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IV: Manned spacecraft."],"prefix":"10.1136","volume":"287","author":[{"given":"F J","family":"Mills","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R M","family":"Harding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1983,8,13]]},"reference":[{"key":"ref_1","article-title":"Entrance requirements for medical school","author":"Association, Secondary Heads","year":"1982","unstructured":"Secondary Heads Association. Entrance requirements for medical school. 3rd ed. London: Secondary Heads Association, 1982.","edition":"3rd ed"},{"unstructured":"Since Gagarin first orbited the earth on 12 April 1961 over 100 human beings have been into space. It has become clear that weightlessness is the major physiological challenge to man in space. Before experiencing microgravity, however, man must first tolerate the increased accelerations imposed by the launch of his spacecraft and be provided with a life supporting environment.","article-title":"Since Gagarin first orbited the earth on 12 April 1961 over 100 human beings have been into space. It has become clear that weightlessness is the major physiological challenge to man in space. Before experiencing microgravity, however, man must first tolerate the increased accelerations imposed by the launch of his spacecraft and be provided with a life supporting environment","key":"ref_2"},{"unstructured":"The 100,, oxygen system was not, however, without hazard. The fire risks of such an atmosphere had been suggested by work at the RAF Institute of Aviation Medicine\" and were tragically confirmed by the fatal launch pad fire of Test Apollo 204 in 1967. The cabin atmosphere for the remaining Apollo launches was changed to 64)O oxygen and 36\", nitrogen at a pressure of just over 259 mm Hg (34-4 kPa), and to compensate for the loss of protection from decompression sickness pure oxygen was breathed for three hours before launch. After entry into orbit oxygen was used to purge nitrogen from the atmosphere through the valve used for discarding urine into space, so that the oxygen content was gradually raised to over 900\u00b0, by the third day of flight. Throughout Apollo flights the Po. was never less than its sea level equivalent.2 Similar atmospheric conditions were provided for Skylab.","article-title":"The 100,, oxygen system was not, however, without hazard. The fire risks of such an atmosphere had been suggested by work at the RAF Institute of Aviation Medicine\" and were tragically confirmed by the fatal launch pad fire of Test Apollo 204 in 1967. The cabin atmosphere for the remaining Apollo launches was changed to 64)O oxygen and 36\", nitrogen at a pressure of just over 259 mm Hg (34-4 kPa), and to compensate for the loss of protection from decompression sickness pure oxygen was breathed for three hours before launch. After entry into orbit oxygen was used to purge nitrogen from the atmosphere through the valve used for discarding urine into space, so that the oxygen content was gradually raised to over 900\u00b0, by the third day of flight. Throughout Apollo flights the Po. was never less than its sea level equivalent.2 Similar atmospheric conditions were provided for Skylab","key":"ref_3"},{"key":"ref_4","article-title":"The most important vestibular disturbance encountered in weightlessness is motion sickness. By itself microgravity does not induce space sickness; indeed, space sickness did not occur in American astronauts until the early Apollo missions. The 22 Mercury and Gemini astronauts were free of symptoms because their head movements were restricted by body restraint and lack of room.'5 The larger size of the Apollo spacecraft allowed more movement, and before the Apollo 10 mission head movements were actually encouraged.2 As a result, five of the six crewmen","volume-title":"of Apollos 8 and; reported symptoms. Similar problems were also experienced by the Soviet cosmonauts: the association between rapid head movements and malaise was first reported by Cosmonaut Titov","volume":"9","unstructured":"The most important vestibular disturbance encountered in weightlessness is motion sickness. By itself microgravity does not induce space sickness; indeed, space sickness did not occur in American astronauts until the early Apollo missions. The 22 Mercury and Gemini astronauts were free of symptoms because their head movements were restricted by body restraint and lack of room.'5 The larger size of the Apollo spacecraft allowed more movement, and before the Apollo 10 mission head movements were actually encouraged.2 As a result, five of the six crewmen of Apollos 8 and 9 reported symptoms. Similar problems were also experienced by the Soviet cosmonauts: the association between rapid head movements and malaise was first reported by Cosmonaut Titov, the second Russian in space.'6"},{"unstructured":"Space sickness produces similar symptoms to terrestrial motion sickness. It usually occurs early in flight, but after three days most astronauts are able to move their heads without any discomfort; all except the scientist astronaut on Apollo 9 were free of symptoms after six to seven days. This adaptation does not, however, afford protection against sea sickness on return to normal gravity. Furthermore, return is often associated with tumbling sensations and vertigo similar to those experienced during weightlessness. Physiologically, space sickness is probably due to absent or incorrect otolithic information which is at variance with normal semicircular canal cues.'6 This is the opposite mechanism to the normogravic sensory mismatch between erroneous canal and correct otolithic cues (see previous article, 28 May, p 1728). The possibility that the redistribution of body fluid during weightlessness has a direct effect on the central nervous system is unlikely.'7","article-title":"Space sickness produces similar symptoms to terrestrial motion sickness. It usually occurs early in flight, but after three days most astronauts are able to move their heads without any discomfort; all except the scientist astronaut on Apollo 9 were free of symptoms after six to seven days. This adaptation does not, however, afford protection against sea sickness on return to normal gravity. Furthermore, return is often associated with tumbling sensations and vertigo similar to those experienced during weightlessness. Physiologically, space sickness is probably due to absent or incorrect otolithic information which is at variance with normal semicircular canal cues.'6 This is the opposite mechanism to the normogravic sensory mismatch between erroneous canal and correct otolithic cues (see previous article, 28 May, p 1728). The possibility that the redistribution of body fluid during weightlessness has a direct effect on the central nervous system is unlikely.'7","key":"ref_5"},{"key":"ref_6","first-page":"154","article-title":"Physiological problems associated with acceleration in space flight","volume":"21","author":"IGlaister, D.H.","year":"1968","unstructured":"IGlaister DH. Physiological problems associated with acceleration in space flight. 7 Br Interplan Soc 1968;21:154-65.","journal-title":"7 Br Interplan Soc"},{"key":"ref_7","first-page":"500","article-title":"Summary of medical experience in the Apollo 7 through 11 manned spaceflights","volume":"41","author":"Berry, C.A.","year":"1970","unstructured":"Berry CA. Summary of medical experience in the Apollo 7 through 11 manned spaceflights. Aerospace Medicine 1970;41:500-19.","journal-title":"Aerospace Medicine"},{"key":"ref_8","first-page":"323","article-title":"Effect of acceleration","volume-title":"Regional differences in the lung","author":"Glaister, D.H.","year":"1977","unstructured":"Glaister DH. Effect of acceleration. In: West JB, ed. Regional differences in the lung. London: Academic Press, 1977:323-79."},{"key":"ref_9","first-page":"372","article-title":"Hypoxemia induced in man by sustained forward acceleration while breathing pure oxygen in a five pounds per square inch absolute environment","volume":"37","author":"Alexander, W.C.; Sever, R.J.; Hoppin, F.G.","year":"1966","unstructured":"Alexander WC, Sever RJ, Hoppin FG. Hypoxemia induced in man by sustained forward acceleration while breathing pure oxygen in a five pounds per square inch absolute environment. Aerospace Medicine 1966;37:372-8.","journal-title":"Aerospace Medicine"},{"key":"ref_10","first-page":"172","article-title":"Soyuz-9 flight, a manned biomedical mission","volume":"42","author":"Mandrovsky, B.N.","year":"1971","unstructured":"Mandrovsky BN. Soyuz-9 flight, a manned biomedical mission. Aerospace Medicine 1971;42:172-7.","journal-title":"Aerospace Medicine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1038\/213648c0","article-title":"Fire risks in space capsules","volume":"213","author":"Denison, D.M.; Howard, P.; Ernsting, J.; Cresswell, A.W.","year":"1967","unstructured":"Denison DM, Howard P, Ernsting J, Cresswell AW. Fire risks in space capsules. Nature 1967;213:648.","journal-title":"Nature"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1172\/JCI105421","article-title":"Effects of in vivo hyperoxia on erythrocytes. III In vivo peroxidation of erythrocyte lipid","volume":"45","author":"Mengel, C.E.; Kann, H.E.","year":"1966","unstructured":"Mengel CE, Kann HE. Effects of in vivo hyperoxia on erythrocytes. III In vivo peroxidation of erythrocyte lipid. 7 Clin Invest 1966;45:1150-8.","journal-title":"7 Clin Invest"},{"key":"ref_13","article-title":"Blood volume changes","volume-title":"Biomedical results from Skylab","author":"Johnson, P.C.; Driscoll, T.B.; LeBlanc, A.D.","unstructured":"Johnson PC, Driscoll TB, LeBlanc AD. Blood volume changes. In: Johnston RS, Dietlein LF, eds. Biomedical results from Skylab. Washington: National Aeronautics and Space Administration, 1977: 235-41; NASA SP-377."},{"key":"ref_14","first-page":"824","article-title":"Some aspects of energy metabolism in human blood erythrocytes under hypokinesia and during space flights","volume":"48","author":"Ushakov, A.S.; Ivanova, S.M.; Brantova, S.S.","year":"1977","unstructured":"Ushakov AS, Ivanova SM, Brantova SS. Some aspects of energy metabolism in human blood erythrocytes under hypokinesia and during space flights. Aviat Space Environ Med 1977;48:824-7.","journal-title":"Aviat Space Environ Med"},{"key":"ref_15","first-page":"193","article-title":"Individual life support systems outside a spacecraft cabin, space suits and capsules","volume-title":"Foundations of space biology and medicine. Vol 3. Space medicine and biotechnology","author":"Jones, W.L.","year":"1975","unstructured":"Jones WL. Individual life support systems outside a spacecraft cabin, space suits and capsules. In: Calvin M, Gazenko OG, eds. Foundations of space biology and medicine. Vol 3. Space medicine and biotechnology. Washington: National Aeronautics and Space Administration, 1975: 193-223."},{"issue":"131","key":"ref_16","first-page":"385","article-title":"The space environment","volume":"1960","author":"Newell, H.E.","unstructured":"Newell HE. The space environment. Science 1960;131:385-90.","journal-title":"Science"},{"key":"ref_17","first-page":"1136","article-title":"View of human problems to be addressed for long-duration space flight","volume":"44","author":"Berry, C.A.","year":"1973","unstructured":"Berry CA. View of human problems to be addressed for long-duration space flight. Aerospace Medicine 1973;44:1136-46.","journal-title":"Aerospace Medicine"},{"key":"ref_18","article-title":"Radiological protection and medical dosimetry for the Skylab crewmen","volume-title":"Biomedical results from Skylab","author":"Bailey, V.J.; Hoffman, R.A.; English, R.A.","unstructured":"Bailey VJ, Hoffman RA, English RA. Radiological protection and medical dosimetry for the Skylab crewmen. In: Johnston RS, Dietlein LF, eds. Biomedical results from Skylab. Washington: National Aeronautics and Space Administration, 1977:64-9; NASA SP-377."},{"key":"ref_19","article-title":"Biology and medicine in space","author":"Bjurstedt, H.","year":"1979","unstructured":"Bjurstedt H. Biology and medicine in space. Paris: European Space Agency, 1979."},{"key":"ref_20","article-title":"Experiment M131. Human vestibular function","volume-title":"Biomedical results from Skylab","author":"Graybiel, A.; Miller, E.F.; Homick, J.L.","unstructured":"Graybiel A, Miller EF, Homick JL. Experiment M131. Human vestibular function. In: Johnston RS, Dietlein LF, eds. Biomedical results from Skylab. Washington: National Aeronautics and Space Administration, 1977:74-103; NASA SP-377."},{"key":"ref_21","article-title":"Possible mechanisms of motion and space sickness","author":"Benson, A.J.","year":"1977","unstructured":"Benson AJ. Possible mechanisms of motion and space sickness. In: Burke WR, Guyenne TD, eds. Life-sciences research in space. Paris: European Space Agency, 1977:101-8; ESA SP-130.","journal-title":"Paris: European Space Agency; research in space"},{"key":"ref_22","first-page":"814","article-title":"Space motion sickness: Skylab revisited. Aviat Space Environ Med","volume":"51","author":"Graybiel, A.","year":"1980","unstructured":"Graybiel A. Space motion sickness: Skylab revisited. Aviat Space Environ Med 1980;51:814-22."},{"key":"ref_23","first-page":"71","article-title":"Co-ordination structure of walking of Soyuz 9 crewmembers before and after flight. Kosmicheskaia Biologiia i Meditsina","volume":"5","author":"Chekirda, I.F.; Bogdashevskiy, R.B.; Yeremin, A.V.; Kolosov, I.A.","year":"1971","unstructured":"Chekirda IF, Bogdashevskiy RB, Yeremin AV, Kolosov IA. Co-ordination structure of walking of Soyuz 9 crewmembers before and after flight. Kosmicheskaia Biologiia i Meditsina (Moskva) 1971;5:71-7.","journal-title":"(Moskva)"},{"key":"ref_24","first-page":"163","article-title":"Caloric and exercise requirements of space flight. I Biostereometric results from Skylab. Aviat Space","volume":"50","author":"Whittle, M.W.","year":"1979","unstructured":"Whittle MW. Caloric and exercise requirements of space flight. I Biostereometric results from Skylab. Aviat Space Environ Med 1979;50: 163-7.","journal-title":"Environ Med"},{"key":"ref_25","article-title":"Mineral and nitrogen metabolic studies","author":"Whedon, G.D.; Lutwak, L.; Rambaut, P.C.","year":"1977","unstructured":"Whedon GD, Lutwak L, Rambaut PC, et al. Mineral and nitrogen metabolic studies. In: Johnston RS, Dietlein LF, eds. Biomedical results from Skylab. Washington: National Aeronautics and Space Administration, 1977:164-74; NASA SP-377.","journal-title":"Biomedical results from Skylab; National Aeronautics and Space Administration; NASA SP-377"},{"key":"ref_26","article-title":"Muscular deconditioning and its prevention in space flight","author":"Thornton, E.W.; Rummel, J.A.","year":"1977","unstructured":"Thornton EW, Rummel JA. Muscular deconditioning and its prevention in space flight. In: Johnston RS, Dietlein LF, eds. Biomedical results from Skylab. Washington: National Aeronautics and Space Administration, 1977:191-7; NASA SP-377.","journal-title":"Biomedical results from Skylab; National Aeronautics and Space Administration; NASA SP-377"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"503","DOI":"10.2214\/ajr.100.3.503","article-title":"Bone demineralisation of foot and hand of Gemini-Titan IV, V and VI astronauts during orbital flight","volume":"100","author":"Mack, P.B.; LaChance, P.A.; Vose, G.P.; Vogt, F.B.","year":"1967","unstructured":"Mack PB, LaChance PA, Vose GP, Vogt FB. Bone demineralisation of foot and hand of Gemini-Titan IV, V and VI astronauts during orbital flight. American Journal of Roentgenology, Radium Therapy, and Nuclear Medicine 1967;100:503-1 1.","journal-title":"American Journal of Roentgenology, Radium Therapy, and Nuclear Medicine"},{"key":"ref_28","article-title":"Bone mineral measurement-experiment M078","volume-title":"Biomedical results from Skylab","author":"Smith, M.C.; Rambaut, P.C.; Vogel, J.M.; Whittle, M.W.","unstructured":"Smith MC, Rambaut PC, Vogel JM, Whittle MW. Bone mineral measurement-experiment M078. In: Johnston RS, Dietlein LF, eds. Biomedical results from Skylab. Washington: National Aeronautics and Space Administration, 1977:183-90; NASA SP-377."},{"issue":"79","key":"ref_29","article-title":"Cosmos 1129: spaceflight and bone changes","volume":"23","author":"Wronski, T.J.; Morey-Holton, E.; Jee, W.S.S.","year":"1980","unstructured":"Wronski TJ, Morey-Holton E, Jee WSS. Cosmos 1129: spaceflight and bone changes. Physiologist 1980;23 suppl:S79-S82.","journal-title":"Physiologist"},{"key":"ref_30","first-page":"849","article-title":"Influence of weightlessness upon the skeleton: a review","volume":"39","author":"Hattner, R.S.; McMillan, D.E.","year":"1968","unstructured":"Hattner RS, McMillan DE. Influence of weightlessness upon the skeleton: a review. Aerospace Medicine 1968;39:849-55.","journal-title":"Aerospace Medicine"},{"key":"ref_31","article-title":"Biochemical responses of the Skylab crewmen: an overview","volume-title":"Biomedical results from Skylab","author":"Leach, C.S.; Rambaut, P.C.","unstructured":"Leach CS, Rambaut PC. Biochemical responses of the Skylab crewmen: an overview. In: Johnston RS, Dietlein LF, eds. Biomedical results from Skylab. 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Endocrinology 1967;81: 1053-62.","journal-title":"Endocrinology"},{"key":"ref_34","first-page":"45","article-title":"Endocrinology. In: Life beyond the earth's environment","author":"Avioli, L.; Biglieri, E.G.; Daughaday, W.; Raisz, L.G.; Reichlin, S.; Vogel, J.","year":"1979","unstructured":"Avioli L, Biglieri EG, Daughaday W, Raisz LG, Reichlin S, Vogel J. Endocrinology. In: Life beyond the earth's environment. Washington: National Academy of Sciences, 1979:45-66.","journal-title":"Washington: National Academy of Sciences"},{"issue":"27","key":"ref_35","article-title":"Artificial gravity in space flight","volume":"23","author":"Kotovskaya, A.R.; Ilyin, E.A.; Korolkov, VI, Shipov; A.A.","year":"1980","unstructured":"Kotovskaya AR, Ilyin EA, Korolkov VI, Shipov AA. Artificial gravity in space flight. Physiologist 1980;23 suppl:S27-S28.","journal-title":"Physiologist"},{"key":"ref_36","first-page":"592","article-title":"Haemodynamic changes in man during immersion with the head above water","volume":"43","author":"Arborelius, M.; Balldin, U.I.; Lilja, B.; Lundgren, C.E.G.","year":"1972","unstructured":"Arborelius M, Balldin UI, Lilja B, Lundgren CEG. Haemodynamic changes in man during immersion with the head above water. Aerospace Medicine 1972;43:592-8.","journal-title":"Aerospace Medicine"},{"key":"ref_37","article-title":"Anthropometric changes and fluid shifts","volume-title":"Biomedical results from Skylab","author":"Thornton, W.E.; Hoffler, G.W.; Rummel, J.A.","unstructured":"Thornton WE, Hoffler GW, Rummel JA. Anthropometric changes and fluid shifts. In: Johnston SR, Dietlein LF, eds. Biomedical results from Skylab. Washington: National Aeronautics and Space Administration 1977:330-8; NASA SP-377."},{"key":"ref_38","article-title":"Skylab 4 crew observations","volume-title":"Biomedical results from Skylab","author":"Gibson, E.G.","unstructured":"Gibson EG. Skylab 4 crew observations. In: Johnston SR, Dietlein LF, eds. Biomedical results from Skylab. Washington: National Aeronautics and Space Administration 1977:22-6; NASA SP-377."},{"author":"Gauer, O.H.; Henry, J.P.","unstructured":"Gauer OH, Henry JP. Neurohormonal control of plasma volume. In: Guyton AC, Cowley AW, eds. International revziew of physiology.","article-title":"Neurohormonal control of plasma volume","key":"ref_39"},{"key":"ref_40","first-page":"145","article-title":"Cardiovascular physiology. Vol 9","year":"1976","unstructured":"Cardiovascular physiology. Vol 9. Baltimore: University Park Press, 1976:145-90."},{"key":"ref_41","first-page":"529","article-title":"Physiological mass measurements in Skylab","volume":"45","author":"Thornton, W.E.; Ord, J.","year":"1974","unstructured":"Thornton WE, Ord J. Physiological mass measurements in Skylab. In: Johnston RS, Dietlein LF, eds. Biomedical results from Skylab. Washington: National Aeronautics and Space Administration, 1977: 175-82; NASA SP-377. 3' Leach CS, Rambaut PC, Johnson PC. Adrenocortical responses of the Apollo 17 crew members. Aerospace Medicine 1974;45:529-34.","journal-title":"Aerospace Medicine; results from Skylab. Washington: National Aeronautics and Space Administration, 1977: 175-82; NASA SP-377. 3' Leach CS, Rambaut PC, Johnson PC. Adrenocortical responses of the Apollo 17 crew members"},{"key":"ref_42","first-page":"\"275","article-title":"Characterisation of the natriuresis caused in normal man by immersion in water","volume":"43","author":"Epstein, M.; Duncan, D.C.; Fishman, L.M.","year":"1972","unstructured":"Epstein M, Duncan DC, Fishman LM. Characterisation of the natriuresis caused in normal man by immersion in water. Clin Sci 1972;43:275-87. 3a Epstein M, Pins DS, Miller M. Suppression of ADH during water immersion in normal man. 7 Appl Physiol 1975;38:1038-44.","journal-title":"Clin Sci; Suppression of ADH during water immersion in normal man"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1152\/jappl.1971.31.3.368","article-title":"Effect of water immersion on renin-aldosterone and renal sodium handling in normal man","volume":"31","author":"Epstein, M.; Saruta, T.","year":"1971","unstructured":"Epstein M, Saruta T. Effect of water immersion on renin-aldosterone and renal sodium handling in normal man. _7 Appl Physiol 1971;31:368-74.","journal-title":"_7 Appl Physiol"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1152\/jappl.1979.46.4.703","article-title":"Fluid shifts during initial phase of immersion diuresis in man","volume":"46","author":"Khosla, S.S.; Dubois, A.B.","year":"1979","unstructured":"Khosla SS, Dubois AB. Fluid shifts during initial phase of immersion diuresis in man. 7 Appl Physiol 1979;46:703-8.","journal-title":"7 Appl Physiol"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1038\/ki.1978.22","article-title":"Presence of a natriuretic factor in urine of normal men undergoing water immersion","volume":"13","author":"Epstein, M.; Bricker, N.S.; Bourgoignie, J.J.","year":"1978","unstructured":"Epstein M, Bricker NS, Bourgoignie JJ. Presence of a natriuretic factor in urine of normal men undergoing water immersion. 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Vectorcardiographic changes during extended space flight (MO93): observations at rest and during exercise. In: Johnston RS, Dietlein LF, eds. Biomedical results from Skylab. Washington: National Aeronautics and Space Administration, 1977:339-49; NASA SP-377."},{"key":"ref_49","article-title":"Effect of prolonged space flight on cardiac function and dimensions","volume-title":"Biomedical results from Skylab","author":"Johnston, R.S.","unstructured":"-Henry WL, Epstein SE, Griffiths JM, Goldstein RE, Redwood DR. Effect of prolonged space flight on cardiac function and dimensions. In: Johnston RS, Dietlein LF, eds. Biomedical results from Skylab. Washington: National Aeronautics and Space Administration, 1977: 366-71; NASA SP-377."},{"key":"ref_50","first-page":"807","article-title":"Apollo space crew cardiovascular evaluations","volume":"45","author":"Hoffler, G.W.; Wolthuis, R.A.; Johnson, R.L.","year":"1974","unstructured":"\" Hoffler GW, Wolthuis RA, Johnson RL. Apollo space crew cardiovascular evaluations. Aerospace Medicine 1974;45:807-20.","journal-title":"Aerospace Medicine"},{"issue":"44","key":"ref_51","first-page":"235","article-title":"Physiological response to exercise after space flight-Apollo","volume":"1973","author":"Rummel, J.A.; Michel, E.L.; Berry, C.A.","unstructured":"Rummel JA, Michel EL, Berry CA. Physiological response to exercise after space flight-Apollo 7 to Apollo 11. Aerospace Medicine 1973,44: 235-8.","journal-title":"Aerospace Medicine"},{"key":"ref_52","article-title":"Lower body negative pressure: third manned Skylab mission","author":"Johnson, R.L.; Hoffler, G.W.; Nicogossian, A.E.; Bergman, S.A.; Jackson, M.M.","year":"1977","unstructured":"\"Johnson RL, Hoffler GW, Nicogossian AE, Bergman SA, Jackson MM. Lower body negative pressure: third manned Skylab mission. In: Johnston RS, Dietlein LF, eds. Biomedical results from Skylab. 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