Bernd Johannes

Psychology and culture during long-duration space missions ☆

The International Academy of Astronautics Study Group on Psychology and Culture in LongDuration Space Missions first convened in May 2003, at the 14 Humans in Space Symposium in Banff, Canada. After this initial meeting to define the group’s task, members divided into subcommittees and worked on drafts of sections of the document over email. The group reconvened in person several times to coordinate the structure of the paper. These sessions occurred at scientific meetings where many of the members were present. The study group formally convened in 2003 at the International Astronautical Congress (IAC) in Bremen and at the Institute for Biomedical Problems 40 Anniversary Symposium in Moscow. In 2004 it convened at the IAC in Vancouver and at the Annual Meeting of the Aerospace Medical Association (AsMA) in Anchorage. In 2005 it convened at the Humans In Space Symposium in Graz, at the IAC in Fukuoka, and at the AsMA Meeting in Kansas City. In 2006 the group worked over e-mail and will convene at the IAC in Valencia after the paper is finished in order to debrief and set out plans for future work. The objective of this report is twofold: a) to describe the current knowledge of cultural, psychological, psychiatric, cognitive, and interpersonal issues that are relevant to the behavior and performance of astronaut crews and ground support personnel; and b) to make recommendations for future human space missions, including both transit and planetary surface operations on the Moon, Mars, and beyond. The focus will be on long-duration missions lasting at least six weeks, when important psychological and interpersonal factors begin to take their toll on crewmembers. This information is designed to provide guidelines for astronaut selection and training, in-flight monitoring and support, and post-flight recovery and re-adaptation. After a consideration of Cultural Issues, which impact on the entire report, four main sections follow: Personality, Coping, and Adaptation; Behavioral Health and Psychiatry; Cognition and Complex Performance Skills; and Interpersonal and Organizational Issues. For each of these sections, there is a review of general issues; implications for mission operations in terms of crew selection, training, monitoring and support, and re-adaptation to Earth; and operational and research recommendations involving future missions to Earth orbit, the lunar surface, or to Mars and beyond.

Magnetic resonance–determined sodium removal from tissue stores in hemodialysis patients

We have previously reported sodium is stored in skin and muscle. The amounts stored in hemodialysis (HD) patients are unknown. We determined whether 23Na magnetic resonance imaging (sodium-MRI) allows assessment of tissue sodium and its removal in 24 HD patients, and 27 age-matched healthy controls. We also studied 20 HD patients before and shortly after HD with a batch dialysis system with direct measurement of sodium in dialysate and ultrafiltrate. Age was associated with higher tissue sodium content in controls. This increase was paralleled by an age-dependent decrease of circulating levels of vascular endothelial growth factor-C (VEGF-C). Older (over 60 years) HD patients showed increased sodium and water in skin and muscle, and lower VEGF-C levels than age-matched controls. After HD, patients with low VEGF-C levels had significantly higher skin sodium content than patients with high VEGF-C levels (low VEGF-C: 2.3 ng/ml and skin sodium: 24.3 mmol/L; high VEGF-C: 4.1ng/ml and skin sodium: 18.2mmol/L). Thus, sodium-MRI quantitatively detects sodium stored in skin and muscle in humans and allows studying sodium storage reduction in ESRD patients. Age and VEGF-C-related local tissue-specific clearance mechanisms may determine the efficacy of tissue sodium removal with HD. Prospective trials on the relationship between tissue sodium content and hard endpoints could provide new insights into sodium homeostasis, and clarify whether increased sodium storage is a cardiovascular risk factor.

Agreement Between 24-Hour Salt Ingestion and Sodium Excretion in a Controlled Environment

Accurately collected 24-hour urine collections are presumed to be valid for estimating salt intake in individuals. We performed 2 independent ultralong-term salt balance studies lasting 105 (4 men) and 205 (6 men) days in 10 men simulating a flight to Mars. We controlled dietary intake of all constituents for months at salt intakes of 12, 9, and 6 g/d and collected all urine. The subjects’ daily menus consisted of 27 279 individual servings, of which 83.0% were completely consumed, 16.5% completely rejected, and 0.5% incompletely consumed. Urinary recovery of dietary salt was 92% of recorded intake, indicating long-term steady-state sodium balance in both studies. Even at fixed salt intake, 24-hour urine collection for sodium excretion (UNaV) showed infradian rhythmicity. We defined a ±25 mmol deviation from the average difference between recorded sodium intake and UNaV as the prediction interval to accurately classify a 3-g difference in salt intake. Because of the biological variability in UNaV, only every other daily urine sample correctly classified a 3-g difference in salt intake (49%). By increasing the observations to 3 consecutive 24-hour collections and sodium intakes, classification accuracy improved to 75%. Collecting seven 24-hour urines and sodium intake samples improved classification accuracy to 92%. We conclude that single 24-hour urine collections at intakes ranging from 6 to 12 g salt per day were not suitable to detect a 3-g difference in individual salt intake. Repeated measurements of 24-hour UNaV improve precision. This knowledge could be relevant to patient care and the conduct of intervention trials.

Increased salt consumption induces body water conservation and decreases fluid intake

BACKGROUND. The idea that increasing salt intake increases drinking and urine volume is widely accepted. We tested the hypothesis that an increase in salt intake of 6 g/d would change fluid balance in men living under ultra-long-term controlled conditions. METHODS. Over the course of 2 separate space flight simulation studies of 105 and 205 days’ duration, we exposed 10 healthy men to 3 salt intake levels (12, 9, or 6 g/d). All other nutrients were maintained constant. We studied the effect of salt-driven changes in mineralocorticoid and glucocorticoid urinary excretion on day-to-day osmolyte and water balance. RESULTS. A 6-g/d increase in salt intake increased urine osmolyte excretion, but reduced free-water clearance, indicating endogenous free water accrual by urine concentration. The resulting endogenous water surplus reduced fluid intake at the 12-g/d salt intake level. Across all 3 levels of salt intake, half-weekly and weekly rhythmical mineralocorticoid release promoted free water reabsorption via the renal concentration mechanism. Mineralocorticoid-coupled increases in free water reabsorption were counterbalanced by rhythmical glucocorticoid release, with excretion of endogenous osmolyte and water surplus by relative urine dilution. A 6-g/d increase in salt intake decreased the level of rhythmical mineralocorticoid release and elevated rhythmical glucocorticoid release. The projected effect of salt-driven hormone rhythm modulation corresponded well with the measured decrease in water intake and an increase in urine volume with surplus osmolyte excretion. CONCLUSION. Humans regulate osmolyte and water balance by rhythmical mineralocorticoid and glucocorticoid release, endogenous accrual of surplus body water, and precise surplus excretion. FUNDING. Federal Ministry for Economics and Technology/DLR; the Interdisciplinary Centre for Clinical Research; the NIH; the American Heart Association (AHA); the Renal Research Institute; and the TOYOBO Biotechnology Foundation. Food products were donated by APETITO, Coppenrath und Wiese, ENERVIT, HIPP, Katadyn, Kellogg, Molda, and Unilever.

Ultra-long–term human salt balance studies reveal interrelations between sodium, potassium, and chloride intake and excretion

BACKGROUND The intake of sodium, chloride, and potassium is considered important to healthy nutrition and cardiovascular disease risk. Estimating the intake of these electrolytes is difficult and usually predicated on urine collections, commonly for 24 h, which are considered the gold standard. We reported on data earlier for sodium but not for potassium or chloride. OBJECTIVE We were able to test the value of 24-h urine collections in a unique, ultra-long-term balance study conducted during a simulated trip to Mars. DESIGN Four healthy men were observed while ingesting 12 g salt/d, 9 g salt/d, and 6 g salt/d, while their potassium intake was maintained at 4 g/d for 105 d. Six healthy men were studied while ingesting 12 g salt/d, 9 g salt/d, and 6 g salt/d, with a re-exposure of 12 g/d, while their potassium intake was maintained at 4 g/d for 205 d. Food intake and other constituents were recorded every day for each subject. All urine output was collected daily. RESULTS Long-term urine recovery rates for all 3 electrolytes were very high. Rather than the expected constant daily excretion related to daily intake, we observed remarkable daily variation in excretion, with a 7-d infradian rhythm at a relatively constant intake. We monitored 24-h aldosterone excretion in these studies and found that aldosterone appeared to be the regulator for all 3 electrolytes. We report Bland-Altman analyses on the value of urine collections to estimate intake. CONCLUSIONS A single 24-h urine collection cannot predict sodium, potassium, or chloride intake; thus, multiple collections are necessary. This information is important when assessing electrolyte intake in individuals.

A methodology to compensate for individual differences in psychophysiological assessment.

The main methodological drawback to use physiological measures as indicators of arousal is, the large interindividual variability of autonomic responses hindering the direct comparability, between individuals. The present methodology has been tested in two cohorts (n1=910, n2=845) of, pilot applicants during a selection procedure. Physiological data were obtained during two mentally, demanding tasks and during a Flight Simulator Test. Five typical Autonomic Response Patterns (ARP), were identified by cluster analyses. Autonomic spaces were constructed separately for each group of, subjects having the same typical ARP, on the basis of their normalized eigenvectors. The length of the, vector sum of scores on autonomic space dimensions provided an integral index for arousal, labeled, Psychophysiological Arousal Value (PAV). The PAV still reflected the changes in mental load during the, tests, but equalized physiological differences among ARP-groups. The results obtained in the first, cohort were verified in the second cohort.

PlanHab study: assessment of psycho-neuroendocrine function in male subjects during 21 d of normobaric hypoxia and bed rest

Abstract Immobilization and hypoxemia are conditions often seen in patients suffering from severe heart insufficiency or primary pulmonary diseases (e.g. fibrosis, emphysema). In future planned long-duration and exploration class space missions (including habitats on the moon and Mars), healthy individuals will encounter such a combination of reduced physical activity and oxygen tension by way of technical reasons and the reduced gravitational forces. These overall unconventional extraterrestrial conditions can result in yet unknown consequences for the regulation of stress-permissive, psycho-neuroendocrine responses, which warrant appropriate measures in order to mitigate foreseeable risks. The Planetary Habitat Simulation Study (PlanHab) investigated these two space-related conditions: bed rest as model of reduced gravity and normobaric hypoxia, with the aim of examining their influence on psycho-neuroendocrine responses. We hypothesized that both conditions independently increase measures of psychological stress and enhance neuroendocrine markers of stress, and that these effects would be exacerbated by combined treatment. The cross-over study composed of three interventions (NBR, normobaric normoxic horizontal bed rest; HBR, normobaric hypoxic horizontal bed rest; HAMB, normobaric hypoxic ambulatory confinement) with 14 male subjects during three sequential campaigns separated by 4 months. The psychological state was determined through three questionnaires and principal neuroendocrine responses were evaluated by measuring cortisol in saliva, catecholamine in urine, and endocannabinoids in blood. The results revealed no effects after 3 weeks of normobaric hypoxia on psycho-neuroendocrine responses. Conversely, bed rest induced neuroendocrine alterations that were not influenced by hypoxia.

Microcirculation in open vs. minimally invasive dorsal stabilization of thoracolumbar fractures

Standard open and percutaneous minimally invasive surgical procedures co-exist in the treatment of fractures of the thoracolumbar spine. Shorter skin incisions just above the pedicles are used in minimally invasive procedures. Full-length skin incisions and invasive preparations are applied in the standard open approach. While both methods show equivalent rates of intraoperative surgical complications and comparable clinical and radiological outcomes, blood loss and operation time have shown to be decreased in minimally invasive treatment. However, no study so far has investigated differences in microcirculation. This study hypothesized less impairment of microcirculation in the minimally invasive approach compared to the open approach and an improvement of microcirculation over time. A prospective cohort study was conducted using non-invasive laser-Doppler spectrophotometry (an O2C “oxygen to see” device) for measurement of cutaneous and subcutaneous blood oxygenation (SO2), haemoglobin concentration (Hb), and blood flow at depths of 2, 8, and 15 mm at six locations on the skin. Measurements were performed before surgery, 8 and 24 h after surgery, and 2, 4, 7, 12 and 20 days after surgery, however the number of patients measured decreased towards the later time points. Forty patients were included in the study, 20 with each approach (18 females and 22 males). Pair-wise comparison of the types of surgical procedure for each measurement point revealed a significantly higher flow value in the minimally invasive group at one of the measurement points located between the incisions (P = .041). The point-wise analyses of SO2 and Hb did not show significant differences between the approaches. In conclusion, significantly albeit moderately higher flow values could be found in minimally invasive procedures compared to open operations of thoracolumbar fractures in the area of skin that is spared by the incisions.

Wireless Monitoring of Changes in Crew Relations during Long-Duration Mission Simulation

Group structure and cohesion along with their changes over time play an important role in the success of missions where crew members spend prolonged periods of time under conditions of isolation and confinement. Therefore, an objective system for unobtrusive monitoring of crew cohesion and possible individual stress reactions is of high interest. For this purpose, an experimental wireless group structure (WLGS) monitoring system integrated into a mobile psychophysiological system was developed. In the presented study the WLGS module was evaluated separately in six male subjects (27–38 years old) participating in a 520-day simulated mission to Mars. Two days per week, each crew member wore a small sensor that registered the presence and distance of the sensors either worn by the other subjects or strategically placed throughout the isolation facility. The registration between two sensors was on average 91.0% in accordance. A correspondence of 95.7% with the survey video on day 475 confirmed external reliability. An integrated score of the “crew relation time index” was calculated and analyzed over time. Correlation analyses of a sociometric questionnaire (r = .35-.55, p< .05) and an ethological group approach (r = .45-.66, p < 05) provided initial evidence of the methods validity as a measure of cohesion when taking behavioral and activity patterns into account (e.g. only including activity phases in the afternoon). This confirms our assumption that the registered amount of time spent together during free time is associated with the intensity of personal relationships.

Muscular forces affect the glycosaminoglycan content of joint cartilage: unloading in human volunteers with the HEPHAISTOS lower leg orthosis.

Background and purpose — Unloading alters the thickness of joint cartilage. It is unknown, however, to what extent unloading leads to a loss of glycosaminoglycans (GAGs) in the cartilage tissue. We hypothesized that muscle forces, in addition to axial loading, are necessary to maintain the joint cartilage GAG content of the knee and the upper and lower ankle. Patients and methods — The HEPHAISTOS orthosis was worn unilaterally by 11 men (mean age 31 (23–50) years old) for 56 days. The orthosis reduces activation and force production of the calf muscles while it permits full gravitational loading of the lower leg. MRI measurements of the knee and ankle were taken before the intervention, during the intervention (on day 49), and 14 days after the end of the intervention. Cartilage segmentation was conducted semiautomatically for the knee joint (4 segments) and for the upper (tibio-talar) and lower (subtalar) ankle joints (2 segments each). Linear mixed-effects (LME) models were used for statistical analysis. Results — 8 volunteers completed the MRI experiment. In the lower ankle joint, differences in ΔT1 were found between the end of the intervention and 14 days after (p = 0.004), indicating a decrease in GAG content after reloading. There were no statistically significant differences in ΔT1 values in the knee and upper ankle joints. Interpretation — Our findings suggest that in addition to gravitational load, muscular forces affect cartilage composition depending on the local distribution of forces in the joints affected by muscle contraction.