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A quantitative comparison of simultaneous BOLD fMRI and NIRS recordings during functional brain activation

Near-infrared spectroscopy (NIRS) has been used to noninvasively monitor adult human brain function in a wide variety of tasks. While rough spatial correspondences with maps generated from functional magnetic resonance imaging (fMRI) have been found in such experiments, the amplitude correspondences between the two recording modalities have not been fully characterized. To do so, we simultaneously acquired NIRS and blood-oxygenation level-dependent (BOLD) fMRI data and compared Delta(1/BOLD) (approximately R(2)(*)) to changes in oxyhemoglobin, deoxyhemoglobin, and total hemoglobin concentrations derived from the NIRS data from subjects performing a simple motor task. We expected the correlation with deoxyhemoglobin to be strongest, due to the causal relation between changes in deoxyhemoglobin concentrations and BOLD signal. Instead we found highly variable correlations, suggesting the need to account for individual subject differences in our NIRS calculations. We argue that the variability resulted from systematic errors associated with each of the signals, including: (1) partial volume errors due to focal concentration changes, (2) wavelength dependence of this partial volume effect, (3) tissue model errors, and (4) possible spatial incongruence between oxy- and deoxyhemoglobin concentration changes. After such effects were accounted for, strong correlations were found between fMRI changes and all optical measures, with oxyhemoglobin providing the strongest correlation. Importantly, this finding held even when including scalp, skull, and inactive brain tissue in the average BOLD signal. This may reflect, at least in part, the superior contrast-to-noise ratio for oxyhemoglobin relative to deoxyhemoglobin (from optical measurements), rather than physiology related to BOLD signal interpretation.

Non-NASA Center↗

Automated Vehicles in Hazardous Merging Traffic: A Chance-Constrained Approach

To realize the energy efficiency and productivity benefits of automated driving, control algorithms must function safely among conventional vehicles. Prototype tests on public roads have revealed a trend of human-driven vehicles rear-ending automated ones. A popular belief holds that unusually conservative control algorithms play a role in such collisions. In August 2018, an automated vehicle was rear-ended while waiting to merge. Inspired by that incident, this paper examines a resemblant scenario in simulation using model predictive control for the automated vehicle. Constraint setup alternatives to avoid collisions with inattentive following vehicles are proposed and assessed in this simulation environment. In one variant, imminent rear-end collisions are detected and constraints are modified to promote more aggressive merging during such an event. Results show that higher-performing chance constraint designs can reduce collision probability, but may have other adverse effects depending on the particular algorithm.

Dollar, R. Austin↗

Cerebellar dysfunction in a mouse model of childhood-onset manganese-induced dystonia parkinsonism

Humans with pathogenic variants of the manganese (Mn) transporter gene SLC39A14 exhibit highly elevated brain Mn concentrations and childhood-onset dystonia-parkinsonism. Here we show that Slc39a14-knockout (KO) mice, a preclinical model of the disease with elevated Mn concentrations in the CB, express deficits in physiological tremor implicating cerebellar (CB) dysfunction. Imaging of intracellular Mn in Purkinje cells (PCs) using synchrotron-based X-ray fluorescence microscopy confirmed highly elevated Mn concentrations in the PCs of Slc39a14-KO mice. To determine biological pathways altered in the CB of Slc39a14-KO mice relative to wildtype (WT), we performed RNA sequencing and discovered significant upregulation of pathways and genes regulating immune response and cell death. To substantiate these findings, we performed quantitative autoradiography of the neuroinflammation biomarker Translocator Protein 18 kDa (TSPO) which was significantly increased in the CB of Slc39a14-KO mice relative to WT. The latter findings were confirmed via immunostaining with the microglial marker Iba-1, revealing widespread microglia activation and clustering in the CB cortex. Immunostaining for cleaved caspase-3 (cCASP3), a marker of apoptosis, showed increased number of PCs with positive immunolabeling for cCASP3 in Slc39a14-KO mice relative to WT. Degeneration of PCs was confirmed by Hematoxylin and Eosin (H&E) staining. Lastly, functional electrophysiological assessment of CB neurocircuitry revealed a marked decrease in firing rates of cerebellar nuclei (CN) neurons and increased variability of PC simple spikes firing. Collectively, these findings show, for the first time, Mn-induced PC degeneration and dysfunctional CB circuitry in Slc39a14-KO mice providing additional evidence for the pathological underpinnings of the dystonia-like movements, balance, and gait abnormalities in SLC39A14 mutation carriers.

36 MATERIALS SCIENCE↗

Interactive Mesh Generation and Comparison Tools for Nuclear Energy Advanced Modeling & Simulation Phase I. Final Report

The promise of computer simulations for nuclear reactor designs is the opportunity to speed up the design process while also improving safety, providing more detail and higher fidelity, reducing cost, minimizing schedule risk, and avoiding many other potential problems; because simulations have the potential to be much less expensive and time-consuming than traditional development – where scale models and physical tests require construction and long lead times – it is possible to consider more alternatives and complete more comprehensive assessments before the design is finalized and constructed. As more design scenarios are studied by simulation, the speed that simulations promise is only available as long as bottlenecks are addressed for these scenarios. A frequent bottleneck is the amount of human labor required to describe the shape of the objects being designed and decompose the shape into simple elements, such as hexahedra, that are small enough to capture the physical phenomena of interest without being so small that even fast computers cannot perform the simulation in a reasonable amount of time. Recently, techniques for creating all-hexahedral decompositions have been developed, but they require some human input. Many simulation codes prefer all-hexahedral decompositions, so we proposed to evaluate the feasibility of these techniques on nuclear reactor geometries to see whether they required too much human input to be commercially viable. Our study concluded that they can be made viable with some additional software tools to reduce the amount of user input required.

22 GENERAL STUDIES OF NUCLEAR REACTORS↗

Mechanical Response of Porcine Liver Tissue under High Strain Rate Compression

In automobile accidents, abdominal injuries are often life-threatening yet not apparent at the time of initial injury. The liver is the most commonly injured abdominal organ from this type of trauma. In contrast to current safety tests involving crash dummies, a more detailed, efficient approach to predict the risk of human injuries is computational modelling and simulations. Further, the development of accurate computational human models requires knowledge of the mechanical properties of tissues in various stress states, especially in high-impact scenarios. In this study, a polymeric split-Hopkinson pressure bar (PSHPB) was utilized to apply various high strain rates to porcine liver tissue to investigate its material behavior during high strain rate compression. Liver tissues were subjected to high strain rate impacts at 350, 550, 1000, and 1550 s –1 . Tissue directional dependency was also explored by PSHPB testing along three orthogonal directions of liver at a strain rate of 350 s –1 . Histology of samples from each of the three directions was performed to examine the structural properties of porcine liver. Porcine liver tissue showed an inelastic and strain rate-sensitive response at high strain rates. The liver tissue was found lacking directional dependency, which could be explained by the isotropic microstructure observed after staining and imaging. Furthermore, finite element analysis (FEA) of the PSHPB tests revealed the stress profile inside liver tissue and served as a validation of PSHPB methodology. The present findings can assist in the development of more accurate computational models of liver tissue at high-rate impact conditions allowing for understanding of subfailure and failure mechanisms.

60 APPLIED LIFE SCIENCES↗

Mechanical Stress and Antioxidant Protection in the Retina of Hindlimb Suspended Rats

It has been postulated that hindlimb suspension (HS) causes a cephalad fluid shift in quadrupeds similar to that occurring to humans in microgravity. Therefore, HS may provide a suitable animal model in which to recapitulate the ocular changes observed in the human Visual Impairment and Intracranial Pressure (VIIP) syndrome. This work reports preliminary results from a tissue sharing project using 34 week-old Brown Norway rats. Two different experiments compared normal posture controls and HS rats for 2 weeks and rats exposed to HS for 2 weeks but allowed to recover in normal posture for 2 additional weeks. The effects of two nutritional countermeasures, green tea extract (GT) and plant polyphenol resveratrol (Rv), were also evaluated. Green tea contains the antioxidant epigallocatechin gallate (EGCG). qPCR gene expression analysis of selected targets was performed on RNA from isolated retinas, and histologic analysis was done on one fixed eye per rat. The transcription factor early growth response protein 1 (Egr1) was upregulated almost 2-fold in HS retinas relative to controls (P = 0.059), and its expression returned to control levels after 2 weeks of recovery in normal posture (P = 0.023). HS-induced upregulation of Egr1 was attenuated (but not significantly) in retinas from rats fed an antioxidant rich (GT extract) diet. In rats fed the GT-enriched diet, antioxidant enzymes were induced, evidenced by the upregulation of the gene heme oxygenase 1 (Hmox1) (P = 0.042) and the gene superoxide dismutase 2 (Sod2) (P = 0.0001). Egr1 is a stretch-activated transcription factor, and the Egr1 mechanosensitive response to HS may have been caused by a change in the translaminal pressure and/or mechanical deformation of the eye globe. The observed histologic measurements of the various retinal layers in the HS rats were lower in value than those of the control animal (n = 1), however insufficient data were available for statistical analysis. Aquaporin 4, a water-selective channel involved in interstitial fluid homeostasis, showed an upregulated trend in HS retinas; however, these results are preliminary. Total retinal thickness increased significantly (P = 0.049) in HS rats fed a resveratrol enriched diet compared to HS rats on a normal diet. This change appeared to be reversed during the 2 weeks of recovery post HS, but no differences in retina thickness were observed between HS animals and HS recovered animals when both groups consumed a normal diet. The reversibility of the increase in retinal thickness induced by resveratrol during HS may therefore reflect an interaction between the stress provoked by HS and the cytoprotective mechanisms elicited by resveratrol

Glass, Aziza↗

Altered astronaut lower limb and mass center kinematics in downward jumping following space flight

Astronauts exposed to the microgravity conditions encountered during space flight exhibit postural and gait instabilities upon return to earth that could impair critical postflight performance. The aim of the present study was to determine the effects of microgravity exposure on astronauts' performance of two-footed jump landings. Nine astronauts from several Space Shuttle missions were tested both preflight and postflight with a series of voluntary, two-footed downward hops from a 30-cm-high step. A video-based, three-dimensional motion-analysis system permitted calculation of body segment positions and joint angular displacements. Phase-plane plots of knee, hip, and ankle angular velocities compared with the corresponding joint angles were used to describe the lower limb kinematics during jump landings. The position of the whole-body center of mass (COM) was also estimated in the sagittal plane using an eight-segment body model. Four of nine subjects exhibited expanded phase-plane portraits postflight, with significant increases in peak joint flexion angles and flexion rates following space flight. In contrast, two subjects showed significant contractions of their phase-plane portraits postflight and three subjects showed insignificant overall changes after space flight. Analysis of the vertical COM motion generally supported the joint angle results. Subjects with expanded joint angle phase-plane portraits postflight exhibited larger downward deviations of the COM and longer times from impact to peak deflection, as well as lower upward recovery velocities. Subjects with postflight joint angle phase-plane contraction demonstrated opposite effects in the COM motion. The joint kinematics results indicated the existence of two contrasting response modes due to microgravity exposure. Most subjects exhibited "compliant" impact absorption postflight, consistent with decreased limb stiffness and damping, and a reduction in the bandwidth of the postural control system. Fewer subjects showed "stiff" behavior after space flight, where contractions in the phase-plane portraits pointed to an increase in control bandwidth. The changes appeared to result from adaptive modifications in the control of lower limb impedance. A simple 2nd-order model of the vertical COM motion indicated that changes in the effective vertical stiffness of the legs can predict key features of the postflight performance. Compliant responses may reflect inflight adaptation due to altered demands on the postural control system in microgravity, while stiff behavior may result from overcompensation postflight for the presumed reduction in limb stiffness inflight.

Clinical Trial↗

A design framework for teleoperators with kinesthetic feedback

The application of a hybrid two-port model to teleoperators with force and velocity sensing at the master and slave is presented. The interfaces between human operator and master, and between environment and slave, are ports through which the teleoperator is designed to exchange energy between the operator and the environment. By computing or measuring the input-output properties of this two-port network, the hybrid two-port model of an actual or simulated teleoperator system can be obtained. It is shown that the hybrid model (as opposed to other two-port forms) leads to an intuitive representation of ideal teleoperator performace and applies to several teleoperator architectures. Thus measured values of the h matrix or values computed from a simulation can be used to compare performance with th ideal. The frequency-dependent h matrix is computed from a detailed SPICE model of an actual system, and the method is applied to a proposed architecture.

Hannaford, Blake↗

Instrumentation for Non-Invasive Assessment of Cardiovascular Regulation

It is critically important to be able to assess alterations in cardiovascular regulation during and after space flight. We propose to develop an instrument for the non-invasive assessment of such alterations that can be used on the ground and potentially during space flight. This instrumentation would be used by the Cardiovascular Alterations Team at multiple sites for the study of the effects of space flight on the cardiovascular system and the evaluation of countermeasures. In particular, the Cardiovascular Alterations Team will use this instrumentation in conjunction with ground-based human bed-rest studies and during application of acute stresses e.g., tilt, lower body negative pressure, and exercise. In future studies, the Cardiovascular Alterations Team anticipates using this instrumentation to study astronauts before and after space flight and ultimately, during space flight. The instrumentation may also be used by the Bone Demineralization/Calcium Metabolism Team, the Neurovestibular Team and the Human Performance Factors, Sleep and Chronobiology Team to measure changes in autonomic nervous function. The instrumentation will be based on a powerful new technology - cardiovascular system identification (CSI) - which has been developed in our laboratory. CSI provides a non-invasive approach for the study of alterations in cardiovascular regulation. This approach involves the analysis of second-to-second fluctuations in physiologic signals such as heart rate and non-invasively measured arterial blood pressure in order to characterize quantitatively the physiologic mechanisms responsible for the couplings between these signals. Through the characterization of multiple physiologic mechanisms, CSI provides a closed-loop model of the cardiovascular regulatory state in an individual subject.

Cohen, Richard J.↗

Simulating New Drop Test Vehicles and Test Techniques for the Orion CEV Parachute Assembly System

The Crew Exploration Vehicle Parachute Assembly System (CPAS) project is engaged in a multi-year design and test campaign to qualify a parachute recovery system for human use on the Orion Spacecraft. Test and simulation techniques have evolved concurrently to keep up with the demands of a challenging and complex system. The primary simulations used for preflight predictions and post-test data reconstructions are Decelerator System Simulation (DSS), Decelerator System Simulation Application (DSSA), and Drop Test Vehicle Simulation (DTV-SIM). The goal of this paper is to provide a roadmap to future programs on the test technique challenges and obstacles involved in executing a large-scale, multi-year parachute test program. A focus on flight simulation modeling and correlation to test techniques executed to obtain parachute performance parameters are presented.

Morris, Aaron L.↗

Biomimetics and the Development of Humanlike Robots as the Ultimate Challenge

Evolution led to effective solutions to nature's challenges and they were improved over millions of years. Humans have always made efforts to use nature as a model for innovation and problems solving. These efforts became more intensive in recent years where systematic studies of nature are being made towards better understanding and applying more sophisticated capabilities. Making humanlike robots, including the appearance, functions and intelligence, poses the ultimate challenges to biomimetics. For many years, making such robots was considered science fiction, but as a result of significant advances in biologically inspired technologies, such robots are increasingly becoming an engineering reality. There are already humanlike robots that walk, talk, interpret speech, make eye-contact and facial expressions, as well as perform many other humanlike functions. In this paper, the state-of-the-art of humanlike robots, potential applications and issues of concern will be reviewed.

humanlike↗

Robotic and Crewed Mars Missions Increasing the Demand for Planetary Protection Technology Needs

Planetary protection (PP) policy seeks to avoid harmful contamination by limiting biological and relevant organic contamination from spacecraft as well as preventing adverse changes to Earth’s biosphere when extraterrestial samples are brought back to Earth. The PP policy at NASA was updated in 2021 (NPR 8715.24) and 2022 (NASA-STD-8719.27) to enable missions by expanding the decades old prescriptive requirements to allow for an option of adopting performance-based requirements that are objectivesdriven, risk-informed and case-assured. In parallel, the final PP knowledge gap workshop was completed representing the international consensus on the key areas to be considered in developing crew PP policy. These knowledge gaps focused on key technology development areas in 1) microbial and human health monitoring, 2) technical and operations needed for contamination control and 3) natural transport of contamination on Mars. As robotic missions start to implement performance-based approaches and research and technology efforts commence to inform crew policy the demand for data quality driven verification and validation in relevant space environments. Examples of the types of testing that is envisioned includes test as you fly validation and verification of decontamination systems in a relevant on-orbit and Mars environment, developing lethality curves of terrestrial organisms to further our understanding of the biocidal impacts of Mars and the space environment, and particle transport model validation and verification. Thus, the PP discipline has identified the need for groundbased space environments to perform preliminary testing as validation and verification of flight systems and to advance the technology readiness level prior to further testing on-orbit or lunar environments to prepare for Mars.

J. Nick Benardini↗

Robotic and Crewed Mars Missions Increasing the Demand for Planetary Protection Technology Needs

Planetary protection (PP) policy seeks to avoid harmful contamination by limiting biological and relevant organic contamination from spacecraft as well as preventing adverse changes to Earth’s biosphere when extraterrestrial samples are brought back to Earth. The PP policy at NASA was updated in 2021 (NPR 8715.24) and 2022 (NASA-STD-8719.27) to enable missions by expanding the decades old prescriptive requirements to allow for an option of adopting performance-based requirements that are objectives-driven, risk-informed and case-assured. In parallel, the final PP knowledge gap workshop was completed representing the international consensus on the key areas to be considered in developing crew PP policy. These knowledge gaps focused on key technology development areas in 1) microbial and human health monitoring, 2) technical and operations needed for contamination control and 3) natural transport of contamination on Mars. As robotic missions start to implement performance-based approaches and research and technology efforts commence to inform crew policy the demand for data quality driven verification and validation in relevant space environments. Examples of the types of testing that is envisioned includes test as you fly validation and verification of decontamination systems in a relevant on-orbit and Mars environment, developing lethality curves of terrestrial organisms to further our understanding of the biocidal impacts of Mars and the space environment, and particle transport model validation and verification. Thus, the PP discipline has identified the need for ground-based space environments to perform preliminary testing as validation and verification of flight systems and to advance the technology readiness level prior to further testing on-orbit or lunar environments to prepare for Mars.

J Nick Benardini↗

Human factors and modeling methods in the development of control room modernization concepts - 315

Control room modernization is one of the most challenging and complex upgrade projects that a nuclear power plant can undertake. It can even have a bigger impact on operations than, for example, turbine replacement. The challenges of migrating an analog control system to a distributed control system are already well known and a number of nuclear utilities have embarked upon various levels of effort to upgrade some of the systems in the control room. When planning for control room upgrades, plants have to deal with a multitude of engineering and operational impacts. This will inevitably include several human factors considerations, including physical ergonomics of workstations, viewing angles, lighting, seating, new communication requirements, and new concepts of operation. In helping nuclear power utilities to deal with these challenges, the Idaho National Laboratory (INL) has developed human factors design and evaluation methods to be used in the development of an end-state control room concept and to manage the various phases of the upgrade life cycle. This included interactive sessions with operators in INL's Human System Simulation Laboratory, and three-dimensional modeling to visualize control board changes. To make the various upgrade phases as concrete and as visible as possible, the end-state concept includes a set of visual representations of the control room before and after various upgrade phases to provide the context and a framework within which to consider the various options in the upgrade. This includes the various control systems, human-system interfaces to be replaced, and possible changes to operator workstations. This paper describes how this framework helps to ensure an integrated and cohesive outcome that is consistent with human factors engineering principles and also provide substantial improvement in operator performance. The paper further describes the application of this integrated approach in the strategic modernization program at a nuclear power plant where legacy systems are upgraded to advanced digital technologies through a systematic process that links human factors principles to the systems engineering process. This approach results in an integrated control room architecture beyond what is possible for individual subsystem upgrades alone. (authors)

22 GENERAL STUDIES OF NUCLEAR REACTORS↗

Liquid Alkaline Water Electrolyzers: Comparing Performance across Design, Operation, and End-of-Life Scenarios

Liquid alkaline water electrolysis (LAWE) is a demonstrated technology for hydrogen production, yet a comprehensive life cycle assessment (LCA) of their deployment is lacking. Research leading to improvements to the core component, the electrochemical stack, along with auxiliary system materials and dynamic operation of stacks from variable electricity supply offers new data that allows for detailed modeling and evaluation. Here, we present an LCA of two facility designs based on the current state-of-the-art stack and an advanced stack with zero-gap between electrodes, and capture dynamic electricity use from solar, wind, and hybrid sources and stack recycling strategies. We present life cycle impact factors characterizing the production of 1 kg of hydrogen across 12 environmental, human health, and resource impact categories (TRACI and ReCiPe) in the contiguous United States. As expected, the source of electricity will drive impacts (e.g., 83-94% of carbon intensity); however, we find that operating using wind electricity can lower hydrogen leakage and the overall carbon intensity (1.03 kgCO 2 e/kgH 2 ) relative to solar electricity (2.57 kgCO 2 e/kgH 2 ) at matched 1:1 capacity between LAWE and the electricity source. The deployment of the advanced design and stack recycling lowers impacts across all life cycle stages. We highlight opportunities to further reduce potential impacts, including the balance of plant materials and operation cycles associated with the use of variable wind and solar electricity that result in hydrogen leakage.

08 HYDROGEN↗

High-Fidelity Accelerated Design of High-performance Electrochemical Systems

Large-scale electrification is vital to addressing the climate crisis, but several scientific and technological challenges remain to fully electrify both the chemical industry and transportation. In both of these areas, new electrochemical materials will be critical, but their development currently relies heavily on human-time-intensive experimental trial and error and computationally expensive first-principles, meso-scale and continuum simulations. To accelerate this process, our team has developed the AutoMat platform. AutoMat can accelerate development of new electrochemical materials along two avenues: first, automated input generation and management of simulations at multiple lengthscales as well as “handoff” of outputs from one lengthscale as inputs to the next; and second, replacement of the most computationally intensive simulation processes with machine-learned surrogate models. The crux of our team’s effort was not “reinventing the wheel” by developing entirely new techniques, but rather building a “superhighway” that allows existing state-of-the-art techniques to run faster and more smoothly than before. AutoMat can utilize tools spanning from first-principles quantum chemistry computations to automated robotic experimentation, and is driven by design space search techniques to reduce the number of iterations through the full simulation loop by rapidly targeting promising regions of design spaces such as single-atom alloy catalysts or blends of liquid electrolytes.

25 ENERGY STORAGE↗

Local Hypothermia as a Radioprotector of the Rectal Wall During Prostate Stereotactic Body Radiation Therapy

Purpose: To compare the single-fraction dose-related incidence of rectal obstruction and/or bleeding in normothermic and hypothermic rectums of a rat model. Methods and Materials: A 1.9-cm length of rectum was irradiated with a single fraction in 57 Sprague-Dawley rats using a dedicated image-guided small animal irradiator and Monte Carlo–based treatment planning system. All rats had a rectal temperature control apparatus placed during irradiation and were stratified to achieve either a normothermic (37°C) or hypothermic (15°C) rectal wall temperature. Radiation was delivered to a 1-cm-diameter cylindrical volume about the cooling device and rectal wall. The radiation dose was escalated from 16 Gy up to 37 Gy to assess the dose response in each arm. The primary endpoint of this study was rectal obstruction and/or bleeding during a follow-up of 180 to 186 days. Histologic scoring was performed on all study rats. Results: Probit analysis showed a dose associated with a 50% incidence of rectal obstruction of 24.6 Gy and 40.8 Gy for normothermic and hypothermic arms, respectively. The occurrence of obstruction and/or bleeding correlated with the posttreatment histologic score for normothermic rats; however, there was no difference in histologic score between normothermic and hypothermic rats at the highest dose levels evaluated. Conclusions: A significant radioprotective effect was observed using local hypothermia during a single large dose of radiation for the functional endpoint of rectal obstruction and/or bleeding. A confirmatory study in a large animal model with anatomic and physiologic similarities to humans is suggested.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

TOWARDS RAPID RESPONSE UPDATES OF POPULATIONS AT RISK

Understanding population at risks has been a focus of the LandScan program through its development of population estimates. With advancements in computer vision, deep learning technologies and access to High Performance Computing (HPC) and high resolution imagery, population estimates are now modeled at the building level. However, when those patterns are disrupted, rapid updates to population distribution estimates are needed to support humanitarian aid and response. Oak Ridge National Laboratory (ORNL) recently adapted an existing deep learning building footprint extraction model in development of a scalable approach to Building Damage Assessments (BDA). This new opportunity opens the possibility of automating BDA to support rapid population distribution estimate updates for geographic areas involved in geopolitical conflicts or natural events for humanitarian aid and response or where to focus recovery efforts. In addition, incorporate social surveys to further model human behavior under conflict or other scenarios that disrupt normal patterns of life.

Urban, Marie↗

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