INTRODUCTION:Long-duration spaceflight and isolated, confined, and extreme environments present various challenges to crewmembers. One less-frequently discussed challenge is altered sensory inputs and how they can adversely affect cognition and performance. Maintaining psychological and performance outcomes is crucial for mission success, and simple sensory-based countermeasures (CMs) can be surprisingly effective. This scoping review examines the impact of altered sensory inputs in these extreme environments, assesses current sensory-based CMs, and compares their effectiveness across sensory modalities to guide future strategies. METHODS:Relevant studies were identified through comprehensive searches of PubMed, PsycINFO, Google Scholar, Science Direct, ProQuest, and the NASA Technical Reports Server. Searches included keywords related to the sensory modalities under investigation and potential outcomes. This review focused on English-language publications, with no date restrictions for sensory alterations and a focus on studies published after 2019 for countermeasure research. RESULTS:Spaceflight leads to sensory changes that affect health and performance. These alterations are highlighted, finding particularly prominent changes in lighting and auditory modalities. These changes result from altered sensory inputs and environmentally driven physiological alterations. Sensory input modulation can influence cognitive and psychological states, affecting performance. Sensory-based CMs were examined for their impact on psychological and performance domains. A total of 285 articles on sensory alterations and 180 on CMs were reviewed, with 52 and 59 articles included, respectively. DISCUSSION:Sensory-based CMs offer promising approaches to maintain or improve performance. Modulating sensory inputs can mitigate spaceflight-related challenges. Personalized, multisensory approaches appear particularly promising. The review highlights research gaps and suggests avenues for enhancing sensory CMs. White BM, Stankovic A, Thoolen S, Kosmyna N, Ivkovic V, Strangman G. Sensory-based alterations and countermeasures in spaceflight and spaceflight analogs. Aerosp Med Hum Perform. 2025; 96(7):556-568.

Background: Long -duration missions in isolated, confined, and extreme environments, including Antarctica and upcoming deep -space operations, can be a source of increased stress. The identification of countermeasures and protective factors is required to support health and performance in similar contexts. Mindfulness disposition is an optimal candidate, but no research has ever explored this potential association. Methods: Twenty-four crew members from two Antarctic expeditions at the Concordia base were repeatedly assessed over the course of a 12 -month mission for stress (Perceived Stress Scale) and mindfulness, using multiple assessment measures, including the Mindful Attention and Awareness Scale (MAAS), the Langer Mindfulness Scale (LMS), the Breath Counting Task, and the Triangle Task. Results: Results indicate a strong negative association over time between mindfulness and stress, particularly when measured with the MAAS and the LMS. Higher MAAS baseline values were also good predictors of lower stress patterns during the mission. Conclusions: Mindfulness disposition was negatively associated with stress over time, suggesting that it can play an important role in stress mitigation in isolated and confined environments, including long -duration space missions. Furthermore, a mindfulness assessment could be added to the crew selection procedure.

Objective This paper surveys the existing literature surrounding problem-solving and team dynamics in complex and unpredictable scenarios, and evaluates the applicability of studying Earth-based construction teams to identify training needs for Lunar construction crews. Background Lunar and other space exploration construction crews will work in extreme environments and face unpredictable challenges, necessitating real-time problem-solving to address unexpected contingencies. This work will require coordination with Mission Control and autonomous assistants, so crew training must account for multi-agent, distributed teamwork. Method A narrative literature review identified processes, attributes, and skills necessary for the success of Lunar construction teams. We summarized relevant frameworks and synthesized collective findings into over-arching trends and remaining research gaps. Results While significant literature exists surrounding team performance, very little systematic inquiry has been done with a focus on Lunar construction crews and operations, particularly with respect to dynamic problem-solving and team-based decision-making. Established and standardized metrics for evaluating team performance are lacking, resulting in significant variation in reported outcomes between studies. Conclusion Lunar and other space exploration construction teams will need training that focuses on developing the right approach to team-based problem-solving, rather than on preparing response execution for known contingencies. An investigation of successful Earth-based construction crews may facilitate the development of relevant metrics for training future Lunar construction crews. Application Metrics and team training protocols developed for future Lunar construction teams may be adaptable and applicable to a wide range of extreme teams facing uncertain challenges, such as aircrews, surgical teams, first responders, and construction crews.

Objective: To train practicing surgeons in robot-assisted distal pancreatectomy (RADP) and assess the impact on 5 domains of healthcare quality. Background: RADP may reduce the treatment burden compared with open distal pancreatectomy (ODP), but studies on institutional training and implementation programs are scarce. Methods: A retrospective, single-center, cohort study evaluating surgical performance during a procedure-specific training program for RADP (January 2006 to September 2017). Baseline and unadjusted outcomes were compared ''before training'' (ODP only; June 2012). Exclusion criteria were neoadjuvant therapy, vascular- and unrelated organ resection. Run charts evaluated index length of stay (LOS) and 90-day comprehensive complication index. Cumulative sum charts of operating time (OT) assessed institutional learning. Adjusted outcomes after RADP versus ODP were compared using a secondary propensityscore-matched (1:1) analysis to determine clinical efficacy. Results: After screening, 237 patients were included in the before-training (133 ODP) and after-training (24 ODP, 80 RADP) groups. After initiation of training, mean perioperative blood loss decreased (-255 mL, P<0.001), OT increased (+65 min, P < 0.001), and median LOS decreased (-1 day, P < 0.001). All other outcomes remained similar (P > 0.05). Over time, there were nonrandom (P < 0.05) downward shifts in LOS, while comprehensive complication index was unaffected. We observed 3 learning curve phases in OT: accumulation (<31 cases), optimization (case 31- 65), and a steadystate (>65 cases). Propensity-score-matching confirmed reductions in index and 90-day LOS and blood loss with similar morbidity between RADP and ODP. Conclusion: Supervised procedure-specific training enabled successful implementation of RADP by practicing surgeons with immediate improvements in length of stay, without adverse effects on safety.

Objective: Celiac artery compression by the median arcuate ligament (MAL) is a potential cause of postprandial abdominal pain and weight loss that overlaps with other common syndromes. Robotic technology may alter the current paradigm for surgical intervention. Open MAL release is often performed with concurrent bypass for celiac stenosis due to the morbidity of reintervention, whereas the laparoscopic approach is associated with high rates of conversion to open due to bleeding. We hypothesized that a robot-assisted technique might minimize conversion events to open, decrease perioperative morbidity, and defer consideration of vascular bypass at the initial operative setting.Methods: We retrospectively analyzed patients treated for MAL syndrome by a multidisciplinary team at a tertiary medical center between September 2012 and December 2013. Diagnosis was based on symptom profile and peak systolic velocity (PSV) >200 cm/s during celiac artery duplex ultrasound imaging. All patients underwent robot-assisted MAL release with simultaneous circumferential neurolysis of the celiac plexus. Postoperative celiac duplex and symptom profiles were reassessed longitudinally to monitor outcomes.Results: Nine patients (67% women) were evaluated for postprandial pain (100%) and weight loss (100%). All patients had celiac stenosis by mesenteric duplex ultrasound imaging (median PSV, 342; range, 238-637 cm/s), and cross-sectional imaging indicated a fishhook deformity in five (56%). Robot-assisted MAL release was completed successfully in all nine patients (100%) using a standardized surgical technique. Estimated blood loss was <50 mL, with a median hospital stay of 2 days (range, 2-3 days). No postoperative complications of grade >= 3, readmissions or reoperations were observed. All patients (100%) improved symptomatically at the 25-week median follow-up. Three patients experienced complete resolution on postoperative celiac duplex ultrasound imaging, and six patients showed an improved but persistent stenosis (PSV >200 cm/s) compared with preoperative velocities (P < .05 by Wilcoxon signed rank). No patients required additional treatment.Conclusions: Robot-assisted MAL release can be performed safely and effectively with avoidance of conversion events and minimal morbidity. Potential factors contributing to success are patient selection by a multidisciplinary team and replication of the open surgical technique by means of robot-assisted dexterity and visualization. The need for delayed reintervention for persistently symptomatic celiac stenosis is uncertain.

Benign duodenal and periampullary tumors are uncommon lesions requiring careful attention to their complex anatomic relationships with the major and minor papillae as well as the gastric outlet during surgical intervention. While endoscopy is less morbid than open resection, many lesions are not amenable to endoscopic removal. Robotic surgery offers technical advantages above traditional laparoscopy, and we demonstrate the safety and feasibility of this approach for a variety of duodenal lesions.