In order to maintain crew health and performance during long-duration spaceflight outside of low-Earth orbit, NASA and its international partners must be capable of providing a safe and effective pharmacy. Given few directed studies of pharmaceuticals in the space environment, it is difficult to characterize pharmaceutical effectiveness or stability during spaceflight; this in turn makes it challenging to select an appropriate formulary for exploration. Here, we present the current state of literature regarding pharmaceutical stability, metabolism, and effectiveness during spaceflight. In particular, we have attempted to highlight the gaps in current knowledge and the difficulties in translating terrestrial-based drug studies to a meaningful interpretation of drug stability, safety, and effectiveness in space. We hope to identify high-yield opportunities for future research that might better define and mitigate pharmaceutical risk for exploration missions.

As human spaceflight seeks to expand beyond low-Earth orbit, NASA and its international partners face numerous challenges related to ensuring the safety of their astronauts, including the need to provide a safe and effective pharmacy for long-duration spaceflight. Historical missions have relied upon frequent resupply of onboard pharmaceuticals; as a result, there has been little study into the effects of long-term exposure of pharmaceuticals to the space environment. Of particular concern are the long-term effects of space radiation on drug stability, especially as missions venture away from the protective proximity of the Earth. Here we highlight the risk of space radiation to pharmaceuticals during exploration spaceflight, identifying the limitations of current understanding. We further seek to identify ways in which these limitations could be addressed through dedicated research efforts aimed toward the rapid development of an effective pharmacy for future spaceflight endeavors.

BACKGROUND Astronauts on exploration missions may be at risk for traumatic injury and medical conditions that lead to life threatening hemorrhage. Resuscitation protocols are limited by the austere conditions of spaceflight. Solutions may be found in low‐resource terrestrial settings. The existing literature on alternative blood product administration and walking blood banks was evaluated for applicability to spaceflight. STUDY DESIGN AND METHODS A literature review was done using PubMed and Google Scholar. References were crosschecked for additional publications not identified using the initial search terms. Twenty‐seven articles were identified, including three controlled trials, six retrospective cohort analyses, 15 reviews, one case report, and two experimental studies. RESULTS Solutions to blood transfusion in austere settings include lyophilized blood products, hemoglobin‐based oxygen carriers (HBOCs), and fresh whole blood. Many of these products are investigational. Protocols for walking blood banks include methods for screening and activating donors, transfusion, and monitoring for adverse reactions. Microgravity and mission limitations create additional challenges for transfusion, including baseline physiologic changes, difficulty reconstituting lyophilized products, risk of air emboli during transfusion, equipment constraints, and limited evacuation and surgical options. CONCLUSION Medical planning for space exploration should consider the possibility of acute blood loss. A model for “floating” blood banks based on terrestrial walking blood bank protocols from austere environments is presented, with suggestions for future development. Constraints on volume, mass, storage, and crew, present challenges to blood transfusion in space and must be weighed against the benefits of expanding medical capabilities.

BackgroundThe purpose of the optic nerve sheath diameter (ONSD) research group project is to establish an individual patient-level database from high quality studies of ONSD ultrasonography for the detection of raised intracranial pressure (ICP), and to perform a systematic review and an individual patient data meta-analysis (IPDMA), which will provide a cutoff value to help physicians making decisions and encourage further research. Previous meta-analyses were able to assess the diagnostic accuracy of ONSD ultrasonography in detecting raised ICP but failed to determine a precise cutoff value. Thus, the ONSD research group was founded to synthesize data from several recent studies on the subject and to provide evidence on the diagnostic accuracy of ONSD ultrasonography in detecting raised ICP.MethodsThis IPDMA will be conducted in different phases. First, we will systematically search for eligible studies. To be eligible, studies must have compared ONSD ultrasonography to invasive intracranial devices, the current reference standard for diagnosing raised ICP. Subsequently, we will assess the quality of studies included based on the QUADAS-2 tool, and then collect and validate individual patient data. The objectives of the primary analyses will be to assess the diagnostic accuracy of ONSD ultrasonography and to determine a precise cutoff value for detecting raised ICP. Secondly, we will construct a logistic regression model to assess whether patient and study characteristics influence diagnostic accuracy.DiscussionWe believe that this IPD MA will provide the most reliable basis for the assessment of diagnostic accuracy of ONSD ultrasonography for detecting raised ICP and to provide a cutoff value. We also hope that the creation of the ONSD research group will encourage further study.Trial registrationPROSPERO registration number: CRD42012003072

An XTREME Technologies XTS 13-35 extreme ultraviolet (EUV) light source creates a xenon z pinch that generates 13.5nm light. Due to the near x-ray nature of light at this wavelength, extremely smooth metal mirrors for photon collection must be employed. These are exposed to the source debris. Dissolution of the z-pinch gas column results in high-energy ion and neutral release throughout the chamber that can have adverse effects on mirror surfaces. The XTREME commercial EUV emission diagnostic chamber was designed to maximize diagnostic access to the light and particulate emissions from the z pinch. The principal investigation is characterization of the debris field and the erosive effects on optics present. Light emission from the z pinch is followed by ejection of multiply charged ions and fast neutral particles that make up an erosive flux to chamber surfaces. Attenuation of this erosive flux to optical surfaces is attempted by inclusion of a debris mitigation tool consisting of foil traps and neutral buffer gas flow. Characterization of the z-pinch ejecta is performed with a spherical sector energy analyzer (ESA) that diagnoses fast ion species by energy-to-charge ratio using ion time-of-flight (ITOF) analysis. This is used to evaluate the debris tool’s ability to divert direct fast ions from impact on optic surfaces. The ITOF-ESA is used to characterize both the energy and angular distribution of the direct fast ions. Xe+ up to Xe+4 ions have been characterized along with Ar+ (the buffer gas used), W+, Mo+, Si+, Fe+, and Ni+. Energy spectra for these species from 0.5 up to 13keV are defined at 20° and 30° from the pinch centerline in the chamber. Results show a drop in ion flux with angular increase. The dominant species is Xe+ which peaks around 8keV. Ion flux measured against buffer gas flow rate suggests that the direct fast ion population is significantly attenuated through increases in buffer gas flow rate. This does not address momentum transfer from scattered ions or fast neutral particles. These results are discussed in the context of other investigations on the effects of total particle flux to normal incidence mirror samples exposed for 1×107 pulses. The samples (Si∕Mo multilayer with Ru capping layer, Au, C, Mo, Pd, Ru, and Si) were exposed to the source plasma with 75% argon flow rate in the debris mitigation tool and surface metrology was performed using x-ray photoelectron spectroscopy, atomic force microscopy, x-ray reflectivity, and scanning electron microscopy to analyze erosion effects on mirrors. These results are compared to the measured direct ion debris field.

The Teflon TM ablation in a micro-pulsed plasma thruster is studied with the aim of understanding the charring phenomenon. Microscopic analysis of the charred areas shows that it contains mainly carbon. It is concluded that the carbon char is formed as a result of carbon flux returned from the plasma. A simplified model of the current layer near the Teflon surface is developed. The current density and the Teflon surface temperature have peaks near the electrodes that explain preferential ablation of these areas, such as was observed experimentally. Comparison of the temperature field and the ablation rate distribution with photographs of the Teflon surface shows that the area with minimum surface temperature and ablation rate corresponds to the charring area. This finding suggests that the charring may be related to a temperature effect.

NASA and commercial spaceflight companies will soon be retuning humans to the Moon and then eventually sending them on to Mars. These distant planetary destinations will pose new risks—in particular for the health of the astronaut crews. The bulk of the evidence characterizing human health and performance in spaceflight has come from missions in Low Earth Orbit. As missions last longer and travel farther from Earth, medical risk is expected to contribute an increasing proportion of total mission risk. To date, there have been no reliable estimates of how much. The Integrated Medical Model (IMM) is a Probabilistic Risk Assessment (PRA) Monte-Carlo simulation tool developed by NASA for medical risk assessment. This paper uses the IMM to provide an evidence-based, quantified medical risk estimate comparison across different spaceflight mission durations. We discuss model limitations and unimplemented capabilities providing insight into the complexity of medical risk estimation for human spaceflight. The results enable prioritization of medical needs in the context of other mission risks. These findings provide a reasonable bounding estimate for medical risk in missions to the Moon and Mars and hold value for risk managers and mission planners in performing cost-benefit trades for mission capability and research investments.

The majority of the 15.4 million human immunodeficiency virus (HIV)–infected women worldwide are of child-bearing age and need access to contraception. Hormonal methods of contraception are safe, acceptable, and effective in preventing unwanted pregnancies. Many published studies have examined the impact of hormonal contraception on HIV disease acquisition and transmissibility. Far fewer have investigated the relationship between hormonal contraception and HIV disease progression. This review examines available data on this relationship from clinical, animal, and immunological studies. Several clinical studies suggest an overall effect but are not definitive, and the mechanisms behind HIV disease progression are unclear. Animal and immunological data suggest that immunomodulation by hormonal contraceptive methods may affect the immune response to HIV infection. Additional work is needed in this area to elucidate the possible relationship between hormonal methods for birth control and progression to acquired immunodeficiency syndrome in HIV-infected women.