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J ULY 2014, N O 9

ISOPTWPO Today

Colours O’IRIS My name is Colours O’IRIS. I’m a peacock dedicated to teaching the world about colors and especially the colors of the Sun! I work at the Stanford Solar Center and I am a big fan of NASA’s IRIS mission.

Scientists here at Stanford want to learn all they can about the Sun. We have the HMI instrument on NASA’s Solar Dynamics Observatory (SDO) and also work with NASA’s IRIS mission. My friend Camilla likes to talk about SDO. I prefer to talk about IRIS – cause IRIS is a spectrograph. And a spectrograph breaks up light into its colors. I love to understand what you can learn from colors!!!

Read about me:

http://about.me/coloursoiris http://coloursoiris.tumblr.com/ https://twitter.com/ColoursOIRIS https://www.facebook.com/pages/Colours-OIris/362948623716347 —Image Credit:Colours O’IRIS

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Heart Rate Variability(HRV) in Space Space medicine was one of the first fields of science and practice where HRV analysis was used for obtaining new scientific information and solving the tasks of exercising medical control over humans working under extreme conditions.

HRV depends in large measure on the degree of tension of the regulatory systems determined by the activation of the pituitary-adrenal system occurring in response to any stressor effect and the reaction of the sympathoadrenal system. The tension of the regulatory systems is an integral response of the body to the whole complex of factors affecting it, irrespective of what they are related to. Exposure to the complex of extreme factors gives rise to the general adaptation syndrome, which is a universal response of the body to stress of any nature.

The first attempts to assess the state of the autonomic nervous system by the HRV values were made as far back as during the first flights of human beings into outer space (1961-1964). At that time, the duration of the ECG RRintervals was measured manually, the main statistical variables (standard deviation, rootmean square deviation, and coefficient of variation) were calculated using 100 to 200 cardiointerval samples; the histograms-the graphs of the distribution of the cardiointerval values were constructed.

At present, the HRV study on board the spacecraft was conducted using (1) Telemetric channels (when transmitting a real-time ECG to the Earth), (2) A radio channel (when transmitting to the Earth the ECG signals modulated by sound frequency and recorded on a portable tape recorder during the physical training of cosmonauts), and (3) Memory devices (floppy disks, magnetic tapes, flash cards, etc.).

The length of the recordings to be analyzed varies from 10-15 min to 24 h(Holter monitoring). The methods for the HRV analysis can be divided into three large classes: (1) The study of general variability (statistical methods and temporal analysis), (2) The study of the periodic HRV components (frequency analysis), and (3) The study of the internal organization of the dynamic series of cardiointervals (nonlinear dynamics methods, autocorrelation analysis, and correlation rhythmography).

Table 1 summarizes the most frequently used in practice HRV values with a short characteristic of their importance in the assessment of the autonomic balance, the levels of the heart rhythm control, and the functional state of the body. The designations of the HRV variables are given with regard to the published recommendations of the European Society of Cardiology and the North American Society for Electrophysiology.

Among the variables presented, the complex index of the activity of regulatory systems (IARS) that was proposed, proceeding from the tasks of space medicine, in the early 1980s occupies an important place. It is calculated in points using a special algorithm taking into account the statistical values, variation pulsometry values, and the data of the spectral analysis of cardiointervals. IARS allows different degrees of tension of the regulatory systems to be differentiated and the adaptation possibilities of the body to be assessed.

The IARS values are expressed in points from 1 to 10. The following functional states can be diagnosed based on the analysis of the IARS values: (1) The state of the optimal tension of the regulatory systems necessary for the maintenance of the active balance of the body with the environment (norm, IARS = 1-2).

(2) The state of moderate tension of the regulatory systems when, to adjust itself to the environmental conditions, the body needs additional functional reserves. Such states occur in the process of adaptation to labor activity, under emotional stress, or on exposure to unfavorable ecological factors (IARS = 3-4).

(3) The results of a marked tension of the regulatory systems that is connected with an active mobilization of deË? adrenal fensive mechanisms including an increase in the activity of the sympathoadrenal system and the pituitaryU system (IARS = 4-6). Ë? adap(4) The state of overstrain of the regulatory systems that is characterized by the insufficiency of the defensiveU tation mechanisms, their inability to provide an adequate reaction of the body to the effect of environmental factors.

Here, excessive activation of the regulatory systems is not reinforced by the corresponding functional reserves (IARS = 6-8).

(5) The state of exhaustion (asthenization) of the regulatory systems when the activity of the controlling mechanisms decreases (insufficient mechanisms of regulation) and the characteristic signs of pathology appear. Here, specific changes distinctly prevail over nonspecific ones (IARS = 8-10).

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Results Table 2 shows the results of the assessment of the functional state of one of the cosmonauts at different stages of the flight: before the start, at the moment of the start, at the beginning of the flight (3 h of the presence in the state of weightlessness), and in the fourth month of the space flight. The first column of Table 2 shows the ranges of the Human Spaceflight Edition c International Space Agency (ISA)

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ISOPTWPO Today normal values of the heart rate variability variables. It should be noted that this is the so-called group physiological rest norm that was developed to be used in the system of medical monitoring of the cosmonauts’ condition.

One hour before the start, the cosmonaut demonstrates an accelerated pulse rate due to psychoemotional tension as well as a RW decrease and an increase in the SW-2 power, which indicates the activation of the sympathetic division of the autonomic nervous system. In the aggregate, the changes observed show that the IARS value is equal to 3 (moderate physiological tension).

Ten minutes before the start, due to an increased psychoemotional stress, the heart rate increases to exceed 90 bpm, and the root-mean-square deviation (RMSD) decreases to 39 ms. A pronounced reaction of the vascular center (an increase in SW-1, IARS = 4, marked functional tension).

During the first minutes after the start, the heart rate increases to 106 bpm, the RMSD falls to 30 ms. The mode amplitude increases to 60%, the stress index (SI) increases to 281 arb. units, and the total spectral power of the heart rhythm sharply decreases. All this reflects a pronounced activation of the sympathetic division of the autonomic nervous system, which, in this case, is determined not only by the psychoemotional excitation of the cosmonaut but also the action of the G-forces and vibrations.

At the active stage of the flight, the IARS score is 5 to 6.

Already during the second circuit round the Earth, 3 h after the spaceship had been put into orbit, all the HRV values were virtually normalized. However, a significant increase in the SW-1 power and a certain decrease in the SW-2 spectrum power are noted.

This is an activation of the vasomotor center characteristic of the condition of weightlessness and determined by the redistribution of blood to the upper parts of the body and the increased filling of the pulmonary circulation and the cerebral vessels. In the condition of weightlessness, the absence of hydrostatic blood pressure creates a new situation for the systems regulating arterial pressure, the vasomotor center experiencing continuous stress, which is seen from the Table 2 where a marked increase in the SW-1 spectrum power is observed both at 48 h and 126 days of the flight. The IARS value in these segments of the flight was within normal limits. A decrease in the mode amplitude and the stress index is also noteworthy, which is indicative of a certain increase in the tone of the parasympathetic division with the corresponding shift in the autonomic balance.

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The results of the analysis of the daily arrays of cardiointervals obtained when using the Holter monitoring in two crew members of the Mir orbital station during a 115-day space flight.

Figures 2 and 3 show the graphs of the dynamics of the heart rate, RMSD, SI, and the HRV spectral components at different stages of the flight. The comparison of the results of the study of the first and second crew members shows that even before the flight there were noticeable differences between them. With the same pulse rate, the RMSD of the second cosmonaut is two times less, while his SI value is twice as high.

This means that, in order to maintain the normal level of the cardiovascular system functioning, the body of the second cosmonaut requires a more strenuous tension of the regulatory mechanisms, since he has lower functional reserves.

This difference becomes understandable due to the age-related differences between the cosmonauts. The second cosmonaut is almost 20 years older than the first one. However, he was making his third space flight and had a wide practical experience of work in space, while the first cosmonaut was making his first space flight.

After the three-week presence in the state of weightlessness, the first cosmonaut showed a statistically significant decrease in the heart rate and a decrease in the root-mean-square deviation (RMSD) without an SI increase. This indicates that his system of regulation switched over to a more economical regimen of work with some shift in the autonomic balance toward an increase in the activity of the parasympathetic link. In the second cosmonaut, the heart rate did not decrease against the background of the significant RMSD decrease and the SI increase; i.e., the stress of his regulatory systems increased significantly. During the subsequent two to three months of the flight, the first cosmonaut restored the near-preflight level of work of the regulatory systems; in the second cosmonaut, the stress of the mechanisms of regulation continued to increase.

At the end of the flight, the existing difference is maintained, and, finally, two days after the landing, with the same heart rate for both cosmonauts (an average of 10 bpm higher as compared to the preflight level), the second cosmonaut revealed a marked stress of the regulatory mechanisms (the SI value exceeds that of the first cosmonaut by a factor of 3).

A significantly higher activity of the sympathetic division of the autonomic nervous system in the second cosmonaut is evidenced by the data of the spectral analysis of the heart rhythm, in particular, the data on the respiratory wave power ( Fig. 3). Before the flight, almost a fivefold difference in the values of this variable is observed. During Human Spaceflight Edition c International Space Agency (ISA)

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ISOPTWPO Today the flight, the insignificant spectral power of the respiratory waves in the second cosmonaut decreases significantly.

The analysis of the data on the activity of the vasomotor center that is responsible for the maintenance of the vascular tone in the long-term condition of weightlessness,when the sensitivity of the intravascular receptors decreases, is of great interest. As seen from Fig. 3, not only the significant difference in the absolute values of the SW-1 power but also their different inflight dynamics is noted. In both cosmonauts, the vasomotor wave power decreases during the first two to three months of the flight. However, in the first cosmonaut,it is restored almost to the preflight level by the end of the flight, while in the second cosmonaut, it continues to decrease.

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The average daily SW-2 power values in the second cosmonaut are substantially lower than in the first cosmonaut both before and during the flight. The dynamics of the in-flight changes virtually coincides in both cosmonauts.

Thus, even in well-trained, healthy people, e.g., cosmonauts, the adaptation to the flight conditions occurs in different ways, depending on the individual peculiarities of the initial status and the level of the functional reserves.

The second cosmonaut, due to his individual specific features, was in need of a continuous active mobilization of the functional reserves for the maintenance of the balance between the body and the environment during the flight.

Long-term stress of the mechanisms of regulation caused the second cosmonaut to develop the signs of overstrain and dysadaptation.

Thus, on the 103rd day of the flight, his EEG showed negative T-waves and the episodes of paroxysmal tachycardia.

HRV studies during the space flight is connected with the problem of long-term adaptation of the human body to the condition of weightlessness. In the most long-term space flight lasting 14 months (438 days), unique investigations aimed at exploring the mechanisms of man’s adaptation to long-term exposure to the complex of stressors were carried out.

Figure 4 shows the dynamics of the values of the main parameters of the cardiovascular homeostasis-the heart rate and arterial pressure-during a long-term flight.

Beginning from the fifth month of the flight, systolic and diastolic arterial pressure lowered by 10 to 20%. The decrease in the diastolic arterial pressure was especially pronounced on the 147th day of the flight. The level of the heart rate and arterial pulse pressure varied within the limits close to the preflight values, the pulse pressure decrease being accompanied by a compensatory pulse rate increase.

During the 14-month flight, the cardiovascular homeostasis was maintained at the near-preflight level with somewhat lower values of systolic and diastolic arterial pressure, beginning with the 5th-6th month of the flight.

Figure 5A and 5B, shows the graphs of changes in the pulse rate and the stress index of the regulatory systems as well as the total spectral power of the heart rhythm during the 14-month flight.During the first five months of the flight no substantial changes in the autonomic balance are noted. Since the end of the sixth month of the flight (209th day), a new stage of the readjustment of the autonomic balance begins. The stress index increases significantly in the Human Spaceflight Edition c International Space Agency (ISA)

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ISOPTWPO Today 8th-9th month of the flight and then decreases to the level of the first half year values.

The changes in the hormonal regulation values studied on the 170th, 287th, and 430th days of the flight.

A significant increase in the blood concentration of aldosterone on the 287th day of the flight was noted as compared with the background value. On the 170th day of the flight, the adrenaline and noradrenaline concentrations increased more than fourfold, and, on the 287th day of the flight, there was more than a threefold excess of the preflight level. Thus, despite the absence of homeostatic disorders, the regulatory mechanisms worked actively.

The inflight data , beginning from the second month of the flight, the amplitude of the ballistocardiogram reflecting the external work of the heart increased almost twofold. This may be connected with three circumstances: (1) The reduction of the circulating blood volume (2) the pressure increase in the pulmonary circulation (3) the disappearance of the gravitational component of the circulation.

All these causes increased the blood ejection rate by the ventricles (an increase in the kinetic energy of the cardiac output).

A dramatic increase in the external work of the heart observed on the 250th day of the flight coincides with maximum activity of the sympathetic division of the autonomic nervous system (an increase in the stress index of the regulatory systems) and maximum activity of the vasomotor center.

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Examination of the Influencing Factors of Space Flight on Autonomic Regulation of Blood Circulation, Respiration and Cardiac Contractile Function in Long Duration Space Flight (Pneumocard) Pneumocard is an integrated study of the adaptation of the cardiovascular system of crewmembers during a longduration microgravity mission.

Acquiring new scientific information to refine the understanding about the mechanisms of adapting the cardiorespiratory system and the whole organism to space flight conditions. Integrated study of a cardiovascular system of astronauts in various phases of a long-duration mission in order to clarify the adaptation mechanisms and phases and determine diagnostic criteria for individual assessment of the organism adaptation to zero-gravity conditions.

Study of the synchronization of heart activity and breathing factors, as well as the cardiorespiratory system control processes based on variability rate of physiological parameters. Study of interconnection between the cardiorespiratory system during a long-duration mission and tolerance of orthostatic and physical activities at the beginning of readaptation for predicting possible reactions of the crewmembers organism during the their return to ground.

Results Heart rate variability (HRV) from Pneumocard experiment was measured and analyzed on 14 Russian cosmonauts during long term space flights (twice before and after flight, monthly in flight) to test the hypothesis that HRV can be used to provide important information for crew health monitoring. Changes of blood pressure (BP) and heart rate (HR) seen in cosmonauts during space flight may be relatively small when compared to patients with cardiovascular diseases. However, these small changes are the result of compensatory changes of the regulatory systems, and measurements of cardiovascular and respiratory control may provide useful health information. Results suggest that the HRV of cosmonauts remained relatively stable during the six months in space with the most pronounced change occurring after landing.

Interestingly, the functional state assessed by HRV improved during space flight if compared to preflight and early

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ISOPTWPO Today postflight data. In some instances, a shift from the physiological normal state to the altered functional state during space flight was also detected, and analysis of individual cosmonauts showed distinct patterns depending on the preflight status. The most pronounced changes were detected early after landing (1-3 days) but returned to preflight values at 5-7 days after landing in most cosmonauts.

The key finding of the study was that the classification system based on analysis of HRV data to calculate a functional state of the cosmonaut before, during, and after space flight may be used to show individual adaptation to microgravity. The monthly measurements during space flight allowed detection of any likely trend toward a lower functional state and potential cardiovascular impairment at the end of flight.

Individual Differences in Neurobehavioral Effects of Pyridostigmine Two double-blind studies designed to test the following specific hypotheses about pyridostigmine bromide (PB): (a) Under well-controlled conditions, AChE and/or BuChE inhibition will be related to alterations in the performance of complex tasks, heart rate variability (HRV), and peripherally mediated measures of physiological and sensorimotor functions (b) Individual differences can be differentiated from pharmacokinetic variability by use of a dose-response design (c) PB will produce more centrally-mediated effects under heat stress.

Both studies were double-blind, placebo-controlled, crossover design. Volunteers were 18-35 yrs of age.

In Study 1, physiological, sensorimotor, and cognitive measures were collected. In addition, plasma and urinary PB and 3-hydroxy-N-methylpyridinium bromide (THMP, the major metabolite of PB), as well as AChE and BuChE, were measured. These endpoints were measured, time- locked to time of intake of the pills and time of the test battery.

Significant PB effects on heart rate and heart rate variability were observed.

In study 2, volunteers were exposed to heat prior to and during testing; on the other day, they were tested at normal room temperature. Study 1 findings on side effects, heart rate and heart rate variability were replicated.

Age Effect on Autonomic Cardiovascular Control in Pilots The autonomic cardiovascular control was determined as a function of age in 66 military pilots and in 39 referents, both groups aged from 20 to 55 yr. It was assessed by time-domain and frequency-domain heart rate variability (HRV) measures and with some HRV derived indices.

Most sensitive to aging process from time-domain HRV measures revealed to be short-term variability and timedomain index, and from frequency-domain HRV measures frequency-domain index. The activity of both ANS branches was found to decline with age, but a different extent of decrease of sympathetic as compared to parasympathetic activity was observed: sympathetic activity reflected by the spectral power of the R-R intervals in the temperature mediated spectral frequency band (0.01-0.05 Hz) decline more slowly than parasympathetic activity reflected by respiratory sinus arrhythmia - mediated spectral frequency band (0.15-0.50 Hz).

As well as such age-desynchronized autonomic cardiovascular control was found only in military pilots but not in referents it is concluded that the aging process in pilots is accelerated due to repetitive and prolonged exposure to persisting stress, caused by the compulsory underload (substantial reduction of flying tasks and physical exercises coinciding with personal interviews). Although the computed Overall Health Risk values in both groups were not substantially deviated from "normal", those in military pilots was significantly higher.

Application of Degree of Complexity in Heart Rate Variability Analysis During Orthostatic Standing To introduce the degree of complexity in characterizing the heart rate variability (HRV), and to discuss the changes of the complexity of cardiovascular system during orthostatic standing posture.

ECG of 8 subjects were recorded during supine and orthostatic standing postures. Degree of complexity was used to analyze the HRV. Compared to supine before orthostatic standing posture, R-R intervals and its standard deviation at 0 - 5 min, 5 - 10 min, 10 - 15 min and 15 - 20 min during orthostatic standing posture were, decreased significantly; the degree of complexity of HRV at 0 - 5 min and 15 - 20 min during orthostatic standing posture were decreased significantly; the approximate entropy of 0 - 5 min and 15 - 20 min were decreased significantly.

The results showed that HRV and complexity of cardiovascular system was decreased during orthostatic stand-

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ISOPTWPO Today ing. It was feasible that the degree of complexity can be used to analyze HRV. Issues of health evaluation during simulated space mission to Mars Among the main tasks of the ground-simulated experiment Mars-500, the task of obtaining experimental data on the health state and the operational capability of an individual staying for a long time under conditions of the isolation and confinement, with simulating the major specific features of the space mission to Mars.

The experience of long-term studies in the field of space medicine shows that it is just the method of the heart rate variability analysis that is capable of delivering the most valuable information with respect to the investigation of the regulatory systems being in response to space flight factors.

The studies of the HRV were conducted with use of the hardware and software system Ecosan in the crew individuals at rest. The HRV analysis was carried out in accordance with the relevant Russian national and international standards applied for evaluation of autonomous regulation by the HRV parameters. For an assessment of individual risks of adaptation disorders, utilized were methods which had been previously developed for an application in the space flight environment, based on the HRV analysis.

Monthly-based mean values of basic statistics and spectral HRV parameters related to 6 crew members that were taken before the experiment and during the latter. The application of the Friedman test made it possible to detect the presence of significant changes in the following parameters: HR, pNN50 and SI (p≤0,02).

The Kendall’s coefficient of concordance related to the above parameters was at a level of 0,3 and showed statistical significance bearing witness to the intra-group concordance of the changes of the parameters in question. On days 56-58 in the experiment, a moderate increase in the heart rate with the significant reduction in the heart rate variability (the TP and parasympathetic activity indicator pNN50) was observed.

On days 89-91, an activation of the parasympathetic member of the regulation was reported: a reduction in the SI parameter was significantly identified that might be considered as a response to the completion of the period of the initial (acute) adaptation. At a later time, starting with days 115-117, an increase in the heart rate was observed (p≤0,05) followed by a reduction in the parasympathetic activity (p≤0,05 for parameter pNN50) (on days 148-150).

The most significant changes in the HRV parameters were reported in the second half of the experiment (the return journey period). During the said period of time, it was significantly established that periodically a decrease in the heart rate (HR) occurred, the parameter of the standard deviation of normal-to-normal beats (SDNN) was increased, and the simultaneous activation of all members of the regulation (pNN50 - parasympathetic regulation, and IC - sympathetic and neurohumoral regulation) took place.

In the experiment, it was reported that the relative power of the high-frequency oscillations of the spectrum (HF%) was reduced since the end of October 2010 (days 148-150 in isolation).

That was in correspondence with the growth of activity of the over-segmentary parts of the regulatory mechanism involved in the regulation of energetic-metabolic processes (VLF%), and the ratio VLF/HF, as of on days 180-182, differed significantly from the background values that was an evidence in support of the growth of the activity of the sympathetic member of the regulation (the reaction of tension).

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In the described case, the activity of the centers of the blood vessel tonicity regulation (LF%) was stepped down, that resulted likely from the reduced physical activity of the crew (Fig. 1).

The revealed dynamics of the HRV parameters confirms the known facts about the multistage nature of the process of a long-term adaptation: upon an acute period of the adaptation to the space flight environment, there comes the period of re-arrangement or re-configuration of all vital functions (space flight months 1 to 3), thereupon the period of a relatively stable adaptation begins (from space flight month 4) with a progressive enhancement of the activity of the regulatory systems, especially the activity of the central loop of the regulation.

In order to analyze the specific features of the adaptation of the crew individuals at different stages of the 520 day isolation experiment, the HRV analysis data were grouped by formal criteria of the experiment management as follows:

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1) Background studies 2) The beginning of the isolation (June - November 2010) 3) preparation and implementation of "landing" to Mars, dividing the crew into groups (December 2010 - February 2011) 4) the return journey to Earth, experiment finishing (March - November 2011).

The most pronounced changes were reported to be associated with the preparation and implementation of the simulated landing to the Red Planet and the final stage of the experiment (Table ). The identified tendencies of the month-by-month dynamics of the HRV parameters became more clear-cut.

The changes occurred in the initial period of the isolation (June - November 2010), as described above, are primarily related to the adaptive re-configurations of the regulatory mechanisms and fluctuations in the autonomous balance.

Therefore, the changes in the vegetative regulation of the hearth rhythm within the entire group in general were falling short of the significance.

It might depend on the fact that the probable adverse effect of the entire complex of the experiment conditions (isolation and confinement, social and cultural differences, changes in nutrition, loading, etc.) was not substantial, and it was balanced out by such an important factor as the work-and-rest scheduling, i.e., by more stable conditions as compared with the usual way of life.

During the period of simulation of orbiting Mars, dividing the crew into groups and landing to the Mars surface, observed was a tendency for the vegetative regulation to be shifted towards strengthening of the sympathetic activity and decreasing that of the parasympathetic (an increase in the VLF/HF index as the ratio between the low-frequency and the highfrequency components of the spectrum; they were the highest HR values on record within the whole experiment period). Hence, even such not appreciably remarkable shifts of the vegetative regulation produce a significant increase in the mean group category risk of the adaptation disorders.

The data obtained thereon allow judging not only the group-related dynamics of the functional state that is of prime importance for extended space expeditions, but the individual adaptive reactions as well, along with the individual risks of the adaptation disorders. The observed dynamics of the vegetative regulation and the adaptive abilities according to the HRV data are consistent with the experiment’s results related to the blood system, human immunity, metabolic changes, adaptive and psychological states of the crew members.

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ISOPTWPO Today The HRV analysis under conditions of the long-term isolation in simulated space mission to Mars has revealed that, in general, no serious changes in the functional state are available, and the adaptive reactions of the crew individuals have been adequate in most cases. The group assessment of the functional state dynamics has demonstrated that the functional state throughout the period of the survey has been found to be within the physiological norm.

When applying the probabilistic approach, a weak tendency for a growth of the prenosological states has been detected. The methodology of the assessment of the adaptation risks to health shows that the above prenosological state growth tendency does not lead to an increase in the risk above risk category 2.

When applying the risk classification scored from 1 to 10, the foregoing category should be treated as a very weak risk of progression of adaptive disorders for health.

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ISOPTWPO Today Reference: 1.Parin, V.V., Baevsky, R.M., Volkov, Yu.N., and Gazenko, O.G., Kosmicheskaya kardiologiya (Space Cardiology), Leningrad: Meditsina, 1967.

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7.Grigor’ev, A.I., Noskov, V.B., Polyakov, V.V., et al., Dynamics of the Reactivity of the System of Hormonal Regulation on Exposure to ODNT during a Long-Term Space Flight, Aviakosmich. Ekol. Med., 1998, no. 3, p. 18.

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9.Baevsky R, Chernikova A, Funtova I, Tank J. Assessment of individual adaptation to microgravity during long term space flight based on stepwise discriminant analysis of heart rate variability parameters. Acta Astronautica. 2011;69(1112):1148-1152.

10.Baevsky RM, Funtova II, Diedrich A, Pashchenko AV, Chernikova AG, Drescher J, et al. Autonomic function testing on board the ISS–update on "Pneumocard". Acta Astronautica 2007 Oct;61(7-8):672-5.

11.http://airex.tksc.jaxa.jp/pl/dr/20010097070 12.http://airex.tksc.jaxa.jp/pl/dr/20000105082 13.http://airex.tksc.jaxa.jp/pl/dr/20010097299 14.Evgenie Y. Bersenev, Vasily B. Rusanov, Anna G. Chernikova,Issues of health evaluation during simulated space mission to Mars,2013.

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ISOPTWPO The ISOPTWPO is International Space Flight & Operations - Personnel Recruitment, Training, Welfare, Protocol Programs Office (International Space Academy). It is a division of the ISA organization.

Mr. Martin Cabaniss is director and Mr. Abhishek Kumar Sinha is Assistant Director of ISOPTWPO. Ad Astra ! To The Stars! In Peace For All Mankind !

Mr. Rick R. Dobson, Jr.(Veteran U.S Navy) — International Space Agency (ISA)

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