Lower Body Negative Pressure (LBNP) redistributes blood from the upper body to the lower body. LBNP may prove to be a countermeasure for the multifaceted physiological changes endured by astronauts during spaceflight related to cephalad fluid shift. Over more than five decades, beginning with the era of Skylab, advancements in LBNP technology have expanded our understanding of neurological, ophthalmological, cardiovascular, and musculoskeletal adaptations in space, with particular emphasis on mitigating issues such as bone loss. To date however, no comprehensive review has been conducted that chronicles the evolution of this technology or elucidates the broad-spectrum potential of LBNP in managing the diverse physiological challenges encountered in the microgravity environment. Our study takes a chronological perspective, systematically reviewing the historical development and application of LBNP technology in relation to the various pathophysiological impacts of spaceflight. The primary objective is to illustrate how this technology, as it has evolved, offers an increasingly sophisticated lens through which to interpret the systemic effects of space travel on human physiology. We contend that the insights gained from LBNP studies can significantly aid in formulating targeted and effective countermeasures to ensure the health and safety of astronauts. Ultimately, this paper aspires to promote a more cohesive understanding of the broad applicability of LBNP as a countermeasure against multiple bodily effects of space travel, thereby contributing to a safer and more scientifically informed approach to human space exploration.

Human space exploration expansion from Low-Earth Orbit to deep space is accelerating the need to monitor and address the known health concerns related to deep space radiation. The human musculoskeletal system is vulnerable to these risks (alongside microgravity) and its health reflects the well-being of other body systems. Multiparametric magnetic resonance imaging (MRI) is an important approach for assessing temporal physiological changes in the musculoskeletal system. We propose that ultra-low-field MRI provides an optimal low Size Weight and Power (SwaP) solution for non-invasively monitoring muscle and bone changes on the planned Gateway lunar space station. Our proposed ultra-low-field Gateway MRI meets low SWaP design specifications mandated by limited room in the lunar space station. This review summarizes the current state of our knowledge on musculoskeletal consequences of spaceflight, especially with respect to radiation, and then elaborates how MRI can be used to monitor the deleterious effects of space travel and the efficacy of putative countermeasures. We argue that an ultra-low-field MRI in cis-lunar space on the Gateway can provide valuable research and medical insights into the effects of deep space radiation exposure on astronauts. Such an MRI would also allow the development of imaging protocols that would facilitate Earth-bound teams to monitor space personnel musculoskeletal changes during future interplanetary spaceflight. It will especially have a role in monitoring countermeasures, such as the use of melanin, in protecting space explorers.

Lunar exploration offers an exciting opportunity for humanity to advance scientific knowledge and future potential economic growth and possibly allow humans to become a multi-planetary species. On April 2, 2024 the US Office of Science and Technology Policy released a memorandum outlining the current Biden-Harris Administration\'s policy on the need to establish time standards at celestial bodies other than Earth. This memorandum also introduced the need for Coordinated Lunar Time (CLT), the concept of having a reference time for the moon. The establishment of CLT would provide a multitude of benefits for astronaut health, from expedition planning, to maintaining a sense of order in an austere environment. International agreements and collaboration will be required prior to the recognition of CLT.

With plans for future long-duration crewed exploration, NASA has identified several high priority potential health risks to astronauts in space. One such risk is a collection of neurologic and ophthalmic findings termed spaceflight associated neuro-ocular syndrome (SANS). The findings of SANS include optic disc edema, globe flattening, retinal nerve fiber layer thickening, chorioretinal folds, hyperopic shifts, and cotton-wool spots. The cause of SANS was initially thought to be a cephalad fluid shift in microgravity leading to increased intracranial pressure, venous stasis and impaired CSF outflow, but the precise etiology of SANS remains ill defined. Recent studies have explored multiple possible pathogenic mechanisms for SANS including genetic and hormonal factors; a cephalad shift of fluid into the orbit and brain in microgravity; and disruption to the brain glymphatic system. Orbital, ocular, and cranial imaging, both on Earth and in space has been critical in the diagnosis and monitoring of SANS (e.g., fundus photography, optical coherence tomography (OCT), magnetic resonance imaging (MRI), and orbital/cranial ultrasound). In addition, we highlight near-infrared spectroscopy and diffusion tensor imaging, two newer modalities with potential use in future studies of SANS. In this manuscript we provide a review of these modalities, outline their current and potential use in space and on Earth, and review the reported major imaging findings in SANS.

Dry eye syndrome (DES) poses a significant challenge for astronauts during space missions, with reports indicating up to 30% of International Space Station (ISS) crew members. The microgravity environment of space alters fluid dynamics, affecting distribution of fluids on the surface of the eye as well as inducing cephalad fluid shifts that can alter tear drainage. Chronic and persistent DES not only impairs visual function, but also compromises the removal of debris, a heightened risk for corneal abrasions in the microgravity environment. Despite the availability of artificial tears on the ISS, the efficacy is challenged by altered fluid dynamics within the bottle and risks of contamination, thereby exacerbating the potential for corneal abrasions. In light of these challenges, there is a pressing need for innovative approaches to address DES in astronauts. Neurostimulation has emerged as a promising technology countermeasure for DES in spaceflight. By leveraging electrical signals to modulate neural function, neurostimulation offers a novel therapeutic avenue for managing DES symptoms. In this paper, we will explore the risk factors and current treatment modalities for DES, highlighting the limitations of existing approaches. Furthermore, we will delve into the novelty and potential of neurostimulation as a countermeasure for DES in future long-duration missions, including those to the Moon and Mars.

Astronauts participating in lunar landing missions will encounter exposure to albedo particles emitted from the lunar surface as well as primary high-energy particles in the spectra of galactic cosmic rays (GCRs) and solar particle events (SPEs). While existing studies have examined particle energy spectra and absorbed doses in limited radiation exposure scenarios on and near the Moon, comprehensive research encompassing various shielding amounts and large SPEs on the lunar surface remains lacking. Additionally, detailed organ dose equivalents of albedo particles in a human model on the lunar surface have yet to be investigated. This work assesses the organ dose equivalents of albedo neutrons and albedo protons during historically large SPEs in August 1972 and September 1989 utilizing realistic computational anthropomorphic human phantom for the first time. Dosimetric quantities within human organs have been evaluated based on the PHITS Monte Carlo simulation results and quality factors of the state-of-the-art NASA Space Cancer Risk (NSCR) model, as well as ICRP publications. The results with the NSCR model indicate that the albedo contribution to organ dose equivalent is less than 3 % for 1 g/cm2 aluminum shielding, while it increases to more than 30 % in some organs for 50 g/cm2 aluminum shielding during exposure to low-energy-proton-rich SPEs.

Large investments over many decades in genomics in diverse fields such as precision medicine, plant biology, and recently, in space life science research and astronaut omics were not accompanied by a commensurate focus on high-throughput and granular characterization of phenotypes, thus resulting in a \"phenomics lag\" in systems science. There are also limits to what can be achieved through increases in sample sizes in genotype-phenotype association studies without commensurate advances in phenomics. These challenges beg a question. What might next-generation phenomics look like, given that the Internet of Things and artificial intelligence offer prospects and challenges for high-throughput digital phenotyping as a key component of next-generation phenomics? While attempting to answer this question, I also reflect on governance of digital technology and next-generation phenomics. I argue that it is timely to broaden the technical discourses through a lens of political theory. In this context, this analysis briefly engages with the recent book \"The Earthly Community: Reflections on the Last Utopia,\" written by the historian and political theorist Achille Mbembe. The question posed by the book, \"Will we be able to invent different modes of measuring that might open up the possibility of a different aesthetics, a different politics of inhabiting the Earth, of repairing and sharing the planet?\" is directly relevant to healing of human diseases in ways that are cognizant of the interdependency of human and nonhuman animal health, and critical and historically informed governance of digital technologies that promise to benefit next-generation phenomics.

The safety and health of individuals who may be exposed to the spaceflight environment are first and foremost cared for through prevention. This environment, which encompasses microgravity, radiation, and alternobaric factors, can have physiologic impacts on every human system. Available medical care and resources in the spaceflight environment are currently limited by mass and volume constraints, with available medical resources thereby focusing on a patient\'s stabilization and evacuation. An understanding of the spaceflight environment and its possible effects is crucial for the treatment of individuals prior to, during, and after spaceflight.

New studies include health data collected from space tourists on first privately funded orbital mission.

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