[Advancing Space Medicine and Astronomy in Chile for Health on Earth]. / Medicina Espacial y Astronomía en Chile: Futuro esplendor.

The sky of Chile has the ideal conditions for astronomy worldwide, which has led to crucial scientific development for the country in this and other areas. In the coming years, several space missions will occur, the crew members' health being essential for their success. Space medicine studies the changes in human physiology in space, which is entirely altered. It is essential to understand the pathology in the space environment to develop countermeasures to mitigate the different risks, one of the main ones being space radiation, among others. The development of this area of medicine will allow new advances in health on Earth.

Historic Firsts: Aeromedical Evacuation and the Transportation Isolation System.

This short communication highlights the US Air Force's recent success with having their aeromedical evacuation crews use the Transportation Isolation System for the first time operationally to transport patients positive for coronavirus disease 2019.

Nurses' responsibilities in the aerospace environment.

OBJECTIVES: to characterize the nurses who work in the aerospace environment and to identify their most frequent responsibilities during the pre-flight, flight, and post-flight periods. METHODS: a quantitative, exploratory-descriptive research, conducted using a survey through Google forms®, from January to April of 2018, with 50 nurses from aerospace services in Brazil. Data were analyzed using descriptive statistics. RESULTS: predominance of male participants (64%), mean age of 37 years, with a mean working time in the aerospace environment of six years, in helicopter (54%), and in the southern region (42%). The main pre-flight, flight, and post-flight activities were, respectively: verification/testing of equipment functionality, nursing care for patients, and replacement of supplies and equipment. CONCLUSIONS: In the aerospace environment, nurses' work are primarily organizational and victim care actions, during all phases of the flight.

Nurses' responsibilities in the aerospace environment / Atribuciones del enfermero en el medio ambiente aeroespacial / Atribuições do enfermeiro no ambiente aeroespacial

ABSTRACT Objectives: to characterize the nurses who work in the aerospace environment and to identify their most frequent responsibilities during the pre-flight, flight, and post-flight periods. Methods: a quantitative, exploratory-descriptive research, conducted using a survey through Google forms®, from January to April of 2018, with 50 nurses from aerospace services in Brazil. Data were analyzed using descriptive statistics. Results: predominance of male participants (64%), mean age of 37 years, with a mean working time in the aerospace environment of six years, in helicopter (54%), and in the southern region (42%). The main pre-flight, flight, and post-flight activities were, respectively: verification/testing of equipment functionality, nursing care for patients, and replacement of supplies and equipment. Conclusions: In the aerospace environment, nurses' work are primarily organizational and victim care actions, during all phases of the flight.

RESUMEN Objetivos: caracterizar a los enfermeros que actúan en el ambiente aeroespacial e identificar las asignaciones más frecuentes desarrolladas por ellos durante los períodos previos a vuelo, vuelo y post-vuelo. Métodos: investigación exploratoria-descriptiva, con abordaje cuantitativo, desarrollada por medio de una encuesta vía Google forms ®, de enero a abril de 2018, con 50 enfermeros de servicios aeroespaciales de Brasil. Los datos se analizaron por medio de estadística descriptiva. Resultados: predominaron participantes del sexo masculino (64%), con edad media de 37 años, con tiempo promedio de actuación en el ambiente aeroespacial de seis años, en aeronaves de ala rotativa (54%) y provenientes de la Región Sur (42%). Las principales actividades en el pre-vuelo, durante el vuelo y post-vuelo fueron, respectivamente: verificación/prueba de la funcionalidad de equipos, asistencia de enfermería a los pacientes y reposición de insumos y equipamientos. Conclusiones: en la actuación del enfermero en el ambiente aeroespacial predominan acciones organizacionales y de cuidado a la víctima durante todas las etapas del vuelo.

RESUMO Objetivos: caracterizar os enfermeiros que atuam no ambiente aeroespacial e identificar as atribuições mais frequentes desenvolvidas por eles durante os períodos pré-voo, voo e pós-voo. Métodos: pesquisa exploratório-descritiva, com abordagem quantitativa, desenvolvida por meio de um survey via Google forms ®, de janeiro a abril de 2018, com 50 enfermeiros de serviços aeroespaciais do Brasil. Os dados foram analisados por meio de estatística descritiva. Resultados: predominaram participantes do sexo masculino (64%), com idade média de 37 anos, com tempo médio de atuação no ambiente aeroespacial de seis anos, em aeronaves de asa rotativa (54%) e provenientes da região Sul (42%). As principais atividades no pré-voo, durante o voo e pós-voo foram, respectivamente: verificação/teste da funcionalidade de equipamentos, assistência de enfermagem aos pacientes e reposição de insumos e equipamentos. Conclusões: na atuação do enfermeiro no ambiente aeroespacial predominam ações organizacionais e de cuidado à vítima durante todas as etapas do voo.

Assisting with air travel medical emergencies: responsibilities and pitfalls.

When medical emergencies arise in flight, commercial airline flight crews may ask for help from onboard medical professionals. Qualified, active, licensed, and sober providers should volunteer to assist in the event of a medical emergency rather than decline out of fear of medicolegal reprisal. An understanding of the typically available resources, the hierarchy of authority, and medicolegal precedents can help providers feel confident in responding to these situations. This review addresses the pathophysiology related to air travel and common causes of in-flight medical emergencies and discusses the medications and equipment commonly stocked by commercial airlines. In addition, the complexity of flight diversion and the medicolegal concerns surrounding volunteering to provide medical care are addressed.

Flight Anxiety Reported from 1986 to 2015.

BACKGROUND: Fear of flying is one of the most common phobias. It hinders people in performing their work and hampers family relations. Even though flight traffic has increased, there are new fears. Valid studies are needed to answer whether there have been changes in the prevalence of flight anxiety, are there sex differences in relation to fear of flying, use of alcohol, and tranquilizers, which situations cause the most flight anxiety, and whether the above factors have changed compared to a similar study from 1986.METHODS: A questionnaire was distributed to a representative random sample of the Norwegian population (N = 5500), where 36% answered. To assess flight anxiety across the time period, we used similar instruments to those we used in 1986.RESULTS: The prevalence of an assumed flight phobia decreased from 8% in 1986 to 3% in 2015. The percentage of those reported to never fly had decreased from 5% in 1986 to 0.5% in 2015. There were 11.0% who always used alcohol in 1986 and 7.5% in 2015 and 3% and 2%, respectively, always used tranquillizers. More women reported being afraid of both flying and other situations compared to men. Turbulence, unknown sounds, and fear of terror attacks caused the most anxiety.DISCUSSION: Flight anxiety still affects a considerable proportion of the Norwegian population and more women than men report that they are afraid of flying. However, in spite of methodology, people are significantly less afraid of flying than in 1986.Grimholt TK, Bonsaksen T, Schou-Bredal I, Heir T, Lerdal A, Skogstad L, Ekeberg Ø. Flight anxiety reported from 1986 to 2015. Aerosp Med Hum Perform. 2019; 90(4):384-388.

Space Medicine Requirements open to Innovation in Biomedical Engineering.

The International Space Medicine Summit II sought to identify mature data with significant clinical implications for Terrestrial populations. This work aims at identifying innovation in biomedical engineering (BE), involving space medicine and translation. METHODS: Following PRISMA Guidelines, we sought to review the published literature and NASA technical resources (from 2012 to 2017) to identify space medical technology which has been translated for use by private costumers. RESULTS: The analysis focuses on technical and medical requirements, human health and Terrestrial implication. DISCUSSION: Innovation in BE arises from matching space medical requirements for developing autonomous medical systems. SIGNIFICANCE: Highlighting the use and benefits of aerospace medical research for Terrestrial medical care.

Gravitational stress during parabolic flights reduces the number of circulating innate and adaptive leukocyte subsets in human blood.

Gravitational stress occurs during space flights or certain physical activities including extreme sports, where the change in experienced gravitational acceleration can reach large magnitudes. These changes include reduction and increase in the physical forces experienced by the body and may potentially induce pathogenic alterations of physiological processes. The immune system is known to regulate most functions in the human organism and previous studies suggest an impairment of the immune function under gravitational stress. However, systematic studies aiming to investigate the effect of gravitational stress on cellular immune response in humans are lacking. Since parabolic flights are considered as feasible model to investigate a short-term impact of gravitational changes, we evaluated the influence of gravitational stress on the immune system by analyzing leukocyte numbers before and after parabolic flight maneuvers in human blood. To correct for circadian effects, samples were taken at the corresponding time points on ground the day before the flight. The parabolic flight maneuvers led to changes in numbers of different leukocyte subsets. Naïve and memory T and B cell subsets decreased under gravitational stress and lower numbers of basophils and eosinophils were observed. Only circulating neutrophils increased during the parabolic flight. The observed changes could not be attributed to stress-induced cortisol effects, since cortisol levels were not affected. Our data demonstrate that the gravitational stress by parabolic flights can affect all parts of the human immune system. Consequently, it is possible that gravitational stress can have clinically relevant impacts on the control of immune responses.

Stem Cell Culture in Microgravity and Its Application in Cell-Based Therapy.

Recent years have witnessed a rapid increase in space experiments. Initially, scientists focused on understanding the phenomenon of microgravity to discover countermeasures for preventing the adverse effects of microgravity on the astronauts' bodies. Lately, the application of microgravity environment has been gradually increasing with diverse objectives. Protein crystallization and three-dimensional cell culture are typical examples of microgravity application. Our recent studies suggested that microgravity is a useful tool for cell culture in cell-based therapy. In this review, we discussed microgravity-induced changes at cellular and molecular levels observed in experiments conducted during space flight or using simulated microgravity device. In addition, we summarized the utility of microgravity environment in cell-based therapy for central nervous system diseases.

Case Report of Extracorporeal Membrane Oxygenation and Aeromedical Evacuation at a Deployed Military Hospital.

The U.S. Military no longer maintains overseas extracorporeal membrane oxygenation (ECMO) capability for patients with severe lung injury including acute respiratory distress syndrome (ARDS). The authors present a case of severe ARDS at a military hospital in Afghanistan with limited capability for rescue therapies to include presentation, treatment, transport, and use of ECMO in the deployed military environment at one Role 3 medical facility. Lack of ECMO in the overseas environment is a significant gap in U.S. Military medical capability. The authors propose a novel solution, "ECMO packs," for prepositioning at strategic Role 3 facilities for early intervention in patients with severe lung injury to close this lethal and unnecessary capability gap.

Algorithm for Management of the Refractive Aerosinusitis Patient.

Introduction: For some career military aviators, their ability to continue on flight status is limited by the pressure and pain of aerosinusitis, which is present only while in the flying environment. Failure to treat their disease process can mean the end of their flying careers and the loss of valuable assets trained with taxpayer dollars. Because some medications commonly used in treatment of sinus diseases are not allowed in aviation, this presents a unique problem for their medical management. Surgical treatment must be aimed at treating to symptom relief and not solely disease mitigation. One alternative is operating "beyond the scope of disease" present during a one-atmosphere clinic visit. Materials and Methods: A case series of nine career aviators with aerosinusitis treated at one academic military Otolaryngology department in a tertiary care facility. Results from a treatment algorithm that balances symptomatology and staged surgical intervention are reviewed. The primary endpoint was return to flight duty. Results: For patients treated according to this algorithm, the mean time to return to flight duty was 3.8 mo, requiring an average of 1.2 surgeries. To date, 100% of career aviators have returned to flight duty using this method. Conclusion: Refractory aerosinusitis represents a potentially career-ending medical condition for the aviator and lost training costs to the taxpayers. Using the treatment algorithm presented, 100% of aviators were able to return to flight duty; a savings of millions of dollars for taxpayers. Future work will focus on modifications to the surgical techniques to reduce the extent of surgery while maintaining satisfactory results. Additional study should be undertaken to assess generalizability of these results in the broader aviation community.

Vape and Aviate: Electronic-Cigarette Use and Misuse in Naval Aviation.

Introduction: Electronic cigarettes (EC) are an emerging form of nicotine replacement that has had a discernible increase in prevalence in the general population. Little is known regarding EC use among different military demographic groups or the extent of influence that social determinants of health may have on the behavior. The purpose of this study was to assess the prevalence and correlates of EC use in a select population of active duty U.S. Naval personnel. This study is unique in that it allows for EC behavior comparison between a traditionally healthy demographic (aviators, a subset of aircrew) and a representative general military population sample. Materials and methods: Cross-sectional survey data were collected anonymously and analyzed in 2015-2016. Active duty Naval personnel (n = 977) were asked about ever trying ECs, frequency of use, and when was the last time an EC was used. Participants were assessed similarly regarding cigarette use. Descriptive and inferential statistics as well as multinomial logistic regression analyses were conducted using categorical and ordinal variables assigned to usage and demographic factors. This protocol was approved by the Institutional Review Board at Naval Hospital Portsmouth located in Portsmouth, Virginia. Results: Within the study population, 31.4% have tried ECs, 9.3% were current users, and only 3.8% were dual (EC and cigarettes) users. EC use was significantly associated with paygrade (enlisted), primary job duty (non-aircrew), and education (less than a bachelor degree, p < 0.001, p < 0.01, and p < 0.001, respectively). ECs were used at some point as a smoking cessation tool for 43.6% of current EC users (p < 0.001), 21.6% of current smokers, and only 5.6% of former smokers. Continued EC use after ever trying ECs (30.0%) was only slightly more prevalent as continued cigarette use after ever trying cigarettes (27.3%). Smokers were nearly five times more likely to currently use ECs compared with non-smokers. Trying cigarettes was associated with nearly 12 times the risk for trying ECs compared with those who never tried cigarettes. No significant misuse of ECs was noted; however, several cases of drinking, tasting, and touching EC fluid were reported. Conclusion: This study is unique in that it examines the use of electronic cigarettes among selected healthy and baseline groups within the active duty U.S. Navy population. The current prevalence of EC use among active duty personnel is much higher than previously thought. Continued use of ECs after ever trying them appears to exceed that of cigarettes even among healthy populations such as aircrew. The findings of increased risk of EC use among those with lower income and less than a bachelor's degree suggest social determinants of health implications. This study sheds new light on EC use, characteristics of use, addiction implications, and highlights concerns for a growing health risk behavior.

Longitudinal Outcomes of U.S. Air Force Pilot Applicants With Waivered Astigmatism.

BACKGROUND: Current U.S. Air Force medical standards allow applicants to enter pilot training with up to 1.50 D of astigmatism. However, waivers are considered for individuals with up to 3.00 D of astigmatism. Although typically a benign finding, higher levels of astigmatism may be progressive and can be associated with corneal ectasia (e.g., keratoconus or pellucid marginal degeneration) leading to reduced visual acuity with spectacles and/or soft contact lenses. The goal of this study was to evaluate the long-term outcomes of pilot applicants waivered into training with astigmatism exceeding the aeromedical standard. METHODS: Subjects were identified on the basis of their enrollment in the Excessive Astigmatism Management Group maintained by the Aeromedical Consultation Service, Ophthalmology branch at Wright-Patterson Air Force Base, Ohio. Metrics evaluated included refractive status, visual acuity, aeromedical waiver status, safety data, and the development of corneal ectasia. FINDINGS: Seventy-six subjects were tracked for up to 10 years, with an average follow-up period of 5.5 years. Mean astigmatism at initial examination was 1.91 D, although mean astigmatism on the basis of the most recent examination was 2.19 D. Subjects with excessive astigmatism who were waivered into pilot training showed an average increase in astigmatism of slightly less than 0.05 D annually, which equates to a total increase in astigmatism of approximately 0.25 D for the duration of the study. No subjects developed ectasia or were disqualified from flying for vision or refractive reasons. No mishaps were identified with vision being a causative or contributing factor. DISCUSSION/IMPACT/RECOMMENDATIONS: This study supports continuation of current Air Force waiver policy, although a longer follow-up period is required to consider modifying the aeromedical standard for astigmatism.