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CMSSF provides updates, emphasizes Guardian Experience during SFA
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By Space Force
The Department of Air Force updated a medical guidance memorandum, Jan. 24, 2025, to offer healthcare providers additional guidance when evaluating Airmen and Guardians for a Pseudofolliculitis Barbae (PFB) diagnosis.
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By Space Force
Mission Delta 31 is committed to developing its people through the Guardian and Airmen Development Program, fostering a new generation of leaders for the U.S. Space Force.
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By Space Force
CMSSF Bentivegna visited Colorado and met with two groups of USSF senior noncomissioned officers to discuss their evolving roles in the USSF.
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By NASA
6 min read
Preparations for Next Moonwalk Simulations Underway (and Underwater)
In-person participants L-R standing: Dave Francisco, Joanne Kaouk, Dr. Richard Moon, Dr. Tony Alleman, Dr. Sean Hardy, Sarah Childress, Kristin Coffey, Dr. Ed Powers, Dr. Doug Ebersole, Dr. Steven Laurie, Dr. Doug Ebert; L-R seated: Dr. Alejandro Garbino, Dr. Robert Sanders, Dr. Kristi Ray, Dr. Mike Gernhardt, Dr. Joseph Dervay, Dr. Matt Makowski). Not pictured: Dr. Caroline Fife In June 2024, the NASA Office of the Chief Health and Medical Officer (OCHMO) Standards Team hosted an independent assessment working group to review the status and progress of research and clinical activities intended to mitigate the risk of decompression sickness (DCS) related to patent foramen ovale (PFO) during spaceflight and associated ground testing and human subject studies.
Decompression sickness (DCS) is a condition which results from dissolved gases (primarily nitrogen) forming bubbles in the bloodstream and tissues. It is usually experienced in conditions where there are rapid decreases in ambient pressure, such as in scuba divers, high-altitude aviation, or other pressurized environments. The evolved gas bubbles have various physiological effects and can obstruct the blood vessels, trigger inflammation, and damage tissue, resulting in symptoms of DCS. NASA presently classifies DCS into two categories: Type I DCS, which is less severe, typically leads to musculoskeletal symptoms including pain in the joints or muscles, or skin rash. Type II DCS is more severe and commonly results in neurological, inner ear, and cardiopulmonary symptoms. The risk of DCS in spaceflight presents during extravehicular activities (EVAs) in which astronauts perform mission tasks outside the spaceflight vehicle while wearing a pressurized suit at a lower pressure than the cabin pressure. DCS mitigation protocols based on strategies to reduce systemic nitrogen load are implemented through the combination of habitat environmental parameters, EVA suit pressure, and breathing gas procedures (prebreathe protocols) to achieve safe and effective mission operations. The pathophysiology of DCS has still not been fully elucidated since cases occur despite the absence of detected gas bubbles but includes right to left shunting of venous gas emboli (VGE) via several potential mechanisms, one of which is a Patent Foramen Ovale (PFO).
From: Dr. Schochet & Dr. Lie, Pediatric Pulmonologists
Reference OCHMO-TB-037 Decompression Sickness (DCS) Risk Mitigation technical brief for additional information.
A PFO is a shunt between the right atrium and the left atrium of the heart, which is a persisting remnant of a physiological communication present in the fetal heart. Post-natal increases in left atrial pressure usually force the inter-septal valve against the septum secundum and within the first 2 years of life, the septae permanently fuse due to the development of fibrous adhesions. Thus, all humans are born with a PFO and approximately 75% of PFOs fuse following childbirth. For the 25% of the population’s whose PFOs do not fuse, ~6% have what is considered by some to be a large PFO (> 2 mm). PFO diameter can increase with age. The concern with PFOs is that with a right to left shunt between the atria, venous emboli gas may pass from the right atrium (venous) to the left atrium (arterial) (“shunt”), thus by-passing the normal lung filtration of venous emboli which prevent passage to the arterial system. Without filtration, bubbles in the arterial system may lead to a neurological event such as a stroke. Any activity that increases the right atrium/venous pressure over the left atrium/arterial pressure (such as a Valsalva maneuver, abdominal compression) may further enable blood and/or emboli across a PFO/shunt.
From: Nuffield Department of Clinical Neurosciences
The purpose of this working group was to review and provide analysis on the status and progress of research and clinical activities intended to mitigate the risk of PFO and DCS issues during spaceflight. Identified cases of DCS during NASA exploration atmosphere ground testing conducted in pressurized chambers led to the prioritization of the given topic for external review. The main goals of the working group included:
Quantification of any increased risk associated with the presence of a PFO during decompression protocols utilized in ground testing and spaceflight EVAs, as well as unplanned decompressions (e.g., cabin depressurization, EVA suit leak). Describe risks and benefits of PFO screening in astronaut candidates, current crewmembers, and chamber test subjects. What are potential risk reduction measures that could be considered if a person was believed to be at increased risk of DCS due to a PFO? What research and/or technology development is recommended that could help inform and/or mitigate PFO-related DCS risk? The working group took place over two days at NASA’s Johnson Space Center and included NASA subject matter experts and stakeholders, as well as invited external reviewers from areas including cardiology, hypobaric medicine, spaceflight medicine, and military occupational health. During the working group, participants were asked to review past reports and evidence related to PFOs and risk of DCS, materials and information regarding NASA’s current experience and practices, and case studies and subsequent decision-making processes. The working group culminated in an open-forum discussion where recommendations for current and future practices were conferred and subsequently summarized in a final summary report, available on the public NASA OCHMO Standards Team website.
The following key findings are the main take-aways from the OCHMO independent assessment:
In an extreme exposure/high-risk scenario, excluding individuals with a PFO and treating PFOs does not necessarily decrease the risk of DCS or create a ‘safe’ environment. It may create incremental differences and slightly reduce overall risk but does not make the risk zero. There are other physiological factors that also contribute to the risk of DCS that may have a larger impact (see 7.0 Other Physiological Factors in the findings section). Based on the available evidence and the risk of current decompression exposures (based on current NASA protocols and NASA-STD-3001 requirements to limit the risk of DCS), it is not recommended to screen for PFOs in any spaceflight or ground testing participants. The best strategy to reduce the risk of DCS is to create as safe an environment as possible in every scenario, through effective prebreathe protocols, safety, and the capability to rapidly treat DCS should symptoms occur. Based on opinion, no specific research is required at this time to further characterize PFOs with DCS and altitude exposure, due to the low risk and preference to institute adequate safe protocols and ensuring treatment availability both on the ground and in spaceflight. For engineering protocols conducted on the ground, it should be ensured that the same level of treatment capability (treatment chamber in the immediate vicinity of the testing) is provided as during research protocols. The ability to immediately treat a DCS case is critical in ensuring the safety of the test subjects. The full summary report includes detailed background information, discussion points from the working group, and conclusions and recommendations. The findings from the working group and resulting summary report will help to inform key stakeholders in decision-making processes for future ground testing and spaceflight operations with the main goal of protecting crew health and safety to ensure overall mission success.
Summary Report About the Author
Sarah D. Childress
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Last Updated Dec 31, 2024 Related Terms
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By NASA
Humans are returning to the Moon—this time, to stay. Because our presence will be more permanent, NASA has selected a location that maximizes line-of-sight communication with Earth, solar visibility, and access to water ice: the Lunar South Pole (LSP). While the Sun is in the lunar sky more consistently at the poles, it never rises more than a few degrees above the horizon; in the target landing regions, the highest possible elevation is 7°. This presents a harsh lighting environment never experienced during the Apollo missions, or in fact, in any human spaceflight experience. The ambient lighting will severely affect the crews’ ability to see hazards and to perform simple work. This is because the human vision system, which despite having a high-dynamic range, cannot see well into bright light and cannot adapt quickly from bright to dark or vice versa. Functional vision is required to perform a variety of tasks, from simple tasks (e.g., walking, operating simple tools) through managing complex machines (e.g., lander elevator, rovers). Thus, the environment presents an engineering challenge to the Agency: one that must be widely understood before it can be effectively addressed.
In past NASA missions and programs, design of lighting and functional vision support systems for extravehicular activity (EVA) or rover operations have been managed at the lowest program level. This worked well for Apollo and low Earth orbit because the Sun angle was managed by mission planning and astronaut self-positioning; helmet design alone addressed all vision challenges. The Artemis campaign presents new challenges to functional vision, because astronauts will be unable to avoid having the sun in their eyes much of the time they are on the lunar surface. This, combined with the need for artificial lighting in the extensive shadowing at the LSP, means that new functional vision support systems must be developed across projects and programs. The design of helmets, windows, and lighting systems must work in a complementary fashion, within and across programs, to achieve a system of lighting and vision support that enables crews to see into darkness while their eyes are light-adapted, in bright light while still dark-adapted, and protects their eyes from injury.
Many of the findings of the assessment were focused on the lack of specific requirements to prevent functional vision impairment by the Sun’s brilliance (which is different from preventing eye injury), while enabling astronauts to see well enough to perform specific tasks. Specifically, tasks expected of astronauts at the LSP were not incorporated into system design requirements to enable system development that ensures functional vision in the expected lighting environment. Consequently, the spacesuit, for example, has flexibility requirements for allowing the astronauts to walk but not for ensuring they can see well enough to walk from brilliant Sun into a dark shadow and back without the risk of tripping or falling. Importantly, gaps were identified in allocation of requirements across programs to ensure that the role of the various programs is for each to understand functional vision. NESC recommendations were offered that made enabling functional vision in the harsh lighting environment a specific and new requirement for the system designers. The recommendations also included that lighting, window, and visor designs be integrated.
The assessment team recommended that a wide variety of simulation techniques, physical and virtual, need to be developed, each with different and well-stated capabilities with respect to functional vision. Some would address the blinding effects of sunlight at the LSP (not easily achieved through virtual approaches) to evaluate performance of helmet shields and artificial lighting in the context of the environment and adaptation times. Other simulations would add terrain features to identify the threats in simple (e.g., walking, collection of samples) and complex (e.g., maintenance and operation of equipment) tasks. Since different facilities have different strengths, they also have different weaknesses. These strengths and limitations must be characterized to enable verification of technical solutions and crew training.
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