Rosemary S. A. Shinkai, DDS, MSc, PhD Professor of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Brazil
We still do not know much about the changes in dental and orofacial structures, functions, and diseases beyond Earth. Early studies on aerospace dentistry published at the end of the 1960’s and 1970’s addressed some concerns about oral health in astronauts and challenges for dental treatment delivery in space. If astronauts are selected for being the most prepared and healthy humans to withstand the hard conditions in outer space, what about everyday regular people, the very young or old individuals? Or pregnant space voyagers? Microgravity and radiation in long-term spaceflights and a lifelong stay in space stations or settlements would require specific oral health care. Teeth, gums, tongue, bones, and muscles are part of a complex system, which is highly innervated and irrigated by blood vessels to allow chewing, swallowing, speaking, and smiling. Saliva is produced by a number of large and small salivary glands to lubricate the mouth, form the food bolus, and counterbalance acids produced by mouth bacteria after meals. Recent studies have shown that the microgravity and spaceflight environment alters jaw bone physiology, dental development, saliva proteins, and salivary gland morphology in mice flown on a US shuttle and a Russian biosatellite. Another study revealed that adult rats submitted to gravity tests showed remodeling of craniomandibular bones. Simulated microgravity also modified gene expression and physiology of Streptoccocus mutans and Streptoccocus sanguinis, possibly altering the cariogenic potential of these bacteria. However, the specific effect of space radiation also needs to be investigated.  Will oral health care need adapting for long-term Mars settlement? It still is unknown to what extent the same effect would occur in human astronauts. Besides the potential structural and physiological changes in the craniomandibular system, other behavioral factors and epigenetics are involved in space oral health. For example, dental caries result from a frequent exposure to acids produced by mouth bacteria after ingestion of sugar, mainly sticky or soft, paste-like foods. Thus, eating and cleaning habits modify the risk for dental caries. And the protective saliva flow and composition vary with water drinking, chewing stimulation, medication, and stress. All these factors may be altered in space life and would affect individual responses to not only dental caries risk, but also gum inflammation, orofacial pain, bone loss and repair. Understanding the underlying mechanisms to prevent oral health problems and have effective interventions seems to be appropriate for the planning of long-term space travel.
So, space dentistry may be an interesting job in the future! Adam J CrellinGraduate Medical Student, Oxford University; Analog Astronaut, Austrian Space Forum  Analog astronaut Adam Crellin giving his graduation speech While attending the 2019 European Mars Conference in London this week at the Institute of Physics, we had the pleasure of witnessing the graduation ceremony of the next cohort of newly qualified Austrian Space Forum (OeWF) analog astronauts, who will take part in next years' AMADEE20 Mars analog mission in Israel. Analog astronauts are people who have been trained to test equipment and conduct activities under simulated space conditions, and they play an important role in preparing for future Moon and Mars missions. We liked so much the graduation speech given by analog astronaut Adam Crellin that we asked if we could publish it here on the InnovaSpace website to inspire all the young would-be astronauts out there - dream big! "I would like to open by saying not only how much of an honour it is to speak on behalf of my classmates and the Austrian Space Forum today, but also to stand in front of you all as a newly qualified analog astronaut. I am especially proud to be speaking at a European-wide conference in the UK, organised by the recently reformed Mars Society UK. In classrooms across the UK, and even the world, children are being asked by their primary school teachers, the existential question of ‘what do you want to be when you grow up?’. Some of these children, fascinated by space, will say they want to be an astronaut. Children often continue this hope as they grow older, perhaps keeping it a bit quieter, guarding it a bit more closely. Later, they then discover that there are a huge range of diverse opportunities in space, and that astronauts are one small cog in a large machine. A machine that contains astronauts who plant flags; plant experts who grow astrocrops; astronomers who study the universe and its laws; lawyers who write legislation through careful engineering; engineers who build spacecraft that rock; and, well, for those who like rocks, there is geology as well as countless other professions." "As we prepare for a renewed age of crewed missions beyond low Earth orbit, to fill the steps of the Apollo astronauts, and extend those tracks further than have ever been achieved before, we are reminded of the importance of analog missions. In the same way famous twentieth-century polar explorer, Roald Amundsen, spent years experimenting, refining, and proving equipment and procedures suitable for a South Pole expedition, we too are preparing for a Mars expedition. And equally so, preparedness will be key to success. For theory and strictly controlled laboratory research, can only partially answer some of the questions about what to expect, and how to work on Mars. Analog research missions, including those of the Austrian Space Forum, help to provide further answers. To be an analog astronaut, is to be a unique cog in our space industry machine. A cog whose sporks interlink with many different cogs, working across disciplines with research groups throughout Europe. A well-oiled cog, remaining fit and healthy in preparedness for any challenge which may arise. And a cog which turns equally well with many cogs, both the rusted expert cogs, and the shiny new ones, who we seek to inspire the next generation of Mars pioneers; perhaps the most important task we all have. But despite these unique qualities, we remember that we are still a small cog and that it is our collective effort, turning together, which will one day lead us to Mars. To be part of this small community with big dreams, is the greatest honour of any analog astronaut." Adam J Crellin, 4th November 2019 Dr Karina OlianiER Doctor, mountaineer & adventurer  My name is Karina Oliani, and I'm a doctor specializing in Emergency Medicine and Rescue in Remote Areas. Outdoor challenges have always been my passion, and because of this, I've participated in countless expeditions at sea, up mountains, in jungles and in the desert, including climbing Everest 2 times - by the South face in 2013 and North face in 2017. I also love diving and have dived in all the oceans with the biggest predators. In parallel, I am a producer of audio-visual content and have already produced work for the Globo programs "Fantástico" and "Esporte Espetacular" in Brazil, and I have worked as a presenter and guide for the reality shows "Celebrities' Challenge" and "Extreme Mission" on the Discovery Channel.
 For more than four years I have been trying to realize my dream of climbing K2, which is considered to be the most difficult and dangerous mountain to climb on Earth. The first year I couldn't do it because of work commitments, the next year through a lack of sponsorship, and then once again it was not possible as I became very ill after being bitten by a tick. But when you have had a desire for such a long time, you don't give up easily! The expedition to K2 wasn't easy for me, either physically or mentally. As already mentioned, for most of 2018 I was battling the tick-borne Lyme disease, which is transmitted by the bite of a tick infected with the bacterium Borrelia burgdorferi, and for which I still have to take medications. As it turned out though, I hardly felt the effects of the disease during the climb, probably because of the decreasing oxygen levels during the ascent - I think perhaps the Borrelia didn't like the lack of oxygen! K2 is a truly beautiful mountain, very impressive, and one that I was always drawn to, maybe because it represents every challenge a climber expects and more. It is situated in the Karakoram mountain range, which is an extension of the Himalayan mountains, and it sits on the borders between Pakistan and China. K2 has been dubbed “The Wild Mountain,” and one in five of the climbers who have attempted to reach its summit have died. K2 is located in a place so remote and inaccessible that it was only discovered by scientific mapping in 1904, and was only climbed for the first time 50 years later, by an Italian team. In 2000, Waldemar Niclevicz became the first and only Brazilian to have ever reached the summit of K2, and subsequently, I became only the 2nd Brazilian and the 1st Brazilian woman to successfully reach the top. In all the expedition took a total of 50 days. We first made our way to a local community called Askole, home to just 200 inhabitants and a place that can only be reached using 4x4 vehicles. Then came eight days of trekking through Pakistani villages and completely inhospitable regions to reach the base camp. This involved walking 120 kilometers along an extremely complex trail of ice, snow, glacial sediment, rocks, small deserts and rivers. K2 is definitely not the type of place where you get tired and decide to go home! We then began the 1st cycle of acclimatization, followed by 4-5 days rest. Acclimatization is extremely important for the body to begin to adapt to the high altitude and prevent more serious side effects. At this time you are submitting your body to a low oxygen environment, and so, your bone marrow understands that it needs to produce more red blood cells to carry the little oxygen that is available. K2 is not a place for beginners and it is the mind that works the hardest in this situation. In high altitude mountains, 20% of success is physical, and the rest is psychological. In mountains like K2, you deal with a high risk of death, little communication and not much to do, and this can seriously affect your mind. Consequently, my climbing partner Maximo Kausch and I tried to look upon the expedition with a positive vibe, and without placing pressure on ourselves. Obviously we had concerns, but we tried to do everything calmly, waiting to see what would happen... if we made it - great! If not, that was fine too... We knew the expedition was much more than just the summit. We passed through beautiful landscapes, and saw completely unknown mountains, and this is worth a lot.  We set off for out attempt on the summit at dawn on the 17th July, accompanied by 118 other climbers. But as we were nearing the top on this same day, an avalanche swept down the mountain, injuring a Sherpa and sweeping away two of the fixed ropes needed to continue the rest of the ascent. The mission had to be aborted and everyone returned to base camp. The avalanche meant that of the 120 climbers who would have attempted the summit this season, only 18 decided to continue on with the mission. After this first attempt to reach the summit, I began to feel that my lungs were feeling a bit wet, namely, the beginning of pulmonary edema, which is common at such extreme altitudes. In mountain medicine, the first medicines to use in this case are Nifedipine, and then Viagra, as they help the vessels in the lungs to relax, preventing the contraction caused by the lack of oxygen and as a consequence, pulmonary hypertension. Despite feeling exhausted, just 2 days after reaching the base camp we decided to attempt to reach the summit again in another time window that emerged. After all, it could be the last opportunity, as in general, K2 does not give many chances to reach the top in a season. Persistence, in this case, was the key to our success, and on the 25th of August, exactly one month since our arrival at the mountain, we succeeded in reaching the summit of K2, the second highest mountain in the world, at an altitude of 8,611 meters. As with nearly everything in life, reaching the end goal involves a series of events leading up to it, and our expedition was filled with stories, things learnt and adventures, and above all, the sweet sensation of having fulfilled another dream! I have to thank wholeheartedly the sponsors of my K2 expedition - Volvo Cars, Pulsar Invest, John John, Outback Steakhouse, and Gillette Venus. And support from Canon, GoPro HERO7, Spot, Puma and The North Face. I am eternally grateful to them for believing in this dream and in my potential.
Ben HammondMSc Space Physiology & Health; Human Performance Intern, McLaren Applied Technologies  With international space agencies and the real-life Tony Stark (Elon Musk) making huge advances in rocket technology, it is likely that within the next couple of decades humankind will touch down on Mars. However, this is only half the battle. The gravity on Mars is roughly one third as strong as Earth’s. You may be thinking “great, everything will require less effort”, and you’d be right, however, there is a huge caveat to that. As we’ve found from the results of time spent in space (the longest continuous period being 14.4 months), when people are exposed to levels of gravity lower than that on Earth, losses in muscle and bone occur; predominantly, in muscles which we continually use to walk and maintain our posture. You may have heard the expression ‘use it or lose it’ - hugely applicable here. These losses can increase astronauts’ risk of injury when returning to Earth by leaving them very weak and fragile. A return mission to Mars will take around 3 YEARS to complete, mainly because of the wait for the two planets to be close enough in proximity again to allow a relatively short journey home. That’s around 12 months in microgravity and around 26 months in Martian gravity. Now, it doesn’t take a rocket scientist to figure out that, based on the numbers, the outlook for muscle retention isn’t great. That being said, we‘re still pretty uninformed about the extent to which living on Mars will stimulate our muscles.  Me using a Lower Body Positive Pressure equipment Recently, my colleagues and I conducted an investigation to try to shed some light on the matter. To do this properly, we needed to achieve two key things: 1) simulate walking in Mars gravity, 2) measure the activity in the muscles used for walking. With this, we compared the muscle activity produced while walking on Mars to that produced when walking on Earth, gauging the degree of muscle loss that we might expect for a mission to Mars and to inform countermeasures. To simulate Mars gravity, we used a technique called lower body positive pressure (LBPP). There are a few different ways in which you can simulate partial gravity environments, but this one has fewer limitations than the rest. LBPP involves putting someone inside an air-tight inflatable box from the waist down. Through manipulation of the air pressure within, it can generate a lifting force, changing the weight of the person inside. Our device was designed and built by engineers at the John Ernsting Aerospace Physiology Laboratory at the Pontificia Universidade do Rio Grande do Sul (PUCRS) in Porto Alegre, Brazil. With a treadmill placed underneath, the participant could then walk in simulated Mars gravity. To measure the amount of activity inside the leg muscles, we then attached electrodes to the skin at each of the muscles we were interested in (a method called electromyography) which picked up an electrical signal that muscles give off when they are being worked. The more intense the signal, the more active that muscle is while walking. What we found was quite unexpected. The results of our investigation suggested that there was no significant difference between the muscle activity observed while walking in Mars gravity and the muscle activity observed walking on Earth. If this were to be true, then it would not be foolish to think that we could use the 26 months on the Martian surface to reverse losses in muscle and bone suffered on the outward journey in preparation for the return trip. However, there were two important variables that we failed to account for in our experiment. These variables were stride length and stride frequency when walking.
The moon is smaller than Mars, and so there is even less gravity there, but the same principle applies. With this in mind, even if the results of our experiment were to be true and the walking muscles are getting just as much activity with each step on Mars as they are on Earth, theoretically, they will be used less often. Considering our ‘use it or lose it’ principle, this would still mean muscle and bone loss to a disabling degree in the absence of effective counter strategies; which are currently lacking. More studies need to be done around this area, accounting for all variables, to further our understanding of human performance on Mars and ensure the safety of our astronauts, or we’ll be keeping Elon Musk waiting at the launch pad!
Dr Andrew WinnardLecturer in Clinical/Musculoskeletal Biomechanics; Lead for the Aerospace Medicine Systematic Review Group; Chartered Physiotherapist; Faculty of Health and Life Sciences, Northumbria University  This was a question that the European Astronaut Centre space medicine office asked the Aerospace Medicine Systematic Review Group (AMSRG). With space agencies planning missions beyond low Earth orbit, in spacecraft that might not be as easy to exercise inside as the International Space Station, this question is becoming more relevant. While it is clear that countermeasures are needed to maintain muscle during microgravity exposure, there were questions such as ‘should we really be going to the Moon without exercising?’; ‘can we safely have pauses in countermeasures during Earth-Mars transits?’; and ultimately ‘how long can humans go in microgravity, without exercising, before the muscles seriously decondition?’.  Bedrest study image: © ESA There appeared to be some information available in the research base but no clear and transparent synthesis existed on which to make evidence based medical decisions. The AMSRG, led by Prof Nick Caplan, Dr Rochelle Velho and myself, based at Northumbria University’s Aerospace Medicine and Rehabilitation Laboratory, is all about working with spaceflight operations to provide high quality, evidence based medical guidance and, therefore, we took these questions on readily. It was determined that if data from inactive/no intervention control groups within any study done with astronauts or bed rest participants could be extracted, it would provide the evidence based information on which to inform the questions being asked. The team worked for almost two years, screening 754 potential studies, before extracting data from control groups of 75 individual included sources, to calculate 922 individual effect sizes, making this the largest review the AMSRG has conducted to date. All the included studies were from bed rest, ranging from 60-120 days, with mostly high risk of bias (using Cochrane’s risk of bias tool) and typically scoring 4 out of 8 for bed rest quality (using AMSRG’s bed rest quality tool). Across all the studies the team found that moderate deconditioning effects (effect size ≥0.6) occur between 7-15 days, with large deconditioning effects (effect size ≥1.2) occurring by 28 days. Based on this, it seems that a 5 day Earth-Lunar transit period is probably safe to complete without exercise, at least for the skeletal muscle outcomes. However a Mars transit, that is likely to be 200+days, needs to counteract muscle deconditioning if the crew is to arrive and be able to function in a gravity loaded environment. Additional consideration was given to ‘worst case scenarios’, such as if there were a crew member more susceptible to low gravity induced muscle changes, for which the team used the most extreme negative end of the confidence intervals as a model. In these cases, a large deconditioning effect could be reached by 7 days and then even the travel time to the Moon could potentially become problematic. However, this model is rather crude due to large confidence intervals caused by the typical low sample sizes in human spaceflight research, and individual effects are difficult to determine in a way that is easily transferable to astronauts. Over the whole evidence base, there was great variety in outcome measures and time points evaluated across studies, along with limited data for all outcome measure subgroups, with research gaps highlighted in the published review’s results tables. No patient reported outcome measures of minimal clinical worthwhile changes were established that would help provide a more patient-centred approach to space medicine. This has been a common finding in AMSRG reviews. While space agencies require astronaut simulating bed rest studies to be done to set standards, it might be useful to try and establish a list of core outcome measures that would benefit human spaceflight operations, to become a foundation for patient-centred space medicine and to standardise the data presented to the field as a whole.
Dr Joaquim Ignácio S da Mota Neto / Dr Thais RussomanoPsychiatrist, Federal University of Pelotas, Brazil / Founder & Scientific Director, InnovaSpace The brain is the prime and most complex organ of the human body and within it takes place the sophisticated phenomena that define us as human beings, enabling recognition of and interaction with our surroundings. Basic and primitive survival functions pass through the different formations and axes of the Central and Peripheral Nervous System, but far beyond this are the many other functions that differ in complexity and high degree of neural connectivity, such as those performed by the limbic system, containing the hypothalamus, hippocampus and amygdala. These important structures are responsible for integrating and giving context to aspects of emotions, memories and learning, thus building our cognitive capacities. Therefore, it is essential to maintain the functionality of these cerebral regions that permit the acquisition, storage and recall of information, as together with the cerebral cortex, they are fundamental for several aspects of personal, social and professional performance. The perception of potential fragility of these intricate brain structures is inevitable, when faced with extreme and unknown situations, such as one might encounter on a manned trip to Mars. The effects of different space features, such as radiation or microgravity, may pose a threat not only to the ability of an astronaut to perform both simple and complex tasks, but also to control emotions or react in an adequate manner to a new environment in which access to old memories may become essential.  A recently published article by Mike Wall of Space.com presented the issue of space radiation and how it can affect the brain function and psychological behaviour of animals, in research using a new scientific approach. The study conducted by Munjal Acharya & Janet Baulch of the University of California and Peter Klein of Stanford University, exposed mice for the first time to a continuous and chronic low-dosage radiation (1mGy/day). The idea of the research team was to mimic a manned trip to Mars, during which astronauts would be exposed to 6 months of low-dosage, deep-space radiation. This type of protocol differs from those previously used, in which animals were submitted to high-dosage radiation over short time periods. The space environment is very unique and is full of radiation in the form of galactic cosmic rays, particles of high energy and charge, and solar particle events, which differ from the low-LET (X- or g-rays) radiation that is predominant on Earth. Radiation is known to affect humans in several ways, in three distinct phases: acute, latent and chronic effects. Chemical mediators are first released from damaged cells, particularly from bone marrow, lymphoid tissues and the gastrointestinal tract, leading to symptoms, such as nausea, vomiting and malaise. The latent phase is free of symptoms as it represents the time between the initial cell injury and manifestation of cell renewal. Chronic effects include a decrease in cell count, and increase in the risk of developing cancer, and degenerative and infectious diseases. The negative impact of radiation on the Central Nervous System (CNS) has been considered relatively minor, as the CNS is formed of few actively dividing cells, which provides it with a type of natural resistance. Nonetheless, some studies have demonstrated that space radiation could potentially produce undesirable effects on the brain, including a decrease in function and neurodegeneration. The results from the mice study would seem to corroborate the hypothesis that radiation can indeed cause deleterious effects on the CNS, perhaps due to the longer 6-month period of exposure to the low-dose radiation. These findings, published in the Society for Neuroscience's open-access journal, eNeuro, suggest that mice exposed to radiation had alterations in their hippocampus, the part of the brain responsible for learning and memory, and the prefrontal lobe of the cortex, dedicated to cognitive functions and social relationships. The neurological pathway has yet to be defined, but it is already of serious concern to the space scientific community, as such alterations could cause impairment in psychological performance, especially during stressful and critical situations, like those that could easily be experienced during an interplanetary trip, which is exactly the occasion when clear and immediate decision-making or problem-solving responses are needed!  Under normal conditions on Earth, the human cognitive and emotional processes can struggle to perform well enough to cope with the demands of everyday life, and therefore, the subjective and objective adversities of adapting to a long-duration trip to another planet could be a huge challenge. Even if we are able to control each one of the many physical or psychological variables that could impact on our relationship with the space environment, aerospace science still needs to deal with poorly understood aspects related to the interaction of executive memory with emotions, with experts having highlighted that what we remember is never the same as what was originally set to be fixed in our memory - the material undergoes change in the storage process as each individual adds personal characteristics to the stored element.
The peculiarities of the human brain and its crossovers between the acts of feeling, thinking, planning and performing have already led humanity to evolve, overcoming innumerous obstacles from the Stone Age to the Modern Era. However, even in a place with no palpable barriers, like the vastness of space, there will be invisible elements, such as radiation, that could be powerful enough to delay or impede human omnipotence and omnipresence in the exploration of the Universe. Dr. Gabriela S. PiloOceanographer, Institute for Marine & Antarctic Studies (University of Tasmania, Australia)  Oceanographer, Dr. Gabriela S. Pilo It is quite easy to draw a parallel between ocean and space exploration. Both require a ship, a large sense of adventure, and a love of discovery. But there are more similarities between the ocean and space than simply their ability to feed the imagination of writers, musicians, and curious minds. The ocean, like space, is still unknown. Similarly to space research, ocean researchers are still trying to fill several knowledge gaps. We’ve advanced a lot since the beginning of modern Oceanography, attributed to the Challenger Expedition in 1872. We have now charted the main ocean currents, from the surface down to the bottom of the ocean, at 6000 m depths. We understand how and where surface waters become dense and sink, creating a conveyor belt that connects the whole planet, travelling for 1000 years before re-surfacing. We also understand that ocean currents interact with the wind, the ocean floor, and with each other, and break into several rotating bodies of water, known as ocean eddies. These eddies spin away, carrying their parent current’s water to distant parts of the ocean. However, as in space, there is still a lot we don’t know. Gaps in ocean research relate to balances of energy and of biogeochemical compounds, and to the response of the ocean to a changing climate.  Preparing a CTD instrument - measures conductivity, temperature, and depth of seawater Considering that there still so much to learn, we often find ourselves in the middle of the ocean looking for answers. This brings up the second similarity between ocean and space research: when you are out there, conditions can get harsh! Open-ocean Oceanographic cruises can last for up to 3 months, having only a few shore stops during this time. Therefore, like in space, an oceanographic vessel must be autonomous for a long period of time. During research cruises, scientists and crew members are putting all their efforts into sampling the water and measuring physical properties of the ocean. Sampling happens under all circumstances, in the middle of the night, in rain, snow, and under very high wave conditions. In addition, icebreaker vessels can go deep into an ice field, and reach the most remote parts of the world. Ocean-sickness, just like space-sickness, often kicks in, as your body gets used to the constant movement. You are also living in a confined space with like-minded people that have one goal: to do science. But the ocean is not just a large body of water, flowing and crashing against the shore. The bathymetry of the ocean, the chemical elements dissolved in the water, and the animals, microbes, and algae that live in it, are equally important and fascinating. Oceanography is a highly multidisciplinary research field. Therefore, to fully understand the ocean, we need to collaborate. It takes a team of physical oceanographers, marine biologists, geologists, meteorologists, glaciologists, and several other scientists to put the pieces of the puzzle together. This team work builds up our knowledge of the ocean. Just like in the space sciences, collaboration is key! For example, the InnovaSpace Team is composed of experts in life science, telehealth, and engineering.  Releasing the CTD back into the ocean Finally, the ocean, like space, is vast. We cannot be everywhere, at all times to study it. To obtain global, constant measurements of the ocean we rely on state-of-the-art sensors, similarly to space research. The sensors to measure the ocean are either aboard a series of artificial satellites orbiting the Earth, or in instruments placed in the water. Sensors onboard satellites can measure the sea surface temperature, salinity, and sea surface height. In the water, sensors are aboard floats, mooring arrays, automated underwater vehicles, remotely operated vehicles, gliders, and seals (!). Operational oceanography is a fascinating field of research, and at its heart sits the Argo array, composed of 4000 Argo floats measuring temperature and salinity of the top 2000 m of the ocean since 2005. This array has helped oceanographers to answer important questions on ocean circulation and climate change.
Ultimately, the ocean - just like the space - brings fascination. The excitement of discovery is present both when exploring a deep canyon or a distant quasar. In the end, the ocean is also a final frontier. A frontier, however, closer to home! |
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