134 decompression sickness, 92 databases, 132-133, 134 gender factors, suits, 60 decompression sickness, 92 medical events in space, 79 microgravity, 121-123, 125, 127, 128, 129 space motion sickness (SMS), 52 NASA efforts, 126, 129-130, 134-135 Extreme environments, 1-2, 4, 6, 11-12, organizational factors, 190, 192, 13, 14, 28, 170, 189, 256-257 210-212 see also Analog environments; triage, 118, 134, 211-212 Confined environments; End of life considerations, see Isolation; Microgravity; Catastrophic illness and death Radiation exposure

INDEX 281 group interactions, 145, 170 data collection and access, 13 Mars exploration, 23, 24-25, 30 extravehicular activity, suits, 60 medical events, 78-86 group interactions, 156, 170 space medicine defined, 34 immune system, 59 Eye-hand coordination, 55, 125 orthostatic hypotension, 59 radiation effects, 5, 59, 88-89 sexual behavior, 138, 142, 149; see also F Contraception and contraceptives Facial and periorbital edema, 26, 87, 90 General living conditions, see Living Fatigue, 53, 55, 66, 106, 107, 153, 155, conditions, general 212, 259 Genetic factors Federal Aviation Administration, 203-204 behavioral effects, 162-163 Females, see Gender factors bone mineral density, 5, 43, 45, 47, 72 Food, see Nutrition databases, 47 Fractures, 42, 45, 46, 64, 72, 79, 123, 124 informatics, 213 Freedom of Information Act, 201 musculoskeletal system, 5, 43, 45, 47 Funding, 10, 20, 31, 141, 202, 203, 262 radiation exposure, 5, 56-57, 67, 72 reproductive system effects of radiation, 5, 56-57 G risk assessment, general, 86-89 Galactic cosmic rays, see Cosmic Goldin, Daniel, 189, 261-262 particles; Radiation exposure Gravity Galvanic stimulation, 128 see also Microgravity Gametes, 56, 58 artificial, 5, 72, 251 Gastrointestinal system exposure to gravity following missions, see also Nutrition; Space motion 30, 48, 97-98, 129 sickness Ground support personnel, 77, 148, 252 absorption factors, 39 behavioral issues, 108-109, 140, 164, bowel infections, 111 166, 168 bowel sounds, 52, 87 emergency and continuing care, 118 cancer, 103 mission control, 108, 136, 140, 150- ileus, 39, 123 151 medical events in Antarctica, 85, 86 space crew interactions with, 108-109, medical events in space, 78, 81, 102- 140, 152-158, 166, 168 103; see also “space motion Group interactions, 2, 21, 28, 142, 145- sickness” infra 157, 160-161, 164-168, 170 medical events in submarines, 82 analog environments, 145-146, 152, medications, 5, 52, 102 156, 159-160, 162, 164, 165-167 space motion sickness (SMS), 5, 39, 51- cultural factors, 149, 156, 164-165, 52, 72, 78, 87, 91, 102, 138, 140 169 Gender factors, 5, 11, 59-60, 77 disruptive, 14, 108, 154-156, 168, 170 see also Reproductive system gender factors, 156, 170 bone mineral loss, 43, 58, 59 leadership, 10, 108, 147, 148 breast cancer, 86-89 privacy while onboard spacecraft, 138, clinical research, 5, 60, 72 142, 144

282 INDEX screening, selection, and training, 77, confidentiality, doctor-patient, 175-176 146-147, 148, 149, 158-165, crew selection, 12 169, 170 injury, responses to, 121 Growth, height, 26 Mars exploration, 23 Gynecologic health issues, 5, 103-105 medical events, 78, 81 contraception and contraceptives, 60, microgravity effects, 37 104 Hormonal contraceptive agents, 60, 104 menstruation effects, 5, 43, 58-59, 72, Hormone replacement therapy, 9, 58-59, 103, 104 104, 113 pelvic examinations, 88 Hormones, see Endocrine function Hubble Space Telescope, 202 Human Exploration of Mars: The H Reference Mission of the NASA Mars Exploration Study Team, Habitability, see Living conditions, general 24 Hazardous substances, 92, 93-94 Hydration, see Dehydration anesthesia and pain management, 118, Hydrostatic pressure, 39 119-120 Hypercalciuria, 44 clinical research, 65 countermeasures, 8, 94, 113 spacecraft maximum allowable I concentrations (SMAC), 93-94, 143 Ileus, 39, 123 Headaches, 110, 140 Immune system, 39, 153, 212 Health care personnel, 131-133, 255-256 cell-mediated immunity, 105, 258 anesthesia and pain management, 118 clinical research, 9, 62, 64, 66, 106, behavioral factors, 150 113 emergency and continuing care, 118 gender factors, 59 flight surgeon, 174, 175, 180-181, 215 injury, responses to, 121, 126 organizational requirements, 193-194 medical events in space, 81, 212 training of, 30, 34, 214-216 surgery, 121, 126 Health registers, 83, 141 Infections, 127 Hearing, see Auditory perception abscesses, 82, 84, 127 Height, see Growth, height analog environments, 82, 84, 85, 105, Hematology, 61, 105-106 126 anemia, 39, 105, 106, 113 bowel, 111 bone density markers, 43, 45, 46 cell-mediated immunity, 105 clinical research, 9, 62, 64, 106, 113 clinical research, 9, 62, 64, 66 erythropoietin, 40, 105 medical events in Antarctica, 85, 86 surgery, 121, 122, 125 medical events in space, 9, 81, 105, High-energy particle radiation, see 111 Radiation exposure medications, 127 Historical perspectives, 3, 18, 26, 38, 137, preflight isolation, 105 197 urinary, 111 see also Analog environments wounds, 9, 105, 106, 113, 126 cardiovascular care, 97 Informatics, 9, 24, 61, 208, 212-214, 217 clinical data collection, 6, 10 Infrastructure, see Organizational factors

INDEX 283 Injury, see Trauma J Institutional factors, see Organizational factors Johnson Space Center (JSC), 173, 183, Integration, 193-194, 197, 198, 218 190, 192, 193, 195, 196, 248, comprehensive health care system 252 (NASA), 7, 9, 21, 40, 70-71, 190-191, 195-199 (passim) interagency coordination, 31, 73, 175, K 193, 194, 195-196, 198, 199, Kidneys, see Renal system 200, 203-208, 217 International cooperation, 198, 207, 217, 251 L behavioral health problems, 138, 140 committee charge, 31 Language factors, 107, 140, 164-165, 169 ethical issues, 174, 186, 187 computer analysis of verbal risk assessment, 114 communication, 154-155 screening, selection and training, 158- Laproscopic surgery, 104, 124, 125 159 Laryngeal mask, 119 standards, general, 8, 16, 17, 107, 219 Leadership International crews, 11, 24, 25, 149 crew, 10, 108, 147, 148 behavioral issues, 107, 137, 145, 170, 168 NASA organization, 20, 21, 192, 193, ethical issues, 174, 186 194-195, 198-199 International Space Station (ISS), 2, 3, 11, Legislation, 201-202 17, 34, 38, 73, 77, 188, 190, 191, see also Regulatory issues 202, 207, 212, 249, 251 Freedom of Information Act, 201 behavioral issues, 150, 152-153, 159 Privacy Act, 16, 175-176, 187, 201 bone mineral density, microgravity, 3, Life on the Screen: Identity in the Age of 40 the Internet, 109 clinical research, 41, 73 Lighting in spacecraft, 5, 28, 142 countermeasures research, 41-42, 68 sleep and circadian rhythm, 53, 55, emergency and continuing care, 117, 144 190 Living conditions, general, 15, 65, 77, ethical issues, 181-186, 186, 187 134, 138, 142-143, 145, 161, 167 informatics, 213 see also Confined environments; injury, responses to, 121 Isolation; Lighting in spacecraft launches from, 25 noise effects and controls, 8, 28, 93, 95 mental health screening, 108 paired transport vehicles, 149 radiation exposure, 96 privacy onboard spacecraft, 138, 142, rehabilitation measures, 129-130, 190 144 space motion sickness (SMS), 52 Longitudinal studies, 15 Intestines, see Gastrointestinal system bone mineral loss, 45 Isolation, 3, 10, 11, 13, 14, 25, 28, 29, death, 78 138, 140, 142, 168, 189, 258-259 epidemiological data, 1, 9, 59, 197 see also Communication and medical events in Antarctica, 83-86 communications technology medical events in space, 78-79 neurological effects, 53 medical events in submarines, 82 preflight, infection rates, 105 mental health issues, 109-110, 157-158

284 INDEX Longitudinal Study of Astronaut Health, pharmacokinetics, 5, 72, 90-91, 110, 176, 209, 212, 249 113 Lucid, Shannon, 26 psychomotor functions, 55 Lungs, see Respiratory system sleep, 53-54, 55 space motion sickness, 5, 52 Melatonin, 54 M Menstruation effects, 5, 43, 58-59, 72, 103, 104 Males, see Gender factors Mental health and illness, 15, 28, 30, 64, Malnutrition, 65, 89 77, 106-110, 113, 138-139 Mars missions, 11, 23-25, 28, 30, 38, 75, see also Behavioral health; Isolation; 137 Mood effects; Screening, bone mineral density loss, 27, 44-45 selection and training countermeasures, 68 analog environment data, 80-81, 82, emergency and continuing care, 123- 85, 86 125, 132 cultural issues, 107, 149, 156, 158 mental health issues, 107 disruptive crew interactions, 14, 108, orthostatic hypotension, 49 154-155, 168, 170 surgical procedures, 123-125 end-of-life care, 9, 130, 134 Medical devices, 19, 112, 129 intramission/postmission problems, see also Robotics 106, 107, 108-110, 153-154, anesthesia and pain management, 118- 157-158 119, 120 longitudinal studies, 109-110, 157-158 electrical stimulation, 128, 129 mission control, 108, 136, 140, 150-151 laryngeal mask, 119 NASA efforts, 106-107, 109-110 nanotechnology, 24, 61-62, 194 suicidal and homicidal ideation, 108, surgery, 124-125 154 Medications Metabolic processes see also Pain management and see also Endocrine function anesthesia bone mineral density, 43, 44-46, 47, bone mineral loss, 5, 44, 46, 47, 72 60-61, 87, 259 clinical research, general, 5, 55, 204 injury, responses to, 121, 123 committee charge, 31 medical events in space, 81 databases, 8, 91, 113 nutrient absorption in microgravity, gastrointestinal system, 5, 52, 102 89-90 hormonal contraceptive agents, 60, 104 pharmacokinetics, 5, 72, 90-91, 110, hormone replacement therapy, 9, 58- 113 59, 104, 113 renal stones, 61, 111-112 infections, 127 Microbiology medical events in space, 79, 102 see also Immune system; Infection mental illness treatment, 108 anesthesia and pain management, 118, muscle loss, 48, 72 119, 120 organizational requirements, 204, 217 contamination, 94-95, 113 orthostatic hypotension, 49, 72 dental care, 99 pancreatitis prevention, 103 Microgravity, 3, 6, 26, 29, 37-39, 40, 138, pharmacodynamics, 59, 60, 65, 86, 90- 189, 191, 249, 261, 262 91, 113 see also Bone mineral density

INDEX 285 airway management during bone mineral loss, 43, 44, 128 anaesthesia, 119 medication usage, 84 analog environments and, 76 mental health issues, 106, 107 artificial gravity, 5, 72, 251 rehabilitation measures, 129 body mass, 90, 127, 128 sleep and circadian rhythm, 53 cardiovascular system, 8, 49-50, 97 surgical wounds, 122-123 clinical research, 5, 6, 9-10, 17, 42-43, Mission control, 108, 136, 140, 150-151 45, 46-47, 62-69 Model Trauma Care System Plan, 192 countermeasures, 40-42, 48, 56, 62-69, Mood effects, 8, 14, 86, 106, 113, 139- 72, 127-128; see also “artificial 142, 155, 259 gravity” supra sleep and circadian rhythm, 53 decompression sickness, 59, 67, 92-93 Moon missions, 34, 38 emergency and continuing care, 121- Motion sickness, see Space motion 123, 125, 127, 128, 129 sickness ergonomic issues, 95-96, 113 Motor functions, see Psychomotor exposure to gravity following, 30, 48, functions 97-98, 129 Musculoskeletal system, 203 injury, responses to, 121, 122 see also Bone mineral density menstruation effects, 5, 43, 58-59, 72, ataxia, 39, 48 103, 104 body mass, 90, 127, 128 muscle loss, 9-10, 39, 47-48, 55-56, 62, clinical research, 5, 9-10, 42-43, 45, 64, 66, 77, 127, 212 46-47, 62, 64, 66, 72 animal models, 48 fractures, 42, 45, 46, 64, 72, 79, 123, countermeasures, 48, 56, 72, 127- 124 128 gender factors, 43, 58, 59 neurological effects, 53, 56, 67 genetic factors, 5, 43, 45, 47 nutrient absorption, 89-90 medical events in Antarctica, 85, 86 orthostatic hypotension, 5, 39, 48-49, medical events in space, 79, 81 50, 53, 59, 72, 97, 102, 110, 190 muscle loss, 9-10, 39, 47-48, 55-56, 62, peripheral nervous system, 56 64, 66, 77, 127, 212 pharmacodynamics, 59, 60, 65, 86, 90- animal models, 48 91 countermeasures, 48, 56, 72, 127- pharmacokinetics, 5, 72, 90-91, 110 128 physical examinations in, 87-88 pain management, 48 radiation, synergistic effects, 65 nutrition, 48 reproductive system, 5, 8, 56 peripheral nervous system, 55-56 menstruation effects, 5, 43, 58-59, surgical wound healing, 122-123 72, 103, 104 space motion sickness (SMS), 5, 39, 51-52, 72, 78, 87, 91, 102, 138, N 140 Nanotechnology, 61, 194 standards, 8, 113 sensors, 24, 61-62 surgery, 121-123, 125 National Aeronautics and Space urinary system, 39, 42, 44, 50, 60-61; Administration (NASA), 24, see also Renal system 189-191 Mir space station, 249 see also Organizational factors behavioral problems, 140, 141, 153

286 INDEX Ames Research Center, 193 space medicine defined, 34 behavioral issues, 138, 139, 141, 143, surgical procedures, 126 146, 147, 148, 150-151, 154, National Cancer Institute, 62 156-159, 160, 162, 164-165, 170 National Institute of Arthritis and astronaut esprit as a problem, 174- Musculoskeletal and Skin 175, 182-183 Diseases, 203 cardiovascular effects of microgravity, National Institute on Aging, 203 50 National Institutes of Health, 194, 199, committee charge and methodology, 200, 203, 204, 208 xi-xiii, 2-3, 29-33, 247-260 National Science Foundation, 195 committee recommendations, 1, 6-21, National Space Biomedical Research 40, 69-73, 114, 135, 170, 187, Institute, 10, 143, 156-157, 193, 191, 202-219 (passim) 196, 202, 250 comprehensive health care system, 7, Nausea, see Space motion sickness 9, 21, 40, 70-71, 190-191, 195, Nephrolithiasis, 60, 111-112 196, 197, 198, 199, 200, 201, Nervous system, 5, 39, 49, 110-111 208-209, 216, 218-219 see also Pain management and countermeasures, general, 27, 68, 193, anesthesia; Psychomotor 194-195 functions; Sleep and circadian behavioral, 156-157 rhythm; Space motion sickness bone mineral loss, 40-42, 46 analog environments, 53 Critical Path Roadmap project, 4, animal models, 53 62-69, 200, 211, 250 ataxia, 39 emergency and continuing care, 126, baroreceptors, 49, 50 129-130, 134-135, 190, 192, behavioral factors, 162, 163 210-212 central nervous system, 53, 55, 65, ethical issues, 174, 175, 181-187 110, 111, 120 funding, 10, 20, 31, 141, 202, 203, 262 clinical research, 5, 10, 66, 72, 111, gamete preservation, 57 113 Johnson Space Center (JSC), 173, 183, closed-head injuries, 111 190, 192, 193, 195, 196, 248, confined environments, 53 252 injury, responses to, 121, 123 leadership, crews, 148 isolation effects, 53 leadership, NASA organization, 20, medical events in Antarctica, 85, 86 21, 192, 193, 194-195, 198-199 medical events in space, 81, 110-111, major health and medical events, 76- 212 77 microgravity, 53, 56, 67 mental health of crew, 106-107, 109- peripheral nervous system, 55-56 110 space motion sickness (SMS), 5, 39, 51- neurological clinical program, 111 52, 72, 78, 87, 91, 102, 138, 140 neurovestibular function, 53 Neurovestibular function, 10, 53, 62, 65, physical training and rehabilitation, 67, 77, 81, 110 129-130 Noise effects and controls, 8, 28, 93, 95 physiological monitoring, 61-62 Nutrition, 11, 51, 88-90, 138, 142, 143, pulmonary system, 51 251 radiation exposure, 96 bioregenerative systems, 89, 143, 145 risk assessment, general, 3-4, 38 bone mineral loss, 44

INDEX 287 clinical research, 5, 62, 63, 65 headaches, 110, 140 injuries, recovery from, 123 medical devices, 118-119, 120 malnutrition, 65, 89 muscle loss and, 48 medical events in space, 81 screening, selection and training, 118, muscle protein, 48 120 Pancreas, 103 Parathyroid hormone, 258, 259 O Performance, see Behavioral health; Task performance Occupational health model, 1, 16-17, 92- Peripheral nervous system, 55-56 97, 178-180, 187, 201, 203-204 Pharmaceuticals, see Medications ergonomics, 95-96, 113 Pharmacodynamics, 59, 60, 65, 86, 90-91 Office of Naval Research, 194 analog environments, 91 Oocytes, 57, 58 databases, 8, 91, 113 Organizational factors, 2, 6-7, 10, 19-20, Pharmacokinetics, 5, 72, 90-91, 110 29-30, 191-219, 262 databases, 8, 91, 113 see also International cooperation Phenotypes, bone mineral loss, 43, 47, 72 authority, 20, 21, 194-195 Physiological monitoring, 39, 61-62, 68, behavioral health, 20, 193 207 comprehensive health care system behavioral adaptation, 154, 155-156, (NASA), 7, 9, 21, 40, 70-71, 169 190-191, 195-199 (passim), 200, bone mineral density markers, 5, 43, 201, 208-209, 216, 218-219 45, 46 ethical issues, 174-175, 182, 187 clinical research, 5, 61, 62, 63, 68, 72 group functioning, 147, 158, 168 Pituitary gland, 57, 58 health care personnel, 193-194 Polar tri-idothyronine (T3) syndrome, see integration, 193-194 Tri-iodothyronine (T3) interagency coordination, 31, 73, 175, Poliakov, Valeri, 26 193, 194, 195-196, 198, 199, Post-flight support and reintegration, 200, 203-208, 217 106, 107, 108-110, 153-154, leadership, crew, 10 157-158 leadership, NASA, 20, 21, 194-195 Pregnancy, 60, 103 neurological clinical program, 111 see also Contraception and standards, 191, 192, 193, 195, 200 contraceptives international cooperation, 8, 16, 17, Preventive measures, 28, 40, 99, 189-190, 107, 219 210, 211, 213 systems development, 199-200 see also Screening, selection, and Orthostasis, 5, 39, 48-49, 50, 53, 59, 72, training 97, 102, 110, 190 surgical infections, 126 Osteoporosis, 45, 47, 64, 212 underreporting of problems, 175, 183, 187 Privacy, see Confidentiality and privacy P Privacy Act, 16, 175-176, 187, 201 Pain management and anesthesia, 9, 118- Prostate gland, 112 122, 129, 134 Protocols backaches, 79 see also Clinical practice guidelines; endotracheal intubation, 118, 119 Standards

288 INDEX confidentiality, 182-186 Regulatory issues, 1, 17, 182, 187 end-of-life considerations, 9, 130, 134 see also Legislation; Occupational mental health, 108 health model; Standards organizational requirements, 200 Rehabilitation practices, 7, 8, 11, 28, 67, physical exercise, 48 71, 73, 127-130, 190, 250 Psychomotor functions, 9, 39, 55, 64, 65, animal models, 127 134, 138, 212 International Space Station (ISS), 129- computerized assessment, 155 130, 190 medications, 55 Renal system recreational activities, 128-129 calculi, 39, 42, 44, 60-61, 66, 85, 111- Public opinion/education, 6, 31, 114, 124, 112, 212 131, 205-207 nephrolithiasis, 60, 111-112 Pulmonary system, see Respiratory system vascular resistance, 50 Reproductive system, 56-60, 111-112 clinical research, 5, 57, 59, 72 Q exercise, 58 gametes, 56, 58 Quality control, 8, 208, 217 genetic factors, 5, 56-57 see also Clinical practice guidelines; gynecological issues Ethical issues; Protocols; hormones, 9, 57, 58, 72 Regulatory issues; Standards replacement therapy, 9, 58-59, 104, expert oversight, 8, 219 113 testosterone, 57 medical events in submarines, 82 R microgravity, gynecological health Race/ethnicity, see Ethnicity issues, 5, 8, 43, 56, 58-59, 72, Radiation exposure, 8, 27-28, 29, 62, 77, 103, 104 92, 96, 113, 189, 249, 261 oocytes, 57, 58 cancer and, 65, 88-89, 212 pelvic examinations, 88 central nervous system, 65 prostate gland, 112 clinical research, 28, 65 radiation effects, 5, 56-57, 67, 72 cosmic particles, 27, 96, 113 sperm production, 56 gender factors, general, 5, 59, 88-89 Resources for the Optimal Care of the genetic factors, 5, 56-57, 67, 72 Injured Patient, 192 microgravity effects, synergies, 65 Respiratory system, 39, 51 neurovestibular adaptation, 67 airway management, 111, 118-119 reproductive health, 5, 56-57, 67, 72 endotracheal intubation, 118, 119 Real-time measurements, 5, 18, 134 laryngeal masks, 119 bone mineral density, 46, 72 medical events in Antarctica, 85, 86 group interactions, 148 medical events in space, 78, 81 neurological effects, 52-53 medical events in submarines, 82, 84 surgical procedures, 123-124 nasal congestion, 78, 87 Recovery systems, see Support and orthostatic hypotension, 5, 39, 48-49, recovery systems 50 Recreation and leisure activities, 14, 128- pulmonary function tests, 36 129, 142, 144, 151 Reticulocytes, 105

INDEX 289 Review of NASA’s Biomedical Research Sex differences, see Gender factors Program, 38 Sexual behavior, 138, 142, 149 Robotics, 262 see also Contraception and Mars exploration, 24 contraceptives surgery, 123-124 Shaw, Chuck, 75 Shuttle program, see Space shuttles Skeletal system, see Musculoskeletal S system Skin diseases, 78-79, 81, 82, 84, 85, 86, Sagan, Carl, 137 203 Screening, selection, and training, 28, 86, cell-mediated immunity, 105 158-165, 169, 170, 250, 256- preflight isolation, 105 257, 259 Skylab, 27, 74 anesthesia and pain management, 118, Sleep and circadian rhythm, 5, 39, 53-55, 120 64, 72, 78, 139, 142, 143-144 behavioral factors, 12, 77, 86, 107, 108 lighting in spacecraft, 53, 55, 144 group interactions, 146-147, 148, medications, 53-54, 55 149, 158-165, 169, 170 Small Clinical Trials: Issues and underreporting of problems, 174- Challenges, 70, 207 175, 183, 187 Small n problem, 214-215 bone mineral density, 45, 63 Social issues, 2, 21, 28, 64 cardiovascular health, 97, 98, 113 see also Behavioral factors; Cultural committee charge and factors; Group interactions; recommendations, 8, 12, 13, 15, Public opinion 29, 32, 170 analog environment data, 80-81 computerized assessment, 154-155 gender factors, 59 crew diversity, 77 group interactions, 2, 21, 28, 138-142, Critical Path Roadmap project, 63 145-149, 156 emergency and continuing care, 123- Socrates, 23 125, 127, 131-132 Solar particle events (SPEs), 27, 96, 113 ethical issues, 182-183, 187 Space Behavioral Assessment Tool, 14, gastrointestinal system, 102 155, 168 group interactions, 77, 146-147, 148, Space Flight Cognitive Assessment Tool, 149, 158-165, 169, 170 14, 155 health care personnel, 30, 34, 214-216 Space Flight Fatigue Assessment Tool, international cooperation, 158-159 155 Mars exploration, 25 Space motion sickness (SMS), 5, 39, 51- mental health issues, 107, 108 52, 72, 78, 87, 91, 102, 138, 140 organizational requirements, 189, 210, medications, 5, 52 214-216 Space shuttle program, 36, 77, 102, 116, paired transport vehicles, 149 136, 190, 207, 248, 252 prostate cancer, 112 behavioral issues, 140, 155 rehabilitation measures, 127, 134 bone mineral loss, 43 surgical skills, 123-125 dehydration, 112 Self-assessment, 108, 109, 139-140, 145, sleep and circadian rhythms, 144 164, 169 toxic chemical exposure, 93 Self-monitoring, 145

290 INDEX Space suits, 93 Surgery, 28, 30, 80, 102, 103, 121, 122, decompression sickness, 92-93 123-127, 136, 215 females, 60 see also Wounds Spacecraft maximum allowable analog environments, 126-127 concentrations (SMAC), 93-94, anesthesia and pain management, 118- 143 119, 123 Sperm production, 56 animal models, 121, 123 Standards, 9 appendicitis, 29, 82, 85, 88, 102, 104, see also Ethical issues; Protocols 127 cardiovascular health screening, 97 cholecystectomy, 102, 103 clinical care, 7, 97, 113, 210-212; see communications technology and, 123- also Clinical practice guidelines 124 ergonomic, 95-96, 113 ethical issues, flight surgeon, 174, 175, group interaction monitoring, 156 180-181, 215 health status measures database, 133 gynecological, 103 international cooperation, 8, 16, 17, hematological considerations, 121, 107, 219 122, 125 mental health, 107 immune system effects, 121, 126 microgravity effects, 8, 113 laproscopic, 104, 124, 125 occupational health model, 1, 16-17, medical devices, 124-125; see also 92-97, 178-180, 187, 201, 203- Robotics 204 medical events in submarines, 83-86 organizational requirements, 191, 192, microgravity during, 121-123, 125 193, 195, 200 musculoskeletal system, 122-123 international cooperation, 8, 16, 17, robotic, 123-124 107, 219 Systemic Multiple Level Observation of toxic substance concentrations Groups, 156 (SMAC), 93-94, 143 Systems development A Strategy for Research in Space Biology bioregenerative systems, 89, 143 and Medicine in the New complex adaptive systems, 148 Century, 38, 139 organizational, 199-200 Submarines, 76, 80-83, 84, 85, 106, 140- triage, 118, 134, 211-212 141, 152, 162, 205, 256-257, 259 Suicide, 108, 154 Suits, see Space suits T Support and recovery systems, 14, 26, Task performance, 62, 64, 66, 68, 198, 138, 147, 149-158, 161, 164, 249, 251 168-169 behavioral issues and, 137-172 see also Ground support personnel gender factors, 60 intramission/postmission problems, mental health factors, 106-107 106, 107, 108-110, 153-154, neurovestibular adaptation, 67 157-158 psychomotor functions, 9, 39, 55 mental health, 106, 107, 108-110, 153- sleep and circadian rhythm, 53 154, 157-158 Telecommunications, see Communication mission control, 108, 136, 140, 150-151 and communications technology psychomotor functions, 55

INDEX 291 Temperature factors, 5, 129 U Mars, 23 sleep and, 55 Urinary system, 60-61 Testosterone, 57 see also Renal system Titov, Vladimir, 26 bone mineral density markers, 5, 43, To Err Is Human, Building a Safer Health 45, 46, 60 System, 217 clinical research, 5 Toxic chemicals, see Hazardous countermeasures, 60-61, 112 substances infections, 111 Training requirements, see Screening, medical events in space, 81, 111-112 selection, and training medical events in submarines, 82 Trauma, 29, 63, 65, 78, 79-80, 81, 121- microgravity, 39, 42, 44, 50, 60-61 123, 127 urinalysis, other than density markers, see also Surgery 61 anesthesia and pain management, 118- 119, 123 animal models, 121 V cardiovascular response, 121-122 Vestibular function, see Neurovestibular clinical research, 63, 65 function closed-head and spinal cord injuries, Visual perception, 53 111 Vomiting, see Space motion sickness emergency and continuing care, 118 fractures, 42, 45, 46, 72, 79 immune system, 121, 126 W medical events in Antarctica, 85, 86 medical events in submarines, 82, 84, Weight, see Body mass 85 Weightlessness, see Microgravity microgravity, response effects, 121, Windows Space Flight Cognitive 122 Assessment, 14, 155, 168 multiple casualties, 118, 134 Women, see Gender factors nutrition, recovery from, 123 Wounds, 42, 84, 105, 113, 122-123 organizational factors, 192 see also Surgery wounds analog environments, 126, 127 Triage, 118, 134, 211-212 animal models, 121, 123 Tri-iodothyronine (T3), 101 clinical research, 9, 106 infections, 9, 105, 106, 113, 126 Wyle Laboratories, 195-196

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Safe Passage: Astronaut Care for Exploration Missions sets forth a vision for space medicine as it applies to deep space voyage. As space missions increase in duration from months to years and extend well beyond Earth's orbit, so will the attendant risks of working in these extreme and isolated environmental conditions. Hazards to astronaut health range from greater radiation exposure and loss of bone and muscle density to intensified psychological stress from living with others in a confined space. Going beyond the body of biomedical research, the report examines existing space medicine clinical and behavioral research and health care data and the policies attendant to them. It describes why not enough is known today about the dangers of prolonged travel to enable humans to venture into deep space in a safe and sane manner. The report makes a number of recommendations concerning NASA's structure for clinical and behavioral research, on the need for a comprehensive astronaut health care system and on an approach to communicating health and safety risks to astronauts, their families, and the public.

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