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  • 1
    Publication Date: 2019-07-19
    Description: Musculoskeletal activity accelerates inert gas elimination during oxygen breathing prior to decompression (prebreathe), but may also promote bubble formation (nucleation) and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity are likely critical to the net effect. The NASA Prebreathe Reduction Program (PRP) combined oxygen prebreathe and exercise preceding a 4.3 psia exposure in non-ambulatory subjects (a microgravity analog) to produce two protocols now used by astronauts preparing for extravehicular activity - one employing cycling and non-cycling exercise (CEVIS: 'cycle ergometer vibration isolation system') and one relying on non-cycling exercise only (ISLE: 'in-suit light exercise'). Current efforts investigate whether light exercise normal to 1 G environments increases the risk of DCS over microgravity simulation.
    Keywords: Aerospace Medicine
    Type: JSC-CN-34708 , Aerospace Medical Association (AsMA) Annual Scientific Meeting: Human Performance and the Year of the Aerospace Medicine Professional; Apr 24, 2016 - Apr 28, 2016; Atlantic City, NJ; United States
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  • 2
    Publication Date: 2019-07-19
    Description: INTRODUCTION: Pressure, oxygen (O2), and time are the pillars to effective treatment of decompression sickness (DCS). The NASA DCS Treatment Model links a decrease in computed bubble volume to the resolution of a symptom. The decrease in volume is realized in two stages: a) during the Boyle's Law compression and b) during subsequent dissolution of the gas phase by the O2 window. METHODS: The cumulative distribution of 154 symptoms that resolved during repressurization was described with a log-logistic density function of pressure difference (deltaP as psid) associated with symptom resolution and two other explanatory variables. The 154 symptoms originated from 119 cases of DCS during 969 exposures in 47 different altitude tests. RESULTS: The probability of symptom resolution [P(symptom resolution)] = 1 / (1+exp(- (ln(deltaP) - 1.682 + 1.089AMB - 0.00395SYMPTOM TIME) / 0.633)), where AMB is 1 when the subject ambulated as part of the altitude exposure or else 0 and SYMPTOM TIME is the elapsed time in min from start of the altitude exposure to recognition of a DCS symptom. The P(symptom resolution) was estimated from computed deltaP from the Tissue Bubble Dynamics Model based on the "effective" Boyle's Law change: P2 - P1 (deltaP, psid) = P1V1/V2 - P1, where V1 is the computed volume of a spherical bubble in a unit volume of tissue at low pressure P1 and V2 is computed volume after a change to a higher pressure P2. V2 continues to decrease through time at P2, at a faster rate if 100% ground level O2 was breathed. The computed deltaP is the effective treatment pressure at any point in time as if the entire deltaP was just from Boyle's Law compression. DISCUSSION: Given the low probability of DCS during extravehicular activity and the prompt treatment of a symptom with options through the model it is likely that the symptom and gas phase will resolve with minimum resources and minimal impact on astronaut health, safety, and productivity.
    Keywords: Aerospace Medicine
    Type: 2014 Human Research Program Investigators'' Workshop; Nov 15, 2013; Galveston, TX; United States
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  • 3
    Publication Date: 2019-07-13
    Description: Ambulation imparts compressive and decompressive forces into the lower body, potentially creating quasi-stable micronuclei that influence the outcome of hypobaric depressurizations. Hypotheses: ambulation before the conclusion of a denitrogenation (prebreathe) protocol at 14.7 pounds per square inch absolute is not sufficient to increase the incidence of venous gas emboli (VGE) at 4.3 pounds per square inch absolute but is sufficient if performed after tissues become supersaturated with nitrogen at 4.3 pounds per square inch absolute.
    Keywords: Aerospace Medicine
    Type: JSC-CN-34472 , 2016 NASA Human Research Program Investigators'' Workshop; Feb 08, 2016 - Feb 11, 2016; Galveston, TX; United States
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  • 4
    Publication Date: 2019-07-13
    Description: INTRODUCTION. Some manufacturers of reduced oxygen (O2) breathing devices claim a comparable hypobaric hypoxia (HH) training experience by providing F(sub I) O2 〈 0.209 at or near sea level pressure to match the ambient O2 partial pressure (iso-pO2) of the target altitude. METHODS. Literature from investigators and manufacturers indicate that these devices may not properly account for the 47 mmHg of water vapor partial pressure that reduces the inspired partial pressure of O2 (P(sub I) O2). Nor do they account for the complex reality of alveolar gas composition as defined by the Alveolar Gas Equation. In essence, by providing iso-pO2 conditions for normobaric hypoxia (NH) as for HH exposures the devices ignore P(sub A)O2 and P(sub A)CO2 as more direct agents to induce signs and symptoms of hypoxia during acute training exposures. RESULTS. There is not a sufficient integrated physiological understanding of the determinants of P(sub A)O2 and P(sub A)CO2 under acute NH and HH given the same hypoxic pO2 to claim a device that provides isohypoxia. Isohypoxia is defined as the same distribution of hypoxia signs and symptoms under any circumstances of equivalent hypoxic dose, and hypoxic pO2 is an incomplete hypoxic dose. Some devices that claim an equivalent HH experience under NH conditions significantly overestimate the HH condition, especially when simulating altitudes above 10,000 feet (3,048 m). CONCLUSIONS. At best, the claim should be that the devices provide an approximate HH experience since they only duplicate the ambient pO2 at sea level as at altitude (iso-pO2 machines). An approach to reduce the overestimation is to at least provide machines that create the same P(sub I)O2 (iso-P(sub I)O2 machines) conditions at sea level as at the target altitude, a simple software upgrade.
    Keywords: Aerospace Medicine
    Type: JSC-CN-24704 , 83rd Annual Scientific Meeting of the Aerospace Medical Association; May 13, 2012 - May 17, 2012; Atlanta, GA; United States
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  • 5
    Publication Date: 2019-07-19
    Description: Musculoskeletal activity accelerates inert gas elimination during oxygen breathing prior to decompression (prebreathe), but may also promote bubble formation (nucleation) and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation are likely critical to the net effect. Understanding the relationships is important to evaluate exercise prebreathe protocols and quantify decompression risk in gravity and microgravity environments. The NASA Prebreathe Reduction Program (PRP) combined oxygen prebreathe and exercise preceding a low pressure (4.3 psia; altitude equivalent of 30,300 ft [9,235 m]) simulation exposure of non-ambulatory subjects (a microgravity analog) to produce two protocols now used by astronauts preparing for extravehicular activity. One protocol included both upright cycling and non-cycling exercise (CEVIS: 'cycle ergometer vibration isolation system') and one protocol relied on non-cycling exercise only (ISLE: 'in-suit light exercise'). CEVIS trial data serve as control data for the current study to investigate the influence of ambulation exercise in 1G environments on bubble formation and the subsequent risk of DCS.
    Keywords: Aerospace Medicine
    Type: JSC-CN-34877 , NASA Human Research Program Investigators'' Workshop (HRP IWS 2016); Feb 08, 2016 - Feb 11, 2016; Galveston, TX; United States
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  • 6
    Publication Date: 2019-07-19
    Description: Musculoskeletal activity has the potential to both improve and compromise decompression safety. Exercise enhances inert gas elimination during oxygen breathing prior to decompression (prebreathe), but it may also promote bubble nuclei formation (nucleation), which can lead to gas phase separation and bubble growth and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation may be critical to the net effect. Understanding the relationships is important to evaluate exercise prebreathe protocols and quantify decompression risk in gravity and microgravity environments. Data gathered during NASA's Prebreathe Reduction Program (PRP) studies combined oxygen prebreathe and exercise followed by low pressure (4.3 psi; altitude equivalent of 30,300 ft [9,235 m]) microgravity simulation to produce two protocols used by astronauts preparing for extravehicular activity. Both the Phase II/CEVIS (cycle ergometer vibration isolation system) and ISLE (in-suit light exercise) trials eliminated ambulation to more closely simulate the microgravity environment. The CEVIS results (35 male, 10 female) serve as control data for this NASA/Duke study to investigate the influence of ambulation exercise on bubble formation and the subsequent risk of DCS. METHODS Four experiments will replicate the CEVIS exercise-enhanced oxygen prebreathe protocol, each with a different exception. The first of these is currently underway. Experiment 1 - Subjects complete controlled ambulation (walking in place with fixed cadence and step height) during both preflight and at 4.3 psi instead of remaining nonambulatory throughout. Experiment 2 - Subjects remain non-ambulatory during the preflight period and ambulatory at 4.3 psi. Experiment 3 - Subjects ambulate during the preflight period and remain non-ambulatory at 4.3 psi. Experiment 4 - The order of heavy and light exercise employed in the CEVIS protocol is reversed, with the light exercise occurring first (subjects remain non-ambulatory throughout). Decompression stress is assessed with non-invasive ultrasound during each of 14 epochs of a 4 hour simulated spacewalk at 4.3 psi; aural Doppler is used to monitor bubbles (Spencer grade 0-IV scale) passing through the pulmonary artery, and two-dimensional echocardiographic imaging is used to look for left ventricular gas emboli (LVGE; the presence of which is a test termination criterion). Venous blood is collected at baseline and twice following repressurization to determine if the decompression stress is correlated with microparticles (cell fragments) accumulation. The plan is to test 25-50 subjects in each experiment. Fisher Exact Tests (one-tailed) are used to compare test and control groups. Trials are suspended when the DCS or grade IV VGE observations reach 70% confidence of DCS risk 〉15% and grade IV VGE risk 〉20%. RESULTS Experiment 1 was concluded with 20 complete trials (15 male, 5 female) since the statistical outcome would not change with five additional trials. The observed DCS was significantly greater in Experiment 1 than in CEVIS trials (4/20 [20%] vs. 0/45 [0%], respectively, p=0.007), as was the frequency of peak grade IV VGE (6/21 [29%; including one additional subject that presented grade IV VGE but whose trial was ended before completion when LVGE were observed] vs. 3/45 [7%], respectively, p=0.024). Experiment 3 trials are now underway, with 11 trials completed (10 male, 1 female). Preliminary results indicate no difference in observed DCS between Experiment 3 and CEVIS trials (1/11 [9%] vs. 0/45 [0%], respectively, p=0.196), or between Experiment 3 and Experiment 1 trials (p=0.405). The frequency of peak grade IV VGE in Experiment 3 (2/11 [18%]) did not differ from CEVIS or Experiment 1 trials (p=0.251 and p=0.425, respectively). Microparticle patterns are widely variable and still under analysis. DISCUSSION The results of the Experiment 1 trials support the thesis that decompression stress is increased by ambulation exercise, given the higher incidence of DCS and grade IV VGE when compared to the non-ambulatory PRP CEVIS trials. Experiment 3 trials are incomplete, but suggest that the effect of ambulation during ground level preflight oxygen breathing alone, when subjects are undersaturated with inert gas, may not differ in risk from ambulation at both preflight and spacesuit pressures, the latter when subjects are supersaturated with inert gas. Further trials are needed to confirm the relative effects of ambulation in undersaturated vs. supersaturated states and to determine whether light exercise facilitates the removal of heavy exercise-induced nucleation (Experiment 4).
    Keywords: Life Sciences (General); Aerospace Medicine
    Type: JSC-CN-32198 , 2015 Human Research Program Investigators Workshop; Jan 13, 2015 - Jan 15, 2015; Galveston, TX; United States
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  • 7
    Publication Date: 2019-08-13
    Description: Extravehicular activities (EVAs) at remote locations must maximize limited resources such as oxygen (O2) and also minimize the risk of decompression sickness (DCS). A proposed remote denitrogenation (prebreathe) protocol requires astronauts to live in a mildly hypoxic atmosphere at 8.2 psia while periodically performing EVAs at 4.3 psia. Empirical data are required to confirm that the protocol meets the current accept requirements: less than or equal to 15% incidence of Type I DCS, less than or equal to 20% incidence of Grade IV venous gas emboli (VGE), both at 95% statistical confidence, with no Type II DCS symptom during the validation trial. METHODS: A repeated measures statistical design is proposed in which groups of 6 subjects with physical characteristics similar to active-duty astronauts would first become equilibrated to an 8.2 psia atmosphere in a hypobaric chamber containing 34% O2 and 66% N2, over 48 h, and then perform 4 simulated EVAs at 4.3 psia over the next 9 days. In the equilibration phase, subjects undergo a 3-h 100% O2 mask prebreathe prior to and during a 5-min ascent to 8.2 psia to prevent significant tissue N2 supersaturation on reaching 8.2 psia. Masks would be removed once 34% O2 is established at 8.2 psia, and subjects would then equilibrate to this atmosphere for 48 h. The hypoxia is equivalent to breathing air at 1,220 meters (4,000 ft) altitude, just as was experienced in the shuttle 10.2 psia - 26.5% O2 staged denitrogenation protocol and the current ISS campout denitrogenation protocol. For simulated EVAs, each subject dons a mask and breathes 85% O2 and 15% N2 during a 3-min depressurization to 6.0 psia, holds for 15 min, and then completes a 3-min depressurization to 4.3 psia. The simulated EVA period starts when 6.0 psia is reached and continues for a total of 240 min (222 min at 4.3 psia). During this time, subjects will follow a prescribed repetitive activity against loads in the upper and lower body with mean metabolic rate approaching 1500 BTU/hr [378 kcal/hr (O2 consumption about 1.3 l(sub STPD)/min)] in ambulatory subjects. Noninvasive Doppler ultrasound bubble monitoring for VGE in the pulmonary artery will be performed on subjects by 2 Doppler Technicians at about 15 min intervals while at 4.3 psia. At the end of this period, a 15-min repressurization returns all subjects back to 8.2 psia and the cycle is repeated 3 additional times with a day of rest between simulated EVAs. RESULTS: With an assumed 1.5% probability of DCS [P(DCS)] and accounting for within-subject correlation, running the proposed study with 20 subjects has a 95% probability of meeting the accept criterion for DCS. But if the true probability of DCS is 3.0%, then 30 subjects would be needed to achieve about the same probability to meet our accept criterion. These results assume a standard deviation of 1.4 for the between-subjects random component of P(DCS) on a logit scale, which was estimated from a previous study.
    Keywords: Man/System Technology and Life Support
    Type: JSC-CN-32084 , 2015 Human Research Program Investigators'' Workshop: Integrated Pathways to Mars; Jan 13, 2015 - Jan 15, 2015; Galveston, TX; United States
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  • 8
    Publication Date: 2019-08-13
    Description: Musculoskeletal activity has the potential to both improve and compromise decompression safety. Exercise enhances inert gas elimination during oxygen breathing prior to decompression (prebreathe), but it may also promote bubble nuclei formation (nucleation), which can lead to gas phase separation and bubble growth and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation may be critical to the net effect. There are limited data available to evaluate cost-benefit relationships. Understanding the relationship is important to improve our understanding of the underlying mechanisms of nucleation in exercise prebreathe protocols and to quantify risk in gravity and microgravity environments. Data gathered during NASA's Prebreathe Reduction Program (PRP) studies combined oxygen prebreathe and exercise followed by low pressure (4.3 psi; altitude equivalent of 30,300 ft [9,235 m]) microgravity simulation to produce two protocols used by astronauts preparing for extravehicular activity. Both the Phase II/CEVIS (cycle ergometer vibration isolation system) and ISLE (in-suit light exercise) trials eliminated ambulation to more closely simulate the microgravity environment. The CEVIS results (35 male, 10 female) serve as control data for this NASA/Duke study to investigate the influence of ambulation exercise on bubble formation and the subsequent risk of DCS.
    Keywords: Aerospace Medicine
    Type: JSC-CN-29922 , 2014 NASA Human Research Program Investigators'' Workshop (HRP 2014); Feb 12, 2014 - Feb 13, 2014; Galveston, TX; United States
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  • 9
    Publication Date: 2019-08-13
    Description: No abstract available
    Keywords: Aerospace Medicine
    Type: JSC-CN-30558 , NASA Human Research Program Investigators Workshop (HRP 2014); Feb 12, 2014 - Feb 13, 2014; Galveston, TX; United States
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  • 10
    Publication Date: 2019-07-13
    Description: The availability of high-speed computers, data analysis software, and internet communication are compelling reasons to describe and make available computer databases from many disciplines. Methods: Human research using hypobaric chambers to understand and then prevent decompression sickness (DCS) during space walks has been conducted at the Johnson Space Center (JSC) from 1982 to 1998. The data are archived in the NASA Hypobaric Decompression Sickness Database, within an Access 2003 Relational Database. Results: There are 548 records from 237 individuals that participated in 31 unique tests. Each record includes physical characteristics, the denitrogenation procedure that was tested, and the outcome of the test, such as the report of a DCS symptom and the intensity of venous gas emboli (VGE) detected with an ultrasound Doppler bubble detector as they travel in the venous blood along the pulmonary artery on the way to the lungs. We documented 84 cases of DCS and 226 cases where VGE were detected. The test altitudes were 10.2, 10.1, 6.5, 6.0, and 4.3 pounds per square inch absolute (psia). 346 records are from tests conducted at 4.3 psia, the operating pressure of the current U.S. space suit. 169 records evaluate the Staged 10.2 psia Decompression Protocol used by the Space Shuttle Program. The mean exposure time at altitude was 242.3 minutes (SD = 80.6), with a range from 120 to 360 minutes. Among our test subjects, 96 records of exposures are females. The mean age of all test subjects was 31.8 years (SD = 7.17), with a range from 20 to 54 years. Discussion: These data combined with other published databases and evaluated with metaanalysis techniques would extend our understanding about DCS. A better understanding about the cause and prevention of DCS would benefit astronauts, aviators, and divers.
    Keywords: Aerospace Medicine
    Type: 79th Annual Scientific Meeting of the Aerospace Conference; May 11, 2008 - May 15, 2008; Boston, MA; United States
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