Call for participants to the Systematic Review Workshop 

Join us in a six-month long project, selecting one mentor and working on a real systematic review in space medicine and life sciences. 
Apply now on the form at the bottom of this page. Application closes on 3rd October 23:59 GMT

 

Check the mentors and their Systematic Reviews’ topics

Since the beginning of time, all living organisms have evolved under a constant terrestrial gravitational field of 9.81 m/s2. On Earth, gravity is always there. The vestibular otoliths – sophisticated receptors inside the inner ear – constantly monitor the magnitude and direction of gravitational acceleration. Gravity is the most persistent sensory signal in the brain, yet it has been largely neglected in experimental psychology and cognitive neuroscience. However, gravity may influence human behaviour more pervasively than any other sensory signal. Exposure to Earth-discrepant gravity – as during spaceflights – leads to dramatic structural and functional changes in the human physiology, including alterations in the cardiovascular, neural and musculoskeletal systems. Astronauts have also reported cognitive, emotional, and perceptual alterations. Remarkably, however, virtually no systematic review has investigated the mechanisms by which gravity influences human behaviour and mental health. Our systematic review will fill this gap by focusing on the effects of altered gravity on physiological, neural and psychological processes.

Government astronauts undertake approximately 18 months of basic training to prepare themselves for spaceflight. Mission specific training takes a further 12-18 months once a mission is assigned. Commercial spaceflight participants will require far less preparation, however training and preparation will be needed and will range from a few days for suborbital participants, to potentially several months for orbital ‘space tourists’ who have the resources to participate in extra vehicle activity (for leisure purposes). The wide range of space vehicles currently in production and the variety of spaceflight opportunity packages, with their associated procedures, are such that there will be no simple prescription for spaceflight preparation in the first few years of commercial human spaceflight. It is clear, however, that appropriate standards will be required which outline the minimal duration and appropriate nature of the preparatory measures necessary to adequately prepare the general public for travel to and spend time in space. Additionally, commercial spaceflight professionals such as space pilots and in due course orbital engineers and scientists, will require training to a far greater standard than space tourists, but far less rigorous and current government astronauts. To further complicate the issue, members of the general public travelling into space will of course exhibit a wide variety of medical conditions and fitness levels, many of which can be impacted by travel to and exposure to space. Preparing one individual for a given spaceflight might require 2 weeks in one instance, but potentially 2 months for someone else if their condition is more likely to be negatively impacted by the experience. There is a need , therefore, to understand what literature and research findings exist that can support the identification and recommendation of the minimal space training/preparation standards that should be employed for commercial spaceflight participant safety, as the embryonic commercial human spaceflight sector becomes a reality. I would propose that a systematic review be conducted on the topic of ‘spaceflight training and preparation for commercial participants’. Please note that this proposal refers to training and preparing people for spaceflight, and not the precursory medical/psychological clearance for space flight.

Managing mental and behavioural health in space is a critical issue. Difficulties related to behaviour, health and wellbeing can have significant consequences and result in poor individual adaptation, impaired performance and disrupted team/interpersonal function. If not addressed, these issues could potentially lead to more serious outcomes such as injury or death. Clearly, it is important to identify methods for managing and optimising behaviour and mental health in space. Solutions are likely to require an interdisciplinary perspective. Indeed, consistent with advances in technology and data science, various digital applications for behaviour and health management for human spaceflight have been or are being explored. This includes interactive tailored educational courses, closed loop digital self-regulation tools, and augmented and virtual reality programmes. The proposed systematic review project would (1) scope the literature on digital training and interventions that have been used in space and other analogous environments, (2) examine the theoretical, methodological and practical approaches used in prior work, and (3) identify best practices for future development of digital solutions for behavioural and mental health management on both long duration exploration missions and in other commercial spaceflight. Depending on timelines and logistics, the review could be supplemented with a small number of Subject Matter Expert (SME) interviews to appropriately shape the implications and applications of the work. The systematic review would be guided by PRISMA principles and pre-registered on PROSPERO in keeping with an open science approach.

 

The medicine is governed by a combination of laws and policies. Development into space is pushing back the boundaries of established professional and legal practice. This new frontier requires informed legal and ethical approaches to human spaceflight and emerging aerospace activities. Specific issues to examine include (but are not limited to) consent, discrimination, therapeutic biomedical research, non-therapeutic bio-medical research, rights and obligations

Within the science fiction genre, putting humans in some form of long-term hibernation or “cryo-sleep” is a well-established trope to ease long duration space travel. The ability of some mammalian species to hibernate or enter states of torpor is also well-established. For such mammals, hibernation results in obvious reductions in metabolic activity and reduction of body temperature. Less obvious features include modification to the normal homeostasis aspects of muscle and bone turnover with the surprising result that muscle loss and bone loss significantly reduces during hibernation compared to similar levels of inactivity in non-hibernation states. It is assumed that the genetic similarity of mammals means that all mammals have the genetic potential to enter hibernation states including humans. There are a number of anecdotal accounts of humans entering pseudo-hibernation states associated with accidental cold-water immersion. Scientifically and technically, three strands of research are pursuing interrelated studies on hibernation. Basic biological research into mammalian hibernation, medically-related research driven by a desire to enter critically-ill patients into a hibernation-like state to allow better medical interventions and the space community where artificial human hibernation could address physiological and engineering challenges associated with future long-duration spaceflight. The latter links back to the speculation offered by the science fiction community. Of the three strands, space-related studies are the least developed. The space community has only recently started preliminary considerations of human hibernation and the impact this could have on future space developments. As examples, ESA has recently established a Topical Team activity to consider artificial human hibernation in a space context and NASA has funded a third-party design study for a Mars missions exploiting the existing medical intervention of therapeutic hypothermia. Given the increasing interest among space agencies around the long-term prospects and implications of human hibernation as part of future space systems, it appears timely to review in a systematic fashion the current knowledge relevant to mammalian and human hibernation and with some focus towards those aspects relevant to space applications. The latter includes those physiological systems normally affected by reduced gravity and increased ionising radiation in space environments. The results of such a review are expected to highlight both current knowledge and key gaps in such knowledge, enable the contextualisation of the knowledge in a future space-use context and contribute to planning required future studies. This will also have supervisory input from Prof David Cullen at Cranfield University.

Fewer than 20 people have flown on suborbital flight profiles, yet estimates suggest that 10,000s of people may take such flights in the next 10-20 years, largely due to the increasing interest in commercial companies offering these experiences. However the physiological effects of these flights are poorly understood, and there is little focussed research in this area. As such, regulatory authorities have limited information on which to base guidance for operations, suborbital vehicle manufacturers and experience providers. The need for such information also relates to specification, design and testing of these vehicles and their life support and protection systems, as well as informing the education and training requirements for both passengers and crew. Additionally, members of the general public who are likely to be able to afford such flights may have quite different physiology and co-morbidities compared with the professional astronaut populations who have thus far experienced these flight profiles. No systematic reviews have been undertaken to evaluate the limited data currently available or to map the future research needs. Supervision will be assisted by the Paraboladies, which will be informed by their previous project on this topic area.

 

Systematic review of osteoporosis pharmacological treatment on bone health in bed rest studies One of the most serious medical concerns during long-duration space flight is significant bone loss. Dual energy X-ray absorptiometry revealed bone loss at rates of 0.9%/month in the lumbar spine and 1.5%/month in the femoral neck of astronauts. Furthermore, this study confirmed using a calcium kinetics study that bone resorption increased, and intestinal calcium absorption decreased during space flight. Another study found that femoral bone density was reduced by more than 2% per month and sand-like urinary lithiasis particles (i.e. kidney stones) were detected by X-ray. This means that astronauts typically lose as much bone mass in the proximal femur in 1 month as postmenopausal women on Earth lose in 1 year. Currently, countermeasures programme has solely depended on exercise or exercise and oral bisphosphonates such as alendronic acid. Despite advances in pharmacological options in preventing or attenuating osteoporosis on Earth, many of these drugs have not been tested in human space flight with the exception of alendronic acid. Biphosphonates are a class of anti-resorptives and most commonly used to treat osteoporosis in post menopausal women. However, a study noted that 2/10 astronauts experienced gastrointestinal intolerance leading to the stop of the medication. Within the bisphosphonate class there are different types that can be delivered orally or intravenously. For example, a single zoledronic acid infusion given preflight would suffice for at least a 6-month flight and would have many advantages over a weekly oral dose. There are also other types of medication classes such as the selective estrogen receptor modulators, raloxifene. Anabolic agents such as parathyroid hormone (PTH) and teriparatide (rhPTH [1-34]) which can be delivered intramuscularly are also viable options. Another candidate for bone loss countermeasure is denosumab. It is a monoclonal antibody that binds the receptor activator of nuclear factor kappa-B ligand (RANKL), preventing the ability of RANKL to promote the maturation, function, and survival of osteoclasts. Denosumab is delivered by intramuscular injection every 6 months. With further testing, other available osteoporosis medications may be a good alternative to bisphosphonates. Bed rest studies are considered a reliable ground-based spaceflight analogue that allow for direct comparison between intervention and control participants. Prior to testing these alternative osteoporosis medications in space flight, bed rest studies can serve as a useful comparison of their effect and safety profile. Therefore, the aim of the systematic review is to identify the gap and evaluate the effectiveness of osteoporosis pharmacological treatment on bone health in bed rest studies. Our study will be guided by PRISMA protocol for systematic reviews and the Aerospace Medicine Systematic Review Group Bed Rest Assessment tool will be used to assess the quality of the studies.

Health and Life Science in Space, the opportunity for innovation: This systematic review will examine the previous health and life science research and innovation activities conducted in space and aligned gravity related platforms. This will provide a peer-reviewed resource that could help inform policy and future strategy for space R&D and innovation. With countries around the world including the UK building further space launch capacity, growing the private launch provider ecosystem as well as investing further in government funded agencies such as ESA and NASA, the opportunity to intelligently utilise space infrastructure (including low earth orbit) to solve R&D challenges and develop new processes and understanding is set to rise. This paper will held support the Health and Life Science Sector understand and explore the opportunity for space.

Applications have now closed. Thank you for your interest.