Crew Autonomy During Simulated Medical Event Management on Long Duration Space Exploration Missions.

OBJECTIVE: Our primary aim was to investigate crew performance during medical emergencies with and without ground-support from a flight surgeon located at mission control. BACKGROUND: There are gaps in knowledge regarding the potential for unanticipated in-flight medical events to affect crew health and capacity, and potentially compromise mission success. Additionally, ground support may be impaired or periodically absent during long duration missions. METHOD: We reviewed video recordings of 16 three-person flight crews each managing four unique medical events in a fully immersive spacecraft simulator. Crews were randomized to two conditions: with and without telemedical flight surgeon (FS) support. We assessed differences in technical performance, behavioral skills, and cognitive load between groups. RESULTS: Crews with FS support performed better clinically, were rated higher on technical skills, and completed more clinical tasks from the medical checklists than crews without FS support. Crews with FS support also had better behavioral/non-technical skills (information exchange) and reported significantly lower cognitive demand during the medical event scenarios on the NASA-TLX scale, particularly in mental demand and temporal demand. There was no significant difference between groups in time to treat or in objective measures of cognitive demand derived from heart rate variability and electroencephalography. CONCLUSION: Medical checklists are necessary but not sufficient to support high levels of autonomous crew performance in the absence of real-time flight surgeon support. APPLICATION: Potential applications of this research include developing ground-based and in-flight training countermeasures; informing policy regarding autonomous spaceflight, and design of autonomous clinical decision support systems.

Space missions: psychological and psychopathological issues.

Exploring space is one of the most attractive goals that humanity ever set, notwithstanding, there are some psychological and psychopathological risks that should be considered. Several studies identified some possible hazards of space travels and related physical and psychological consequences on astronauts. If some psychological reactions are obviously inherent to the characteristics of the spaceships (habitability, confinement, psychological, and interpersonal relationships), other (disturbances of sleep-wake cycle, personality changes, depression, anxiety, apathy, psychosomatic symptoms, neurovestibular problems, alterations in cognitive function, and sensory perception) represent a clear warning of possible central nervous system (CNS) alterations, possibly due to microgravity and cosmic radiation. Such conditions and eventual CNS changes might compromise the success of missions and the ability to cope with unexpected events and may lead to individual and long-term impairments. Therefore, further studies are needed, perhaps, requiring the birth of a novel branch of psychology/psychiatry that should not only consider the risks related to space exploration, but the implementation of targeted strategies to prevent them.

Medical Event Management for Future Deep Space Exploration Missions to Mars.

BACKGROUND: Long-duration exploration missions (LDEMs), such as voyages to Mars, will present unique medical challenges for astronaut crews, including communication delays and the inability to return to Earth early. Medical events threaten crewmember lives and increase the risk of mission failure. Managing a range of potential medical events will require excellent technical and nontechnical skills (NTSs). We sought to identify medical events with potential for rescue, range them according to the potential impact on crew health and mission success during LDEMs, and develop a list of NTSs to train for management of in-flight medical events. MATERIALS AND METHODS: Twenty-eight subject matter experts with specializations in surgery, medicine, trauma, spaceflight operations, NTS training, simulation, human factors, and organizational psychology completed online surveys followed by a 2-d in-person workshop. They identified and rated medical events for survivability, mission impact, and impact of crewmember NTSs on outcomes in space. RESULTS: Sudden cardiac arrest, smoke inhalation, toxic exposure, seizure, and penetrating eye injury emerged as events with the highest potential mission impact, greatest potential for survival, and that required excellent NTS for successful management. Key NTS identified to target in training included information exchange, supporting behavior, communication delivery, and team leadership/followership. CONCLUSIONS: With a planned Mars mission on the horizon, training countermeasures need to be developed in the next 3-5 y. These results may inform policy, selection, medical system design, and training scenarios for astronauts to manage in-flight medical events on LDEMs. Findings may extend to surgical and medical care in any rural and remote location.

Factors affecting flavor perception in space: Does the spacecraft environment influence food intake by astronauts?

The intention to send a crewed mission to Mars involves a huge amount of planning to ensure a safe and successful mission. Providing adequate amounts of food for the crew is a major task, but 20 years of feeding astronauts on the International Space Station (ISS) have resulted in a good knowledge base. A crucial observation from the ISS is that astronauts typically consume only 80% of their daily calorie requirements when in space. This is despite daily exercise regimes that keep energy usage at very similar levels to those found on Earth. This calorie deficit seems to have little effect on astronauts who spend up to 12 months on the ISS, but given that a mission to Mars would take 30 to 36 months to complete, there is concern that a calorie deficit over this period may lead to adverse effects in crew members. The key question is why astronauts undereat when they have a supply of food designed to fully deliver their nutritional needs. This review focuses on evidence from astronauts that foods taste different in space, compared to on Earth. The underlying hypothesis is that conditions in space may change the perceived flavor of the food, and this flavor change may, in turn, lead to underconsumption by astronauts. The key areas investigated in this review for their potential impact on food intake are the effects of food shelf life, physiological changes, noise, air and water quality on the perception of food flavor, as well as the link between food flavor and food intake.

NEUROPHYSIOLOGICAL STATE OF HUMANS IN LONG-DURATION ISOLATION.

During the 520-d imitation of isolation and confinementin a long-duration exploration mission, the neuroufunctional state of 6 crewmembers was studied by synchronous registration of cerebral electrical (EEG) and energy (permanent potential level (PPL)) activities of the brain. Two baseline investigations predicted high adaptability of all crew members and low probability of depletion of the adaptation reserve in the experiment. During isolation, dynamics of neurofunctional correlates of the cerebral activity was generally proportionate to the factors the crewmembers were affected by. Events epochal to the crew gave rise to physiological reactions both of the metabolic and electrical activity of the brain. On week 54, crew physiological adaptation to the experimental environment was manifested by decreases in PPL without interhemispheric asymmetry and absolute a-power. All through the experiment none of the crew members showed signs of a distinct stress-reaction (a-activity asymmetry with a significant PPL decrease) supporting our prediction of low probability of adaptation reserve depletion in participants in the 520-day isolation and confinement study.

Effects of 72hours total sleep deprivation on male astronauts' executive functions and emotion.

BACKGROUND: To provide evidence for better understanding stressful situations, the present study was designed to investigate the specific physiological and psychological responses under stressful situations like social isolation and sleep deprivation. METHODS: Twelve healthy male adults (age: 18-30years old) who participated in our study were randomized to the 72hours of social isolation and 72hours of sleep deprivation experimental conditions. Performances (event-related potentials and physiological activities) on the Go/Nogo task which reflected the executive functions were accessed at baseline (pretest) and after 72-hour of the experiment (posttest). RESULTS: The results showed that compared to the social isolation, the participants got strengthened heart rate (HR), weakened HR variability and smaller amplitude of the P300 under the sleep deprivation condition; moreover, they had lower positive emotion and higher negative mood in the posttest. CONCLUSIONS: The present study indicated that sleep deprivation specifically influenced the intensity of task-relevant information processing, mood and vagal tone.

Perception of affordances during long-term exposure to weightlessness in the International Space station.

On Earth, visual eye height (VEH)--the distance from the observer's line of gaze to the ground in the visual scene--constitutes an effective cue in perceiving affordance such as the passability through apertures, based on the assumption that one's feet are on the ground. In the present study, we questioned whether an observer continues to use VEH to estimate the width of apertures during long-term exposure to weightlessness, where contact with the floor is not required. Ten astronauts were tested in preflight, inflight in the International Space Station, and postflight sessions. They were asked to adjust the opening of a virtual doorway displayed on a laptop device until it was perceived to be just wide enough to pass through (i.e., the critical aperture). We manipulated VEH by raising and lowering the level of the floor in the visual scene. We observed an effect of VEH manipulation on the critical aperture. When VEH decreased, the critical aperture decreased too, suggesting that widths relative to the body were perceived to be larger when VEH was smaller. There was no overall significant session effect, but the analysis of between-subjects variability revealed two participant profile groups. The effect of weightlessness was different for these two groups even though the VEH strategy remained operational during spaceflight. This study shows that the VEH strategy appears to be very robust and can be used, if necessary, in inappropriate circumstances such as free-floating, perhaps promoted by the nature of the visual scene.

Human cognitive performance in spaceflight and analogue environments.

Maintaining intact cognitive performance is a high priority for space exploration. This review seeks to summarize the cumulative results of existing studies of cognitive performance in spaceflight and analogue environments. We focused on long-duration (>21 d) studies for which no review has previously been conducted. There were 11 published studies identified for long-duration spaceflight (N = 42 subjects) as well as 21 shorter spaceflight studies (N = 70 subjects). Overall, spaceflight cognitive studies ranged from 6-438 d in duration. Some 55 spaceflight analogue studies were also identified, ranging from 6 to 520 d. The diverse nature of experimental procedures and protocols precluded formal meta-analysis. In general, the available evidence fails to strongly support or refute the existence of specific cognitive deficits in low Earth orbit during long-duration spaceflight, which may be due in large part to small numbers of subjects. The studies consistently suggest that novel environments (spaceflight or other) induce variable alterations in cognitive performance across individuals, consistent with known astronaut experiences. This highlights the need to better quantify the magnitude and scope of this interindividual variability, and understand its underlying factors, when predicting in-flight cognitive functioning for extended periods.

Subject anxiety and psychological considerations for centrifuge-simulated suborbital spaceflight.

INTRODUCTION: Anxiety and psychological concerns may pose a challenge to future commercial spaceflight. To help identify potential measures of anxiousness and indicators of flight-related stress, the psychiatric histories and anxiousness responses of volunteers exposed to G forces in centrifuge-simulated spaceflight acceleration profiles were examined. METHODS: Over 2 d, 86 individuals (63 men, 23 women), 20-78 yr old, underwent up to 7 centrifuge runs. Day 1 consisted of two +G(z) runs (peak = +3.5 G(z)) and two +Gx runs (peak = +6.0 G(x)). Day 2 consisted of three runs approximating suborbital spaceflight profiles (combined +G(x) and +G(z)). Hemodynamic data were collected during the profiles. Subjects completed a retrospective self-report anxiety questionnaire. Medical monitors identified individuals exhibiting varying degrees of anxiousness during centrifuge exposure, medical histories of psychiatric disease, and other potential indicators of psychological intolerance of spaceflight. RESULTS: The retrospective survey identified 18 individuals self-reporting anxiousness, commonly related to unfamiliarity with centrifuge acceleration and concerns regarding medical history. There were 12 individuals (5 men, 7 women, average age 46.2 yr) who were observed to have anxiety that interfered with their ability to complete training; of these, 4 reported anxiousness on their questionnaire and 9 ultimately completed the centrifuge profiles. Psychiatric history was not significantly associated with anxious symptoms. DISCUSSION: Anxiety is likely to be a relevant and potentially disabling problem for commercial spaceflight participants; however, positive psychiatric history and self-reported symptoms did not predict anxiety during centrifuge performance. Symptoms of anxiousness can often be ameliorated through training and coaching. Even highly anxious individuals are likely capable of tolerating commercial spaceflight.

[Ecopsychological investigations in 520-day isolation].

Assessment of the importance of higher plants for emotions and relations within the group of test-subjects was performed in the long-duration chamber experiment MARS-500 designed as an imitation of an exploration mission. It was shown that the degree of involvement with the plants dictated the magnitude and character of the ecopsychological effect. Subjects with high psychological stability and dominating introversion were more inclined to interact with plants. Remoteness of the greenhouse from recreation areas weakened the ecopsychological effect and denied the crew the opportunity to interact with plants. At the same time, the presence of the plant growth unit with decorative plants in the lounge had certainly a positive psychological effect. The crew gave preference to big bright flowers that did not demand much care. This observation should be taken into consideration by designers of psychological recreation environments. Choice of plants to be grown as a dietary supplement for the crew in isolation and confinement should be made with allowance for cultural preferences of crew members.

Observing the earth from space: Does a virtual reality overview effect experience increase pro-environmental behaviour?

Astronauts (and recently businessmen) often express a renewed sense of responsibility for taking care of the environment, after observing the overwhelming beauty of Earth from space. Despite recent attention for this "overview effect", it is unclear whether experiencing the effect directly impacts pro-environmental behaviour. Using a virtual reality experience, the current research tests in two experimental studies the direct impact of an immersive overview effect experience on both short-term and longer term subsequent pro-environmental behaviours (donating to an environmental NGO, consuming less diary and meat). Furthermore, it investigates whether the technological immersiveness of the VR experience amplifies the effect, and the mediating role of connectedness to nature. Results show no effects of the short (7 minutes) overview effect VR video on pro-environmental behaviour (Study 1). For the longer video (15 minutes, Study 2), the results showed that the most immersive experience (video featuring meditative music and voice-over) appeared to increase connection with nature and higher donation amounts to an eco-NGO, but not significantly. No effects were found for subsequent meat and dairy consumption behaviours (measured on day 2, 4, and 6). These findings contribute to a deeper understanding of the specific features determining the effectiveness of the overview effect experiences on actual pro-environmental behaviour, providing important insights to businesses and educational institutions.

Sleep-Monitoring Technology Progress and Its Application in Space.

INTRODUCTION: Sleep is an indispensable physiological phenomenon. The complexity of sleep and the time it occupies in human life determine that its quality is positively correlated with human health. Since polysomnography was used in spaceflight in 1967, the sleep problem during astronaut flight has been studied in depth for more than 50 yr, and many solutions have been proposed, but astronauts have always had sleep problems during orbital flight. Insufficient sleep and changes in the rhythm of human sleep-wake activity will lead to disturbance of the human body's internal rhythm indicators, which will lead to psychological and emotional fluctuations and reduced cognitive ability, decision-making ability, teamwork, and work performance. NASA has identified operational errors due to sleep deprivation and altered circadian rhythms as an important risk factor in the key biomedical roadmap for long-term flight, so the importance of sleep monitoring in spaceflight is self-evident. On-orbit sleep-monitoring methods include both subjective and objective aspects. We review objective sleep-monitoring technology based on its application, main monitoring physiological indicators, intrusive advantages, and limitations. This paper reviews the subjective and objective sleep evaluation methods for on-orbit applications, summarizes the progress, advantages, and disadvantages of current ground sleep-monitoring technologies and equipment, and looks forward to the application prospects of new sleep-monitoring technologies in spaceflight.Zhang C, Chen Y, Fan Z, Xin B, Wu B, Lv K. Sleep-monitoring technology progress and its application in space. Aerosp Med Hum Perform. 2024; 95(1):37-44.

Study protocol to examine the effects of spaceflight and a spaceflight analog on neurocognitive performance: extent, longevity, and neural bases.

BACKGROUND: Long duration spaceflight (i.e., 22 days or longer) has been associated with changes in sensorimotor systems, resulting in difficulties that astronauts experience with posture control, locomotion, and manual control. The microgravity environment is an important causal factor for spaceflight induced sensorimotor changes. Whether spaceflight also affects other central nervous system functions such as cognition is yet largely unknown, but of importance in consideration of the health and performance of crewmembers both in- and post-flight. We are therefore conducting a controlled prospective longitudinal study to investigate the effects of spaceflight on the extent, longevity and neural bases of sensorimotor and cognitive performance changes. Here we present the protocol of our study. METHODS/DESIGN: This study includes three groups (astronauts, bed rest subjects, ground-based control subjects) for which each the design is single group with repeated measures. The effects of spaceflight on the brain will be investigated in astronauts who will be assessed at two time points pre-, at three time points during-, and at four time points following a spaceflight mission of six months. To parse out the effect of microgravity from the overall effects of spaceflight, we investigate the effects of seventy days head-down tilted bed rest. Bed rest subjects will be assessed at two time points before-, two time points during-, and three time points post-bed rest. A third group of ground based controls will be measured at four time points to assess reliability of our measures over time. For all participants and at all time points, except in flight, measures of neurocognitive performance, fine motor control, gait, balance, structural MRI (T1, DTI), task fMRI, and functional connectivity MRI will be obtained. In flight, astronauts will complete some of the tasks that they complete pre- and post flight, including tasks measuring spatial working memory, sensorimotor adaptation, and fine motor performance. Potential changes over time and associations between cognition, motor-behavior, and brain structure and function will be analyzed. DISCUSSION: This study explores how spaceflight induced brain changes impact functional performance. This understanding could aid in the design of targeted countermeasures to mitigate the negative effects of long-duration spaceflight.

Weightlessness alters up/down asymmetries in the perception of self-motion.

In the present study, we investigated the effect of weightlessness on the ability to perceive and remember self-motion when passing through virtual 3D tunnels that curve in different direction (up, down, left, right). We asked cosmonaut subjects to perform the experiment before, during and after long-duration space flight aboard the International Space Station (ISS), and we manipulated vestibular versus haptic cues by having subjects perform the task either in a rigidly fixed posture with respect to the space station or during free-floating, in weightlessness. Subjects were driven passively at constant speed through the virtual 3D tunnels containing a single turn in the middle of a linear segment, either in pitch or in yaw, in increments of 12.5°. After exiting each tunnel, subjects were asked to report their perception of the turn's angular magnitude by adjusting, with a trackball, the angular bend in a rod symbolizing the outside view of the tunnel. We demonstrate that the strong asymmetry between downward and upward pitch turns observed on Earth showed an immediate and significant reduction when free-floating in weightlessness and a delayed reduction when the cosmonauts were firmly in contact with the floor of the station. These effects of weightlessness on the early processing stages (vestibular and optokinetics) that underlie the perception of self-motion did not stem from a change in alertness or any other uncontrolled factor in the ISS, as evidenced by the fact that weightlessness had no effect on the perception of yaw turns. That the effects on the perception of pitch may be partially overcome by haptic cues reflects the fusion of multisensory cues and top-down influences on visual perception.

An isolation and confinement facility for the selection of astronaut candidates.

BACKGROUND: In 2008, JAXA conducted its fifth astronaut candidate recruitment. The final stage involved 10 of 963 applicants undergoing the first and second examination stages based on physical checks, written tests, and interviews. The third (final) stage focused on evaluating the behavioral attitudes required for ISS crewmembers. Since it is difficult to assess these attitudes by paper testing or interview alone, JAXA has established an environment in which the assessors could observe the behavior of examinees on a continuous basis. METHODS: The 10 examinees stayed in the isolation and confinement facility for 1 wk. During their stay, several group and personal tasks were assigned along with predetermined daily schedules covering aspects of leadership, teamwork ability, productivity (performance), and so on. Subsequently, psychologists, psychiatrists, and JAXA officials/managers experienced in practical human space development evaluated them. RESULTS: During the confinement, no examinees showed any excessive character traits or psychopathologic behavior. Repeated observations led to a convergence of opinions among the experts. Three examinees ultimately passed this assessment and were assigned as new Japanese astronaut candidates. DISCUSSION: This unique assessment enabled the assessors to conduct longitudinal evaluations, evaluations based on observing detailed behavior, and easy control of test conditions and safety. Although "selection of the right stuff" may differ among each space agency, this method offers the unique advantage of allowing experts in various fields to evaluate the competencies of examinees both synthetically and longitudinally.

[Association between the person-unique individual behavior styles and the quality and reliability of operator's professional performance].

Among the prioritized objectives of maintaining psychophysiological safety in extended space missions is the buildup of crew professional reliability. Reliability of operator's performance hinges as on skills level, so personal working style. The purpose of the investigation was to penetrate into the patterns of association between a person-unique individual behavior style and quality and reliability of simulated professional operator's jobs. The investigation was part of the MARS-500 experiment (RF SSC - IBMP RAS, 2010-2011) and employed 2 procedures: the well-established manual vehicle control (Pilot-1) and a new one tasking with planetary surface exploration (VIRTU). Observation of individual work styles resulted in identification of 2 fundamentally different approaches to handling the operator's duties--reliable and innovative. It is noteworthy that a separate participant adhered to one and the same style when coping with either procedure. Also, personality traits predisposing to a concrete behavior were found, which confirms the hypothesis of deep personal nature of operator's work style that reveals itself consistently and isomorphically no matter the type of important job.