Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 1850  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
  »  Similar in PUBMED
 »Related articles
  »  Article in PDF (1,956 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

 
  In this Article
 »  Abstract
 »  Challenges of Hu...
 »  Inflight Medical...
 »  Telemedicine Cap...
 »  Medical Support ...
 » Psychological Issues
 » Analogs
 »  Future Medical S...
 » Conclusions
 »  References
 »  Article Figures

 Article Access Statistics
    Viewed199    
    Printed9    
    Emailed0    
    PDF Downloaded16    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
REVIEW ARTICLE
Year : 2019  |  Volume : 67  |  Issue : 8  |  Page : 190-195

Health challenges including behavioral problems in long-duration spaceflight


1 Department of Family and Community Medicine, College of Medicine, University of Cincinnati; Office of the Chief Health and Medical Officer, NASA, Washington, DC, USA
2 Office of the Chief Health and Medical Officer, NASA, Washington, DC, USA

Date of Web Publication24-May-2019

Correspondence Address:
Dr. Charles R Doarn
Department of Family and Community Medicine, University of Cincinnati, 231 Albert Sabin Way, Medical Sciences Building (MSB) - Room 4453B, Cincinnati, Ohio 45267-0582
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.259116

Rights and Permissions

 » Abstract 


Over the past 60 years, our ability to live and work in space has evolved. From short sojourns in small spacecraft to landing on the moon and residing in an orbiting international space station, we have learned to adapt to an extreme environment and safely return home. Human missions to the Moon, Mars, and exploration of deep space are different. This paper summarizes the challenges of providing medical care, specifically mental health care during long-duration flights. Considerable information about challenges that crews bound for Mars will face is available. Literature regarding this issue is summarized. This manuscript provides a short historical summary of long-duration spaceflight to date; the challenges including limited communication with mission controllers on Earth; and, a summary of the behavioral impacts space flight has had on humans. A look at how the future autonomous systems might support physical and mental health when definitive care is millions of miles away, is also provided. Human spaceflight to Mars or other distant sites will require new approaches to mission preparedness and inflight medical support systems. Exploration class missions will be more autonomous than anything deployed until now. The concepts of telemedicine that have aptly supported crews from the 1960s to the present will no longer be in real-time. While communication between Earth and Mars is possible, it will be characterized by significant time delays. Mars-based crews will need to have systems onboard and on Mars to support all health and performance issues.


Keywords: Behavioral health in space, remote healthcare, space medicine
Key Message: The current update regarding the challenges encountered in providing health care during long duration flights is presented. The significant time delays in communication, the issues related to mental health care, and the mandatory role of autonomus systems of health care and performance issues that need to be on board during the execution of these long duration flights are discussed.


How to cite this article:
Doarn CR, Polk J D, Shepanek M. Health challenges including behavioral problems in long-duration spaceflight. Neurol India 2019;67, Suppl S2:190-5

How to cite this URL:
Doarn CR, Polk J D, Shepanek M. Health challenges including behavioral problems in long-duration spaceflight. Neurol India [serial online] 2019 [cited 2019 Jun 18];67, Suppl S2:190-5. Available from: http://www.neurologyindia.com/text.asp?2019/67/8/190/259116


Over the past six decades of human spaceflight, the ability to live and work in Low Earth Orbit (LEO) and on short sojourns to the lunar surface for several days has been demonstrated. During this period, human spaceflight was dominated by the United States (US) and the Union of Soviet Socialist Republics (USSR).[1] The objective during the 1960s was a “space race,” with landing a man on the moon as the ultimate goal. The US focused its successive missions on short duration missions, designed to build on the success of each platform with the eventual landing of man on the moon on July 20, 1969.

The Soviet approach was focused on longer duration missions over successive space stations. US missions were measured in days, whereas the Soviet missions were measured in weeks and months. In 1987, cosmonauts Vladimir Titov and Musa Manarov spent nearly 366 days onboard the Mir Space Station, and in 1994, Valeri Polyakov spent nearly 438 days on board Mir, a record that still stands today. US astronauts spent 84 days on Skylab 4 mission in 1975; the longest US record until the International Space Station (ISS) program. In 2015, Scott Kelly and Mikhail Kornienko spent 346 days on the ISS [Figure 1].[2]
Figure 1: Scott Kelly and Mikhail Kornienko onboard the ISS in 2015 (courtesy of NASA)

Click here to view


Most missions of long-duration have been less than or equal to 1 year with one outlier – Polyakov in 1994. These missions have been conducted in LEO with the Earth in full view, and with protocols and capabilities to return to definitive care on Earth in the event of an emergency. The ISS always has two Soyuz Transfer Modified attached to docking ports in case of a need to return to Earth, a ballistic entry to the Steppes of Kazakhstan. Emergency returns, in the case of a significant medical emergency or if the crew has to abandon the ISS, must be coordinated with the ground prior to a return.[3],[4]

Future long-duration missions will be conducted with knowledge obtained from the LEO missions and the lunar landings of 50 years ago. Scientific knowledge from life sciences research and aerospace medicine practice provides a wealth of knowledge on physiological and psychological changes in outer space to practitioners and mission designer's today.[5],[6],[7],[8],[9] Selection of appropriate individuals and matching them into highly productive crews have resulted in successful missions. Living and working in space requires life support systems to maintain health and human performance.[9],[10] Medical systems onboard, to support the crew's medical needs from basic first aid and ambulatory care to emergent care, must exist.

The size and capability of the onboard medical system is dependent on the available volume in the spacecraft and the mission profile (distance from the Earth and time in orbit). This system must be linked to the expertize available at the terrestrial Mission Control Centers to support the appropriate medical needs of the crew.[11],[12] Although crews have always been in contact with select personnel on the ground, including physicians through private medical conferences (PMCs), there are times when the communication is limited.[11],[12] As the international community contemplates long-distance and long-duration missions beyond LEO to the Moon, Mars, or beyond, this proven model of care fundamentally has to change, and the length of time it takes to interact with Earth will be a key driver.

[Figure 2] illustrates the distance from the Earth to the Moon (239,800 miles (380,000 km)). One-way delay in communications is measured at 1.25 s or 2.50 s roundtrip. The distance from the Earth to Mars varies depending on where the planets are in relation to one another. At their closest, the distance is 34.8 million miles (54.6 million km) and the farthest about 250 million miles (401 million km) or an average of 140 million miles (225 million km). The distance between the two planets has a direct impact on mission planning and communications. Due to the distance, communications between a spacecraft on the surface of Mars and a control center on the Earth can be 3 to 22 min one-way. This is because of the distance between the two planets and the speed of light. This causes latency in communications. This means that real-time or synchronous communications cannot be accomplished. This is one of the many significant challenges that humans will have to experience in long-distance and long-duration missions. Several more challenges are highlighted below. The implication is that Mars-bound crews must have a complex medical system onboard to address their medical needs.[13] Such an autonomous system will have a significantly delayed communications capability.
Figure 2: A graphical representation of the distances between the Earth and Mars. (courtesy of NASA)

Click here to view



 » Challenges of Human Space Flight Top


In addition to the delay in communications, access to definitive care is possible from LEO but not on a transit mission to the Moon, Mars, or any other destination. [Figure 3] illustrates the view of the Earth from the cupola on the ISS.
Figure 3: US Astronaut Karen Nyberg viewing Earth from the ISS (courtesy of NASA)

Click here to view


The crew members aboard a spacecraft destined for a great distance from the Earth will experience acceleration, radiation, as well as physiological, and psychological impacts owing to confinement, remoteness, and isolation.[14] The crew members will leave not only the physical environment of Earth but also work, family, social and interpersonal environments, networks, and resources in which they lived, while on Earth. As the Earth recedes, so will all the physical, professional, and personal resources on which the crew members grew and trained. As the Earth recedes further and further, the Earth will only be seen as another small dot in the blackness of space. To ameliorate these challenges, life scientists and aerospace medicine specialists are developing specific onboard systems. These will address inflight medical and environmental monitoring. Countermeasures to meet the physiological and psychological impact on cardiovascular, musculoskeletal, neurosensory, and other human systems will be integrated.[15],[16] Research over the last several decades has provided considerable data, leading to design and evaluation of appropriate systems to meet specific needs of various programs and mission profiles.

As indicated earlier, crews on the ISS and previous human spaceflight missions have been linked to the ground through a network that permits telemedicine commmnication to be established.[11],[12] This capability in LEO is synchronous (near real-time) as the bandwidth is available, and the distance for data to travel is unlike that seen in deep space travel. This permits interaction of the crew members and ground personnel to address health concerns.


 » Inflight Medical Capability Top


The medical system on the ISS is adequate to address a wide variety of the crew's needs. Each mission has a designated crew medical officer, medical kits have necessary medications, limited diagnostic tools, and the ability to support PMCs. Furthermore, the crew member and the flight surgeon interaction is supported by the telemedicine link and a network of ground-based subject matter experts in a synchronous mode.[17]

Although spaceflight can affect an individual in many ways, the focus in this communication is on performance and management of behavioral problems during long-duration flights.[9] Individuals, selected to fly in space, are chosen from a very select group of individuals through a set of international standards. This includes physical and mental health testing and evaluation.[18] The crew composition is done to match skills and individual personalities with mission objectives.[19],[20] Task selection and training are honed for each mission, with protocols for pre-flight as well as in-flight skill development and maintenance.


 » Telemedicine Capabilities Top


For crew members to be continuously monitored by ground-based medical personnel and their flight surgeons, a robust and secure communication link is a necessary requirement. This link provides the ability to support telemedicine and has been a key component of human spaceflight since the very first flight of a dog, sent into space in 1957.[11],[12] Synchronous communications permit remote monitoring and interactive PMCs. However, as the spacecraft continues to move beyond LEO, the delay in communications limits this capability. Although terrestrial medical care in some instances must be done in real-time, this is not possible in long-distance spaceflight.


 » Medical Support during Orbit Top


Medical care systems, deployed on the spacecraft over the past six decades, have evolved to meet the needs of crew members, the mission profile, the mission duration, and the capability of the crew. The systems are designed and deployed depending on the risk assessment, the available volume in the spacecraft, and the ability of the crew to respond to medical needs.[17] As spacecrafts have grown in size and complexity, more equipment and, more capability can be accommodated. The ISS has more space available than the capsules used previously to transport crews to the LEO, the Moon, or the ISS. The larger volume and the mission profile are key elements in determining what the medical system includes.[21]

In addition to the medical components of the system, other elements include environmental monitoring (water, air, and surfaces) and exercise countermeasures (treadmill, bicycle ergometer, resistive exercise, etc.).[19] These systems support the crew health and performance during the in-flight phase of spaceflight. The pre-flight selection, crew assignments, training, and work-rest schedules are all designed to support the overall mission objective (e.g., deployment of a satellite, construction of a system in space, conduct research, etc.).[18] In addition, the human spaceflight programs are also supported by a robust policy framework.[22]

The medical system contains the appropriate hardware, instruments, and medications to support the mission. The medications onboard support a variety of medical events and meet the crew's needs. Over the years, the formulary has changed because of the mission, the crew compliment, and the spacecraft. Longer duration missions to Mars will require smarter medical systems with greater crew autonomy.


 » Psychological Issues Top


Spaceflight affects human systems in many ways. The neurovestibular system is the first system that is affected when an individual reaches orbit.[23],[24] Almost all are affected by space motion sickness (SMS) in the first few days. SMS affects each individual differently. The condition, characterized by vertigo, nausea, fatigue, dizziness, and disorientation can be mild, moderate, or severe. Regardless of the discomfort level, it can affect crew performance. Once an individual has arrived in LEO, their physiology begins to adapt.[25]

Musculoskeletal, neurovestibular, ocular, and cardiovascular changes can affect crew health.[26],[27],[28],[29],[30],[31] Other changes include work/rest schedule, sleep shifting (sleep deprivation), changes in circadian rhythm, fatigue, food, hygiene, noise levels, social interaction, and sense of confinement and isolation. Understanding of these events is often anecdotal reported in crew diaries or books that crew members write after they have retired. Aside from private medical records, methodical evaluation of the crew members from a mental health perspective has not been conducted. Personal medical records are protected. However, the following are documented events that have occurred on the Mir Space Station.

  1. In 1997, with the American and Russian crew on board Mir, a solid fuel oxygen generator ignited, starting a fire in the Kvnat module of Mir. This event occurred during the six-member crew dinner. The crew responded by donning protective gear and extinguishing the fire. Communications with mission controllers in Russia were not synchronous and were deemed to be poor. This event had an immediate and post event impact on the crew [32]
  2. In July 1990, two Russian cosmonauts completed their assigned external repairs on Mir. They could not close the airlock door, forcing them to re-enter the space station at a different entry point. This event caused physical and mental exhaustion as the spacewalk took 2 h more than originally scheduled
  3. In June 1997, with the American and Russia crew onboard Mir, a progress resupply ship was being docked to the station. The Russian crewmember misinterpreted the distance of the vehicle and it collided with the Spektr module, causing an immediate rupture in the integrity of the module and a loss of pressure. This event caused the crew to rapidly egress the area and seal-off the damaged module, resulting in the spaceship itself spinning. The sudden loss of pressure and potential catastrophic outcomes impacted the crew.[33]


These illustrations demonstrate how even a well-trained crew can be pushed to their limits. They become physically and mentally exhausted. Each event could have resulted in a catastrophic failure. The immediate response and post-event analysis have served as useful scenarios in the subsequent system design and crew training. Asthenia can make the individual hypersensitive, irritable, and hypoactive. Some of these conditions can be managed with modifications to the work schedule and a synchronous dialogue with ground controllers.

Systems and protocols that have been developed, tested, and integrated into spaceflight are helpful. Historically, most individuals adapt in a relatively quick manner to the spaceflight environment. Adherence to countermeasure protocols assists in a normal physiologic and psychologic state upon return to Earth. In LEO, the crew members can interact with ground controllers, flight surgeons, family, and friends. As crews travel farther distances from Earth, they will become both more isolated and autonomous. Their behavior and performance will change. Crew members will have their vehicle, equipment, and other crew members as the only physical resources they can rely on. The physical and psychological environment will be continuously changing, requiring constant adaptation. Interactions with the ground will evolve. The crew commander's challenge to maintain the crew efficiency will have elements in common with Shackelton's phenomenal accomplishment in overcoming the loss of their ship Endeavour in the Antarctic in the early 20th century and the subsequent rescue of every member of the crew.[34]


 » Analogs Top


Analog environments can provide excellent testbeds but are limited in their ability to emulate the microgravity environment. Such environments include bedrest studies, submarines, expeditions to the Antarctic, and environments where participants are often isolated. There is a significant amount of research on isolation and responses from humans during extended stays in confined extreme environments.[35],[36] NASA has used the Antarctic as a research and technology testbed for more than 40 years from testing plant growth chambers to studying personal and group dynamics.[35] NASA has used the underwater habitat aquarius as a platform for ground-based research and training [Figure 4].[37],[38]
Figure 4: Aquarius habitat of the coast of the Ker Largo, Florida (courtesy of NASA)

Click here to view


The Russians built an analog system at the Institute for Biomedical Problems in Moscow, Russia. Called Mars 500, the facility provides crews an opportunity to live and work in isolation, emulating a long-duration mission to Mars.[38] Analog environments provide a unique terrestrial testbed for evaluating a variety of systems, technology, and protocols, as well as serve as a training area. A broad range of crew dynamics and medical preparedness have been studied in these environments.[20],[39],[40]


 » Future Medical Systems Top


The collective experience of all human spaceflight is in the region of the Earth and the Moon. Researchers and policymakers have begun to design medical care systems to support human exploration of Mars. Such systems will be autonomous and include artificial intelligence and an expanded formulary.[41],[42],[43],[44] As the experience base for exploration of Mars and other celestial sites evolves over the coming decades, concomitant with advances in medicine, the onboard medical care systems will also embrace new technologies and new treatment modalities.


 » Conclusions Top


Health and wellbeing of individuals in space are paramount to a mission's success. Historically, the systems that have been used to support in-flight medical issues have been linked to the ground through a telemedicine capability. As these individuals travel a great distance from the Earth, they will be isolated with no real-time communications. This implies that whatever health issues arise, the onboard systems must be able to support it. If it is not an emergency then Earth-based expertise can be provided.[43],[44],[45],[46],[47],[48],[49] The crew dynamics, as well as neurovestibular, and physiological and psychological challenges will occur and the experiential base we have today will lead us to new systems and approaches for tomorrow. The evidence of tomorrow will help us further develop and build smart medical systems to address those yet undiscovered challenges of long-duration, long-distance spaceflight.[47],[48],[49],[50],[51]

Acknowledgments

The men and women who fly in space and those who tirelessly support them from the ground.

Financial support and sponsorship

Nil.

Conflict of interest

The authors are all employed by NASA.



 
 » References Top

1.
Nicogossian AE, Doarn CR, Hu Y. Evolution of human capabilities and space medicine. In: Nicogossian A, Huntoon CL, Williams RS, Doarn CR, Schneider V, Polk JD, editors. Space Physiology and Medicine – From Evidence to Practice. 4th ed. New York: Springer; 2016. p. 3-57.  Back to cited text no. 1
    
2.
Charles JB, Pietrzyk RA. A year on the international space station: Implementing a long-duration biomedical research mission. Aerosp Med Hum Perform 2019;90:4-11.  Back to cited text no. 2
    
3.
Bacal K, Beck G, McSwain NE Jr. A concept of operations for contingency medical care on the international space station. Mil Med 2004;169:631-41.  Back to cited text no. 3
    
4.
Barratt M. Medical support for the international space station. Aviat Space Environ Med 1999;70:155-6.  Back to cited text no. 4
    
5.
Kanas N. Psychological and psychiatric issues in space. J Gravit Physiol 2002;9:307-10.  Back to cited text no. 5
    
6.
Sandal GM. Psychosocial issues in space: Future challenges. Gravit Space Biol Bull 2001;14:47-54.  Back to cited text no. 6
    
7.
Kanas N. Psychiatric issues affecting long duration space missions. Aviat Space Environ Med 1998;69:1211-6.  Back to cited text no. 7
    
8.
Williams DR. The biomedical challenges of space flight. Annu Rev Med 2003;54:245-56.  Back to cited text no. 8
    
9.
Baisden DL, Beven GE, Campbell MR, Charles JB, Dervay JP, Foster E, et al. Human health and performance for long-duration spaceflight. Aviat Space Environ Med 2008;79:629-35.  Back to cited text no. 9
    
10.
Eksuzian DJ. Psychological and behavioral healthissues of long-duration space missions. Life Support BiosphSci 1999;6:35-8.  Back to cited text no. 10
    
11.
Doarn CR, Nicogossian AE, Merrell RC. Applications of telemedicine in the United States space program. Telemed J 1998;4:19-30.  Back to cited text no. 11
    
12.
Nicogossian AE, Pober DF, Roy SA. Evolution of telemedicine in the space program and earth applications. Telemed J E Health 2001;7:1-15.  Back to cited text no. 12
    
13.
Buckey JC Jr. Preparing for Mars: The physiologic and medical challenges. Eur J Med Res 1999;4:353-6.  Back to cited text no. 13
    
14.
Cucinotta FA. Review of NASA approach to space radiation risk assessments for Mars exploration. Health Phys 2015;108:131-42.  Back to cited text no. 14
    
15.
Reschke MF, Clement G, Thorson SL, Harm DL, Mader TH, Dudely AM, et al. In: Nicogossian A, Huntoon CL, Williams RS, Doarn CR, Schneider V, Polk JD, editors. Space Physiology and Medicine – from Evidence to Practice. 4th ed. New York: Springer; 2016. p. 245-82.  Back to cited text no. 15
    
16.
Sipes WE, Polk JD, Beven G, Shepanek M. Behavioral health and performance. In: Nicogossian A, Huntoon CL, Williams RS, Doarn CR, Schneider V, Polk JD, editors. Space Physiology and Medicine – from Evidence to Practice. 4th ed. New York: Springer; 2016. p. 367-89.  Back to cited text no. 16
    
17.
Doarn CR, Williams RS, Schneider VS, Polk JD. Principles of crew health monitoring and care. In: Nicogossian A, Huntoon CL, Williams RS, Doarn CR, Schneider V, Polk JD, editors. Space Physiology and Medicine – from Evidence to Practice. 4th ed. New York: Springer; 2016. p. 393-421.  Back to cited text no. 17
    
18.
Bogomolov VV, Castrucci F, Comtois JM, Damann V, Davis JR, Duncan JM, et al. International space station medical standards and certification for space flight participants. Aviat Space Environ Med 2007;78:1162-9.  Back to cited text no. 18
    
19.
Landon LB, Slack KJ, Barrett JD. Teamwork and collaboration in long-duration space missions: Going to extremes. Am Psychol 2018;73:563-75.  Back to cited text no. 19
    
20.
Luger TJ, Stadler A, Gorur P, Terlevic R, Neuner J, Simonsen O, et al. Medical preparedness, incidents, and group dynamics during the analogMARS 2013 mission. Astrobiology 2014;14:438-50.  Back to cited text no. 20
    
21.
Gontcharov IB, Kovachevich IV, Pool SL, Navinkov AL, Barratt MR. Medical care system for NASA-Mir spaceflights. Aviat Space Environ Med 2002;73:1219-23.  Back to cited text no. 21
    
22.
Grigoriev AI, Williams RS, Comtois JM, Damann V, Tachibana SC, Nicogossian AE, et al. Space medicine policy development for the International Space Station. Acta Astronautica 2009;65:603-12.  Back to cited text no. 22
    
23.
Morita H, Abe C, Tanaka K. Long-term exposure to microgravity impairs vestibulo-cardiovascular reflex. Sci Rep 2016;6:33405.  Back to cited text no. 23
    
24.
Fujii MD. Patten BM. Neurology of microgravity and space travel. Neurol Clin 1992;10:999-1013.  Back to cited text no. 24
    
25.
Nicogossian AE, Williams RS, Huntoon CL, Doarn CR. Living and working in space: An overview of physiological adaptation, performance, and health risks. In: Nicogossian A, Huntoon CL, Williams RS, Doarn CR, Schneider V, Polk JD, editors. Space Physiology and Medicine – From Evidence to Practice. 4th ed. New York: Springer; 2016. p. 95-134.  Back to cited text no. 25
    
26.
Lee AG, Mader TH, Gibson CR, Brunstetter TJ, Tarver WJ. Space flight-associated neuro-ocular syndrome (SANS). Eye (Lond) 2018;32:1164-7.  Back to cited text no. 26
    
27.
Lee AG, Mader TH, Gibson CR, Tarver W. Space flight-associated neuro-ocular syndrome. JAMA Ophthalmol 2017;135:992-4.  Back to cited text no. 27
    
28.
Flynn CF. An operational approach to long-duration mission behavioral health and performance factors. Aviat Space Environ Med 2005;76:42-51.  Back to cited text no. 28
    
29.
Sipes WE, Vander Ark ST. Operational behavioral health and performance resources for international space station crews and families. Aviat Space Environ Med 2005;76:36-41.  Back to cited text no. 29
    
30.
Kim KJ, Gimmon Y, Sorathia S, Beaton KH, Schubert MC. Exposure to an extreme environment comes at a sensorimotor cost. NPJ Microgravity 2018;4:17.  Back to cited text no. 30
    
31.
Van Ombergen A, Demertzi A, Tomilovskaya E, Jeurissen B, Sijbers J, Kozlovskaya IB, et al. The effect of spaceflight and microgravity on the human brain. J Neurol 2017;264:18-22.  Back to cited text no. 31
    
32.
James JT. In: Nicogossian A, Huntoon CL, Williams RS, Doarn CR, Schneider V, Polk JD, editors. Space Physiology and Medicine – from Evidence to Practice. 4th ed. New York: Springer; 2016. p. 137-53.  Back to cited text no. 32
    
33.
Kanas N, Salnitskiy V, Grund EM, Weiss DS, Gushin V, Bostrom A, et al. Psychosocial issues inspace: Results from Shuttle/Mir. Gravit Space Biol Bull 2001;14:35-45.  Back to cited text no. 33
    
34.
Browning BW. Leadership in desperate times: An analysis of endurance: Shackleton's incredible voyage through the lens of leadership theory. Advanc Develop Hum Resour 2007;9:183-98.  Back to cited text no. 34
    
35.
Palinkas LA. Summary of research issues in behavior and performance inisolatedand confined extreme (ICE) environments. Aviat Space Environ Med 2000;71:48-50.  Back to cited text no. 35
    
36.
Lugg DJ. Behavioral health in Antarctica: Implications for long-duration space missions. Aviat Space Environ Med 2005;76:74-7.  Back to cited text no. 36
    
37.
Anglin KM, Kring JP. Lessons from a space analog on adaptation for long-duration exploration missions. Aerosp Med Hum Perform 2016;87:406-10.  Back to cited text no. 37
    
38.
Nicogossian AE, Williams DR, Williams RS, Schneider VS. atbIn: Nicogossian A, Huntoon CL, Williams RS, Doarn CR, Schneider V, Polk JD, editors. Space Physiology and Medicine – from Evidence to Practice. 4th ed. New York: Springer; 2016. p. 441-61.  Back to cited text no. 38
    
39.
Anderson AP, Fellows AM, Binsted KA, Hegel MT, Buckey JC. Autonomous, computer-based behavioral health countermeasure evaluation at HI-SEAS Mars analog. Aerosp Med Hum Perform 2016;87:912-20.  Back to cited text no. 39
    
40.
Mogilever NB, Zuccarelli L, Burles F, Iaria G, Strapazzon G, Bessone L, et al. Expedition cognition: A review and prospective of subterranean neuroscience with spaceflight applications. Front Hum Neurosci 2018;12:407.  Back to cited text no. 40
    
41.
Hamilton D, Smart K, Melton S, Polk JD, Johnson-Throop K. Autonomous medical care for exploration class space missions. J Trauma 2008;64:354-63.  Back to cited text no. 41
    
42.
Houtchens BA. Medical-care systems for long-duration space missions. Clin Chem 1993;39:13-21.  Back to cited text no. 42
    
43.
Cooke WH. Autonomic neural control and implications for remote medical monitoring in space. J Gravit Physiol 2007;14:43-6.  Back to cited text no. 43
    
44.
Friedman E, Bui B. A psychiatric formulary for long-duration spaceflight. Aerosp Med Hum Perform 2017;88:1024-33.  Back to cited text no. 44
    
45.
Gardner RM, Ostler DV, Nelson BD, Logan JS. The role of smart medical systems in the space station. Int J Clin Monit Comput 1989;6:91-8.  Back to cited text no. 45
    
46.
Doarn CR. Telemedicine in extreme environments: Analogs for space flight. Stud Health Technol Inform 2003;97:35-41.  Back to cited text no. 46
    
47.
Deming CA, Vasterling JJ. Workplace social support and behavioral health prior to long-duration spaceflight. Aerosp Med Hum Perform 2017;88:565-73.  Back to cited text no. 47
    
48.
Britt TW, Sytine A, Brady A, Wilkes R, Pittman R, Jennings K, et al. Enhancing the meaningfulness of work for astronauts on long duration spaceexploration missions. Aerosp Med Hum Perform 2017;88:779-83.  Back to cited text no. 48
    
49.
Landon LB, Slack KJ, Barrett JD. Teamwork and collaboration in long-duration space missions: Going to extremes. Am Psychol 2018;73:563-75.  Back to cited text no. 49
    
50.
Morris NP. Behavioral healthpolicy for human spaceflight. Aerosp Med Hum Perform 2018;89:1068-75.  Back to cited text no. 50
    
51.
Doarn CR, Williams D, Nicogossian AE, Williams RS. Medical care for a Mars transit mission and extended stay on the surface. J Cosmology 2010;12:3758-67.  Back to cited text no. 51
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow