Safe Passage Astronaut Care for Exploration Missions (2001) / Chapter Skim
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Index A Abscesses, 82, 84, 127 Accidents and injury, see Trauma Aerospace Medical Association, 34 Age factors, 11,58,64,77,78 breast cancer, 89 medical events in space, 81 Agency for Healthcare Research and Quality, 205 Airway management, 111, 118-119 Alimentary system, see Gastrointestinal system Ambient lighting, see Lighting in spacecraft American College of Surgeons, 192 American Medical Association, 34 Ames Research Center, 193 Analog environments, 12, 13, 28, 30, 73, 80, 195, 249, 256-260, 262 see also Antarctic stations; International Space Station behavioral issues, 12, 13, 139, 140-141, 42, 145, 149, 152, 159-160, 62, 164, 165-167, 170 group interactions, 145-146, 152, 156, 159-160, 162, 164, 165-167 mental illness, 80-81, 82, 85, 86 bone mineral density loss, 40 confidentiality issues, 177-178 ~ . emergency and continuing care, 117118, 126-127, 131, 132-133, 134 gastrointestinal medical events, 85, 86 infections, 82, 84, 85, 105, 126 longitudinal studies, 82, 83-86 microgravity, 76 neurological effects, 53 pharmacokinetics and pharmacodynamics, 91 respiratory disorders, 82, 84, 85, 86 submarines, 76, 80-83, 84, 85, 106, 140-141, 152, 162, 205, 256257, 259 surgery, 126-127 urinary system, 82 Anemia, 39, 105, 106, 113 Anesthesia, see Pain management and anesthesia Animal models behavioral, 150 275
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, 150, 152-153, 159 medical events in space, 80-81 Mir space station, 140, 141, 153 NASA efforts, 138, 139, 141, 143, 146, 147, 148, 150-151, 154, 156159, 160, 162, 164-165, 170 astronaut esprit as a problem, 174175, 182-183 neurological factors, 162, 163 organizational factors, 20, 193 physiological monitoring of, 154, 155156, 169 screening, 12, 77, 86, 107, 108 group interactions, 146-147, 148, 149, 158-165, 169, 170 underreporting of problems, 174175, 183, 187 sexual behavior, 138, 142, 149; see also Contraceptives and contraception sleep and circadian rhythm, 5, 39, 5355, 64, 72, 78, 139, 142, 143-144
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. monltormg Bioastronautics Institute, 192, 196, 251 Bioavailabilities, 104, 113 Bioregenerative systems, 89, 143, 145 Blood, see Cardiovascular system; Hematology Body mass, 90, 127, 128 Bone, see Musculoskeletal system Bone mineral density, 3, 5, 9, 26-27, 39, 40, 42-47, 62, 64, 66, 77, 123, 127, 128, 129, 153 analog environments, 40 animal models, 45-46 biomarkers, 5, 43, 45, 46 bone resorption, 43, 259 calcium absorption, 43, 259 calcium excretion, 43, 60, 259 clinical research, 5, 46-47, 72 countermeasures, 27, 44, 46, 47, 6061, 72, 127-128 gender factors, 43, 58, 59 genetic factors, 5, 43, 45, 47, 72 medications, 5, 44, 46, 47, 72 metabolic processes, 43, 44-46, 47, 6061, 87, 259 Mir space station, 43, 44, 128 nutrition, 44 osteoporosis, 45, 47, 64, 212 real-time measurements, 46, 72 Bone resorption, 43, 259 Bowel sounds, 52, 87 Breast cancer, 86-89 C Calcium absorption, 43, 259 Calcium excretion, 43, 60, 259 Carcinogenesis and cancer, 78, 86-89 breast, 86-89 gastrointestinal system, 103 277 prostate, 112 radiation effects, 65, 88-89, 212 Cardiovascular system, 8, 49-50, 77, 78 anesthesia and pain management, 118 central venous pressure, 49-51 clinical research, 5, 48-49, 50, 62, 64, 66,72 end-of-life care, resuscitation considerations, 9, 130, 249 health care practice, 97-98 historical perspectives, 97 hydrostatic pressure, 39 injury, responses to, 121-122 medical events in space, 81, 113, 212 medical events in submarines, 82, 85 microgravity, 8, 49-50, 97 neurovestibular adaptation, 67 orthostatic hypotension, 5, 39, 48-49, 50, 97, 102 physical examinations in space, 87 renal system, vascular resistance, 50 screening, 97, 98, 113 Catastrophic illness and death, 6, 29, 114, 130, 138, 218 end-of-life care, 9, 130, 134, 211 historical perspectives, 78, 79 suicidal and homicidal ideation, 108, 154 triage, 118, 134, 211-212 Cell-mediated immunity, 105, 258 Chemicals, hazardous, see Hazardous substances Central nervous system anaesthesia, 120 closed-head injuries, 111 orthostasis, 110 psychomotor functions, 55 radiation effects, 65 sleep and circadian rhythm, 53 Central venous pressure, 49-51 Circadian rhythm, see Sleep and circadian rhythm Clinical Care Capability Development project, 209, 250 Clinical practice guidelines, 8, 9, 31, 134, 204-205, 208, 217, 218 end-of-life considerations, 9, 130, 134
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, 5, 52, 72 Clinical Research Plan, 202 Closed-head injuries, 111 Communication and communications technology, 2, 6, 11, 13, 142, 143, 151 see also Isolation computer analysis of verbal communication, 154-155 emergency and continuing care, 118, 132, 204-205 family and friends, 14, 151, 152, 168 group interactions, 147, 154, 166 monitoring, 15,151, 169 robotics, 24, 123-124, 262 surgical procedures, 123-124 time delays, 25, 109 Comprehensive health care system (NASA) , 7, 9, 21, 40, 70-71, 190-191, 195, 196, 197, 198, 199, 200, 201, 208-209, 216, 218-219 Computer- aided design/computer- aided manufacturing (CAD-CAM)
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. trammg Crew Status and Support Tracker, 14, 168 Critical Path Roadmap project, 4, 62-69, 200,211,250 Cultural issues see also Ethnicity; International crews; Public opinion astronaut esprit as a problem, 174-175, 182-183 committee methodology, xii, 3 committee recommendations, 11, 21 ethical issues, 174-175, 182 food preparation 88 group interactions, 149, 156, 164-165, 169 language factors, 107, 140, 164-165, 169 mental health, 107, 149, 156, 158 D Databases, 9, 11, 73 behavioral issues, 139, 142, 165-166 bone mineral density, genetics, 47 emergency and continuing care, 132133, 134 pharmacokinetics and pharmacodynamics, 8, 91,113 Decisionmaking, general see also Ethical issues; Organizational factors emergency and continuing care, 117, 118, 130, 134 group, 147 individual astronauts, 4, 21, 31, 194 informatics, 9, 24, 61, 208, 212-214, 217
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. " Department of Veterans Affairs, 204, 205 Diagnostic and Statistical Manual, 159 Diarrhea, 102 Diet, see Nutrition Digestive system, see Gastrointestinal system Dual agency, 175 Dying, see Catastrophic illness and death Dysbarism, 51, 189, 261 Electrical stimulation, 128, 129 Emergency and continuing care, 25, 30, 117-136, 169 see also Pain management and anesthesia; Surgery; Trauma analog environments, 117-118, 126127, 131, 132-133, 134 databases, 132-133, 134 decompression sickness, 92 microgravity, 121-123,125,127,128, 129 NASA efforts, 126, 129-130, 134-135 organizational factors, 190, 192, 210-212 triage, 118, 134, 211-212 End of life considerations, see Catastrophic illness and death INDEX Endocrine function, 258 contraceptives, 60, 104 exogenous hormone therapy, 9 gametes, female, 57 growth hormone, neurological effects, 5 injury, responses to, 121, 123 medical events in space, 81, 101 neurohormonal, 49 reproductive, 9, 57, 58, 72 replacement therapy, 9, 58-59, 104, 113 testosterone, 57 Endotracheal intubation, 118, 119 Environmental Protection Agency, 194 Epidemiological data, 1, 9, 59, 197 see also Analog environments; Clinical research; Longitudinal studies Ergonomics, 95-96, 113 Erythropoietin, 40, 105 Ethical issues, 77, 173-187, 249 see also Confidentiality and privacy committee methodology, xii, 30 flight surgeon, 174, 175, 180-181, 215 international crews, 174, 186 NASA efforts, 174, 175, 181-187 risk assessment, 4, 30, 31, 114, 206-207 public education, 6, 31, 114, 124, 13 1, 205-207 Ethnicity, 11, 13, 88 see also Cultural issues; International crews Exercise countermeasures, 48, 127-128, 129, 142 female reproductive physiology, 58 Extravehicular activity (EVA)
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30, 48, 97-98, 129 Ground support personnel, 77, 148, 252 behavioral issues, 108-109, 140, 164, 166, 168 emergency and continuing care, 118 mission control, 108, 136, 140, 150151 space crew interactions with, 108-109, 140, 152-158, 166, 168 Group interactions, 2, 21, 28, 142, 145157, 160-161, 164-168, 170 analog environments, 145-146, 152, 156, 159-160, 162, 164, 165-167 cultural factors, 149, 156, 164-165, 169 disruptive, 14,108,154-156,168, 170 gender factors, 156, 170 leadership, 10,108,147, 148 privacy while onboard spacecraft, 138, 142, 144
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282 screening, selection, and training, 77, 146-147, 148, 149, 158-165, 169, 170 Growth, height, 26 Gynecologic health issues, 5, 103-105 contraception and contraceptives, 60, 104 menstruation effects, 5, 43, 58-59, 72, 103, 104 pelvic examinations, 88 H Habitability, see Living conditions, general Hazardous substances, 92, 93-94 anesthesia and pain management, 118, 1 19-120 clinical research, 65 countermeasures, 8, 94, 113 spacecraft maximum allowable concentrations (SMAC) , 93-94, 143 Headaches, 110, 140 Health care personnel, 131-133, 255-256 anesthesia and pain management, 118 behavioral factors, 150 emergency and continuing care, 118 flight surgeon, 174, 175, 180-181, 215 organizational requirements, 193-194 training of, 30, 34, 214-216 Health registers, 83, 141 Hearing, see Auditory perception Height, see Growth, height Hematology, 61, 105-106 anemia, 39, 105, 106, 113 bone density markers, 43, 45, 46 clinical research, 9, 62, 64, 106, 113 erythropoietin, 40, 105 surgery, 121,122, 125 High-energy particle radiation, see Radiation exposure Historical perspectives, 3, 18, 26, 38, 137, 197 see also Analog environments cardiovascular care, 97 clinical data collection, 6, 10 INDEX confidentiality, doctor-patient, 175-176 crew selection, 12 injury, responses to, 121 Mars exploration, 23 medical events, 78, 81 microgravity effects, 37 Hormonal contraceptive agents, 60, 104 Hormone replacement therapy, 9, 58-59 104, 113 Hormones, see Endocrine function Hubble Space Telescope, 202 Human Exploration of Mars: The Reference Mission of the NASA Mars Exploration Study Team, 24 Hydration, see Dehydration Hydrostatic pressure, 39 Hypercalciuria, 44 Ileus, 3 9, 123 Immune system, 39, 153, 212 cell-mediated immunity, 105, 258 clinical research, 9, 62, 64, 66, 106, 113 gender factors, 59 injury, responses to, 121, 126 medical events in space, 81, 212 surgery, 121, 126 Infections, 127 abscesses, 82, 84, 127 analog environments, 82, 84, 85, 105, 126 bowel, 111 cell-mediated immunity, 105 clinical research, 9, 62, 64, 66 medical events in Antarctica, 85, 86 medical events in space, 9, 81, 105, 111 medications, 127 preflight isolation, 105 urinary, 111 wounds, 9, 105, 106, 113, 126 Informatics, 9, 24, 61, 208, 212-214, 217 Infrastructure, see Organizational factors
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interagency coordination, 31, 73, 175, 193, 194, 195-196, 198, 199, 200, 203-208, 217 International cooperation, 198, 207, 217, 251 behavioral health problems, 138, 140 committee charge, 31 ethical issues, 174, 186, 187 risk assessment, 114 screening, selection and training, 158159 standards, general, 8, 16, 17, 107, 219 International crews, 11, 24, 25, 149 behavioralissues, 107,137,145,170, 168 ethical issues, 174, 186 International Space Station (ISS) , 2, 3, 11, 17, 34, 38, 73, 77, 188, 190, 191, 202,207,212,249,251 behavioral issues, 150, 152-153, 159 bone mineral density, microgravity, 3, 40 clinical research, 41, 73 countermeasures research, 41-42, 68 emergency and continuing care, 117, 190 ethical issues, 181-186, 186, 187 informatics, 213 injury, responses to, 121 launches from, 25 mental health screening, 108 radiation exposure, 96 rehabilitation measures, 129-130, 190 space motion sickness (SMS)
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. nutrient absorption in m1crograv1ty, 89-90 pharmacokinetics, 5, 72, 90-91, 1lo, 113 renal stones, 61, 11 1-112 Microbiology see also Immune system; Infection anesthesia and pain management, 118, 119, 120 contamination, 94-95, 113 dental care, 99 Microgravity, 3, 6, 26, 29, 37-39, 40, 138, 189, 191, 249, 261, 262 see also Bone mineral density
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, 24, 189-191 see also Organizational factors
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, 173, 183, 190, 192, 193, 195, 196, 248, 252 leadership, crews, 148 leadership, NASA organization, 20, 21, 192, 193, 194-195, 198-199 major health and medical events, 7677 mental health of crew, 106-107, 109110 neurological clinical program, 111 neurovestibular function, 53 physical training and rehabilitation, 129-130 physiological monitoring, 61-62 pulmonary system, 51 radiation exposure, 96 risk assessment, general, 3-4, 38 space medicine defined, 34 surgical procedures, 126 National Cancer Institute, 62 National Institute of Arthritis and Musculoskeletal and Skin Diseases, 203 National Institute on Aging, 203 National Institutes of Health, 194, 199, 200, 203, 204, 208 National Science Foundation, 195 National Space Biomedical Research Institute, 10,143,156-157, 193, 196,202,250 Nausea, see Space motion sickness Nephrolithiasis, 60, 111-112 Nervous system, 5, 39, 49, 110-111 see also Pain management and anesthesia; Psychomotor functions; Sleep and circadian rhythm; Space motion sickness analog environments, 53 animal models, 53 ataxia, 39 baroreceptors, 49, 50 behavioral factors, 162, 163 central nervous system, 53, 55, 65, 110, 111, 120 clinical research, 5, 10, 66, 72, 111, 113 closed-head injuries, 111 confined environments, 53 injury, responses to, 121, 123 isolation effects, 53 medical events in Antarctica, 85, 86 medical events in space, 81, 110-111, 212 microgravity, 53, 56, 67 peripheral nervous system, 55-56 space motion sickness (SMS) , 5, 39, 5152, 72, 78, 87, 91, 102, 138, 140 Neurovestibular function, 10, 53, 62, 65, 67, 77, 81, 110 Noise effects and controls, 8, 28, 93, 95 Nutrition, 11, 51, 88-90, 138, 142, 143, 251 bioregenerative systems, 89, 143, 145 bone mineral loss, 44
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, 200, 201, 208-209, 216, 218-219 ethical issues, 174-175, 182, 187 group functioning, 147, 158, 168 health care personnel, 193-194 integration, 193 -194 interagency coordination, 31, 73, 175, 193, 194, 195-196, 198, 199, 200, 203-208, 217 leadership, crew, 10 leadership, NASA, 20, 21, 194-195 neurological clinical program, 111 standards, 191, 192, 193, 195, 200 international cooperation, 8, 16, 17, 107, 219 systems development, 199-200 Orthostasis, 5, 39, 48-49, 50, 53, 59, 72, 97, 102, 110, 190 Osteoporosis, 45, 47, 64, 212 p Pain management and anesthesia, 9, 118122, 129, 134 backaches, 79 endotrachealintubation, 118, 119 287 headaches, 110, 140 medical devices, 118-119, 120 muscle loss and, 48 screening, selection and training, 118, 120 Pancreas, 103 Parathyroid hormone, 258, 259 Performance, see Behavioral health; Task performance Peripheral nervous system, 55-56 Pharmaceuticals, see Medications Pharmacodynamics, 59, 60, 65, 86, 90-91 analog environments, 91 databases, 8, 91, 113 Pharmacokinetics, 5, 72, 90-91, 110 databases, 8, 91, 113 Phenotypes, bone mineral loss, 43, 47, 72 Physiological monitoring, 39, 61-62, 68, 207 behavioral adaptation, 154, 155-156, 169 bone mineral density markers, 5, 43, 45,46 clinical research, 5, 61, 62, 63, 68, 72 Pituitary gland, 57, 58 Polar tri-idothyronine (T3) syndrome, see Tri-iodothyronine (T3)
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288 confidentiality, 182-186 end-of-life considerations, 9, 130, 134 mental health, 108 organizational requirements, 200 physical exercise, 48 Psychomotor functions, 9, 39, 55, 64, 65, 134, 138, 212 computerized assessment, 155 medications, 55 recreational activities, 128-129 Public opinion/education, 6, 31, 114, 124, 13 1, 205-207 Pulmonary system, see Respiratory system Q Quality control, 8, 208, 217 see also Clinical practice guidelines; Ethical issues; Protocols; Regulatory issues; Standards expert oversight, 8, 219 R Race/ethnicity, see Ethnicity Radiation exposure, 8, 27-28, 29, 62, 77, 92, 96, 113, 189, 249, 261 cancer and, 65, 88-89, 212 central nervous system, 65 clinical research, 28, 65 cosmic particles, 27, 96, 113 gender factors, general, 5, 59, 88-89 genetic factors, 5, 56-57, 67, 72 microgravity effects, synergies, 65 neurovestibular adaptation, 67 reproductive health, 5, 56-57, 67, 72 Real-time measurements, 5, 18, 134 bone mineral density, 46, 72 group interactions, 148 neurological effects, 52-53 surgical procedures, 123-124 Recovery systems, see Support and recovery systems Recreation and leisure activities, 14, 128129, 142, 144, 151 INDEX Regulatory issues, 1, 17, 182, 187 see also Legislation; Occupational health model; Standards Rehabilitation practices, 7, 8, 11, 28, 67, 71, 73, 127-130, 190, 250 animal models, 127 International Space Station (ISS) , 129130, 190 Renal system calculi, 39, 42, 44, 60-61, 66, 85, 111112, 212 nephrolithiasis, 60, 111-112 vascular resistance, 50 Reproductive system, 56-60, 111-112 clinical research, 5, 57, 59, 72 exercise, 58 gametes, 56, 58 genetic factors, 5, 56-57 gynecological issues hormones, 9, 57, 58, 72 replacement therapy, 9, 58-59, 104, 113 testosterone, 57 medical events in submarines, 82 microgravity, gynecological health issues, 5, 8, 43, 56, 58-59, 72, 103, 104 oocytes, 57, 58 pelvic examinations, 88 prostate gland, 112 radiation effects, 5, 56-57, 67, 72 sperm production, 56 Resources for the Optimal Care of the Injured Patient, 192 Respiratory system, 39, 51 airway management, 111, 118-119 endotrachealintubation, 118, 119 laryngeal masks, 119 medical events in Antarctica, 85, 86 medical events in space, 78, 81 medical events in submarines, 82, 84 nasal congestion, 78, 87 orthostatic hypotension, 5, 39, 48-49, 50 pulmonary function tests, 36 Reticulocytes, 105
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, 5, 39, 5152, 72, 78, 87, 91, 102, 138, 140 medications, 5, 52 Space shuttle program, 36, 77, 102, 116, 136, 190,207,248,252 behavioral issues, 140, 155 bone mineral loss, 43 dehydration, 112 sleep and circadian rhythms, 144 toxic chemical exposure, 93
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~ . Cults, see Space Suits Support and recovery systems, 14, 26, 138, 147, 149-158, 161, 164, 168-169 see also Ground support personnel intramission/postmission problems, 106, 107, 108-110, 153-154, 157-158 mentalhealth, 106,107,108-110, 153154, 157-158 mission control, 108, 136, 140, 150-151 psychomotor functions, 55 INDEX Surgery, 28, 30, 80, 102, 103, 121, 122, 123-127, 136, 215 see also Wounds analog environments, 126-127 anesthesia and pain management, 118119, 123 animal models, 121, 123 appendicitis, 29, 82, 85, 88, 102, 104, 127 cholecystectomy, 102, 103 communications technology and, 123124 ethical issues, flight surgeon, 174, 175, 180-181, 215 gynecological, 103 hematological considerations, 121, 122, 125 immune system effects, 121, 126 laproscopic, 104,124, 125 medical devices, 124-125; see also Robotics medical events in submarines, 83-86 microgravity during, 121-123, 125 musculoskeletal system, 122-123 robotic, 123-124 Systemic Multiple Level Observation of Groups, 156 Systems development bioregenerative systems, 89, 143 complex adaptive systems, 148 organizational, 199-200 triage, 118, 134, 211-212 T Task performance, 62, 64, 66, 68, 198, 249, 251 behavioral issues and, 137-172 gender factors, 60 mental health factors, 106-107 neurovestibular adaptation, 67 psychomotor functions, 9, 39, 55 sleep and circadian rhythm, 53 Telecommunications, see Communication and communications technology
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INDEX Temperature factors, 5, 129 Mars, 23 sleep and, 55 Testosterone, 57 Titov, Vladimir, 26 To Err Is Human, Building a Safer Health System, 217 Toxic chemicals, see Hazardous substances Training requirements, see Screening, selection, and training Trauma, 29,63, 65,78,79-80, 81, 121123, 127 see also Surgery anesthesia and pain management, 118119, 123 animal models, 121 cardiovascular response, 121-122 clinical research, 63, 65 closed-head and spinal cord injuries, 111 emergency and continuing care, 118 fractures, 42, 45, 46, 72, 79 immune system, 121, 126 medical events in Antarctica, 85, 86 medical events in submarines, 82, 84, 85 microgravity, response effects, 121, 122 multiple casualties, 118, 134 nutrition, recovery from, 123 organizational factors, 192 wounds Triage, 118, 134, 211-212 Tri-iodothyronine (T3) , 101 291 U Urinary system, 60-61 see also Renal system bone mineral density markers, 5, 43, 45,46,60 clinical research, 5 countermeasures, 60-61, 112 infections, 111 medical events in space, 81, 111-112 medical events in submarines, 82 microgravity, 39, 42, 44, 50, 60-61 urinalysis, other than density markers, 61 V Vestibular function, see Neurovestibular function Visual perception, 53 Vomiting, see Space motion sickness W Weight, see Body mass Weightlessness, see Microgravity Windows Space Flight Cognitive Assessment, 14,155, 168 Women, see Gender factors Wounds, 42, 84, 105, 113, 122-123 see also Surgery analog environments, 126, 127 animal models, 121, 123 clinical research, 9, 106 infections, 9, 105, 106, 113, 126 Wyle Laboratories, 195-196
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