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BACKGROUND: Board certification in aviation (and later aerospace) medicine was first approved through the American Board of Preventive Medicine (ABPM) in 1953 and has provided specialists to support all manner of flight programs. The aeromedical events and the associated lessons learned from human spaceflight are occasionally high profile but, more frequently and in keeping with the basis in preventive medicine, occur discretely and without widespread awareness. The practice of highquality preventive medicine has resulted in a stellar track record of mission support wherein primary medical events have very rarely resulted in mission impact. As commercial space opportunities increase and a wider range of health conditions become compatible with spaceflight, the training and certification provided by aerospace medicine training programs accredited by ABPM becomes increasingly important. OVERVIEW: No mandate for medical standards currently exists for certifying commercial astronauts for spaceflight. This freedom places significant responsibility on the individual spaceflight providers and their medical departments to practice in the best interest of their crewmembers, mission, company, and overall industry. A solid base as a clinician in a primary specialty and the augmented clinical capabilities provided by accredited training in aerospace medicine is a proven method to produce high quality operational flight surgeons capable of supporting all aeromedical aspects of commercial spaceflight. As commercial operations grow to include more international partners, the pathway to ABPM board certification or recognition of international equivalency becomes less of an obstacle to employment as compared to obtaining US licensure to practice. DISCUSSION: As human spaceflight grows to include more commercial operations, the current state of legislation and lack of binding medical standards makes aerospace board certification more important to the safe process of certifying crewmembers for commercial spaceflight and providing guidance on vehicle and mission design/support. It is unreasonable to assume the current training curriculums perfectly meet the needs of the industry but, as has been demonstrated over the past 70 years, the accredited training programs that produce board-certified flight surgeons are capable of adapting to meet the needs of the patient. Learning Objectives 1. The audience will learn about the practice of aerospace medicine and the value of board certification to commercial space companies. 2. The audience will learn about the history and evolution of accredited aerospace medical training over the past 70 years. [ABSTRACT FROM AUTHOR]

BACKGROUND: Commercial suborbital spaceflight has unique medical considerations given the short duration of training and flight, dynamic phases of flight, and the spaceflight participant (SFP) population. Astronaut screening paradigms are discussed specific to this mission set. OVERVIEW: We provide an overview of the medical screening process for prospective suborbital spaceflight participants, discuss risk assessment and mitigation for a variety of medical conditions and pharmaceutical agents, and lessons learned after a year of commercial spaceflight operations. We highlight challenges in attending to the physical, mental, and emotional health of crew, mission specialists, SFPs, and family, friends, and guests. DISCUSSION: Medical support for missions requires not only consideration of the physiological and medical implications of the spaceflight profile but also integrating operational support and risk mitigation for medical, psychological, and emotional needs through multidisciplinary collaboration with training, engineering, maintenance, customer operations, and commercial teams. Learning Objectives 1. The participant will learn about unique medical considerations for commercial suborbital spaceflight. 2. The participant will learn about multidisciplinary risk mitigation during commercial suborbital spaceflight. [ABSTRACT FROM AUTHOR]

Abstract: An 18-month-old male infant was placed on high-frequency oscillatory ventilation for profound hypoxemia and subsequently developed tension pneumoperitoneum. He underwent a bedside exploratory laparotomy for suspected perforated viscous. No intestinal perforation was identified, and a diagnosis of tension pneumoperitoneum secondary to pneumatosis cystoides intestinalis was made. To our knowledge, this is the only report of a pediatric patient developing tension pneumoperitoneum from high-frequency oscillatory ventilation. A review of the literature examines the differential diagnosis, physiology, and treatment of tension pneumoperitoneum. [Copyright &y& Elsevier]

Abstract: Catheter-related central venous thrombosis is a complication seen with long-term indwelling central venous catheters. The uses of total parenteral nutrition, catheter location, and duration of catheter use have been shown to increase the risk of thrombus formation. However, organized calcification of such a thrombus is a rare occurrence and, to our knowledge, has never been reported in a patient unexposed to total parenteral nutrition. We report a patient with an extensive, organized, calcified “cast” surrounding a central venous catheter used solely for chemotherapy administration. [Copyright &y& Elsevier]

The article reports on the surgical management of incidental adrenal Schwannomas in a 31-year-old female patient. The diagnostic procedure, a pathologic analysis of the surgical specimen, for identifying the benign tumor and an adherent normal right adrenal gland is discussed. The rarity of adrenal Schwannomas is noted.