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First Reported Occurrence And Treatment Of Spaceflight Medical Risk On ISS, LSU

"Ultrasound examinations of the astronauts' internal jugular veins were performed at scheduled times in different positions during the mission. Results of the ultrasound performed about two months into the mission revealed a suspected obstructive left internal jugular venous thrombosis (blood clot) in one astronaut. The astronaut, guided in real time and interpreted by two independent radiologists on earth, performed a follow-up ultrasound, which confirmed the suspicion. ... The study was funded by the National Aeronautics and Space Administration under the Human Research Program (grant NNJ11ZSA002NA)."

Keith's note: When I lived at Everest Base Camp for a month at 17,600 ft in 2009 with astronaut Scott Parazynski I saw something serious like this happen almost daily. People came off the mountain in a bad way. Some came down in bags. I was on stretcher duty to the helo pad at one point. Indeed I suffered from extreme food poisoning and dehydration and have a permanent medical issue to this day as a direct result. I never heard anyone complain about the medical stuff since this is part of what it meant to be there. We all signed waivers. Alpine research continues to try and better understand all of the maladies that come with high altitude living and mountaineering and how to avoid and, if need be, treat them. Meanwhile people still climb.

This is going to be the same with the human exploration of space. You can reduce risks and be prepared for the worst and hopefully for some of the unexpected. But at the end of the day there is an embedded risk that has to be accepted. This instance may be the first case of diagnosing and treating a medical issue like this - remotely - while the patient is in space. It will not be the last.

While NASA to its credit has sought to reduce the risks of space travel, there is now a new player on the scene: Space Force - and as a branch of the military they have a different approach to dealing with risk. Interestingly the military can openly advertise recruitment of people to risk their lives for their country but NASA is prohibited by law from doing similar advertising and recruitment. It will be interesting to see how these two parallel approaches to human activities in space intersect and/or compete.

This government-funded biomedical research was conducted by government personnel on government employees on a government research facility. We should all be able to read about it. According to the LSU press release (NASA has published nothing about this that I know of) the link that they include (Venous Thrombosis during Spaceflight, New England Journal of Medicine) points to a page where you have to pay to read the full summary of the article. There is no link to the actual article. Yet if you know about the non-advertised/promoted NASA PubSpace service you can search for the title and find an open access version of the paper (which was actually published a month and a half ago).

This research was mentioned in the NASA Spaceline Current Awareness List #875 22 November 2019 (Space Life Science Research Results) (see item #4) which links to this summary on NCBI's PubMed (where the nation's biomedical research is collected) which, in turn, links to the open access article. But you have to dig to find this resource since, as is the case with PubSpace, NASA and CASIS make little effort to tell you about it. FWIW we have a full Spaceline archive back to 1996. NASA only has an archive online that goes back to 2003).

NASA regularly gets open access for planetary science results and puts that in press releases. The same should be done for biomedical research. HEOMD, SMD, and PAO need to talk to each other as to how to get more of this science out to the people who paid for it. NASA was required by law to create PubSpace. It has also had Spaceline online since 1996. Yet NASA goes out of its way not to tell people that these resources exist. The only way that NASA is going to get everyone on the same page when it comes to understanding the risks of spaceflight and what research is being done on ISS to mitigate these risks is get itself on the same page and use the resources it has at hand. This is an important piece of research. NASA should have been talking about it in November 2019 not letting it sneak out in a university press release over the holidays.

Keith's note: Speaking as someone who did graduate research in gravitational biology and who worked at NASA Headquarters and elsewhere as a space life scientist, I am quite interested in the adaptations of life to prolonged exposure to conditions on the Moon. I am certain that there are changes in living systems in fractional gravity wherein changes in genomic expression can be measured. We've seen it in humans and other organisms exposed to microgravity in spaceflight and centrifugation (simulated hypergravity) on Earth. Alas, to date, the vast bulk of research where changes in gene expression are studied have to do with microgravity - not lunar or martian gravity.

Its nice to know that someone at NASA Gene Lab is paying attention to the news regarding Artemis and Moon2024. But the suggestion in this tweet that they might have anything relevant to 0.16G biology at this time is probably tenuous, at best. Indeed, a simple key word search of their website for "lunar" and "moon" shows this to be the case. But at least they are stepping up to the plate - which is good. A look at the NASA Space Station and CASIS websites shows no mention of Artemis or Moon2024.

One would hope that NASA would have an integrated strategy for such research that spans Earth- and space-based facilities. Right now its more like competing fiefdoms within NASA's sphere of funding influence rather than an overall, integrated program with clear goals directly related to operational as well as fundamental science. If preparatory work is needed to enable safe human operations and other life forms in lunar gravity to support the Artemis program (which is going to start up on the lunar surface in 2024) NASA should have already have enabling research under way. Instead it has a scattered collection of things. Someone needs to bring order to this disarray and create an integrated program of space biology and medicine at NASA so as to flight certify humans and other forms of life for prolonged exposure to other worlds. And this integrated program needs to be able to provide useful information in time to actually inform NASA mission planners - not after the fact.


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