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PubMedDate not supplied

James P. Bagian on patient safety initiatives. Interview by Deborah Mears.

James P. Bagian, MD, is director of the Veterans Health Administration (VHA) National Center for Patient Safety (NCPS). With a focus on systems and an emphasis on "prevention not punishment," NCPS is working to improve patient safety, prevent health care errors, and nurture a culture of safety throughout the 173 VHA medical centers. Previously, Dr. Bagian served as deputy director of the Regional and State Programs Division, Office of Mobile Sources, Environmental Protection Agency. From 1980 to 1995, Dr. Bagian served as a NASA astronaut. He took part in both the planning and provision of emergency medical and rescue support for the first six Space Shuttle flights. In 1986, Dr. Bagian served as an investigator for the Space Shuttle Challenger accident. A veteran of two space flights (STS-29 in 1989 and STS-40 in 1991), Dr. Bagian has logged more than 337 hours in space. Dr. Bagian is currently an adjunct assistant professor of military and emergency medicine at the Uniformed Services University of Health Sciences at F. Edward Herbert School of Medicine and also a clinical assistant professor of preventive medicine and community health at the University of Texas Medical Branch. He is a Colonel in the U.S. Air Force Reserve where he is a pararescue flight surgeon with the 920th Air Rescue Group. He has received the American Medical Association's Nathan S. Davis Award for outstanding public service in the advancement of public health. The NCPS received the 2001 Innovations in American Government Award given by the Institute for Government Innovation at the John F. Kennedy School of Government of Harvard University. The NCPS was the only federal organization to be so identified in 2001.

Hospitals, Veterans↗
PubMed1994

Medical management of U.S. astronauts.

The medical management of U.S. astronauts involves a comprehensive health care program and a variety of NASA and support organizations. The scope of this program includes aspects of medical monitoring and certification, health maintenance and counter-measures programs, medical intervention, psychosocial support, and environmental health monitoring. Each of these areas have activities in all mission phases preflight, inflight, and postflight. The wide range of potential health hazards from space flight mandates an aggressive health care program to maintain crew health and performance, and to prevent unwanted mission and long-term health consequences.

Aerospace Medicine↗
PubMed2002

A brief history of aerospace dentistry.

In April 2000, the National Academy of Sciences Institute of Medicine (NAS/IOM) Committee on Space Medicine held a workshop under contract with the National Aeronautics and Space Administration (NASA) to explore "innovative terrestrial medical care." There was also a NAS/IOM panel held on "Space Dentistry: Maintaining Astronauts' Oral Health on Long Missions." Air Force Dental Officer Col. Shannon E. Mills chaired the dental committee. Many questions were raised but few answers were available. Prevention was emphasized with the hope that within twenty to thirty years there may be a number of astronaut candidates with no existing dental restorations and with optimum oral health. However, there remains the concern that trauma to teeth could occur within the confines of a zero gravity space capsule as crew members carry out their daily responsibilities. The possibility is evident considering the duration of a space flight to Mars and back could require up to three years. The dental concerns of a space mission are only a small part of a much larger team effort, however, it is one not to be overlooked. An historical review of dentistry's involvement with America's flight and space programs of the 20th Century would be prudent. Many of same questions asked today were addressed in the early days of aviation dentistry as it transitioned into aerospace dentistry. Any past research and experiences would help serve as a foundation to build upon.

Aerospace Medicine↗
PubMed1984

NASA' s life sciences and space radiation biology.

Plans for the various missions in which men and women are expected to participate during the next 10 years are outlined. Such missions include flights of up to three months duration in low earth orbit as well as possible short excursions to geosynchronous orbit. Research activities are described which cover the full spectrum of physiological and psychological responses to space flight. These activities are shown to contribute to the ongoing Shuttle program and the future Space Station. The paper includes a summary of the major technical thrusts needed to support extended habitation in space.

Adaptation, Physiological↗
PubMed2001

Image acquisition: ultrasound, computed tomography, and magnetic resonance imaging.

As the transition toward total digital image acquisition continues, radiology is transcending the current standard of two-dimensional (2-D) cross-sectional anatomic imaging to more complex models. Among these are three-dimensional (3-D) anatomic images, constructed either from a synthesis of traditional 2-D data sets, or directly from volumetrically acquired data. However, current trends are moving beyond mere anatomic imaging to include physiological data once mainly obtained via nuclear medicine. Recent magnetic resonance pulse sequences, in addition to Doppler and harmonic ultrasound methods, are providing insight into blood flow, oxygenation, and metabolite concentrations non-invasively. Through image registration techniques, these data (even from differing modalities) are being assembled into 2-D and 3-D "fusion" images that promise to revolutionize diagnosis. Furthermore, with improvements in miniaturization, reliability, speed, built-in intelligence, and ease of use, these new developments are finding their way into use by nonspecialists. For instance, a new hand-held ultrasound unit will likely become a common tool among emergency medical teams, military medical teams, and in NASA's manned space program. Portable computed tomography (CT) scanners are already being used in the operating room. The increasing sophistication of imaging instruments will bring about a complementary increase in ease of use for both scanning and data interpretation, bringing diagnostic imaging and therapeutic capabilities closer to the patient, rather than the converse.

Diagnostic Imaging↗
PubMed1994

Interview with Dr. Oleg Atkov [interview by Winston Huff].

Last summer International Space University (ISU) was held in Huntsville, Alabama. Leading international space experts came to take part in the activities. Dr. Oleg Atkov, a Russian cardiologist who was also a cosmonaut for eight months in 1984, has extensive experience in cardiovascular medicine and first-hand experience in issues of life support, making him a valuable resource. He also serves on the Journal's Advisory Board. Winston Huff took advantage of the unique opportunity of having Valery Aksamentov, Paul Wieland, and Dr. Atkov together in Huntsville to conduct a general discussion of issues important to those studying life support. Dr. Valery Aksamentov was involved for many years in the development of the Russian life support systems. Dr. Aksamentov now leads the only university program specializing in life support at the University of Alabama in Huntsville. His command of both languages and his technical knowledge were critical to the success of this discussion. Paul Wieland from NASA Marshall Space Flight Center is involved with the development of the life support systems for the space station. He and Dr. Aksamentov are topic coordinators for the Journal. The following interview was conducted at the University of Alabama in Huntsville on August 16, 1993.

Ecological Systems, Closed↗
PubMed1985

First haemorheological experiment on NASA space shuttle 'Discovery' STS 51-C: aggregation of red cells.

The 'secret' D.O.D. Mission on flight STS 51-C also carried nearly 100 kg of automated instrumentation of the Australian experiment on aggregation of red cells ("ARC"). The automated Slit-Capillary Photo Viscometer contained blood samples from subjects with history of coronary heart disease, cancer of the colon, insulin-dependent diabetes, etc., as well as normals. The experiment ran for nine hours, according to the program of its microcomputers. When shuttle landed and instrumentation recovered and opened in the presence of NASA quality control officers, it was obvious that experiment was a success. Tentative and preliminary results can be summarized as follows: red cells did not change shape under zero gravity; red cells do aggregate under zero gravity, although the size of aggregates is smaller than on the ground; the morphology of aggregates of red cells appears to be of rouleaux type under zero gravity, notwithstanding the fact that pathological blood was used. These results will have to be confirmed in the future flights. The background and history of development of the project are described, and put into context of our general haemorheological studies.

Aerospace Medicine↗
PubMed2005

Life, survival, and behavioral health in small closed communities: 10 years of studying isolated Antarctic groups.

In the late 1980s the Australian Antarctic Division collaborated with NASA to use the Australian National Antarctic Research Expeditions' (ANARE) stations to pursue research of benefit to both programs. This article outlines the data collection efforts, the development of analyses, and selected results, and describes some of the benefits for the aerospace, health, and environmental psychology communities. The Behavior and Performance Laboratory at Johnson Space Center developed a questionnaire to sample broadly the many aspects of life in extreme environments analogous to space missions. Data were collected from volunteers involved in various ANAREs conducted from 1994 to 2003. Pool-timed series regression, hierarchical models, and content analysis have all enhanced the understanding of the kinds of psychosocial variables relevant in extreme environments, and how these variables relate to each other; examples are given. Observations gathered over the last 10 yr comprise a unique, comprehensive, and advanced representation of psychosocial factors in this extreme environment and provide a strong base for future research and application.

Adaptation, Psychological↗
PubMed1999

Preparing for Mars: the physiologic and medical challenges.

As the twentieth century closes, retrospectives cite the Apollo moon missions as one of the important events of the past 100 years. A trip to Mars, however, would be even more challenging and significant. A round-trip Mars journey would require nearly three years away from Earth, a significant leap in complexity compared to the two week long Moon trips or the record-breaking fourteen-month flight on Mir. What would be the physiologic and medical challenges of a Mars flight? Two key areas of physiology present the greatest potential problems--calcium metabolism and radiation exposure. Data from Mir missions show that bone loss continues in space despite an aggressive countermeasure program. Average losses were 0.35% per month, but some load bearing areas lost >1% per month. A 1% loss rate, if it continued unabated for 30 months, could produce osteoporosis. Smaller losses could still increase fracture risk. Some bone loss can be well tolerated, particularly if the bone can be regained after the mission. But the effectiveness of post-flight rehabilitation to restore the density and quality of bone after spaceflight is not well known. Bone loss estimates are based on continuous weightlessness exposure, but this is not a requirement for a Mars trip. Most of the time on a Mars trip will be spent in the 1/3 Earth's gravity environment on Mars, and either intermittent or continuous artificial gravity can be provided for the transit between planets (although at an engineering cost). The dosing of the gravity exposure (e.g. the level and duration), however, has not been established. Radiation protection also requires a balance between engineering cost and human health. Excessive shielding could add billions of dollars to the cost of a mission. Trips in interplanetary space, however, expose the crew to heavy high-energy particles from cosmic rays (HZE particles), which have a high linear energy transfer. This high energy leads to significant biological damage (e.g. chromosomal aberrations, cancer induction). A recent report from the Committee on Space Biology and Medicine notes that only one systematic study of cancer induction from high-energy particles has been conducted (using the mouse Harderian gland). Predictions of cancer risk and acceptable radiation exposure in space are extrapolated from minimal data. Other areas of physiology also present problems, such as muscle loss, cardiovascular deconditioning, and vestibular adaptation. Despite all the issues, however, a focussed, aggressive research program that uses the resources of the International Space Station should pave the way for mankind's greatest adventure--a trip to Mars.

Humans↗
PubMed1994

Helium-ion-induced human cataractogenesis.

Retrospective and ongoing analyses of clinical records from 347 primary intraocular melanoma patients treated with helium ions at LBL will allow examination of the exposure-response data for human cataract; which is a complication of the therapy from incidental exposure of the lens. Direct particle beam traversal of at least a portion of the lens usually is unavoidable in treatment of posterior intraocular tumors. The precise treatment planned for each patient permits quantitative assessment of the lenticular dose and its radiation quality. We are reporting our preliminary results on the development of helium-ion-induced lens opacifications and cataracts in 54 of these patients who had 10% or less of their lens in the treatment field. We believe these studies will be relevant to estimating the human risk for cataract in space flight.

Adult↗
PubMed2005

Invulnerability, coping, salutogenesis, integration: four phases of space psychology.

The relationship between NASA and the psychological research community has progressed through a number of phases during the past four decades. This paper summarizes how the relationship has developed as data have accumulated and space missions and crews have changed. In the beginning, most NASA astronauts and staff considered possible psychological problems during space missions to be a non-issue. It was assumed that people with "the right stuff" would not experience any such problems. A more realistic recognition of stress and its consequences has led to a concern with prevention and countermeasures, a concern that has come to dominate NASA's involvement with psychology. Very recently, space psychologists have started to import the concepts of positive psychology, and consider the benefits of participation in the space program, including the self-enhancing aspects of stressful experiences (salutogenesis). Both the agency and psychologists now need to broaden their thinking and their research to cover the gamut of empirical data and theoretical concepts. These include human strengths as well as vulnerabilities, both negative and positive impacts of spaceflight, long- as well as short-term effects, and the reactions not only of the astronauts themselves but also of ground personnel and the families of both groups.

Adaptation, Psychological↗
PubMed1989

Diagnostic and treatment support for the NASA space program astronauts.

For over 9 years our research unit has been investigating medical databases that would be required to support astronauts on long-term missions. The configuration that has been developed will allow complete separation from earth-based experts and the capability of an on-board stand-alone system for knowledge engineering and medical decision support. Our data processing base of operation has advanced from the early stages on mainframe computers to the now ubiquitous microcomputer. Over this nine-year period we have seen several generations of improvements in every level of technology to the point where we can now package and deliver for space travel a rather broad-based decision support tool for astronauts that can provide the basic needs of medical treatment and diagnostic support which is vital for the proper execution of manned space missions.

Aerospace Medicine↗
PubMed1986

Sudden emesis following parabolic flight maneuvers: implications for space motion sickness.

Episodes of emesis unaccompanied by the usual prodromal signs of motion sickness have been reported by astronauts in the space shuttle program (10). Such reports have raised the issue whether space motion sickness has different characteristics from terrestrial motion sickness. We present evidence here from parabolic flight experiments that sudden vomiting can occur in response to a provocative vestibular stimulus even when no premonitory symptoms are being experienced. Accordingly, in chronic exposure conditions, the absence of prominent signs or symptoms of motion sickness does not necessarily mean an absence of sensitization.

Aerospace Medicine↗
PubMed1998

Applications of telemedicine in the United States space program.

Since the beginning of human space flight, NASA has been placing humans in extreme and remote environments. There are many challenges in maintaining humans in outer space, including the provision of life-support systems, radiation shielding, and countermeasures for minimizing the effect of microgravity. Because astronauts are selected for their health, among other factors, disease and illness are minimized. However, it is still of great importance to have appropriate medical care systems in place to address illness and injury should they occur. With the exception of the Apollo program, exploration of space has been limited to missions that are within several hundred miles of the surface of the Earth. At the drawn of the 21st century and the new millennium, human exploration will be focused on operation of the International Space Station (ISS) and preparation for human missions to Mars. These missions will present inherent risks to human health, and, therefore, appropriate plans must be established to address these challenges and risks. Crews of long-duration missions must become more independent from ground controllers. New systems, protocols, and procedures are currently being perfected. Application of emerging technologies in information systems and telecommunications will be critical to inflight medical care. Application of these technologies through telemedicine will provide crew members access to information, noninvasive procedures for assessing health status, and guidance through the integration of sensors, holography, decision-support systems, and virtual environments. These technologies will also serve as a basis to enhance training and medical education. The design of medical care for space flight should lead to a redesign of the practice of medicine on Earth.

Computer Communication Networks↗
PubMed1997

Prevention of decompression sickness during extravehicular activity in space: a review.

Extended and more frequent extravehicular activity (EVA) is planned in NASA's future space programs. The more EVAs are conducted, the higher the incidence of decompression sickness (DCS) that is anticipated. Since Japan is also promoting the Space Station Freedom project with NASA, DCS during EVA will be an inevitable complication. The author reviewed the pathophysiology of DCS and detailed four possible ways of preventing decompression sickness during EVA in space: (1) higher pressure suit technology; (2) preoxygenation/prebreathing; (3) staged decompression; and (4) habitat or vehicle pressurization. Among these measures, development of zero-prebreathe higher pressure suit technology seems most ideal, but because of economic and technical reasons and in cases of emergency, other methods must also be improved. Unsolved problems like repeated decompression or oxygen toxicity were also listed.

Aerospace Medicine↗
PubMed1992

Environmental monitoring and research at the John F. Kennedy Space Center.

The Biomedical Operations and Research Office at the NASA John F. Kennedy Space Center has been supporting environmental monitoring and research since the mid-1970s. Program elements include monitoring of baseline conditions to document natural variability in the ecosystem, assessments of operations and construction of new facilities, and ecological research focusing on wildlife habitat associations. Information management is centered around development of a computerized geographic information system that incorporates remote sensing and digital image processing technologies along with traditional relational data base management capabilities. The proactive program is one in which the initiative is to anticipate potential environmental concerns before they occur and, by utilizing in-house expertise, develop impact minimization or mitigation strategies to reduce environmental risk.

Aerospace Medicine↗
PubMed2002

Crime scene investigations using portable, non-destructive space exploration technology.

The National Institute of Justice (NIJ) and the National Aeronautics and Space Administration's (NASAs) Goddard Space Flight Center (GSFC) have teamed up to explore the use of NASA developed technologies to help criminal justice agencies and professionals solve crimes. The objective of the program is to produce instruments and communication networks that have application within both NASA's space program and NIJ programs with state and local forensic laboratories. A working group of NASA scientists and law enforcement professionals has been established to develop and implement a feasibility demonstration program. Specifically, the group has focused its efforts on identifying gunpowder and primer residue, blood, and semen at crime scenes. Non-destructive elemental composition identification methods are carried out using portable X-ray fluorescence (XRF) systems. These systems are similar to those being developed for planetary exploration programs. A breadboard model of a portable XRF system has been constructed for these tests using room temperature silicon and cadmium-zinc telluride (CZT) detectors. Preliminary tests have been completed with gunshot residue (GSR), blood-spatter and semen samples. Many of the element composition lines have been identified. Studies to determine the minimum detectable limits needed for the analyses of GSR, blood and semen in the crime scene environment have been initiated and preliminary results obtained. Furthermore, a database made up of the inorganic composition of GSR is being developed. Using data obtained from the open literature of the elemental composition of barium (Ba) and antimony (Sb) in handswipes of GSR, we believe that there may be a unique GSR signature based on the Sb to Ba ratio.

Antimony↗
PubMedDate not supplied

Radiation transport modeling and assessment to better predict radiation exposure, dose, and toxicological effects to human organs on long duration space flights.

NASA is very interested in improving its ability to monitor and forecast the radiation levels that pose a health risk to space-walking astronauts as they construct the International Space Station and astronauts that will participate in long-term and deep-space missions. Human exploratory missions to the moon and Mars within the next quarter century, will expose crews to transient radiation from solar particle events which include high-energy galactic cosmic rays and high-energy protons. Because the radiation levels in space are high and solar activity is presently unpredictable, adequate shielding is needed to minimize the deleterious health effects of exposure to radiation. Today, numerous models have been developed and used to predict radiation exposure. Such a model is the Space Environment Information Systems (SPENVIS) modeling program, developed by the Belgian Institute for Space Aeronautics. SPENVIS, which has been assessed to be an excellent tool in characterizing the radiation environment for microelectronics and investigating orbital debris, is being evaluated for its usefulness with determining the dose and dose-equivalent for human exposure. Thus far. the calculations for dose-depth relations under varying shielding conditions have been in agreement with calculations done using HZETRN and PDOSE, which are well-known and widely used models for characterizing the environments for human exploratory missions. There is disagreement when assessing the impact of secondary radiation particles since SPENVIS does a crude estimation of the secondary radiation particles when calculating LET versus Flux. SPENVIS was used to model dose-depth relations for the blood-forming organs. Radiation sickness and cancer are life-threatening consequences resulting from radiation exposure. In space. exposure to radiation generally includes all of the critical organs. Biological and toxicological impacts have been included for discussion along with alternative risk mitigation methods--shielding and anti-carcinogens.

Aerospace Medicine↗