Performance Risks During Surface Extravehicular Activity and Potential Mitigation Using Multimodal Displays.

BACKGROUND: Surface extravehicular activity (sEVA) will be a critical component of future human missions to the Moon. sEVA presents novel risks to astronaut crews not associated with microgravity operations due to fundamental differences in task demands, physiology, environment, and operations of working on the lunar surface. Multimodal spacesuit informatics displays have been proposed as a method of mitigating sEVA risk by increasing operator autonomy.METHODS: A formalized literature review was conducted. In total, 95 journal articles, conference papers, and technical reports were included. Characteristics of U.S. spacesuits were reviewed, ranging from the Apollo A7L to the xEMU Z-2.5. Multimodal display applications were then reviewed and assessed for their potential in aiding sEVA operations.RESULTS: Through literature review 25 performance impairments were identified. Performance impairments caused by the spacesuit represented the greatest number of sEVA challenges. Multimodal displays were mapped to impairments and approximately 36% of performance impairments could be aided by using display interfaces.DISCUSSION: Multimodal displays may provide additional benefits for alleviating performance impairments during sEVA. Utility of multimodal displays may be greater in certain performance impairment domains, such as spacesuit-related impairments.Zhang JY, Anderson AP. Performance risks during surface extravehicular activity and potential mitigation using multimodal displays. Aerosp Med Hum Perform. 2023; 94(1):34-41.

Modeling Occupational Fingernail Onycholysis Disorders in the Population of US Astronauts Who Have Engaged in Extravehicular Activity.

OBJECTIVES: Spacesuits are designed to be reliable personal spacecraft that preserve the life and well-being of the astronaut from the extremes of space. However, materials, operating pressures, and suit design requirements often result in a risk of musculoskeletal discomfort and injury to various areas of the body. In particular, this investigation looked at fingernails and their risk of developing onycholysis. METHODS: An onycholysis literature review was followed by a retrospective analysis of injury characteristics, astronaut suited training and spaceflight events, hand anthropometry, glove sizing, and astronaut demographics. Multiple logistic regression was used to assess the likelihood of onycholysis occurrence by testing potential risk variables against the dataset compiled from the retrospective data mining. RESULTS: The duration of event exposure, type of glove used, distance (delta) between the fingertip and the tip of the glove, sex, and age were found to be significantly related to occurrence of onycholysis (whether protective or injurious). CONCLUSION: An initial risk formula (model) for onycholysis was developed as a result of this investigation. In addition to validation through a future study, further improvement to this onycholysis equation and spacesuit discomfort and injury in general can be aided by future investigations that lead to better definition of the threshold between safe and risky exposure for each type of risk factor. APPLICATION: This work described a potential method that can be used for EVA spacesuit glove onycholysis injury risk analysis for either iterative glove design or between glove comparisons, such as during a product downselect process.

Exercise-Related Effects on Executive Functions During a Simulated Underwater Extravehicular Activity.

OBJECTIVE: Investigation of cognitive performance during extravehicular activities (EVAs) in a space-analog setting. BACKGROUND: EVAs performed by humans in microgravity on the International Space Station (ISS) call for high cognitive performance during upper-body workload. Higher cardiovascular demands interact with cognitive performance, but no knowledge exists about EVA's special requirements. This study simulates EVA-training underwater to investigate its effects on the executive functions inhibition and switching. METHOD: In a counterbalanced crossover design, 16 divers (age: 28 ± 2.4 years; eight females) performed two conditions (i.e., EVA vs. Inactivity [INACT]) in 3-5 m submersion (diving gear; not in a space-suit). EVA included 30 min of moderate-, followed by 30 min of high-intensity upper-body exercise intervals, paired with EVA-specific cognitive-motor tasks. INACT included no exercise in submersion and neutral buoyancy. Both conditions included cognitive testing at pre, mid (after the first 30 min), and post (after the second 30 min) on a tablet computer. Reaction times (RTs) and response accuracy (ACC) were calculated for both tasks. RESULTS: ACC was significantly lower during EVA compared with INACT for inhibition (post: p = .009) and switching (mid: p = .019) at post (p = .005). RTs for inhibition were significantly faster during EVA (p = .022; ηp2 = 0.320). CONCLUSION: Specific physical exercise, intensity, duration, and tasks performed during the EVA might differently affect the exercise-cognition interaction and need further investigation, especially for future long-term space travel. APPLICATION: Future research might serve to improve mission success and safety for EVAs and long-term space travel.

Evaluating Lumbar Shape Deformation With Fabric Strain Sensors.

OBJECTIVE: To better study human motion inside the space suit and suit-related contact, a multifactor statistical model was developed to predict torso body shape changes and lumbar motion during suited movement by using fabric strain sensors that are placed on the body. BACKGROUND: Physical interactions within pressurized space suits can pose an injury risk for astronauts during extravehicular activity (EVA). In particular, poor suit fit can result in an injury due to reduced performance capabilities and excessive body contact within the suit during movement. A wearable solution is needed to measure body motion inside the space suit. METHODS: An array of flexible strain sensors was attached to the body of 12 male study participants. The participants performed specific static lumbar postures while 3D body scans and sensor measurements were collected. A model was created to predict the body shape as a function of sensor signal and the accuracy was evaluated using holdout cross-validation. RESULTS: Predictions from the torso shape model had an average root mean square error (RMSE) of 2.02 cm. Subtle soft tissue deformations such as skin folding and bulges were accurately replicated in the shape prediction. Differences in posture type did not affect the prediction error. CONCLUSION: This method provides a useful tool for suited testing and the information gained will drive the development of injury countermeasures and improve suit fit assessments. APPLICATION: In addition to space suit design applications, this technique can provide a lightweight and wearable system to perform ergonomic evaluations in field assessments.

Modular Robotic Limbs for Astronaut Activities Assistance.

In order to meet the assist requirements of extravehicular activity (EVA) for astronauts, such as moving outside the international space station (ISS) or performing on-orbit tasks by a single astronaut, this paper proposes an astronaut robotic limbs system (AstroLimbs) for extravehicular activities assistance. This system has two robotic limbs that can be fixed on the backpack of the astronaut. Each limb is composed of several basic module units with identical structure and function, which makes it modularized and reconfigurable. The robotic limbs can work as extra arms of the astronaut to assist them outside the space station cabin. In this paper, the robotic limbs are designed and developed. The reinforcement learning method is introduced to achieve autonomous motion planning capacity for the robot, which makes the robot intelligent enough to assist the astronaut in unstructured environment. In the meantime, the movement of the robot is also planned to make it move smoothly. The structure scene of the ISS for extravehicular activities is modeled in a simulation environment, which verified the effectiveness of the proposed method.

Electrical Shock Hazard Severity Estimation During Extravehicular Activity for the International Space Station.

INTRODUCTION: Research has shown that astronauts performing extravehicular activities may be exposed, under certain conditions, to undesired electrical hazards. This study used computer models to determine whether these undesired induced electrical currents could be responsible for involuntary neuromuscular activity caused by either large diameter peripheral nerve activation or reflex activity from cutaneous afferent stimulation.METHODS: A multiresolution variant of the admittance method along with a magnetic resonance image millimeter resolution model of a male human body were used to calculate the following: 1) induced electric fields; 2) resistance between contact areas in a Extravehicular Mobility Unit spacesuit; 3) currents induced in the human body; 4) the physiological effects of these electrical exposures; and 5) the risk to the crew during extravehicular activities.RESULTS: Using typical EMU shock exposure conditions, with a 15V source, the current density magnitudes and total current injected are well above previously reported startle reaction thresholds. This indicates that, under the considered conditions during a spacewalk in the charged ionospheric plasma of space, astronauts could experience possibly harmful involuntary motor response and sensory pain nerve activation.Hamilton DR. Electrical shock hazard severity estimation during extravehicular activity for the International Space Station. Aerosp Med Hum Perform. 2021; 92(4):231239.

Tuberosity Healing after Reverse Shoulder Arthroplasty for Proximal Humerus Fractures: Is there Clinical Improvement? / Consolidação dos tubérculos na artroplastia reversa do ombro após fratura proximal do úmero: Existe melhoria nos resultados funcionais?

Abstract Objective To compare the functional results of patients with complex proximal humerus fracture submitted to total shoulder reverse arthroplasty with and without tuberosity healing. The secondary goal was to know the tuberosity healing rate after reverse shoulder arthroplasty with our surgical technique. Methods A retrospective, cohort type study, with a prospective database collection. In total, 28 patients fulfilled the inclusion criteria: age ≥ 65 years, reverse shoulder arthroplasty for complex proximal humerus fracture (type-3 or -4, according to Neer), and a minimum of 24 months of follow-up. At six months of follow-up, all of the patients were evaluated radiographically for tuberosity, and then they were divided into 2 groups: those with healed tuberosities and those with non-healed tuberosities. A clinical evaluation using the Constant score, active range of motion and the Visual Analog Scale (VAS) at the last follow-up was also performed. Results Tuberosity healing occurred in 21 patients (76.3%). There were statistically significant differences in the Constant scoring system (p < 0.001), forward elevation (p = 0.020), internal rotation (p = 0.001) and external rotation (p = 0.003) when comparing the group of healed tuberosities with the group of non-healed tuberosities. No differences were found regarding the VAS score. Conclusion Tuberosity healing results in an improvement of the functional outcomes of patients submitted to reverse shoulder arthroplasty as a treatment for complex proximal humeral fractures in the elderly.

Resumo Objetivo Comparar os resultados funcionais entre pacientes com fratura complexa do úmero proximal submetidos a artroplastia reversa com tubérculos consolidados e tubérculos não consolidados. O objetivo secundário foi determinar a taxa de consolidação dos tubérculos com este tipo de prótese. Métodos Estudo de tipo coorte, retrospectivo, com coleta prospectiva de dados. No total, 28 pacientes cumpriram os critérios de inclusão: idade superior a 65 anos, prótese reversa do ombro por fratura complexa do úmero proximal (3 ou 4 partes, segundo Neer), e tempo de seguimento mínimo de 24 meses. Aos seis meses, todos os pacientes foram avaliados radiograficamente quanto à consolidação dos tubérculos e divididos em dois grupos: grupo com tubérculos consolidados e grupo com tubérculos não consolidados. A avaliação funcional realizou-se segundo o sistema de pontuação de Constant, da amplitude de movimento ativo, e da Escala Visual Analógica (EVA) à data da última consulta. Registaram-se todas as complicações. Resultados A consolidação dos tubérculos ocorreu em 21 pacientes (76,3%). Verificou-se diferenças estatisticamente significativas no sistema de pontuação de Constant (p < 0.001), elevação anterior (p = 0.020), rotação interna (p = 0.001) e externa (p = 0.003), quando se comparou o grupo dos tubérculos consolidados com o grupo dos tubérculos não consolidados. Não houve diferenças significativas na EVA entre os 2 grupos. Conclusão A consolidação dos tubérculos traduz uma melhoria dos resultados funcionais em pacientes submetidos a artroplastia reversa do ombro como tratamento de fraturas complexas do úmero proximal em idosos.

Percutaneous Fixation without Bone Graft for Scaphoid Nonunion / Fixação percutânea sem enxerto ósseo para pseudartrose do escafóide

Abstract Objective To describe the clinical and radiographic outcomes of patients submitted to percutaneous fixation without bone graft for scaphoid nonunion, with a minimum follow-up of six months. Methods A case series study of a convenience sample of hand surgeons with prospective evaluation. Patients with scaphoid (waist or proximal pole) nonunion and the following features were included: more than six months of history; X-rays showing sclerosis of the edges of the nonunion, with resorption of the nonunion focus measuring less than 4 mm (Slade & Gleissler I, II, III and IV) and no angular deformity; and no proximal pole necrosis on magnetic resonance imaging (MRI). Results After six months of follow-up, all nonunion were consolidated, with no major complications. The functional outcomes revealed good scores on the disabilities of the arm, shoulder and hand (DASH; n = 12; mean: 6.9; standard deviation [SD]: 2.1) and patient-rated wrist evaluation (PRWE; n = 12; mean: 7.97, SD: 1.5) questionnaires. The results of the visual analog scale (VAS) showed little residual pain (n = 12; mean: 0.71; SD: 0.2). Slight decreases in flexion (69 versus 59.1; p = 0.007), extension (62.4 versus 48.7; p = 0.001) and radial deviation (29.6 versus 24.6; p = 0.014) were detected in comparison to the contralateral side. Conclusions All cases in the series presented consolidation and good functional scores at the six-month evaluation. This is a promising option (with lower technical demand and morbidity) for the treatment of scaphoid nonunion. Comparative studies are required to assess the effectiveness of this technique in comparison with other options.

Resumo Objetivo Descrever os resultados clínico-radiográficos de pacientes tratados por meio de fixação percutânea sem enxerto ósseo para pseudartrose do escafóide, com seguimento mínimo de seis meses. Métodos Série de casos de uma amostra de conveniência de grupo de cirurgiões de mão com avaliação prospectiva.. Foram incluídos pacientes com diagnóstico de pseudartrose do escafóide (cintura ou polo proximal) com as seguintes características: mais de seis meses de histórico; radiografias demonstrando esclerose das bordas da pseudartrose, com reabsorção do foco de pseudartrose menor do que 4 mm (Slade & Gleissler I, II, III e IV), sem deformidade angular; e sem necrose do polo proximal pela ressonância magnética (RM). Resultados Na avaliação com mais de seis meses, todas as pseudartroses estavam consolidadas e sem maiores complicações. Os resultados funcionais demonstraram boas pontuações nos questionários de disfunções do braço, ombro e mão (disabilities of the arm, shoulder and hand, DASH; n = 12; média: 6,9; desvio padrão [DP]: 2,1) e de avaliação do punho pelo paciente (patient-rated wrist evaluation, PRWE; n = 12; média: 7,97; DP: 1,5). Observou-se pouca dor residual de acordo com a escala visual analógica (EVA; n = 12; média: 0,71; DP: 0,2). Houve discreta diminuição da flexão (69 versus 59,1; p = 0,007), da extensão (62,4 versus 48,7; p = 0,001) e do desvio radial (29,6 versus 24.6; p = 0,014) em comparação ao lado contralateral. Conclusões Nesta série, todos os casos estavam consolidados ao sexto mês de avaliação, com bom status funcional. Trata-se de uma opção promissora (menor demanda técnica e morbidade) para o tratamento da pseudartrose do escafóide. Estudos comparativos serão úteis para avaliar a efetividade da técnica com relação a outras opções.

The Partial Pressure of Inspired Carbon Dioxide Exposure Levels in the Extravehicular Mobility Unit.

BACKGROUND: NASA has been making efforts to assess the carbon dioxide (CO2) washout capability of spacesuits using a standard CO2 sampling protocol. This study established the methodology for determining the partial pressure of inspired CO2 (PIco2) in a pressurized spacesuit. We applied the methodology to characterize PIco2 for the extravehicular mobility unit (EMU).METHODS: We suggested an automated and mathematical algorithm to find the end-tidal CO2 and the end of inspiration. We provided objective and standardized guidelines to identify acceptable breath traces, which are essential to accurate and reproducible calculation of the in-suit inhaled and exhaled partial pressure of CO2 (Pco2). The mouth guard-based method for measurement of inhaled and exhaled dry-gas Pco2 was described. We calculated all individual concentrations of PIco2 inhaled by 19 healthy subjects classified into 3 fitness groups. The transcutaneous Pco2 was monitored as a secondary measure to validate washout performance.RESULTS: Mean and standard deviation values for the data collection performance and the CO2 metrics were presented (e.g., minimum time weighted average Pco2 at suited workloads of resting, 1000, 2000, and 3000 (BTU h1) were 4.75 1.03, 8.09 1.39, 11.39 1.26, and 14.36 1.29 (mmHg s1). All CO2 metrics had a statistically significant association and all positive slopes with increasing metabolic rate. No significant differences in CO2 metrics were found between the three fitness groups.DISCUSSION: A standardized and automated methodology to calculate PIco2 exposure level is presented and applied to characterize CO2 washout in the EMU. The EMU has been operated successfully in over 400 extravehicular activities (EVAs) and is considered to provide acceptable CO2 washout performance. Results provide a basis for establishing verifiable Pco2 requirements for current and future EVA spacesuits.Kim KJ, Bekdash OS, Norcross JR, Conkin J, Garbino A, Fricker J, Young M, Abercromby AFJ. The partial pressure of inspired carbon dioxide exposure levels in the extravehicular mobility unit. Aerosp Med Hum Perform. 2020; 91(12):923931.

[Delegation modalities for general practitioners in North Rhine-Westphalia: Results of a survey among general practitioners on the assignment of defined tasks to EVA, VERAH and VERAH Plus]. / Hausärztliche Delegationskonzepte in Nordrhein-Westfalen Ergebnisse der hausärztlichen Befragung zum Einsatz von EVA, VERAH, VERAH Plus zur Delegation definierter Tätigkeiten.

BACKGROUND: The delegation of traditional GP tasks to qualified medical assistants (MFA) includes several modalities based on extended qualification curricula known as "Nicht-ärztliche Praxisassistentin" (NäPa) [non-physician practice assistant], also known as the "Entlastende Versorgungsassistentin" (EVA) and the "Versorgungsassistentin in der Hausarztpraxis" (VERAH and VERAH Plus) [professional healthcare assistants in the family practice]. Delegation to MFA has gained importance in recent years due to an increasing workload of general practitioners in Germany. OBJECTIVES: This article examines the characteristics of general practitioners (GPs) currently delegating activities to MFAs with and without extended qualification based on the three mentioned modalities (EVA, VERAH and VERAH Plus). In addition, we explore whether the delegated activities are delivered in the office, at the patient's home or in the nursing home and how GPs perceived the potential of future delegation. MATERIALS AND METHODS: Between April and August 2016, we conducted an anonymous postal survey of a representative randomized sample of general practitioners in North Rhine-Westphalia (n = 2,404). The questionnaire contained questions about practice staff, setting for delivery of the delegated activity as well as the perceived added values of and barriers to delegation. We compare characteristics of GPs delegating to MFA with extended qualification to those delegating to standard qualified MFA. RESULTS: The response rate was 32 % (n = 762). Almost one third of the respondents (n = 239) delegated tasks to MFAs with extended qualification. These GPs are more likely to be younger and male and less likely to be working alone in individual practice. They delegate more activities to be delivered in all settings than GPs employing MFAs without extended qualification. DISCUSSION AND CONCLUSIONS: GPs benefit from delegating to MFA with extended qualification as shown by the associated added values and setting of deployment for delivery of tasks. Delegation to non-medical staff should be considered by more GPs as a means of supporting healthcare delivery. In addition to legal changes, further procedures are needed to encourage GPs to get more actively involved with the issue of delegation and consider to further develop the competence of their staff and deploy them accordingly.

Efficacy of paravertebral block techniques in thoracic surgery: systematic literature review / Eficacia de las técnicas de bloqueo paravertebral en cirugía torácica. Revisión sistemática de la literatura

Abstract Introduction: Postoperative pain in thoracic surgery in adults is usually severe, and to control it there are many analgesic methods that include paravertebral blockade (PVB). Until now, there is no clarity on which is the most effective technique to perform this blockade. Objective: To describe the different PVB techniques and its analgesic effect in thoracic surgery. Methods: A systematic review of the literature was performed. We included studies that analyzed patients in open chest surgery and used PVB as analgesic technique. The Cochrane and Grading of Recommendation Assessment, Development and Evaluation strategies were used to analyze biases and evidence. The results are presented graphically by means of a visual analog scale (VAS) pain and opioid consumption equivalent to morphine for each technique found. We summarize the results with a qualitative approach without meta-analysis. Results: A total of 38 articles were analyzed (2188 patients). 13 using PVB guided by surface anatomy (SA-PVB), 7 Ultrasound-guided PVB (US-PVB), 1 neurostimulation guided PVB (NE-PVB) and the remaining using PVB performed under direct visualization by the surgeon (S-PVB). A VAS of less than 3 was found in studies with SA-PVB and US-PVB, and greater than 5 in studies with S-PVB; however, opioid consumption in the postoperative period was similar between the techniques described. Conclusion: PVB can be performed through 4 techniques. Techniques of US-PVB or SA-PVB have shown better consistency to manage postoperative acute pain in thoracic surgery.

Resumen Introducción: El dolor posoperatorio en cirugía de tórax en adultos usualmente es grave, y para su control existen varios métodos analgésicos que incluyen el bloqueo paravertebral (BPV). En la actualidad no hay claridad acerca de la técnica más efectiva para su realización. Objetivo: Describir las diferentes técnicas de colocación del BPV y su efecto en el control analgésico en cirugía de tórax. Métodos: Se realizó una revisión sistemática de la literatura. Se incluyeron estudios que analizaron pacientes sometidos a cirugía de tórax abierta y que utilizaron el BPV como técnica analgésica. Se emplearon las estrategias Cochrane y GRADE (Grading of Recommendation Assessment, Development and Evaluation) para valorar la evidencia disponible. Se presentan los resultados de manera gráfica mediante escala visual análoga de dolor y consumo de opioide equivalente a morfina para cada técnica encontrada. Se realizó síntesis cualitativa de los resultados sin metanálisis. Resultados: Se analizaron en total 38 artículos (2188 pacientes). 13 estudios usaban BPV guiado por anatomía de superficie (BPV-AS), 7 BPV con guía ecográfica (BPV-US), 1 BPV guiado por neuroestimulación (BPV-NE) y los restantes BPV bajo visualización directa por el cirujano (BPV-C). Se encontró una escala visual análoga (EVA) menor a 3 en los estudios con BPV-AS y BPV-US y mayor a 5 en estudios con BPV-C; sin embargo, el consumo de opioides en el posoperatorio fue similar entre las técnicas descritas. Conclusión: Se han descrito cuatro técnicas para la realización del BPV. Las técnicas de BPV-US o BPV-AS han mostrado mejor consistencia para el manejo del dolor agudo posoperatorio en cirugía de tórax.

Transforaminal Endoscopic Lumbar Discectomy: Clinical Outcomes and Complications / Discectomia endoscópica transforaminal lombar: Resultados clínicos e complicações

Abstract Objective To evaluate the clinical and functional results of transforaminal endoscopic lumbar discectomy. Materials and Methods From August 2015 to January 2017, 101 patients with lumbar disc hernia refractory to clinical treatment underwent endoscopic discectomy. Through clinical evaluation by the Visual Analogue Scale and functional evaluation by the Oswestry Disability Index questionnaire, the patients were analyzed in the preoperative period, the immediate postoperative period, at 1 month, 3 months, 6 months and 1 year after surgery. Results The mean age of the participants was 48.1 years. The most affected disc levels were L4-L5 and L5-S1. A total of 29 patients were treated at 2 disc levels. After 1 month of postoperative follow-up, the mean scores on the questionnaires (VAS and ODI) decreased significantly (p < 0.001). Conclusion Transforaminal endoscopic Lumbar discectomy has been shown to be a safe, effective and minimally-invasive alternative for the treatment of lumbar disc herniation. The procedure has advantages, such as short hospital stay, surgery performed under local anesthesia and sedation, early return to daily activities, and low rate of complications.

Resumo Objetivo Avaliar os resultados clínicos e funcionais da discectomia endoscópica transforaminal lombar. Materiais e Métodos De agosto de 2015 a janeiro de 2017, 101 pacientes portadores de hérnia de disco lombar refratária ao tratamento clínico foram submetidos a discectomia endoscópica. Por meio de avaliação clínica pela Escala Visual Analógica e análise funcional pelo questionário Oswestry Disability Index, os pacientes foram analisados no período pré-operatório, no pós-operatório imediato, com 1 mês, 3 meses, 6 meses e 1 ano após a cirurgia. Resultados A média de idade dos participantes foi de 48.1 anos. Os níveis discais mais acometidos foram L4-L5, seguidos de L5-S1. Um total de 29 pacientes foram abordados em 2 níveis discais. Após 1 mês de seguimento pós-operatório, a média das pontuações nos questionários (EVA e ODI) diminuiu significativamente (p < 0.001). Conclusão A discectomia endoscópica transforaminal lombar mostrou ser uma alternativa segura, eficaz e minimamente invasiva para o tratamento de hérnia de disco lombar. O procedimento tem vantagens, como curto período de internação hospitalar, cirurgia realizada sob anestesia local e sedação, retorno precoce às atividades diárias, e baixa taxa de complicações.

Use of Exogenous Hyaluronic Acid for the Treatment of Patellar Chondropathy- A Six-Month Randomized Controlled Trial / Uso do ácido hialurônico exógeno no tratamento da condropatia patelar - Ensaio clínico randomizado com acompanhamento de seis meses

Abstract Objective To evaluate the clinical and radiological benefits of intra-articular exogenous hyaluronic acid for the treatment of chondral patellar injury. Method Randomized clinical trial with 70 patients divided into 2 groups: those submitted to physical therapy for 3 months, and those submitted to physical therapy associated with the intra-articular administration of 2 mL of hyaluronic acid for the same period, who had anterior knee pain and patellar cartilage injury of grades II or III with no significant bone abnormalities. The functional scores and the characteristics of the physical and imaging exams were evaluated before and 3 and 6 months after the treatment. Result The average age of the patients was 32 ± 7.6 years. Patients from the hyaluronic acid group had better Kujala et al and Lysholm scores, and lower pain scores after 3 and 6 months of treatment when compared to the control group. The incidence of positive Clarke maneuver was lower in the treated group, but there was no difference in the magnetic resonance imaging classification. Conclusion Patients with patellar chondropathy of grades II or III treated with hyaluronic acid and physical therapy had less pain (visual analogue scale, VAS), and better functional results in the Lysholm and Kujala et al questionnaires after 3 and 6 months of treatment compared to patients undergoing physical therapy alone. In addition, the number of cases with a negative Clarke maneuver was larger in the treated group after 6 months of treatment.

Resumo Objetivo Avaliar os benefícios clínicos e radiológicos do uso do ácido hialurônico exógeno intra-articular para o tratamento da lesão condral da patela. Método Ensaio clínico randomizado com 70 pacientes divididos em dois grupos: o de tratamento fisioterápico por 3 meses, e o de tratamento fisioterápico associado à aplicação de 2 ml de ácido hialurônico intra-articular pelo mesmo período, composto por pacientes com dor na região anterior do joelho e lesão de graus II ou III da cartilagem da patela, sem anormalidades ósseas significativas. Foram avaliados os escores funcionais e as características do exame físico e de imagem antes, e após 3 e 6 meses de tratamento. Resultado A idade média dos pacientes foi de 32 ± 7,6 anos. Os pacientes do grupo submetido à aplicação de acido hialurônico apresentaram melhores escores de Kujala et al e de Lysholm, e menor pontuação de dor após 3 e 6 meses de tratamento quando comparados ao grupo controle. A manobra de Clarke positiva foi menor no grupo em que foi feita a aplicação do ácido, mas não houve diferença na classificação da imagem obtida pela ressonância magnética. Conclusão Pacientes com condropatia patelar de graus II ou III do joelho tratados com ácido hialurônico e fisioterapia apresentaram menos dor (escala visual analógica, EVA), e melhores resultados funcionais nos questionários de Lysholm e de Kujala et al após 3 e 6 meses de tratamento quando comparados com os pacientes submetidos apenas à fisioterapia. Além disso, estes pacientes apresentaram manobra de Clarke negativa em maior número após 6 meses de tratamento.

Implications of Space Suit Injury Risk for Developing Computational Performance Models.

INTRODUCTION: Although a space suit is a technological feat sustaining human life outside the spacecraft, working in the space suit environment can lead to musculotendon and soft tissue injuries in astronauts. In this literature review, we consider the injury risk mechanisms for human-space suit interactions. We first present a review of space suit injury risk founded in empirical, statistical, and experimental studies. We then review efforts in computational modeling of a human and space suit. As the interpretation of models for injury risk has not previously been defined, a review is presented of biomechanical considerations of injury risk to the tissue and joints based on previously observed space suit injuries. A review of risk assessment in occupational health in the workplace is then presented, an adjacent area that informs relevant measures of consideration for human-space suit applications. Finally, we discuss how the work-to-date can inform continued efforts in minimizing risk of musculoskeletal injury to the human when using a space suit. From the literature, this review concludes space suits cause biomechanical alterations, inducing musculoskeletal injury. Combining occupational health kinematic constraints with computational models could enable a trade space evaluation on space suited biomechanics to reduce risk mechanisms. Future work, though, is required to enable computational models to be predictive of individual injury risk. Our findings show there are significant gaps in our current knowledge on tissue injuries that preclude biomechanical models from being used directly as an injury risk assessment model. This review identifies how risk factor monitoring and modeling will enable improved space suit design and evaluation.Stirling L, Arezes P, Anderson A. Implications of space suit injury risk for developing computational performance models. Aerosp Med Hum Perform. 2019; 90(6):553-565.

Using Science-Driven Analog Research to Investigate Extravehicular Activity Science Operations Concepts and Capabilities for Human Planetary Exploration.

Biologic Analog Science Associated with Lava Terrains (BASALT) is a science-driven exploration program seeking to determine the best tools, techniques, training requirements, and execution strategies for conducting Mars-relevant field science under spaceflight mission conditions. BASALT encompasses Science, Science Operations, and Technology objectives. This article outlines the BASALT Science Operations background, strategic research questions, study design, and a portion of the results from the second field test. BASALT field tests are used to iteratively develop, integrate, test, evaluate, and refine new concepts of operations (ConOps) and capabilities that enable efficient and productive science. This article highlights the ConOps investigated during BASALT in light of future planetary extravehicular activity (EVA), which will focus on scientific exploration and discovery, and serves as an introduction to integrating exploration flexibility with operational rigor, the value of tactical and strategic science planning and execution, and capabilities that enable and enhance future science EVA operations.

Strategic Planning Insights for Future Science-Driven Extravehicular Activity on Mars.

Short-term and long-term science plans were developed as part of the strategic planning process used by the Biologic Analog Science Associated with Lava Terrains (BASALT) science team to conduct two Mars-simulation missions investigating basalt habitability at terrestrial volcanic analog sites in 2016. A multidisciplinary team of scientists generated and codified a range of scientific hypotheses distilled into a Science Traceability Matrix (STM) that defined the set of objectives pursued in a series of extravehicular activity (EVA) campaigns performed across multiple field deployments. This STM was used to guide the pre-deployment selection of sampling stations within the selected Mars analog sites on the Earth based on precursor site information such as multispectral imagery. It also informed selection of hand-held instruments and observational data to collect during EVA to aid sample selection through latency-impacted interaction with an Earth-based Science Support Team. A significant portion of the pre-deployment strategic planning activities were devoted to station selection, ultimately the locations used for sample collection and EVA planning. During development of the EVAs, the BASALT science team identified lessons learned that could be used to inform future missions and analog activities, including the critical need for high-resolution precursor imagery that would enable the selection of stations that could meet the scientific objectives outlined in the STM.

Assessing the Acceptability of Science Operations Concepts and the Level of Mission Enhancement of Capabilities for Human Mars Exploration Extravehicular Activity.

The Biologic Analog Science Associated with Lava Terrains (BASALT) research project is investigating tools, techniques, and strategies for conducting Mars scientific exploration extravehicular activity (EVA). This has been accomplished through three science-driven terrestrial field tests (BASALT-1, BASALT-2, and BASALT-3) during which the iterative development, testing, assessment, and refinement of concepts of operations (ConOps) and capabilities were conducted. ConOps are the instantiation of operational design elements that guide the organization and flow of personnel, communication, hardware, software, and data products to enable a mission concept. Capabilities include the hardware, software, data products, and protocols that comprise and enable the ConOps. This paper describes the simulation quality and acceptability of the Mars-forward ConOps evaluated during BASALT-2. It also presents the level of mission enhancement and acceptability of the associated Mars-forward capabilities. Together, these results inform science operations for human planetary exploration.

Developing Intra-EVA Science Support Team Practices for a Human Mission to Mars.

During the BASALT research program, real (nonsimulated) geological and biological science was accomplished through a series of extravehicular activities (EVAs) under simulated Mars mission conditions. These EVAs were supported by a Mission Support Center (MSC) that included an on-site, colocated Science Support Team (SST). The SST was composed of scientists from a variety of disciplines and operations researchers who provided scientific and technical expertise to the crew while each EVA was being conducted (intra-EVA). SST management and organization developed under operational conditions that included Mars-like communication latencies, bandwidth constraints, and EVA plans that were infused with Mars analog field science objectives. This paper focuses on the SST workspace considerations such as science team roles, physical layout, communication interactions, operational techniques, and work support technology. Over the course of BASALT field deployments to Idaho and Hawai'i, the SST team made several changes of note to increase both productivity and efficiency. For example, new roles were added for more effective management of technical discussions, and the layout of the SST workspace evolved multiple times during the deployments. SST members' reflexive adjustments resulted in a layout that prioritized face-to-face discussions over face-to-data displays, highlighting the importance of interpersonal communication during SST decision-making. In tandem with these workspace adjustments, a range of operational techniques were developed to help the SST manage discussions and information flow under time pressure.

Opportunities and Challenges of Promoting Scientific Dialog throughout Execution of Future Science-Driven Extravehicular Activity.

Science-driven, human spaceflight missions of the future will rely on regular and interactive communication between Earth- and space-based teams during activity in which astronauts work directly on Mars or other planetary surfaces (extravehicular activity, EVA). The Biologic Analog Science Associated with Lava Terrains (BASALT) project conducted simulated human missions to Mars, complete with realistic one-way light time (OWLT) communication latency. We discuss the modes of communication used by the Mars- and Earth-based teams, including text, audio, video, and still imagery. Real-time communication between astronauts in the field (extravehicular, EV) and astronauts in a communication relay station (intravehicular, IV) was broadcast over OWLT, providing important contextual information to the Science Backroom Team (SBT) in Mission Control. Collaborative communication between the Earth- and Mars-based teams, however, requires active communication across latency via the Mission Log. We provide descriptive statistics of text communication between IV and SBT in a high-fidelity, scientifically driven analog for human space exploration. Over an EVA, the SBT sent an average of ∼23 text messages containing recommendations, requests, and answers to questions, while the science-focused IV crew member (IV2) sent an average of ∼38 text messages. Though patterns varied, communication between the IV and SBT teams tended to be highest during ∼50-150 min into the EVA, corresponding to the candidate sample search and presampling instrument survey phases, and then decreased dramatically after minute ∼200 during the sample collection phase. Generally, the IV2 and SBT used ∼4.6 min to craft a reply to a direct question or comment, regardless of message length or OWLT, offering a valuable glimpse into actual time-to-reply. We discuss IV2-SBT communication within the context of case examples from an EVA during which communication failures affected operations in the field. Finally, we offer recommendations for communication practices for use in future analogs and, perhaps, science-driven human spaceflight.

Carbon Monoxide Levels in the Extravehicular Mobility Unit by Modeling and Operational Testing.

INTRODUCTION: Carbon monoxide (CO) is a toxic gas with potential for detriment to spaceflight operations. An analytical model was developed to investigate if a maximum CO contamination of 1 ppm in the oxygen (O2) supply reached dangerous levels during extravehicular activity (EVA). Occupational monitoring pre- and postsuited exposures provided supplementary data for review.METHODS: The analytical model estimated O2 and CO concentrations in the extravehicular mobility unit (EMU) based on O2 and CO flow rates into and out of the system. The model was based on 3 h of prebreathe at 15.2 psia, 8 h of EVA at 4.3 psia, and 1 h at 15.2 psia for suit doffing. The Coburn-Forster-Kane equation was used to calculate crewmember carboxyhemoglobin saturation (COHb%) as a function of time. Monitoring of hemoglobin CO saturation (Spco) with a CO-oximeter was conducted pre- and post-EVA during operations on the International Space Station and in ground-based analog environments.RESULTS: The model predicted a maximum PCO in the EMU of 0.061 mmHg and a maximum crewmember COHb% of 2.1%. Operational Spco measurements in mean ± SD during ground-based analog testing were 0.7% ± 1.8% pretest and 0.5% ± 1.5% posttest. Spco values on the ISS were 1.5% ± 0.7% pre-EVA and 1.1% ± 0.3% post-EVA.DISCUSSION: The model predicted that astronauts are not exposed to toxic levels of CO during EVA and operational measurements did not show significant differences between Spco levels between pre- and post-EVA.Makowski MS, Norcross JR, Alexander D, Sanders RW, Conkin J, Young M. Carbon monoxide levels in the extravehicular mobility unit by modeling and operational testing. Aerosp Med Hum Perform. 2019; 90(2):84-91.