Introduction: A major aim of performance investigation is to predict real-life performance, which is why both ESA [1] and NASA [2] have described the need to validly and reliably detect potential performance decrement as absolute requirements to manned long-duration missions. Whereas the predictive validity of such assessment has been extensively described for medium-term to long-term outcomes, as is the case for cognitive performance selection of student pilots for example, similar evidence is lacking regarding the immediate predictive value of cognitive testing, i.e., whether these results reflect real-life performance on an immediately subsequent task. Furthermore, whereas selection procedures are derived from population-based approaches, real-time monitoring of performance is often meant to be individual, which is an additional call for caution before concluding results from one setting can readily be applied to another. In the present series of experiment, we investigated whether various combinations of cognitive tests, associated to autonomic reactivity responses assessed through cardio-respiratory recordings, would relate to real-life performance on short and medium-term outcomes.

Method: In a first experiment, we investigated whether psychophysiological results would predict success of military student pilots (SPs; N=14) on a major evaluation flight right after the testing, and success in the rest of their flight training after a 6 months period. In a second experiment, we investigated whether extensive preliminary cognitive testing and individually tailored longitudinal monitoring of physical and cognitive performance could predict success of Special Forces trainees (N=7) during their training.

Results: The first experiment showed no relationship whatsoever between cognitive performance on the very broad array of tests and immediately subsequent performance on the evaluation flight. However, physiological results showed a trend for students who passed the test to exhibit a larger physiological reactivity. Furthermore, the medium-term outcome of SPs in their flight training showed to be related to their test performance. Results of the second experiment (still in progress) will show whether, for an individual monitoring situation, there is a potential link between performance IQ and success on the training, and whether the longitudinal assessment of both cognitive performance, physical performance and physiological reactivity relates to immediately subsequent performance.

Discussion: These results suggest that a critical distinction could be made regarding predictive performance assessment, namely trait and state dimensions. Since one of the intended uses of operational test batteries is to provide an instantaneous measure of the cognitive status of the subject to allow the immediate execution of critical tasks, our results show this would be an inappropriate application so far. However, a dimension showing promising potential is the physiological reactivity. Whereas operational priorities clearly state the need for performance evaluation tools, their application cannot guide operational choices before sufficient validation allows justifying such decisions.

References
[1] HUMEX: Study on the Survivability and Adaptation of Humans to Long-duration Exploratory Missions (2000). European Space Agency. [2] BPCR: Bioastronautics Critical Path Roadmap (2004). National Aeronautics and Space Administration.

The experience of many years' medical observations shows that there are medical problems, associated with deconditioning of physiological systems in cosmonauts under microgravitation.Despite the use of different countermeasures during space flight, the occurrences of orthostatic intolerance, cardiovascular regulation changes, increase of leg venous distensibility and decrease in tolerance to the gravitational loads in men are still observed.

The French equipment ECHOGRAPH and PHYSIOLAB on board the Russian space stations have been in use over 17 years, from 1982 to 1999. That gave an opportunity to perform the unique investigations. In total, it was performed about 400 complex experiments on studying the cardiovascular system in man at rest and during functional tests before, during and after flights by duration from 8 till 438 days, and half of those investigations were performed during real space flights. For the first time it's allowed to study mechanisms of hemodynamics changes in microgravitation on the basis of large actual material received directly in the space flights.

During those investigations it was determined the unfavorable prognostic hemodynamics changes, pointing out the latent stress of adaptation mechanisms. In some cases hemodynamics changes revealed by this equipment were registered in the absence of there subjective and generally accepted objective symptoms of orthostatic deconditioning. It gave the basis to believe, that early diagnostics of the latent hemodynamics disturbances will allow to estimate, improve and predict cardiovascular conditioning of cosmonauts, especially in long-term flights.

The creation of medical equipment system CARDIOMED is the logical continuation of works on use complex PHYSIOLAB in CASSIOPEE, PEGAS and PERSEUS projects (1996-1999) according to the joint Russian-French flights, which have allowed to receive the unique fundamental and applied data. The use of CARDIOMED system in medical control system of cosmonauts on the Russian segment of the International Space Station will allow to diagnose, but the main thing - to predict an unfavorable hemodynamics changes and to give required recommendations during space flight.

Keywords: Gravitational Physiology, Medical Instrumentation in Space, Cosmonaut Medical Survey, LBNP Countermeasure, Physiological Data Analysis.

Cardiomed system results from a cooperation between CNES and IMBP. It was developed with a dual objective: (1) Cosmonauts medical survey onboard ISS together with LBNP countermeasure; (2) scientific study of the cardio-vascular system in micro-gravity.

Cardiomed is an end-to-end system, from the onboard segment which integrates different medical instruments, to the ground segment which provides real-time telemetry of on-board experiments and off-line analysis of physiological measurements.

In the first part of the paper, Cardiomed is described from an architecture point of view together with some typical uses. The Lower Body Negative Pressure protocol is the most demanding one: (1) different instruments (newly developed tchibis, cardiopres, doppler, and blood pressure holter) are to be configured and controlled on-board. (2) For assisting cosmonauts in such operations, a single software interface is provided. (3) Physiological data are transmitted to Cardiomed ground segment in TSOUP, enabling the medical team to stop the experiment whether cosmonaut health is put at risks. Data transmitted in real time include tchibis depression level, ECG, blood pressure but also Doppler blood flow envelops, enabling to track the variations of femoral, aortic and cerebral artery blood flows to anticipate syncope.

In the second part, the functional requirements the most constraining with respect to system design are introduced. Some requirements are common to medical survey and scientific objectives such using almost “on the shelf” medical instruments for reducing costs, instrument qualification for space or providing cosmonauts with a user-friendly interface including detailed descriptions of operations to perform. Some requirements are specific to medical survey. For instance, physiological parameters are monitored by the on-board software, enabling the cosmonaut, in case of alarm, to decide autonomously to stop the protocol.. Other requirements are more specific to research such as the most demanding ones concerning the off-line analysis of measurements (tool physiopost part of cardiomed ground segment). Such requirements concern measurement and time accuracy, extended beat per beat analysis but also the possibility to export data and results to different tools (Excel, Matlab, Notocord…). In the last part, the main technical challenges which were addressed during the development and the qualification of Cardiomed and the lessons learnt are presented. Such technical challenges include:

(1) a precise synchronisation of measurements provided by different instruments and which are acquired numerically by the onboard software; (2) the availability of a very limited bandwidth for real time communication between ISS Russian segment and TSOUP; (2) the potentially poor quality of measurements (due to noise and possible operational problems) requiring robust algorithms for analysing ECG and Doppler flows but also user friendly interfaces enabling the scientist to select valid ranges of measurements before interpreting results.

Dental Emergencies and Dental Maintenance needs to be addressed for Space travel, since humans live in micro-gravity for several months to years (long distance travel or on the ISS). What if an astronaut has an abscess or fractures a tooth while on a mission? What if a pre-existing restoration or virgin tooth fractures? How can you maintain proper Oral Hygiene on long flights or extended stays on the ISS? What affect does micro-gravity have on the Oral Cavity as it relates to gingivitis, periodontal disease, and bone loss? Since teeth are housed in bone, what effect will weightlessness have on tooth support; in order to maintain proper bone density? OR, does zero gravity affect Maxillary and/or Mandibular bone density at all? After a permanent tooth is extracted, with no bone filler within the "socket", the bone at the extraction site will atrophy. HOWEVER, if you place an implant in the site of a previously extracted tooth, bone will not be lost.

My Research and Experimentation initiatives are the following: 1. What Dental procedures are compatible in micro-gravity? After research, methods and proven techniques are established, training a selected crew member on the Space Shuttle or working on the ISS for an extended stay is necessary. Dental Emergency Protocol must be realized and standardized in order to prevent what would be a common post-op complication on earth, but in space, would be life threatening.

It is imperative that we send that "FIRST DENTIST IN SPACE" to perform first response protocol through experimentation. Understanding the affects of tooth extractions (including bleeding time, healing time, infection rate, bone regeneration, bone degeneration, periodontal disease, and caries prevalence). It is in the best interest for space travelers to have a "Dental Emergency and Maintenance Protocol System" (DEMPS) available. Such a protocol is imperative for long distance space travel (Mars) or a working settlement including the ISS in space, This Protocol has EXTREME IMPORTANCE and BENEFITS to all those crew members that may have a Dental Emergency (the cost of "scrubbing" a mission due to a toothache would be MILLIONS of dollars). While strengthening the space program, the knowledge gained from micro-gravity tested procedures would help those who need Emergency Dental Care in Third World Countries.

Anyone who has experienced a tooth abscess can attest to the intensity and severity of the pain, and how rapidly one becomes incapacitated. On Earth, there is access to Emergency Care within hours. On the Space Shuttle, ISS, or Lunar Settlement, one of the ONLY treatments would be antibiotics and pain medication. This is a temporary solution, since in micro-gravity; antibiotics have less if any affect on resistant anaerobic bacteria. The only course of action is accessing the nerve of the tooth and treat the infection directly. HOWEVER, can this be accomplished in Zero Gravity? Can any Dental Procedure be performed safely and successfully in a micro-gravity environment? An astronaut's immune system is significantly reduced, bone density loss still occurs, especially on weight bearing bones; bleeding, clotting and healing time is altered, and the affects of Gamma radiation will affect the healing site of an extracted tooth. Dental Experimentation needs to become a priority for the safety of anyone who travels in space.

Objective: to validate a method for tele-operating (from an expert site) in routine, an echographic examination in isolated sites where the patient stay.

Method: We used the robotic arm (ESTELE) holding a real ultrasound probe remotely controlled from the expert site with a fictive probe, and that reproduces on the real probe all the movements of the expert (sonographer) hand. The isolated places, are areas with reduced medical facilities: secondary hospitals 20 to 100 km from the main hospital in Europ, dispensaries in Africa, Amazonia, a rescue vehicles...where there is only a general practitioner and / or non sonographer paramedics. The ESTELE system was installed in 4 secondary hospitals, 40 to 100km from our University Hospital.

Results: During a period of 4 months the remote echographies were perform on demand, and the patient site was served within a delay of approximately 30 min. ESTELE was tested on 200 adults and 50 pregnant using ISDN telephone lines. The time duration of the remote echography was 1,5 time longer than a regular echography. During fetal tele-operated echography the expert was able to perform appropriate views of the fetal structures in 95% of the cases. During exploration of adult abdomen and pelvis the expert visualized the main organs in 93% of the cases.

Conclusion: Robotized tele-echography provide similar information as direct examination. Such method could be used between the ISS (patient site) and an expert center on the ground, on a war field or for serving any area contaminated by microbs, radiation…

Extravehicular Activity (EVA) represents one of the most dangerous endeavors. As of June 2007 there have been 115.7 crew-days doing spacewalks. Events that have occurred during EVA include thermal injury, separation from space craft, suit leak in vacuum, contact with toxic substances, and severe pain due to improper fit. Other potential concerns include radiation, retinal injury from sunlight, life support system failures, worksite injury (crush, electrical), hypobaric Decompression Sickness, and space suit pressure loss due to micrometeoroid/ orbital debris (MMOD). Space Motion Sickness (SMS) has delayed EVAs and vomiting has occurred in a space suit. Threats during planetary surface exploration include partial gravity locomotion, change in center of gravity due to EVA suit, pressurized exoskeleton suit mobility effects, unstable surface material, sloping terrain, surface motor vehicle operations, dust and soil contamination, altered/ absent light (lunar poles), and weather (Mars).

In June 2006 a 3 day lessons learned summit was conducted with 8 Apollo astronauts, and an additional 7 Apollo astronauts were also contacted to attain insight into medical problems during the Apollo program. 13 topic categories were identified, and data from the EVA suit and lunar surface operations will be presented. On 11 Apollo missions from 1967 to 1972, 170 man-hours of EVA (15 on lunar surface, 5 outside CM) were performed. The most fatiguing EVA tasks were repetitive gripping, and fingernail and skin trauma was common. Falls were common and contributing factors included bulky equipment, terrain features, suit CG, and fatigue. Potential risk factors for injuries included traversing craters > 26° slope, rover activities, and falling from a high ladder. Repetitive use injuries are a concern for multiple lunar EVAs Lunar dust was hard to clear and impaired zipper function on subsequent EVA. Dust was very abrasive to suit and visors. Crew had difficulty maneuvering through hatch.

Recommendations from the Apollo Medical Summit included reducing EVA suit mass twofold, increasing mobility fourfold, and lowering Center of Gravity (CG). Other recommendations included improving peripheral vision, reducing helmet fogging, developing a Heads Up Display (HUD) to display data on demand by voice command, and improving drink bag and Urine Collection Device (UCD). Hatch and ingress corridor should be sized for inflated suit, and airlock would improve ingress/ egress and dust control.

Efficacious pharmaceuticals with adequate shelf life are essential for successful space medical operations in support of space exploration missions. Physical and environmental factors unique to space missions such as vibration, G forces and ionizing radiation may adversely affect stability of pharmaceuticals intended for standard care of astronauts aboard space missions. Stable pharmaceuticals, therefore, are of paramount importance for assuring health and wellness of astronauts in space. Preliminary examination of stability of formulations from Shuttle and International Space Station (ISS) medical kits revealed that some of these medications showed physical and chemical degradation after flight raising concern of reduced therapeutic effectiveness with these medications in space. A research payload experiment was conducted with a select set of formulations stowed aboard a shuttle flight and on ISS.

The payload consisted of four identical pharmaceutical kits containing 31 medications in different dosage forms that were transported to the International Space Station (ISS) aboard the Space Shuttle, STS 121. One of the four kits was stored on the shuttle and the other three were stored on the ISS for return to Earth at six months intervals on a pre-designated Shuttle flight for each kit; the shuttle kit was returned to Earth on the same flight. Standard stability indicating physical and chemical parameters were measured for all pharmaceuticals returned from the shuttle and from the first ISS increment payload along with ground-based matching controls. Results were compared between shuttle, ISS and ground controls. Evaluation of data from the three paradigms indicates that some of the formulations exhibited significant degradation in space compared to respective ground controls; a few formulations were unstable both on the ground and in space. An increase in the number of pharmaceuticals from ISS failing USP standards was noticed compared to those from the shuttle flight. A comprehensive evaluation of results is in progress.