ALBERT

Description: INTRODUCTION: There is limited data about the long-term pulmonary effects of nitrox use in divers at shallow depths. This study examined changes in pulmonary function in a cohort of working divers breathing a 46% oxygen enriched mixture while diving at depths less than 12 m. METHODS: A total of 43 working divers from the Neutral Buoyancy Laboratory (NBL), NASA-Johnson Space Center completed a questionnaire providing information on diving history prior to NBL employment, diving history outside the NBL since employment, and smoking history. Cumulative dive hours were obtained from the NBL dive-time database. Medical records were reviewed to obtain the diver's height, weight, and pulmonary function measurements from initial pre-dive, first year and third year annual medical examinations. RESULTS: The initial forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were greater than predicted, 104% and 102%, respectively. After 3 yr of diving at the NBL, both the FVC and FEV1 showed a significant (p 〈 0.01) increase of 6.3% and 5.5%, respectively. There were no significant changes in peak expiratory flow (PEF), forced mid-expiratory flow rate (FEF(25-75%)), and forced expiratory flow rates at 25%, 50%, and 75% of FVC expired (FEF25%, FEF50%, FEF75%). Cumulative NBL dive hours was the only contributing variable found to be significantly associated with both FVC and FEV1 at 1 and 3 yr. CONCLUSIONS: NBL divers initially belong to a select group with larger than predicted lung volumes. Regular diving with nitrox at shallow depths over a 3-yr period did not impair pulmonary function. Improvements in FVC and FEV1 were primarily due to a training effect.

Description: Extravehicular activity (EVA) is at the core of a manned space exploration program. Some elements of exploration may be safely and effectively performed by robots, but certain critical elements will require the trained, assertive, and reasoning mind of a human crewmember. To effectively use these skills, NASA needs a safe, effective, and efficient EVA component integrated into the human exploration program. The EVA preparation time should be minimized and the suit pressure should be low to accommodate EVA tasks without causing undue fatigue, physical discomfort, or suit-related trauma. Commissioned in 2005, the Exploration Atmospheres Working Group (EAWG) had the primary goal of recommending to NASA an internal environment that allowed efficient and repetitive EVAs for missions that were to be enabled by the former Constellation Program. At the conclusion of the EAWG meeting, the 8.0 psia and 32% oxygen (O2) environment were recommended for EVA-intensive phases of missions. After re-evaluation in 2012, the 8/32 environment was altered to 8.2 psia and 34% O2 to reduce the hypoxic stress to a crewmember. These two small changes increase alveolar O2 pressure by 11 mmHg, which is expected to significantly benefit crewmembers. The 8.2/34 environment (inspired O2 pressure = 128 mmHg) is also physiologically equivalent to the staged decompression atmosphere of 10.2 psia / 26.5% O2 (inspired O2 pressure = 127 mmHg) used on 34 different shuttle missions for approximately a week each flight. As a result of selecting this internal environment, NASA gains the capability for efficient EVA with low risk of decompression sickness (DCS), but not without incurring the additional negative stimulus of hypobaric hypoxia to the already physiologically challenging spaceflight environment. This report provides a review of the human health and performance risks associated with the use of the 8.2 psia / 34% O2 environment during spaceflight. Of most concern are the potential effects on the central nervous system (CNS), including increased intracranial pressure, visual impairment, sensorimotor dysfunction, and oxidative damage. Other areas of focus include validation of the DCS mitigation strategy, incidence and treatment of transient acute mountain sickness (AMS), development of new exercise countermeasure protocols, effective food preparation at 8.2 psia, assurance of quality sleep, and prevention of suit-induced injury. Although missions proposing to use an 8.2/34 environment are still years away, it is recommended that these studies begin early enough to ensure that the correct decisions pertaining to vehicle design, mission operational concepts, and human health countermeasures are appropriately informed.

Description: The Risk of Decompression Sickness (DCS) is identified by the NASA Human Research Program (HRP) as a recognized risk to human health and performance in space, as defined in the HRP Program Requirements Document (PRD). This Evidence Report provides a summary of the evidence that has been used to identify and characterize this risk. Given that tissue inert gas partial pressure is often greater than ambient pressure during phases of a mission, primarily during extravehicular activity (EVA), there is a possibility that decompression sickness may occur.

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.

Description: Decompression sickness (DCS) is a complex, multivariable problem. A mathematical description or model of the likelihood of DCS requires a large amount of quality research data, ideas on how to define a decompression dose using physical and physiological variables, and an appropriate analytical approach. It also requires a high-performance computer with specialized software. I have used published DCS data to develop my decompression doses, which are variants of equilibrium expressions for evolved gas plus other explanatory variables. My analytical approach is survival analysis, where the time of DCS occurrence is modeled. My conclusions can be applied to simple hypobaric decompressions - ascents lasting from 5 to 30 minutes - and, after minutes to hours, to denitrogenation (prebreathing). They are also applicable to long or short exposures, and can be used whether the sufferer of DCS is at rest or exercising at altitude. Ultimately I would like my models to be applied to astronauts to reduce the risk of DCS during spacewalks, as well as to future spaceflight crews on the Moon and Mars.

Description: A TBDM DCS probability model based on an existing biophysical model of inert gas bubble growth provides significant prediction and goodness-of-fit with 84 cases of DCS in 668 human altitude exposures. 2. Model predictions suggest that 15-minute O2 prebreathe protocols used in conjunction with suit ports and an 8.2 psi, 34% O2, 66% N2 atmosphere may enable rapid EVA capability for future exploration missions with the risk of DCS 12%. EVA could begin immediately at 6.0 psi, with crewmembers decreasing suit pressure to 4.3 psi after completing the 15-minute in-suit prebreathe. 3. Model predictions suggest that intermittent recompression during exploration EVA may reduce decompression stress by 1.8% to 2.3% for 6 hours of total EVA time. Savings in gas consumables and crew time may be accumulated by abbreviating the EVA suit N2 purge to 2 minutes (20% N2) compared with 8 minutes (5% N2) at the expense of an increase in estimated decompression risk of up to 2.4% for an 8-hour EVA. Increased DCS risk could be offset by IR or by spending additional time at 6 psi at the beginning of the EVA. Savings of 0.48 lb of gas and 6 minutes per person per EVA corresponds to more than 31 hours of crew time and 1800 lb of gas and tankage under the Constellation lunar architecture. 6. Further research is needed to characterize and optimize breathing mixtures and intermittent recompression across the range of environments and operational conditions in which astronauts will live and work during future exploration missions. 7. Development of exploration prebreathe protocols will begin with definition of acceptable risk, followed by development of protocols based on models such as ours, and, ultimately, validation of protocols through ground trials before operational implementation.

Description: No abstract available

Description: Exploration missions are expected to use variable pressure extravehicular activity (EVA) spacesuits as well as a spacecraft "exploration atmosphere" of 56.5 kPa (8.2 psia), 34% O2, both of which provide the possibility of reducing the oxygen prebreathe times necessary to reduce decompression sickness (DCS) risk. Previous modeling work predicted 8.4% DCS risk for an EVA beginning at the exploration atmosphere, followed by 15 minutes of in-suit O2 prebreathe, and 6 hours of EVA at 29.6 kPa (4.3 psia). In this study we model notional prebreathe protocols for a variable pressure suit where the exploration atmosphere is unavailable.

Description: Actual tissue nitrogen (N2) kinetics are complex; the uptake and elimination is often approximated with a single half-time compartment in statistical descriptions of denitrogenation [prebreathe(PB)] protocols. Air breaks during PB complicate N2 kinetics. A comparison of symmetrical versus asymmetrical N2 kinetics was performed using the time to onset of hypobaric decompression sickness (DCS) as a surrogate for actual venous N2 tension. METHODS: Published results of 12 tests involving 179 hypobaric exposures in altitude chambers after PB, with and without airbreaks, provide the complex protocols from which to model N2 kinetics. DCS survival time for combined control and airbreaks were described with an accelerated log logistic model where N2 uptake and elimination before, during, and after the airbreak was computed with a simple exponential function or a function that changed half-time depending on ambient N2 partial pressure. P1N2-P2 = (Delta)P defined decompression dose for each altitude exposure, where P2 was the test altitude and P1N2 was computed N2 pressure at the beginning of the altitude exposure. RESULTS: The log likelihood (LL) without decompression dose (null model) was -155.6, and improved (best-fit) to -97.2 when dose was defined with a 240 min half-time for both N2 elimination and uptake during the PB. The description of DCS survival time was less precise with asymmetrical N2 kinetics, for example, LL was -98.9 with 240 min half-time elimination and 120 min half-time uptake. CONCLUSION: The statistical regression described survival time mechanistically linked to symmetrical N2 kinetics during PBs that also included airbreaks. The results are data-specific, and additional data may change the conclusion. The regression is useful to compute additional PB time to compensate for an airbreak in PB within the narrow range of tested conditions.