{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T16:07:27Z","timestamp":1787155647465,"version":"build-2736575974"},"reference-count":99,"publisher":"Oxford University Press (OUP)","issue":"1173","license":[{"start":{"date-parts":[[2022,7,20]],"date-time":"2022-07-20T00:00:00Z","timestamp":1658275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,6,30]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>\u00a0<\/jats:title><jats:p>Space medicine is critical in enabling safe human exploration of space. The discipline focuses on supporting human survival, health, and performance in the austere environment of space. It is set to grow ever more important as significant transitions in the standard of space operations in the suborbital, low earth orbit (LEO) and beyond LEO domains will take place in the coming years. NASA along with their international and commercial partners have committed to returning to the Moon through the Artemis missions in this decade with the aim of achieving a permanent sustainable human presence on the lunar surface. Additionally, the development of reusable rockets is set to increase the number and frequency of humans going to space by making space travel more accessible. Commercial spaceflight and missions beyond LEO present many new challenges which space medicine physicians and researchers will need to address. Space medicine operates at the frontier of exploration, engineering, science and medicine. Aviation and Space Medicine (ASM) is the latest specialty to be recognised by the Royal College of Physicians and the General Medical Council in the UK. In this paper, we provide an introduction to space medicine, review the effects of spaceflight on human physiology and health along with countermeasures, medical and surgical issues in space, the varied roles of the ASM physician, challenges to UK space medicine practice and related research, and finally we explore the current representation of space medicine within the undergraduate curriculum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Learning points<\/jats:title><\/jats:sec>","DOI":"10.1136\/pmj-2022-141875","type":"journal-article","created":{"date-parts":[[2022,7,20]],"date-time":"2022-07-20T17:25:14Z","timestamp":1658337914000},"page":"763-776","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Space Medicine: Inspiring a new generation of physicians"],"prefix":"10.1093","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4035-4052","authenticated-orcid":false,"given":"Areeb","family":"Mian","sequence":"first","affiliation":[{"name":"Department of Surgery , , Cambridge , UK"},{"name":"University of Cambridge , , Cambridge , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3558-0079","authenticated-orcid":false,"given":"Minahel","family":"Aamir Mian","sequence":"additional","affiliation":[{"name":"School of Medicine , , Cardiff , UK"},{"name":"Cardiff University , , Cardiff , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,7,20]]},"reference":[{"key":"2023063014164988600_R1","article-title":"Aviation and space medicine","author":"JRCPTB","year":"2016"},{"key":"2023063014164988600_R2","article-title":"SpaceX to launch astronauts \u2014 and a new era of private human spaceflight","author":"Witze","year":"2020","journal-title":"Nature"},{"key":"2023063014164988600_R3","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1056\/NEJMra1609012","article-title":"Space medicine in the era of civilian spaceflight","volume":"380","author":"Stepanek","year":"2019","journal-title":"N Engl J Med"},{"key":"2023063014164988600_R4","first-page":"649","article-title":"The medical implications of space tourism","volume":"71","author":"Tarzwell","year":"2000","journal-title":"Aviat Space Environ Med"},{"key":"2023063014164988600_R5","volume-title":"NASA risk management and health standards","author":"Kahn","year":"2014"},{"key":"2023063014164988600_R6","article-title":"NASA\u2019s Plan for Sustained Lunar Exploration and Development","author":"NASA","year":"2020"},{"key":"2023063014164988600_R7","article-title":"NASA\u2019s Lunar Exploration Program Overview","author":"NASA","year":"2020"},{"key":"2023063014164988600_R8","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.actaastro.2004.01.023","article-title":"Life science research in space brings health on earth","volume":"54","author":"Mortimer","year":"2004","journal-title":"Acta Astronaut"},{"key":"2023063014164988600_R9","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/0094-5765(90)90079-Z","article-title":"Earth benefits from space life sciences","volume":"21","author":"Garshnek","year":"1990","journal-title":"Acta Astronaut"},{"key":"2023063014164988600_R10","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/S0094-5765(98)00053-8","article-title":"On the contribution of space medicine in the public health care","volume":"41","author":"Grigoriev","year":"1997","journal-title":"Acta Astronaut"},{"key":"2023063014164988600_R11","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.9458","article-title":"Applications of space technologies to global health: Scoping review","volume":"20","author":"Dietrich","year":"2018","journal-title":"J Med Internet Res"},{"key":"2023063014164988600_R12","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1038\/s41526-020-0095-y","article-title":"Selected discoveries from human research in space that are relevant to human health on earth","volume":"6","author":"Shelhamer","year":"2020","journal-title":"NPJ Microgravity"},{"key":"2023063014164988600_R13","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1007\/s00421-012-2523-5","article-title":"Space physiology VI: exercise, artificial gravity, and countermeasure development for prolonged space flight","volume":"113","author":"Hargens","year":"2013","journal-title":"Eur J Appl Physiol"},{"key":"2023063014164988600_R14","doi-asserted-by":"crossref","DOI":"10.3389\/fphys.2017.00547","article-title":"Human pathophysiological adaptations to the space environment","volume":"8","author":"Demontis","year":"2017","journal-title":"Front Physiol"},{"key":"2023063014164988600_R15","article-title":"Research to boost astronaut health for future space missions. 2021; 2022","author":"Space Agency"},{"key":"2023063014164988600_R16","volume-title":"Why Space : The opportunity for Health and Life Science Innovation","author":"Robson Brown","year":"2021"},{"key":"2023063014164988600_R17","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/0273-1177(92)90302-E","article-title":"Long-term space flights--personal impressions","volume":"12","author":"Polyakov","year":"1992","journal-title":"Adv Space Res"},{"key":"2023063014164988600_R18","first-page":"17","article-title":"Changes in basal heart rate in spaceflights up to 438 days","volume":"73","author":"Gundel","year":"2002","journal-title":"Aviat Space Environ Med"},{"key":"2023063014164988600_R19","first-page":"A9","article-title":"Renal stone formation among astronauts","volume":"78","author":"Pietrzyk","year":"2007","journal-title":"Aviat Space Environ Med"},{"key":"2023063014164988600_R20","doi-asserted-by":"crossref","first-page":"113S","DOI":"10.1016\/S8756-3282(98)00013-1","article-title":"Future human bone research in space","volume":"22","author":"LeBlanc","year":"1998","journal-title":"Bone"},{"key":"2023063014164988600_R21","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0226434","article-title":"A human mission to Mars: predicting the bone mineral density loss of astronauts","volume":"15","author":"Axpe","year":"2020","journal-title":"PLoS One"},{"key":"2023063014164988600_R22","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/s41526-021-00158-4","article-title":"Update on the effects of microgravity on the musculoskeletal system","volume":"7","author":"Juhl","year":"2021","journal-title":"NPJ Microgravity"},{"key":"2023063014164988600_R23","doi-asserted-by":"crossref","first-page":"4444","DOI":"10.1096\/fj.201700208RR","article-title":"Space microgravity drives transdifferentiation of human bone marrow-derived mesenchymal stem cells from osteogenesis to adipogenesis","volume":"32","author":"Zhang","year":"2018","journal-title":"Faseb J"},{"key":"2023063014164988600_R24","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1038\/s41526-022-00194-8","article-title":"The effects of microgravity on bone structure and function","volume":"8","author":"Man","year":"2022","journal-title":"NPJ Microgravity"},{"key":"2023063014164988600_R25","article-title":"Research into ageing set to blast into space","author":"UK-GOV","year":"2021"},{"key":"2023063014164988600_R26","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s00421-010-1556-x","article-title":"Disuse of the musculo-skeletal system in space and on earth","volume":"111","author":"Narici","year":"2011","journal-title":"Eur J Appl Physiol"},{"key":"2023063014164988600_R27","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.autneu.2006.07.014","article-title":"Space motion sickness: incidence, etiology, and countermeasures","volume":"129","author":"Heer","year":"2006","journal-title":"Auton Neurosci"},{"key":"2023063014164988600_R28","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1038\/s41526-020-0097-9","article-title":"Spaceflight associated neuro-ocular syndrome (SANS) and the neuro-ophthalmologic effects of microgravity: a review and an update","volume":"6","author":"Lee","year":"2020","journal-title":"NPJ Microgravity"},{"key":"2023063014164988600_R29","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1152\/physrev.00017.2016","article-title":"Spaceflight-Induced intracranial hypertension and visual impairment: pathophysiology and countermeasures","volume":"98","author":"Zhang","year":"2018","journal-title":"Physiol Rev"},{"key":"2023063014164988600_R30","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/WNO.0000000000000467","article-title":"Persistent asymmetric optic disc swelling after long-duration space flight: implications for pathogenesis","volume":"37","author":"Mader","year":"2017","journal-title":"J Neuroophthalmol"},{"key":"2023063014164988600_R31","doi-asserted-by":"crossref","first-page":"4281","DOI":"10.1002\/hbm.25546","article-title":"Ophthalmic changes in a spaceflight analog are associated with brain functional reorganization","volume":"42","author":"McGregor","year":"2021","journal-title":"Hum Brain Mapp"},{"key":"2023063014164988600_R32","doi-asserted-by":"crossref","first-page":"105","DOI":"10.2147\/EB.S234076","article-title":"Spaceflight associated Neuro-Ocular syndrome (SANS): a systematic review and future directions","volume":"12","author":"Martin Paez","year":"2020","journal-title":"Eye Brain"},{"key":"2023063014164988600_R33","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1001\/jamaophthalmol.2017.2396","article-title":"Space Flight-Associated Neuro-ocular syndrome","volume":"135","author":"Lee","year":"2017","journal-title":"JAMA Ophthalmol"},{"key":"2023063014164988600_R34","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2021.648958","article-title":"Head-Down tilt bed rest studies as a terrestrial analog for spaceflight associated Neuro-Ocular syndrome","volume":"12","author":"Ong","year":"2021","journal-title":"Front Neurol"},{"key":"2023063014164988600_R35","doi-asserted-by":"crossref","first-page":"835","DOI":"10.3357\/ASEM.2276.2008","article-title":"Immune system dysregulation following short- vs long-duration spaceflight","volume":"79","author":"Crucian","year":"2008","journal-title":"Aviat Space Environ Med"},{"key":"2023063014164988600_R36","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1038\/s41526-020-0104-1","article-title":"How does spaceflight affect the acquired immune system?","volume":"6","author":"Akiyama","year":"2020","journal-title":"NPJ Microgravity"},{"key":"2023063014164988600_R37","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2018.01437","article-title":"Immune system dysregulation during spaceflight: potential countermeasures for deep space exploration missions","volume":"9","author":"Crucian","year":"2018","journal-title":"Front Immunol"},{"key":"2023063014164988600_R38","first-page":"43","volume-title":"Biomedical results of Apollo","author":"Hawkins","year":"1975"},{"key":"2023063014164988600_R39","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.semnephrol.2005.05.006","article-title":"Anemia and erythropoietin in space flights","volume":"25","author":"De Santo","year":"2005","journal-title":"Semin Nephrol"},{"key":"2023063014164988600_R40","doi-asserted-by":"crossref","first-page":"2490","DOI":"10.1016\/j.juro.2009.07.010","article-title":"Effect of potassium citrate therapy on the risk of renal stone formation during spaceflight","volume":"182","author":"Whitson","year":"2009","journal-title":"J Urol"},{"key":"2023063014164988600_R41","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/S1474-4422(14)70122-X","article-title":"Prevalence of sleep deficiency and use of hypnotic drugs in astronauts before, during, and after spaceflight: an observational study","volume":"13","author":"Barger","year":"2014","journal-title":"Lancet Neurol"},{"key":"2023063014164988600_R42","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1183\/09031936.00001414","article-title":"Microgravity and the respiratory system","volume":"43","author":"Prisk","year":"2014","journal-title":"Eur Respir J"},{"key":"2023063014164988600_R43","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1002\/bjs.10908","article-title":"Surgery in space","volume":"105","author":"Panesar","year":"2018","journal-title":"Br J Surg"},{"key":"2023063014164988600_R44","doi-asserted-by":"crossref","first-page":"491","DOI":"10.3390\/life4030491","article-title":"Space radiation: the number one risk to astronaut health beyond low earth orbit","volume":"4","author":"Chancellor","year":"2014","journal-title":"Life"},{"key":"2023063014164988600_R45","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/S1470-2045(06)70695-7","article-title":"Cancer risk from exposure to galactic cosmic rays: implications for space exploration by human beings","volume":"7","author":"Cucinotta","year":"2006","journal-title":"Lancet Oncol"},{"key":"2023063014164988600_R46","first-page":"130","article-title":"Medical mitigation strategies for acute radiation exposure during spaceflight","volume":"77","author":"Epelman","year":"2006","journal-title":"Aviat Space Environ Med"},{"key":"2023063014164988600_R47","volume-title":"Space physiology and medicine","author":"Nicogossian","year":"1989\/2016","edition":"2nd\/4th Edition"},{"key":"2023063014164988600_R48","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1038\/s41526-022-00193-9","article-title":"Estimating medical risk in human spaceflight","volume":"8","author":"Antonsen","year":"2022","journal-title":"NPJ Microgravity"},{"key":"2023063014164988600_R49","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.annemergmed.2005.02.010","article-title":"Emergencies in space","volume":"46","author":"Summers","year":"2005","journal-title":"Ann Emerg Med"},{"key":"2023063014164988600_R50","doi-asserted-by":"crossref","first-page":"117","DOI":"10.3357\/ASEM.2270.2009","article-title":"Musculoskeletal injuries and minor trauma in space: incidence and injury mechanisms in U.S. astronauts","volume":"80","author":"Scheuring","year":"2009","journal-title":"Aviat Space Environ Med"},{"key":"2023063014164988600_R51","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1752-2897-3-4","article-title":"Severe traumatic injury during long duration spaceflight: light years beyond ATLS","volume":"3","author":"Kirkpatrick","year":"2009","journal-title":"J Trauma Manag Outcomes"},{"key":"2023063014164988600_R52","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1503\/cjs.024610","article-title":"Prophylactic surgery prior to extended-duration space flight: is the benefit worth the risk?","volume":"55","author":"Ball","year":"2012","journal-title":"Can J Surg"},{"key":"2023063014164988600_R53","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1503\/cmaj.090628","article-title":"Acclimation during space flight: effects on human physiology","volume":"180","author":"Williams","year":"2009","journal-title":"CMAJ"},{"key":"2023063014164988600_R54","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/S1072-7515(02)01145-6","article-title":"A review of surgical care in space","volume":"194","author":"Campbell","year":"2002","journal-title":"J Am Coll Surg"},{"key":"2023063014164988600_R55","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1002\/bjs.10908","article-title":"Surgery in space","volume":"105","author":"Panesar","year":"2018","journal-title":"Br J Surg"},{"key":"2023063014164988600_R56","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jemermed.2006.05.031","article-title":"Emergency medicine in space","volume":"32","author":"Stewart","year":"2007","journal-title":"J Emerg Med"},{"key":"2023063014164988600_R57","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.actaastro.2012.04.014","article-title":"Surgery in space: where are we at now?","volume":"79","author":"Drudi","year":"2012","journal-title":"Acta Astronaut"},{"key":"2023063014164988600_R58","doi-asserted-by":"crossref","DOI":"10.1186\/s13049-020-00793-y","article-title":"Cardiopulmonary resuscitation (CPR) during spaceflight - a guideline for CPR in microgravity from the German Society of Aerospace Medicine (DGLRM) and the European Society of Aerospace Medicine Space Medicine Group (ESAM-SMG)","volume":"28","author":"Hinkelbein","year":"2020","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"2023063014164988600_R59","article-title":"NASA Human Research Road Map - Risk of Adverse Health Outcomes and Decrements in Performance Due to Medical Conditions that occur in Mission, as well as Long Term Health Outcomes Due to Mission Exposures","author":"NASA","year":"2022"},{"key":"2023063014164988600_R60","doi-asserted-by":"crossref","first-page":"537","DOI":"10.3357\/AMHP.5582.2020","article-title":"The role of artificial intelligence (AI) in space healthcare","volume":"91","author":"Cinelli","year":"2020","journal-title":"Aerosp Med Hum Perform"},{"key":"2023063014164988600_R61","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1093\/occmed\/kqz099","article-title":"Medical considerations for a return to the moon","volume":"69","author":"Anderton","year":"2019","journal-title":"Occup Med"},{"key":"2023063014164988600_R62","volume-title":"StatPearls [Internet]","author":"Stein","year":"2022"},{"key":"2023063014164988600_R63","doi-asserted-by":"crossref","first-page":"i143","DOI":"10.1093\/bja\/aex336","article-title":"An overview of space medicine","volume":"119","author":"Hodkinson","year":"2017","journal-title":"Br J Anaesth"},{"key":"2023063014164988600_R64","article-title":"UK space agency launches multi-million pound drive to design hospital of the future","author":"UKSA","year":"2021"},{"key":"2023063014164988600_R65","doi-asserted-by":"crossref","first-page":"16031","DOI":"10.1038\/npjmgrav.2016.31","article-title":"Towards human exploration of space: the THESEUS review series on cardiovascular, respiratory, and renal research priorities","volume":"2","author":"Aubert","year":"2016","journal-title":"NPJ Microgravity"},{"key":"2023063014164988600_R66","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/0094-5765(91)90067-F","article-title":"NASA spinoffs to bioengineering and medicine","volume":"25","author":"Rouse","year":"1991","journal-title":"Acta Astronaut"},{"key":"2023063014164988600_R67","article-title":"Health and medicine Spinoffs: the National Aeronautics and space administration","author":"NASA","year":"2009"},{"key":"2023063014164988600_R68","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1038\/s41591-021-01665-3","article-title":"Mars mission could bring health benefits on earth","volume":"28","author":"Renault","year":"2022","journal-title":"Nat Med"},{"key":"2023063014164988600_R69","article-title":"Aerospace medicine","author":"KCL"},{"key":"2023063014164988600_R70","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1038\/s41526-020-00124-6","article-title":"Red risks for a journey to the red planet: the highest priority human health risks for a mission to Mars","volume":"6","author":"Patel","year":"2020","journal-title":"NPJ Microgravity"},{"key":"2023063014164988600_R71","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1097\/01.HP.0000339020.92837.61","article-title":"Modeling the acute health effects of astronauts from exposure to large solar particle events","volume":"96","author":"Hu","year":"2009","journal-title":"Health Phys"},{"key":"2023063014164988600_R72","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1002\/j.1552-4604.1991.tb03663.x","article-title":"Changes in total body water during spaceflight","volume":"31","author":"Leach","year":"1991","journal-title":"J Clin Pharmacol"},{"key":"2023063014164988600_R73","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/BF00209721","article-title":"Fluid shifts into and out of superficial tissues under microgravity and terrestrial conditions","volume":"71","author":"Kirsch","year":"1993","journal-title":"Clin Investig"},{"key":"2023063014164988600_R74","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1093\/pcmedi\/pbaa022","article-title":"Long-Term spaceflight and the cardiovascular system","volume":"3","author":"Vernice","year":"2020","journal-title":"Precis Clin Med"},{"key":"2023063014164988600_R75","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780195137255.001.0001","volume-title":"Space physiology","author":"Buckey","year":"2006"},{"key":"2023063014164988600_R76","first-page":"372","volume-title":"Biomedical results from Skylab","author":"Michel","year":"1977"},{"key":"2023063014164988600_R77","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCEP.117.005959","article-title":"Effects of prolonged spaceflight on atrial size, atrial electrophysiology, and risk of atrial fibrillation","volume":"11","author":"Khine","year":"2018","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2023063014164988600_R78","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/S0361-9230(98)00092-6","article-title":"Physiological basis and pharmacology of motion sickness: an update","volume":"47","author":"Yates","year":"1998","journal-title":"Brain Res Bull"},{"key":"2023063014164988600_R79","first-page":"P107","article-title":"Relative bioavailability of scopolamine dosage forms and interaction with Dextroamphetamine","volume":"14","author":"Boyd","year":"2007","journal-title":"J Gravit Physiol"},{"key":"2023063014164988600_R80","first-page":"172","article-title":"Immunosuppression during spaceflight deconditioning","volume":"69","author":"Levine","year":"1998","journal-title":"Aviat Space Environ Med"},{"key":"2023063014164988600_R81","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1152\/japplphysiol.91126.2008","article-title":"Spaceflight effects on T lymphocyte distribution, function and gene expression","volume":"106","author":"Gridley","year":"2009","journal-title":"J Appl Physiol"},{"key":"2023063014164988600_R82","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4419-9905-4","volume-title":"Fundamentals of space medicine","author":"Cl\u00e9ment","year":"2011"},{"key":"2023063014164988600_R83","doi-asserted-by":"crossref","DOI":"10.1007\/978-0-387-68164-1","volume-title":"Principles of clinical medicine for space flight","author":"Barratt","year":"2008"},{"key":"2023063014164988600_R84","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1038\/s41526-020-0103-2","article-title":"A systematic review and meta-analysis of bone loss in space travelers","volume":"6","author":"Stavnichuk","year":"2020","journal-title":"NPJ Microgravity"},{"key":"2023063014164988600_R85","doi-asserted-by":"crossref","first-page":"3011","DOI":"10.3892\/mmr.2017.6357","article-title":"Duration of simulated microgravity affects the differentiation of mesenchymal stem cells","volume":"15","author":"Xue","year":"2017","journal-title":"Mol Med Rep"},{"key":"2023063014164988600_R86","volume-title":"A world without gravity: research in space for health and industrial processes","author":"Di Prampero","year":"2001"},{"key":"2023063014164988600_R87","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1007\/s00198-012-2243-z","article-title":"Bisphosphonates as a supplement to exercise to protect bone during long-duration spaceflight","volume":"24","author":"Leblanc","year":"2013","journal-title":"Osteoporos Int"},{"key":"2023063014164988600_R88","first-page":"335","article-title":"Alendronate as an effective countermeasure to disuse induced bone loss","volume":"2","author":"LeBlanc","year":"2002","journal-title":"J Musculoskelet Neuronal Interact"},{"key":"2023063014164988600_R89","doi-asserted-by":"crossref","first-page":"439","DOI":"10.2165\/00007256-200939060-00002","article-title":"Exercise and bone mass in adults","volume":"39","author":"Guadalupe-Grau","year":"2009","journal-title":"Sports Med"},{"key":"2023063014164988600_R90","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1519\/JSC.0000000000001460","article-title":"The effect of the gravity loading countermeasure Skinsuit upon movement and strength","volume":"31","author":"Carvil","year":"2017","journal-title":"J Strength Cond Res"},{"key":"2023063014164988600_R91","article-title":"Artificial gravity as a countermeasure for mitigating physiological deconditioning during long-duration space missions","volume":"9","author":"Cl\u00e9ment","year":"2015","journal-title":"Front Syst Neurosci"},{"key":"2023063014164988600_R92","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/00005768-199610000-00026","article-title":"Pulmonary function and cardiopulmonary interactions at microgravity","volume":"28","author":"Linnarsson","year":"1996","journal-title":"Med Sci Sports Exerc"},{"key":"2023063014164988600_R93","doi-asserted-by":"crossref","first-page":"190","DOI":"10.3357\/ASEM.3387.2013","article-title":"Particulate deposition in the human lung under lunar habitat conditions","volume":"84","author":"Darquenne","year":"2013","journal-title":"Aviat Space Environ Med"},{"key":"2023063014164988600_R94","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0093298","article-title":"Psychological and behavioral changes during confinement in a 520-day simulated interplanetary mission to Mars","volume":"9","author":"Basner","year":"2014","journal-title":"PLoS One"},{"key":"2023063014164988600_R95","article-title":"On-orbit sleep problems of astronauts and countermeasures","volume":"5","author":"Wu","year":"2018","journal-title":"Mil Med Res"},{"key":"2023063014164988600_R96","volume-title":"18Th IAA humans in space symposium","author":"Watkins","year":"2011"},{"key":"2023063014164988600_R97","doi-asserted-by":"crossref","first-page":"383","DOI":"10.2147\/IJGM.S114188","article-title":"Incidence of clinical symptoms during long-duration orbital spaceflight","volume":"9","author":"Crucian","year":"2016","journal-title":"Int J Gen Med"},{"key":"2023063014164988600_R98","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1056\/NEJMc1905875","article-title":"Venous thrombosis during spaceflight","volume":"382","author":"Au\u00f1\u00f3n-Chancellor","year":"2020","journal-title":"N Engl J Med"},{"key":"2023063014164988600_R99","article-title":"Curriculum for Aviation and Space Medicine Training - Draft New Curriculum","author":"JRCPTB","year":"2022"}],"container-title":["Postgraduate Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/99\/1173\/763\/50753537\/pmj-2022-141875.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/99\/1173\/763\/50753537\/pmj-2022-141875.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T20:10:39Z","timestamp":1700856639000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pmj\/article\/99\/1173\/763\/7150864"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,20]]},"references-count":99,"journal-issue":{"issue":"1173","published-online":{"date-parts":[[2022,7,20]]},"published-print":{"date-parts":[[2023,6,30]]}},"URL":"https:\/\/doi.org\/10.1136\/pmj-2022-141875","relation":{},"ISSN":["0032-5473","1469-0756"],"issn-type":[{"value":"0032-5473","type":"print"},{"value":"1469-0756","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,7]]},"published":{"date-parts":[[2022,7,20]]}}}