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INTRODUCTION: A ccessible spaceflight may seem a distant concept. As part of a diverse European Space Agency funded Topical Team, we are working on the physiological feasibility of space missions being undertaken by people with physical disabilities. Here, the first activity of this team is presented in the form of key lessons learned from aviation to inform new work on space missions. DISCUSSION: The first lesson is agreeing on realistic expectations about impairments, their severity, and the possibility of flying independently. This is important in terms of astronaut recruitment and societal expectations. The second lesson relates to training and adjustments for people with disabilities. Flexibility is important while maintaining safety for everyone involved. The third lesson is about managing unconscious bias from the different stakeholders. We conclude by arguing that engagement with people from different backgrounds is essential for the success of the first space mission with people with physical disabilities. [ABSTRACT FROM AUTHOR]

Introduction: During heatwaves, it is important to monitor workers' cardiovascular health since 35% of those working in hot environments experience symptoms of heat strain. Wearable technology has been popularized for monitoring heart rate (HR) during recreational activities, but it can also be used to monitor occupational heat strain based on core and skin temperatures and HR. To our knowledge, no devices estimate the cardiovascular strain directly based on stroke volume (SV) or cardiac output (CO). In addition to the hardware, there are limitations regarding the lack of suitable algorithms that would provide such an index based on relevant physiological responses. The validation of the formulae already existing in literature was the principle aim of the present study. Methods: We monitored the cardiovascular responses of our participants to a supine and 60° head-up tilt at the same time each day. During the test, we measured blood pressure derived by finger photoplethysmography, which also provided beat-by-beat measures of SV and CO. Afterwards, we compared the SV derived from the photoplethysmography with the one calculated with the different equations that already exist in literature. Results: The evaluation of the formulae was based on comparing the error of prediction. This residual analysis compared the sum of the squared residuals generated by each formula using the same data set. Conclusion: Our findings suggest that estimating SV with existing formulae is feasible, showing a good correlation and a relatively small bias. Thus, simply measuring workers' blood pressure during breaks could estimate their cardiac strain. [ABSTRACT FROM AUTHOR]

New Findings: What is the central question of this study?Why does blood pressure increases during cold air exposure? Specifically, what is the contribution of skin and skeletal muscle vascular resistance during whole body versus isolated face cooling?What is the main finding and its importance?Whole‐body cooling caused an increase in blood pressure through an increase in skeletal muscle and cutaneous vascular resistance. However, isolated mild face cooling caused an increase in blood pressure predominately via an increase in cutaneous vasoconstriction. The primary aim of this investigation was to determine the individual contribution of the cutaneous and skeletal muscle circulations to the cold‐induced pressor response. To address this, we examined local vascular resistances in the cutaneous and skeletal muscle of the arm and leg. Thirty‐four healthy individuals underwent three different protocols, whereby cold air to clamp skin temperature (27°C) was passed over (1) the whole‐body, (2) the whole‐body, but with the forearm pre‐cooled to clamp cutaneous vascular resistance, and (3) the face. Cold exposure applied to the whole body or isolated to the face increased mean arterial pressure (all, P < 0.001) and total peripheral resistance (all, P < 0.047) compared to thermal neutral baseline. Whole‐body cooling increased femoral (P < 0.005) and brachial artery resistance (P < 0.003) compared to thermoneutral baseline. Moreover, when the forearm was pre‐cooled to remove the contribution of cutaneous resistance (P = 0.991), there was a further increase in lower arm vasoconstriction (P = 0.036) when whole‐body cooling was superimposed. Face cooling also caused a reflex increase in lower arm cutaneous (P = 0.009) and brachial resistance (P = 0.050), yet there was no change in femoral resistance (P = 0.815) despite a reflex increase in leg cutaneous resistance (P = 0.010). Cold stress causes an increase in blood pressure through a change in total peripheral resistance that is largely due to cutaneous vasoconstriction with face cooling, but there is additional vasoconstriction in the skeletal muscle vasculature with whole‐body cooling. [ABSTRACT FROM AUTHOR]

BACKGROUND: One in 5 people worldwide lives with a disability, frequently facing challenges in aviation. This makes accessible space flight seem like a distant dream. Recently, ESA selected the first astronaut with a physical disability. Our ESA Topical Team supports this opportunity by reviewing the existing literature and lived experience in the field, to investigate the physical and physiological challenges and also the potential advantages of astronauts with disabilities. OVERVIEW: Given the overlap between the medical standards required for pilot medical certification and those for astronaut selection, we started by examining the experience of a disabled flying charity, Aerobility. Three key lessons were learned from this review which will support the collaboration between stakeholders when working with astronauts with physical impairments.The first lesson was to recognise that not everyone will meet the standards for aeromedical certification. Astronauts face similar requirements and a transparent approach to assessment is required. However, these criteria can evolve over time, as advancements in both medical and technological fields may mitigate the impact of physical impairments on an individual's ability to participate in space missions. The second lesson was that people with disabilities can meet the requirements for flying with adapted training and technical modifications. In this context, flexibility and open discussions are needed to understand individual needs and find optimal solutions. Likewise, considering astronauts, dedicated efforts are required to adapt systems and procedures, ensuring accessibility. The third lesson highlighted the significance of involving different stakeholders when reviewing recruitment, training, adaptations, and operations. Unconscious bias remains a challenge in the field. Without scientific evidence demonstrating the suitability of candidates with physical disabilities, space accessibility would remain partial. DISCUSSION: We reviewed the experience of a leading flying charity to define key lessons from aviation that could be translated and adapted for space flight. Our overarching goal is to evaluate the physiological considerations for people with physical disabilities in order to support ESA's team and space missions. This work will become even more relevant with the emergence of space tourism, and the need for accommodating a diverse array of candidates for both short-term and extended space flights. Learning Objectives 1. To discuss the requirements and adjustments for people with disabilities in aviation and how they can inform space missions. 2. To identify the needs and adjustments for astronauts with a physical disability. [ABSTRACT FROM AUTHOR]

Spaceflight-associated neuro-ocular syndrome (SANS) involves unilateral or bilateral optic disc edema, widening of the optic nerve sheath, and posterior globe flattening. Owing to posterior globe flattening, it is hypothesized that microgravity causes a disproportionate change in intracranial pressure (ICP) relative to intraocular pressure. Countermeasures capable of reducing ICP include thigh cuffs and breathing against inspiratory resistance. Owing to the coupling of central venous pressure (CVP) and intracranial pressure, we hypothesized that both ICP and CVP will be reduced during both countermeasures. In four male participants (32 ± 13 yr) who were previously implanted with Ommaya reservoirs for treatment of unrelated clinical conditions, ICP was measured invasively through these ports. Subjects were healthy at the time of testing. CVP was measured invasively by a peripherally inserted central catheter. Participants breathed through an impedance threshold device (ITD, (7 cmH2O) to generate negative intrathoracic pressure for 5 min, and subsequently, wore bilateral thigh cuffs inflated to 30 mmHg for 2 min. Breathing through an ITD reduced both CVP (6 ± 2 vs. 3 ± 1mmHg; P = 0.02) and ICP (16 ± 3 vs. 12 ± 1mmHg; P = 0.04) compared to baseline, a result that was not observed during the free breathing condition (CVP, 6 ± 2 vs. 6 ± 2mmHg, P = 0.87; ICP, 15±3 vs. 15±4mmHg, P = 0.68). Inflation of the thigh cuffs to 30 mmHg caused no meaningful reduction in CVP in all four individuals (5 ± 4 vs. 5 ± 4mmHg; P = 0.1), coincident with minimal reduction in ICP (15 ± 3 vs. 14 ± 4mmHg; P = 0.13). The application of inspiratory resistance breathing resulted in reductions in both ICP and CVP, likely due to intrathoracic unloading. [ABSTRACT FROM AUTHOR]

Spaceflight-associated neuro-ocular syndrome (SANS) involves unilateral or bilateral optic disc edema, widening of the optic nerve sheath, and posterior globe flattening. Owing to posterior globe flattening, it is hypothesized that microgravity causes a disproportionate change in intracranial pressure (ICP) relative to intraocular pressure. Countermeasures capable of reducing ICP include thigh cuffs and breathing against inspiratory resistance. Owing to the coupling of central venous pressure (CVP) and intracranial pressure, we hypothesized that both ICP and CVP will be reduced during both countermeasures. In four male participants (32 ± 13 yr) who were previously implanted with Ommaya reservoirs for treatment of unrelated clinical conditions, ICP was measured invasively through these ports. Subjects were healthy at the time of testing. CVP was measured invasively by a peripherally inserted central catheter. Participants breathed through an impedance threshold device (ITD, -7 cmH 2 O) to generate negative intrathoracic pressure for 5 min, and subsequently, wore bilateral thigh cuffs inflated to 30 mmHg for 2 min. Breathing through an ITD reduced both CVP (6 ± 2 vs. 3 ± 1 mmHg; P = 0.02) and ICP (16 ± 3 vs. 12 ± 1 mmHg; P = 0.04) compared to baseline, a result that was not observed during the free breathing condition (CVP, 6 ± 2 vs. 6 ± 2 mmHg, P = 0.87; ICP, 15 ± 3 vs. 15 ± 4 mmHg, P = 0.68). Inflation of the thigh cuffs to 30 mmHg caused no meaningful reduction in CVP in all four individuals (5 ± 4 vs. 5 ± 4 mmHg; P = 0.1), coincident with minimal reduction in ICP (15 ± 3 vs. 14 ± 4 mmHg; P = 0.13). The application of inspiratory resistance breathing resulted in reductions in both ICP and CVP, likely due to intrathoracic unloading. NEW & NOTEWORTHY Spaceflight causes pathological changes in the eye that may be due to the absence of gravitational unloading of intracranial pressure (ICP) under microgravity conditions commonly referred to as spaceflight-associated neuro-ocular syndrome (SANS), whereby countermeasures aimed at lowering ICP are necessary. These data show that impedance threshold breathing acutely reduces ICP via a reduction in central venous pressure (CVP). Whereas, acute thigh cuff inflation, a popular known spaceflight-associated countermeasure, had little effect on ICP and CVP.