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The topics of agency and enterprise goals, OLMSA organization, life sciences relationship to NASA/HEDS strategic plans, budget allocated by the HEDS strategic plan goals, 1998 successes, exploration and the International Space Station, congressional budgets, OLMSA grants, biomedical research and countermeasures, medical care, biologically inspired technologies, and publication, education and outreach are all presented in viewgraph form.

Perhaps one of the greatest gifts that has been given to the people of the world in the last few hundred years has been an emerging sense of the place of our planet and its inhabitants within the context of the vast universe. Our knowledge of the rest of the universe has not come quickly, nor was the process of attaining it only recently begun; however, the unprecedented acceleration of that process has benefitted from a fundamental new aspect of our species that has only manifested itself in the last 30 years or so, the ability to travel in space. Before the space age, the Universe was studied only through observations from the Earth. All that has changed with the beginning of the space age. Machines built by humans have flown to all but one of the nine planets that revolve around our Sun, have ventured billions of miles from the Earth and looked back, and have landed on three other worlds. Spacecraft in orbit around the Earth have viewed the sky at a vast number of electromagnetic wavelengths, detecting the shape of the galaxy and the universe, and even measuring the remnants of the universe's beginning. Human explorers have ventured forth, first for short stays in orbit, then, later, walking upon the Moon and living for long periods in space. As they did so, billions of people on the Earth came to view the Earth in a fundamentally different way, not just as the familiar day to- day backdrop for their lives, but as a small oasis suspended in the night sky above an alien landscape. It is this new view of the Earth that is the true gift of space exploration. Space exploration has at once given us a new perspective on the value of our world, and a new perspective from which to understand how it operates. It has shown us that the Earth is by far the most precious place in the solar system in terms of supporting human life, while revealing that other destinations may still be compelling. The exploration of space has at once become a challenge for humanity to overcome and a path to our common future. But for humanity to embark on this path, we need to understand ourselves in a new environment. As such, an understanding of the biological consequences of and opportunities in space flight is essential. In this, the first volume of a joint U.S./Russian series on space biology and medicine, we describe the current status of our understanding of space and present general information that will prove useful when reading subsequent volumes. Since we are witnesses to the beginning of a new era of interplanetary travel, a significant portion of the first volume will concentrate on the physical and ecological conditions that exist in near and outer space, as well as heavenly bodies from the smallest ones to the giant planets and stars. While space exploration is a comparatively recent endeavor, its foundations were laid much more than 30 years ago, and its history has been an eventful one. In the first part of this volume, Rauschenbach, Sokolskiy, and Gurjian address the "Historical Aspects of Space Exploration" from its beginnings to a present-day view of the events of the space age. The nature of space itself and its features is the focus of the second section of the volume. In the first chapter of the part, "Stars and Interstellar Space," the origin and evolution of stars, and the nature of the portions of space most distant from Earth are described by Galeev and Marochnik. In Chapter 2, Pisarenko, Logachev, and Kurt in "The Sun and Interplanetary Space" bring us to the vicinity of our own solar system and provide a description and discussion of the nearest star and its influence on the space environment that our Earth and the other planets inhabit. In our solar system there are many fascinating objects, remnants of the formation of a rather ordinary star in a rather obscure portion of the galaxy. Historical accident has caused us to be much more curious (and knowledgeable) about "The Inner Planets of the Solar System" than about any of these other objects. In Chapter 3, Marov describes the planets Mercury, Venus, Earth, and Mars, their history and origin, and their environmental conditions, and in Chapter 4 Owen provides similar information about Jupiter, Saturn, Uranus, Neptune, and Pluto, "The Outer Planets of the Solar System." Morrison provides a thorough discussion of "Asteroids, Comets, and Other Small Bodies" in Chapter 5. The understanding of these relics of the formation of the solar system may form the center of our ability to understand the origin of solar systems in general, and of the critical role that the beginning of the solar system had on the prospects for the origin of life and its continued survival and evolution in the face of their recurrent impacts on Earth. In Chapter 6, the first chapter of the third part, Rummel describes the area of "Exobiology," the study of the origin, evolution, and distribution of life in the context of the origin and evolution of the universe. The same processes that have given rise to life on Earth may have given rise to life elsewhere. In Chapter 7, the "Earth and the Biosphere," the nature and function of the Earth are discussed as a specific instance of planetary and biological evolution. The effects of biological processes on the Earth under the influence of human activities are also addressed by Moore and Bartlett in Chapter 7. The final chapter in this section concerns the prospects that life in the universe may be widespread; "SETI," the Search for Extraterrestrial Intelligence, by Billingham and Tarter, presents the arguments for conducting a search for evidence of life elsewhere in the galaxy, and describes the various methods proposed for conducting such a search. While SETI has a distinctly exploration al character, more direct means are available for exploring the solar system around us. The fourth part of the volume addresses this subject of space exploration. Considering the prospects for research on space biology and medicine, the means of providing "Access to Space" are described by Feoktistov and Briggs in Chapter 9. This chapter addresses carriers and launch systems, the unmanned and manned spacecraft that they loft into space, and the task of mission operations by which these precious vessels are monitored, navigated, and controlled. Despite the successes of the past and the capabilities of the present, it is clear that the study of space biology and medicine will be even more rewarding in the future than it has been to date. The work of the next few years that will be undertaken by the U.S. and Russia, both independently and jointly, will focus first on enabling greater capabilities in the exploration of space, and then on using the unique characteristics of the space environment to provide insight and greater understanding into biological systems, their behavior, development, and origin. The chapters of the first volume were written by leaders in their fields from the U.S. and Russia. The material presented summarizes our current understanding of space and its exploration. We understand that the first volume will be of interest not only to medical personnel and biologists, but also to general readers who want information about space beyond their own particular fields of expertise.

In the 21st century, NASA's long-term strategy for the exploration of the solar system will combine the assurance of human health and performance for long periods in space with investigations aimed at searching for traces of life on other planets and acquiring fundamental scientific knowledge of life processes. Implementation of this strategy will involve a variety of disciplines including radiation health, life support, human factors, space physiology and countermeasures, medical care, environmental health, and exobiology. It will use both ground-based and flight research opportunities such as those found in current ongoing programs, on Spacelab and unmanned biosatellite flights, and during Space Station Freedom missions.

Manned space flight can be viewed as an interaction of three general elements: the human crewmember, spacecraft systems, and the environment. While the human crewmember is a crucial element in the system, certain physiological, psychological, environ- mental and spacecraft systems factors can compromise human performance in space. These factors include atmospheric pressure, physiology, uncertainties associated with space radiation, the potential for exposure to toxic materials in the closed environment, and spacecraft habitability. Health protection in space, for current and future missions, relies on a philosophy of risk reduction, which in the space program is achieved in four ways-through health maintenance, health care, design criteria, an selection and training. Emphasis is place upon prevention, through selection criteria and careful screening. Spacecraft health care systems must be absolutely reliable, and they will be automated and computerized to the maximum extent possible, but still designed with the human crewmember's capabilities in mind. The autonomy and technological sophistication of future missions will require a greater emphasis on high-level interaction between the human operator and automated systems, with effective allocation of tasks between humans and machines. Performance in space will include complex tasks during extravehicular activity (EVA) and on planetary surfaces, and knowledge of crewmembers' capability and limitations during such operations will be critical to mission success. Psychological support will become increasingly important on space missions, as crews spend long periods in remote and potentially hazardous environments. The success of future missions will depend on both individual psychological health and group cohesion and productivity, particularly as crew profiles become more heterogeneous. Thus, further human factors are needed in the area of small-group dynamics and performance.

Over the last three decades the Life Sciences Program has significantly contributed to NASA's manned and unmanned exploration of space, while acquiring new knowledge in the fields of space biology and medicine. The national and international events which have led to the development and revision of NASA strategy will significantly affect the future of life sciences programs both in scope and pace. This document serves as the basis for synthesizing the options to be pursued during the next decade, based on the decisions, evolution, and guiding principles of the National Space Policy. The strategies detailed in this document are fully supportive of the Life Sciences Advisory Subcommittee's 'A Rationale for the Life Sciences,' and the recent Aerospace Medicine Advisory Committee report entitled 'Strategic Considerations for Support of Humans in Space and Moon/Mars Exploration Missions.' Information contained within this document is intended for internal NASA planning and is subject to policy decisions and direction, and to budgets allocated to NASA's Life Sciences Program.

The NASA manned space flight program from Project Mercury onward is reviewed. Particular attention is given to the Gemini missions, Apollo, Skylab, and the Space Shuttle. Aspects of medical care and health maintenance in the U.S. space program are treated in some detail. Consideration is also given to opportunities connected with Space Station Freedom, issues for human exploration of the solar system, and international cooperation in the space life sciences.

Past experience with piloted space missions is reviewed to develop potential countermeasures to the medical problems associated with a long-duration space flight. Particular attention is given to the Extended Duration Orbiter Medical Program, which is aimed at ensuring crew health and safety on Space Shuttle missions; Soviet experience with long-duration space flights; and a variety of countermeasures including physiological, psychological, environmental health, radiation protection, and artificial gravity countermeasures.

Human exploration of space requires the interaction of three general systems: environmental health and life support systems, countermeasure systems, and medical care systems. These systems address atmospheric pressure, uncertainties associated with space radiation, the potential for exposure to toxic materials in the closed environment, spacecraft habitability, human physiology, and microgrvaity. While these interdependent systems serve the same overall goal -- the protection of the human crewmember from the hostile space environment -- each has specific essential roles. Individually and in combination the three systems should be responsive to a strategy of risk reduction, so that the scientific possibilities of exploration missions may be maximized.

The Telemedicine Spacebridge, a satellite mediated audio-video-fax link between four U.S. and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. 209 patients were discussed, requiring expertise in 20 specialty areas. Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several U.S. medical centers was judged beneficial; quality of data transmission was judged excellent. These results suggest that interactive consultation by remote specialists can provide valuable assistance to onsite physicians and favorably influence clinical decisions in the aftermath of major disasters.

In space, adaptive physiological changes have been observed in virtually all body systems, but how far these changes progress with time is not known. Their time course demonstrates variable patterns; some systems show evidence of gradual and progressive change. Biomedical postflight data have shown that a compensatory period of readaptation to one gravity is required after space flight, with longer intervals required for longer missions. Consistent readaptation trends include orthostatic intolerance and neurovestibular difficulties. For the long-duration missions of the exploration era, it is critical to determine the extent to which deleterious changes (e.g., bone loss and possible immunological changes) can be reversed upon return to earth. Radiation protection is another critical enabling element for missions beyond low earth orbit. Radiation exposure guidelines have not been established for exploration missions. Currently our experience is insufficient to prescribe countermeasures for the stay times associated with a lunar base or a mission to Mars. Artificial gravity may provide a solution, but the level and duration of exposure necessary to prevent deconditioning must be determined. Central issues for medical care in remote settings are preventive, diagnostic, and therapeutic care and the minimization of risk.

Alterations of the human cardiopulmonary system in space flight are examined, including fluid shifts, orthostatic intolerance, changes in cardiac dynamics and electromechanics, and changes in pulmonary function and exercise capacity. Consideration is given to lower body negative pressure data from Skylab experiments and studies on the Space Shuttle. Also, echocardiography, cardiac dysrhythmias during spaceflight, and the role of neural mechanisms in circulatory control after spaceflight are discussed.

The fundamental biomedical issues involved in manned space flight are examined in review chapters contributed by leading U.S. experts. Sections are devoted to the history of manned space flight, the space environment, space-flight systems and procedures, physiological adaptation to space flight, health maintenance of space crewmembers, and medical problems of space flight. Extensive diagrams, drawings, graphs, photographs, and tables of numerical data are provided.

Biomedical issues related to a manned mission to Mars are reviewed. Consideration is given to cardiovascular deconditioning, hematological and immunological changes, bone and muscle changes, nutritional issues, and the development of physiological countermeasures. Environmental issues are discussed, including radiation hazards, toxic chemical exposure, and the cabin environment. Also, human factors, performance and behavior, medical screening of the crew, disease prediction, and health maintenance are examined.

The implications of human participation in Mars missions are reviewed. The psychological effects of long-term confinement, tension, and boredom are examined. The medical implications of travel to Mars, including the effects of low gravity and exposure to radiation, are discussed. The difficulty of providing sufficient consumables, such as air, food, and water, is considered.

The state of knowledge in space physiology and medicine are reviewed. Overviews of manned space flight, the space environment, spaceflight systems and procedures, physiological adaptation to space flight, health maintenance of space crew members, and medical problems of space flight are presented.