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Space radiation research has progressed rapidly in recent years, but there remain large uncertainties in predicting and extrapolating biological responses to humans. Exposure to cosmic radiation and Solar Particle Events may pose a critical health risk to future spaceflight crews and can have a serious impact to all biomedical aspects of space exploration. The relatively minimal shielding of the cancelled 1960's Manned Orbiting Laboratory program's space vehicle and the high inclination polar orbits would have left the crew susceptible to high exposures of cosmic radiation and high dose-rate SPEs that are mostly unpredictable in frequency and intensity. In this study, we have modeled the nominal and off-nominal radiation environment that a MOL-like spacecraft vehicle would be exposed to during a 30-day mission using high performance, multi-core computers. Projected doses from a historically large SPE (e.g. the August 1972 solar event) have been analyzed in the context of the MOL orbit profile, providing an opportunity to study its impact to crew health and subsequent contingencies.It is reasonable to presume that future commercial, government, and military spaceflight missions in low-Earth orbit will have vehicles with similar shielding and orbital profiles. Studying the impact of cosmic radiation to the mission's operational integrity and the health of MOL crewmembers provides an excellent surrogate and case-study for future commercial and military spaceflight missions., Comment: 6 pages, 4 figures, 2 tables

Before Apollo fire, early Apollo missions were expected to continue pattern established in Gemini program of accommodating significant scientific and biological experimentation, including human biomedical studies, during flights. Apollo1 and Apollo2, both 2-week engineering test flights, were to carry almost as many biomedical studies as Gemini 7, a 2-week medical test mission.

Effective use of the unique capabilities of the International Space Station (ISS) for risk reduction on future deep space missions involves preliminary work in analog environments to identify and evaluate the most promising techniques, interventions and treatments. This entails a consolidated multinational approach to biomedical research both on ISS and in ground analogs. The Multilateral Human Research Panel for Exploration (MHRPE) was chartered by the five ISS partners to recommend the best combination of partner investigations on ISS for risk reduction in the relatively short time available for ISS utilization. MHRPE will also make recommendations to funding agencies for appropriate preparatory analog work. In 2011, NASA's Human Research Program (HRP) and the Institute of Biomedical Problems (IBMP) of the Russian Academy of Science, acting for MHRPE, developed a joint US-Russian biomedical program for the 2015 one-year ISS mission (1YM) of American and Russian crewmembers. This was to evaluate the possibilities for multilateral research on ISS. An overlapping list of 16 HRP, 9 IBMP, 3 Japanese, 3 European and 1 Canadian investigations were selected to address risk-reduction goals in 7 categories: Functional Performance, Behavioral Health, Visual Impairment, Metabolism, Physical Capacity, Microbial and Human Factors. MHRPE intends to build on this bilateral foundation to recommend more fully-integrated multilateral investigations on future ISS missions commencing after the 1YM. MHRPE has also endorsed an on-going program of coordinated research on 6-month, one-year and 6-week missions ISS expeditions that is now under consideration by ISS managers. Preparatory work for these missions will require coordinated and collaborative campaigns especially in the psychological and psychosocial areas using analog isolation facilities in Houston, Köln and Moscow, and possibly elsewhere. The multilateral Human Analogs research working group (HANA) is the focal point of those planning discussions, with MHRPE coordinating between the national programs and then supporting implementation on ISS. Experience gained during preparations for the 1YM has identified improvements in both American and Russian processes to enable well-integrated investigations on all subsequent ISS expeditions. Among those is that the greatest efficiency is to be gained with investigations that are fully integrated from their conception, with co-principal investigators, a consolidated proposal and integrated plans for crewmember time and other flight-related resources. Analog investigations preceding future ISS expeditions will employ these lessons in efficiency to evaluate the techniques and tools to be validated aboard ISS. In this way, the resources and capabilities of ISS can be applied most efficiently to solving the problems facing astronauts of all nations in missions deep into the solar system.

Weightlessness during spaceflight causes cephalad redistribution of intravascular and extravascular fluid, provoking cardiovascular and autonomic nervous system adaptations. The resulting functional state is appropriate for weightlessness but can result in orthostatic hypotension and intolerance during and after return to a persistent acceleration or gravitational environment. Lower body negative pressure (LBNP) applies subambient air pressure to the legs and lower abdomen inside a volume sealed at the waist, and decompression by 40‐50 mmHg reverses the spaceflight‐induced cephalad shift. LBNP has been used both to test the state of cardiovascular system during spaceflight and as a countermeasure by all space‐faring nations. Two configurations have thus far been used in spaceflight since the first LBNP flew on the first Soviet Salyut station in 1971. The Soviet and Russian configuration, used in four Salyut stations, the Mir space station and the Russian segment of the International Space Station, has no saddle to support the body so during decompression the feet press against the bottom of the collapsible chamber which shortens and applies force against the feet proportional to the decompression level. Thus, activation of the skeletal musculature partially counteracts vascular and venous pooling in the enclosed body segments, stimulating the orthostatic compensatory mechanisms as they would be standing on Earth. In the American configuration, used aboard Skylab and the Space Shuttle, a saddle supported the astronaut so the feet did not contact the bottom of the chamber, and vascular engorgement was not countered by muscular contraction. This minimized skeletal muscle involvement, unmasked vascular compensatory mechanisms for research purposes, and allowed measurements of changes in leg volume and muscle sympathetic nerve activity. Both variants have demonstrated research and therapeutic value in appropriately designed protocols. LBNP continues to be used for research and countermeasures on ISS, and future versions may explore the value of exercise during LBNP as an integrated countermeasure. This paperwill review the history and development of LBNP for spaceflight research and therapeutic purposes.

The One Year Mission (1YM) by two astronauts on the International Space Station (ISS), starting in March 2015, offers a unique opportunity to expand multilateral collaboration by sharing data and resources among the partner agencies in preparation for planned space exploration missions beyond low Earth orbit. Agreements and protocols will be established for the collection, distribution, analysis and reporting of both research and clinical data. Data will be shared between the agencies sponsoring the investigators, and between the research and clinical medicine communities where common interests are identified. The assignment of only two astronauts, one Russian and the other American, to the 1YM necessitated creativity in bilateral efforts to maximize the biomedical return from the opportunity. Addition of Canadian, European and Japanese investigations make the effort even more integrative. There will be three types of investigations: joint, cross‐participation and data‐exchange. The joint investigations have US and Russian coprincipal investigators, and the data acquired will be their common responsibility. The other two types must develop data sharing agreements and processes specific to their needs. A multilateral panel of ISS partner space agencies will develop policies for international exchange of scientific information to meet their science objectives and priorities. They will promote archiving of space flight data and will inform each other and the scientific community at large about the results obtained from space life sciences studies. Integration tasks for the 1YM are based on current experience from the ISS and previous efforts on the Russian space station Mir. Closer coordination between international partners requires more common approaches to remove barriers to multilateral resource utilization on the ISS. Greater integration in implementation should increase utilization efficiency to benefit all participants in spaceflight human research. This presentation will describe the overarching principles for multilateral data collection, analysis and sharing and for data security for medical and research data shared between ISS partners prior to release in public forums.

The technique of neutral buoyancy during water immersion was applied to a variety of questions pertaining to human performance factors in the early years of the space age. It was independently initiated by numerous aerospace contractors at nearly the same time, but specific applications depended on the problems that the developers were trying to solve. Those problems dealt primarily with human restraint and maneuverability and were often generic across extravehicular activity (EVA) and intravehicular activity (IVA) worksites. The same groups often also considered fractional gravity as well as weightless settings and experimented with ballasting to achieve lunar and Mars-equivalent loads as part of their on-going research and development. Dr. John Charles reviewed the association of those tasks with contemporary perceptions of the direction of NASA's future space exploration activities and with Air Force assessments of the military value of man in space.

An attempt to clarify some vague memories of underwater studies of astronaut capabilities in space led Dr. John Charles to become acquainted with Sam Mattingly, one of the pioneers in the field, and to greater insights into Mattingly's work simulating Gemini EVAs in the mid-1960s. Charles recounted major accomplishments by Environmental Research Associates (ERA), Mattingly's company for contracting with NASA Langley on several early studies. ERA's work was considered within the context of contemporary efforts to simulate weightlessness and the widespread development of neutral buoyancy facilities after ERA's successful demonstration for Gemini 12.

Astronaut missions lasting up to six months aboard the International Space Station (ISS) have much in common with interplanetary flights, especially the outbound, Earth-to-Mars transit portion of a Mars mission. Utilization of ISS and other appropriate platforms to prepare for crewed expeditions to planetary destinations including Mars has been the work of NASA's Human Research Program (HRP) since 2005. HRP is charged specifically to understand and reduced the risks to astronaut health and performance in space exploration missions: everything HRP does and has done is directly related to that responsibility. Two major categories of human research have capitalized on ISS capabilities. The first category centers on the biomedical aspects of long-duration exposure to spaceflight factors, including prolonged weightlessness, radiation exposure, isolation and confinement, and actual risk to life and limb. These studies contribute to astronaut safety, health and efficiency on any long-duration missions, whether in low Earth orbit (LEO) or beyond. Qualitatively, weightlessness is weightlessness, whether in LEO or en route to Mars. The HRP sponsors investigations into losses in muscle and bone integrity, cardiovascular function, sensory-motor capability, immune capacity and psychosocial health, and development and demonstration of appropriate treatments and preventative measures. The second category includes studies that are focused on planetary expeditions beyond LEO. For these, ISS offers a high fidelity analog to investigate the combined effects of spaceflight factors (described above) plus the isolation and autonomy associated with simulated increasing distance from Earth. Investigations address crew cohesion, performance and workload, and mission control performance. The behavioral health and performance and space human factors aspects of planetary missions dominate this category. Work has already begun on a new investigation in this category which will examine the effects of a simulated lag in communications (mimicking that expected in transit to Mars) on astronaut performance aboard ISS. Extension of the current ISS increment duration from six months to nine or even twelve months would provide opportunities for expanded research relevant to long duration missions, albeit at the cost of fewer astronauts as subjects for those investigations. Given the possible limited access to ISS after 2020, if ISS is intended to facilitate future exploration missions, then the in-flight human investigations should focus on those that clearly enable future exploration missions.

Early on, bed rest was recognized as a method for inducing many of the physiological changes experienced by spaceflight. Head-down tilt (HDT) bed rest was first introduced as an analog for spaceflight by a Soviet team led by Genin and Kakurin. Their study was performed in 1970 (at -4 degrees) and lasted for 30 days; results were reported in the Russian Journal of Space Biology (Kosmicheskaya Biol. 1972; 6(4): 26-28 & 45-109). The goal was to test physiological countermeasures for cosmonauts who would soon begin month-long missions to the Salyut space station. HDT was chosen to produce a similar sensation of blood flow to the head reported by Soyuz cosmonauts. Over the next decade, other tilt angles were studied and comparisons with spaceflight were made, showing that HDT greater than 4 degrees was superior to horizontal bed rest for modeling acute physiological changes observed in space; but, at higher angles, subjects experienced greater discomfort without clearly improving the physiological comparison to spaceflight. A joint study performed by US and Soviet investigators, in 1979, set the goal of standardization of baseline conditions and chose 6-degrees HDT. This effectively established 6-degree HDT bed rest as the internationally-preferred analog for weightlessness and, since 1990, nearly all further studies have been conducted at 6-degrees HDT. A thorough literature review (1970-2010) revealed 534 primary scientific journal articles which reported results from using HDT as a physiological analog for spaceflight. These studies have ranged from as little as 10 minutes to the longest duration of 370 days. Long-term studies lasting four weeks or more have resulted in over 170 primary research articles. Today, the 6-degree HDT model provides a consistent, thoroughly-tested, ground-based analog for spaceflight and allows the proper scientific controls for rigorous testing of physiological countermeasures; however, all models have their strengths and limits. The 6-degrees HDT model must continue to be scrutinized, re-examined, validated and compared to other analog environments whenever possible. Only by understanding the strengths and limits of this model, will it continue to serve as a critical physiological analog to spaceflight for many more years to come.

This poster paper reviews the Astronaut health and performance issues for a Near Earth Asteroid (NEA) mission. Risks and other considerations are grouped into four categories and they are characterized for criticality.

The advent of the Space Shuttle era elevated cardiovascular deconditioning from a research topic in gravitational physiology to a concern with operational consequences during critical space mission phases. NASA has identified three primary cardiovascular risks associate with short-duration (less than 18 d) spaceflight: orthostatic intolerance; decreased maximal oxygen uptake; and cardiac arrhythmias. Orthostatic hypotension (OH) was observed postflight in Mercury astronauts, studied in Gemini and Apollo astronauts, and tracked as it developed in-flight during Skylab missions. A putative hypotensive episode in the pilot during an early shuttle landing, and well documented postflight hypotension in a quarter of crewmembers, catalyzed NASA's research effort to understand its mechanisms and develop countermeasures. Shuttle investigations documented the onset of OH, tested mechanistic hypotheses, and demonstrated countermeasures both simple and complex. Similarly, decreased aerobic capacity in-flight threatened both extravehicular activity and post-landing emergency egress. In one study, peak oxygen uptake and peak power were significantly decreased following flights. Other studies tested hardware and protocols for aerobic conditioning that undergird both current practice on long-duration International Space Station (ISS) missions and plans for interplanetary expeditions. Finally, several studies suggest that cardiac arrhythmias are of less concern during short-duration spaceflight than during long-duration spaceflight. Duration of the QT interval was unchanged and the frequency of premature atrial and ventricular contractions was actually shown to decrease during extravehicular activity. These investigations on short-duration Shuttle flights have paved the way for research aboard long-duration ISS missions and beyond. Efforts are already underway to study the effects of exploration class missions to asteroids and Mars.

This slide presentation reviews some of the health and performance issues for an manned exploration mission to some of the Near Earth Asteroids (NEA). The issues that NASA is reviewing are: 1. Radiation exposure 2. Inadequate food and nutrition 3. Challenges to behavioral health 4. Muscle, cardiovascular, bone atrophy 5. Dust and volatiles 6. Remote medical care 7. Decompression sickness.

The National Aeronautics and Space Administration (NASA) is currently considering plans for the human exploration of a Near Earth Asteroid (NEA). Reasons for undertaking the human exploration of a NEA include increasing the scientific understanding of the origins of our solar system, and developing technology for the exploration of more distant destinations such as Mars. Most mission scenarios have a duration on the order of several months or a year, most of which is spent in transit to and from the NEA. The choice of a particular NEA destination determines the mission duration and guides the types of exploration activities that can be performed on and near the NEA. NASA s Human Research Program (HRP) has identified short and long-term health risks associated with such missions and begun characterizing the level of risk. Some risk drivers are well known from missions to low Earth orbit and the Moon (e.g., the limited mass, volume, and power available for the medical care system). Other factors emerge as major drivers for NEA missions. Some are fundamental characteristics of the mission parameters (e.g., mission duration, distance) and others are strongly dependent on the specifics of how the mission is implemented (e.g., isolation and confinement). Careful consideration of these factors will be required for safe and effective missions to NEAs.

Evaluation of DRM4 in terms of the human system includes the ability to meet NASA standards, the inclusion of the human system in the design trade space, preparation for future missions and consideration of a robotic precursor mission. Ensuring both the safety and the performance capability of the human system depends upon satisfying NASA Space Flight Human System Standards.1 These standards in turn drive the development of program-specific requirements for Near-earth Object (NEO) missions. In evaluating DRM4 in terms of these human system standards, the currently existing risk models, technologies and biological countermeasures were used. A summary of this evaluation is provided below in a structure that supports a mission architecture planning activities. 1. Unacceptable Level of Risk The duration of the DRM4 mission leads to an unacceptable level of risk for two aspects of human system health: A. The permissible exposure limit for space flight radiation exposure (a human system standard) would be exceeded by DRM4. B. The risk of visual alterations and abnormally high intracranial pressure would be too high. 1

There is currently too little reproducible data for a scientifically valid understanding of the initial responses of a diverse human population to weightlessness and other space flight factors. Astronauts on orbital space flights to date have been extremely healthy and fit, unlike the general human population. Data collection opportunities during the earliest phases of space flights to date, when the most dynamic responses may occur in response to abrupt transitions in acceleration loads, have been limited by operational restrictions on our ability to encumber the astronauts with even minimal monitoring instrumentation. The era of commercial personal suborbital space flights promises the availability of a large (perhaps hundreds per year), diverse population of potential participants with a vested interest in their own responses to space flight factors, and a number of flight providers interested in documenting and demonstrating the attractiveness and safety of the experience they are offering. Voluntary participation by even a fraction of the flying population in a uniform set of unobtrusive biomedical data collections would provide a database enabling statistical analyses of a variety of acute responses to a standardized space flight environment. This will benefit both the space life sciences discipline and the general state of human knowledge.

The Human Research Program is instrumental in developing and delivering research findings, health countermeasures, and human systems technologies for spacecraft. :HRP is subdivided into 6 research entities, or Elements. Each Element is charged with providing the Program with knowledge and capabilities to conduct research to address the human health and performance risks as well as advance the readiness levels of technology and countermeasures. Project: An Element may be further subdivided into Projects, which are defined as an integrated set of tasks undertaken to deliver a product or set of products

We evaluated the space life sciences utility of the International Space Station (ISS) to simulate the outbound transit portion of missions to Mars and Near Earth Asteroids (NEA) to investigate biomedical and psychological aspects of such transits, to develop and test space operation procedures compatible with communication delays and outages, and to demonstrate and validate technologies and countermeasures. Two major categories of space life sciences activities can capitalize on ISS capabilities. The first includes studies that require ISS (or a comparable facility), typically for access to prolonged weightlessness. The second includes studies that do not strictly require ISS but can exploit it to maximize their scientific return more efficiently and productively than in ground-based simulations. For these studies, ISS offers a high fidelity analog for fundamental factors on future missions, such as crew composition, mission control personnel, operational tasks and workload, real-world risk, and isolation, and can mimic the effects of distance and limited accessibility. In addition to conducting Mars- and NEA-transit simulations on 6-month ISS increments, extending the current ISS increment duration from 6 months to 9 or even 12 months will provide opportunities for enhanced and focused research relevant to long duration Mars and NEA missions. Increasing the crew duration may pose little additional risk to crewmembers beyond that currently accepted on 6-month increments, but additional medical monitoring capabilities will be required beyond those currently used for ISS operations. Finally, while presenting major logistical challenges, such a simulation followed by a post-landing simulation of Mars exploration could provide quantitative evidence of capabilities in an actual mission. Thus, the use of ISS to simulate aspects of Mars and NEA missions seems practical. If it were to be implemented without major disruption of on-going ISS activities, then planning should begin soon, in close consultation with all international partners.

An overview of research and development activities of NASA's Human Research Science Management Program is presented. The topics include: 1) Human Research Program Goals; 2) Elements and Projects within HRP; 3) Development and Maintenance of Priorities; 4) Acquisition and Evaluation of Research and Technology Proposals; and 5) Annual Reviews

The presentations will be given during the X-Prize symposium, exploring the multi-faceted dimensions of spaceflight ranging from the technical developments necessary to achieve safe routine flight to and from and through space to the new personal business opportunities and economic benefits that will open in space and here on Earth. The symposium will delve into the technical, regulatory, market and financial needs and challenges that must be met in charting and executing the incremental developments leading to Personal Spaceflight and the opening of a Place Called Space. The presentation covers facets of human space flight including descriptions of life in space, the challenges of delivering medical care in space, and the preparations needed for safe and productive human travel to the moon and Mars.

Recent long-range planning for exploration-class missions has emphasized the need for anticipating the medical and human factors aspects of such expeditions. Missions returning Americans to the moon for stays of up to 6 months at a time will provide the opportunity to demonstrate the means to function safely and efficiently on another planet. Details of mission architectures are still under study, but a typical Mars design reference mission comprises a six-month transit from Earth to Mars, eighteen months in residence on Mars, and a six-month transit back to Earth. Physiological stresses will come from environmental factors such as prolonged exposure to radiation, weightlessness en route to Mars and then back to Earth, and low gravity and a toxic atmosphere while on Mars. Psychological stressors will include remoteness from Earth, confinement, and potential interpersonal conflicts, all complicated by circadian alterations. Medical risks including trauma must be considered. The role of such risk-modifying influences as artificial gravity and improved propulsion technologies to shorten round-trip time will also be discussed. Results of planning for assuring human health and performance will be presented.

Astronaut missions to Mars may be many years or even decades in thc future but current and planned efforts can be extrapolated to required treatments and prophylaxis for delerious efforts of prolonged space flight on the cardiovascular system. The literature of candidate countermeasures was considered in combination with unpublished plans for countermeasure implementation. The scope of cardiovascular countermeasures will be guided by assessments of the efficacy of mechanical, physiological and pharmacological approaches in protecting the cardiovascular capacities of interplanetary crewmembers. Plans for countermeasure development, evaluation and validation will exploit synergies among treatment modalities with the goal of maximizing protective effects while minimizing crew time and in-flight resource use. Protection of the cardiovascular capacity of interplanetary crewmembers will become more effective and efficient over the next few decades, but trade-offs between cost and effectiveness of efficiency are always possible if the increased level of risk can be accepted.

BACKGROUND: Many cardiovascular changes associated with spaceflight reduce the ability of the cardiovascular system to oppose gravity on return to Earth, leaving astronauts susceptible to orthostatic hypotension during re-entry and landing. Consequently, an anti-G suit was developed to protect arterial pressure during re-entry. A liquid cooling garment (LCG) was then needed to alleviate the thermal stress resulting from use of the launch and entry suit. METHODS: We studied 34 astronauts on 22 flights (4-16 d). Subjects were studied 10 d before launch and on landing day. Preflight, crewmembers were suited with their anti-G suits set to the intended inflation for re-entry. Three consecutive measurements of heart rate and arterial pressure were obtained while seated and then again while standing. Three subjects who inflated the anti-G suits also donned the LCG for landing. Arterial pressure and heart rate were measured every 5 min during the de-orbit maneuver, through maximum G-loading (max-G) and touch down (TD). After TD, crew-members again initiated three seated measurements followed by three standing measurements. RESULTS: Astronauts with inflated anti-G suits had higher arterial pressure than those who did not have inflated anti-G suits during re-entry and landing (133.1 +/- 2.5/76.1 +/- 2.1 vs. 128.3 +/- 4.2/79.3 +/- 2.9, de-orbit; 157.3 +/- 4.5/102.1 +/- 3.6 vs. 145.2 +/- 10.5/95.7 + 5.5, max-G; 159.6 +/- 3.9/103.7 +/- 3.3 vs. 134.1 +/- 5.1/85.7 +/- 3.1, TD). In the group with inflated anti-G suits, those who also wore the LCG exhibited significantly lower heart rates than those who did not (75.7 +/- 11.5 vs. 86.5 +/- 6.2, de-orbit; 79.5 +/- 24.8 vs. 112.1 +/- 8.7, max-G; 84.7 +/- 8.0 vs. 110.5 +/- 7.9, TD). CONCLUSIONS: The anti-G suit is effective in supporting arterial pressure. The addition of the LCG lowers heart rate during re-entry.

Heart rate and arterial pressure were measured during shuttle re-entry, landing and initial standing in crewmembers with and without inflated anti-g suits and with and without liquid cooling garments (LCG). Preflight, three measurements were obtained seated, then standing. Prior to and during re-entry, arterial pressure and heart rate were measured every five minutes until wheels stop (WS). Then crewmembers initiated three seated and three standing measurements. In subjects without inflated anti-g suits, SBP and DBP were significantly lower during preflight standing (P = 0.006; P = 0.001 respectively) and at touchdown (TD) (P = 0.001; P = 0.003 respectively); standing SBP was significantly lower after WS. on-LeG users developed significantly higher heart rates during re-entry (P = 0.029, maxG; P = 0.05, TD; P = 0.02, post-WS seated; P = 0.01, post-WS standing) than LCG users. Our data suggest that the anti-g suit is effective, but the combined anti-g suit with LCG is more effective.

The contents include: 1) Crew Autonomy; 2) Bioastronautics Critical Path Roadmap (CPR); 3) CPR Issues; and 4) Clinical Problems.

Human exploration of space requires an understanding of the risks to which crews will be exposed during such missions, and the mitigation of those risks to the fullest extent practical. This becomes a greater imperative as we prepare for interplanetary expeditions involving long periods in weightlessness in transit to and then from the destination (a planet, such as Mars, or perhaps a point in space, such as the Lagrangian point L2), and exposure to the unique environment of the destination itself. We need to know, more definitively, what the risks are to human health, safety, and performance, and how to prevent or counteract them throughout all phases of a long duration mission. The Johnson Space Center's Space and Life Sciences Directorate and the National Space Biomedical Research Institute (NSBRI) have implemented an effort to identify the most critical risks confronting humans on such mission and the types of research and technology efforts required to mitigate and otherwise reduce the probability and severity of those risks. This paper describes the "Critical Path Roadmap Project" to define, assess and prioritize the risks and present the results of the assessment with an emphasis on the research and technology priorities to meet the challenge of long duration human spaceflight mission.

This paper will describe the current planning for exploration-class missions, emphasizing the medical, and human factors aspects of such expeditions. The details of mission architecture are still under study, but a typical Mars design reference mission comprises a six-month transit from Earth to Mar, eighteen months in residence on Mars, and a six-month transit back to Earth. Physiological stressors will include environmental factors such as prolonged exposure to radiation, weightlessness in transit, and hypogravity and a toxic atmosphere while on Mars. Psychological stressors will include remoteness from Earth, confinement, and potential interpersonal conflicts, all complicated by circadian alterations. Medical risks including trauma must also be considered. Results of planning for assuring human health and performance will be presented.

Human exploration of space requires the ability to understand and mitigate risks to crews exposed to the conditions associated with such missions. This becomes a greater imperative as we prepare for interplanetary expeditions involving humans who will be subjected to long transit periods in microgravity as they travel to a distant planet such as Mars, embark and live on the planet's surface for an extended time, and finally, return to the 1 g environment of Earth. We need to know, more definitively, what the human health, safety, and performance risks are, and how to prevent or counteract them throughout all phases of a long duration mission. The Johnson Space Center's Space and Life Sciences Directorate along with the National Space Biomedical Research Institute (NSBRI) have been engaged in a strategic planning effort that identifies the most critical risks confronting humans who will venture forth on such missions and the types of research and technology efforts required to mitigate and otherwise reduce the probability and/or severity of those risks. This paper describes the unique approach used to define, assess and prioritize the risks and presents the results of the assessment with an emphasis on the research and technology priorities that will help us to meet the challenge of long duration human spaceflight missions.

Approximately three years ago, the Agency's lead center for the human elements of spaceflight (the Johnson Space Center), along with the National Biomedical Research Institute (NSBRI) (which has the lead role in developing countermeasures) initiated an activity to identify the most critical risks confronting extended human spaceflight. Two salient factors influenced this activity: first, what information is needed to enable a "go/no go" decision to embark on extended human spaceflight missions; and second, what knowledge and capabilities are needed to address known and potential health, safety and performance risks associated with such missions. A unique approach was used to first define and assess those risks, and then to prioritize them. This activity was called the Critical Path Roadmap (CPR) and it represents an opportunity to develop and implement a focused and evolving program of research and technology designed from a "risk reduction" perspective to prevent or minimize the risks to humans exposed to the space environment. The Critical Path Roadmap provides the foundation needed to ensure that human spaceflight, now and in the future, is as safe, productive and healthy as possible (within the constraints imposed on any particular mission) regardless of mission duration or destination. As a tool, the Critical Path Roadmap enables the decision maker to select from among the demonstrated or potential risks those that are to be mitigated, and the completeness of that mitigation. The primary audience for the CPR Web Site is the members of the scientific community who are interested in the research and technology efforts required for ensuring safe and productive human spaceflight. They may already be informed about the various space life sciences research programs or they may be newcomers. Providing the CPR content to potential investigators increases the probability of their delivering effective risk mitigations. Others who will use the CPR Web Site and its content include program managers and administrators who track the program and are involved in decisions regarding resource allocation and program evaluation.

Spaceflight causes adaptive changes in cardiovascular function that may deleteriously affect crew health and safety. Over the last three decades, symptoms of cardiovascular changes have ranged from postflight orthostatic tachycardia and decreased exercise capacity to serious cardiac rhythm disturbances during extravehicular activities (EVA). The most documented symptom of cardiovascular dysfunction, postflight orthostatic intolerance, has affected a significant percentage of U.S. Space Shuttle astronauts. Problems of cardiovascular dysfunction associated with spaceflight are a concern to NASA. This has been particularly true during Shuttle flights where the primary concern is the crew's physical health, including the pilot's ability to land the Orbiter, and the crew's ability to quickly egress and move to safety should a dangerous condition arise. The study of astronauts during Shuttle activities is inherently more difficult than most human research. Consequently, sample sizes have been small and results have lacked consistency. Before the Extended Duration Orbiter Medical Project (EDOMP), there was a lack of normative data on changes in cardiovascular parameters during and after spaceflight. The EDOMP for the first time allowed studies on a large enough number of subjects to overcome some of these problems. There were three primary goals of the Cardiovascular EDOMP studies. The first was to establish, through descriptive studies, a normative data base of cardiovascular changes attributable to spaceflight. The second goal was to determine mechanisms of cardiovascular changes resulting from spaceflight (particularly orthostatic hypotension and cardiac rhythm disturbances). The third was to evaluate possible countermeasures. The Cardiovascular EDOMP studies involved parallel descriptive, mechanistic, and countermeasure evaluations.

The human element is the most complex element of the mission design Mars missions will pose significant physiological and psychological challenges to crew members Some challenges (human engineering, life support) must be overcome (potential "non-starters") Some challenges (bone, radiation) may be show-stoppers ISS will only Indirectly address Mars questions before any "Go/No Go" decision Significant amount of ground-based and specialized flight research will be required -- Critical Path Roadmap project will direct HSLSPO's research toward Mars exploration objectives

Spaceflight is associated with decreased orthostatic tolerance after landing. Short-duration spaceflight (4 - 5 days) impairs one neutral mechanism: the carotid baroreceptor-cardiac reflex. To understand the effects of longer-duration spaceflight on baroreflex function, we measured R-R interval power spectra, antecubital vein plasma catecholamine levels, carotid baroreceptor-cardiac reflex responses, responses to Valsalva maneuvers, and orthostatic tolerance in 16 astronauts before and after shuttle missions lasting 8 - 14 days. We found the following changes between preflight and landing day: (1) orthostatic tolerance decreased; (2) R-R interval spectral power in the 0.05- to 0.15-Hz band increased; (3) plasma norepinephrine and epinephrine levels increased; (4) the slope, range, and operational point of the carotid baroreceptor cardiac reflex response decreased; and (5) blood pressure and heart rate responses to Valsalva maneuvers were altered. Autonomic changes persisted for several days after landing. These results provide further evidence of functionally relevent reductions in parasympathetic and increases in sympathetic influences on arterial pressure control after spaceflight.

Decreases in arterial baroreflex function after space flight may be related to changes in blood pressure and heart rate patterns during flight. Ambulatory blood pressure and heart rate were measured for 24 hours, in fourteen astronauts on two occasions before flight, two to three occasions in flight, and 2 days after landing on Shuttle missions lasting 4 to 14 days. Blood pressure and heart rate were recorded every 20minutes during awake periods and every 30 minutes during sleep. In pre- and postflight studies, the 24-hour ambulatory measurements were followed by studies of carotid baroreceptor-cardiac reflex responses. Carotid baroreceptors were stimulated using a sequence of neck pressure and suction from +40 to -65 mmHg.

During the STS-50/USML-1 mission and five other Shuttle flights, decompression of the legs and lower abdomen ('lower body negative pressure,' LBNP) was used: (1) to apply a standardized stress to the cardiovascular system, to document the loss of orthostatic function during an extended period in weightlessness, and (2) to test its efficacy as a treatment which may be used to protect astronauts from gravitationally-induced fainting during and after reentry on Space Shuttle flights. The loss of orthostatic tolerance (as determined by LBNP) occured even earlier than indicated by similar testing on Skylab (1973-1974). The treatment was shown to be effective in reversing some of the effects of extended weightlessness on the cardiovascular system for at least one day after treatment.

Investigators have shown that after 1-2 weeks of bed rest ingestion of 1000 ml of a salt water solution during 4 hours of continuous exposure to 30 mm Hg of lower body negative pressure will protect plasma volume and orthostatic function for up to 24 hours. We hypothesize that a similar countermeasure will reduce the effects of fluid loss induced by headward fluid shift during space flight. The objective of this flight experiment is to evaluate the efficacy of the proposed countermeasure in reversing these effects on the cardiovascular system. Lower Body Negative Pressure (LBNP) involves exposing the legs and lower abdomen to reduced air pressure. The LBNP device is an air-tight chamber that seals the subject's waist to enclose the lower body. As used in this experiment, LBNP provides both the candidate treatment as well as the means of assessing the effectiveness of the treatment.