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NASA NTRS2007

The Lunar Environment: Determining the Health Effects of Exposure to Moon Dusts

The Earth s moon presents a hostile environment in which to live and work. There is no atmosphere to protect its surface from the ravages of solar wind and micrometeorite impacts. As a result, the moon s surface is covered with a thin layer of fine, charged, reactive dust capable of entering habitats and vehicle compartments, where it can result in crewmember health problems. During the Apollo missions, lunar dusts were introduced into the crew vehicle, resulting in direct exposure and occasional reports of respiratory, dermal and ocular irritation. In order to study the toxicological effects of lunar dust, NASA formed the Lunar Airborne Dust Toxicity Advisory Group (LADTAG). This interdisciplinary group is comprised of leading experts in space toxicology, lunar geology, space medicine and biomedical research. LADTAG has demonstrated that lunar soil contains several types of reactive dusts, including an extremely fine respirable component. These dusts have highly reactive surfaces in the lunar environment; the grains contain surface coatings which are generated by vapor phases formed by hypervelocity impact of micrometeorites. This unique class of dusts has surface properties that are unlike any Earth based analog. These distinctive properties are why lunar dusts are of great toxicological interest. Understanding how these reactive components behave "biochemically" in a moisture-rich pulmonary environment will aid in determining how toxic these particles are to humans. The data obtained from toxicological examination of lunar dusts will determine the human risk criteria for lunar dust exposure and produce a lunar health standard. LADTAG s analysis of lunar dusts and lunar dust simulants will include detailed lunar particle characterizations, determining the properties of particle activation, reactivation of lunar dust, the process of dust passivation and discerning the pathology of lunar dust exposure via inhalation, intratracheal instillation, cell culture exposure, dermal exposure and ocular exposure. The resulting health standard will be time-based and will vary by the duration and type of exposure. It may also be necessary to set multiple standards for different types of lunar dust, as well as for dust in its activated form vs. aged & passivated dust. This standard, set to protect the health of our robust astronaut crews, will not only impact NASA medical operations, but engineering designs as well. The data from our multidisciplinary research are vital in developing remediation devices and environmental monitors. Ultimately, the engineering and safety groups will design and develop countermeasures for space vehicles, suits, rovers and habitats that will be sustained within the limits of the health standard.

Khan-Mayberry, Noreen↗
NASA NTRS2007

Validation of the Pulmonary Function System for Use on the International Space Station

Aerobic deconditioning occurs during long duration space flight despite the use of exercise countermeasures (Convertino, 1996). As a part of International Space Station (ISS) medical operations, periodic tests designed to estimate aerobic capacity are performed to track changes in aerobic fitness and to determine the effectiveness of exercise countermeasures. These tests are performed prior to, during, and after missions of greater than 30 days in duration. Crewmembers selected for missions aboard the ISS perform a graded exercise test on a cycle ergometer approximately 270 days prior to their scheduled launch date in order to measure peak oxygen consumption (VO2PK) and peak heart rate (HRpk). Approximately 30 to 45 days prior to launch, crewmembers perform a submaximal cycle ergometer test at work rates set to elicit 25, 50 and 75% of their pre-flight VO2PK. This test, known as the Periodic Fitness Evaluation (PFE), serves as a baseline measure to which subsequent in-and post-flight exercise tests are compared. While onboard the ISS, crewmembers are normally scheduled to perform the PFE beginning with flight day (FD) 14 and every 30 days thereafter. The PFE is also conducted 5 and 30 days following flight. Using PFE data, aerobic fitness is estimated by quantifying the VO2 vs. HR relationship using linear regression and calculating the VO2 that would occur at the crewmember s previously measured HRpk. Currently, for data collected during flight, this technique assumes that the pre- vs. in-flight oxygen consumption per given cycle workload is similar. However, the validity of this assumption is based upon a sparse amount of data collected during the Skylab era (Michel, et al. 1977). The method of using heart rate and cycle ergometer work rates has been used to estimate aerobic fitness in normal gravity (Astrand and Ryhming, 1954; Lee, 1993). Due to spaceflight induced physiological alterations, such as shifts in extracellular fluid (e.g. plasma) volume, this method may not be valid during space flight. In addition, the ergometer onboard ISS is vibration-isolated and moves with the astronaut s application of force into the pedals. The effect of this movement on the VO2 of cycle exercise on ISS has not been quantified.

McCleary, Frank A.↗
NASA NTRS2005

Introduction and Mission Response Team (MRT)

On February 1, 2003 the Space Shuttle Columbia, returning to Earth with a crew of seven astronauts, disintegrated along a track extending from California to Louisiana. Observers on the ground filmed breakup of the spacecraft. Debris fell along a 567 statute mile track from Littlefield, Texas to Fort Polk, Louisiana; the largest ever recorded debris field. At the time of the accident the National Aeronautics and Space Administration (NASA) flight surgeon on-duty at the Mission Control Center (MCC) in Houston, Texas initiated the medical contingency response. The DOD surgeon at Patrick Air Force Base was notified, NASA medical personnel were recalled and the services of Armed Forces Institute of Pathology (AFIP) were requested. Subsequent to the accident the NASA flight surgeons that had supported the crew on orbit now provided medical support to the crewmember s families. Federal Emergency Management Agency (FEMA), the National Transportation Safety Board (NTSB), the Federal Bureau of Investigation (FBI) and numerous other federal, state and local agencies along with the citizens of Texas and Louisiana responded to the disaster. Search and recovery was managed from a Disaster Field Office (DFO) established in Lufkin, Texas. Mishap Investigation Team (MIT) medical operations were managed from Barksdale Air Force Base, Louisiana. Accident investigation teams (Columbia Accident Investigation Task Force (CAITF) and Columbia Accident Investigation Board (CAIB)) appointed immediately after the disaster included current and former authorities in space medicine. In August 2003, the CAIB concluded its investigation and released its findings in a report published in February 2004.

Pool, Sam↗
NASA NTRS2010

Psychosocial Characteristics of Optimum Performance in Isolated and Confined Environments (ICE)

The Behavioral Health and Performance (BHP) Element addresses human health risks in the NASA Human Research Program (HRP), including the Risk of Adverse Behavioral Conditions and the Risk of Psychiatric Disorders. BHP supports and conducts research to help characteristics and mitigate the Behavioral Medicine risk for exploration missions, and in some instances, current Flight Medical Operations. The Behavioral Health and Performance (BHP) Element identified research gaps within the Behavioral Medicine Risk, including Gap BMed6: What psychosocial characteristics predict success in an isolated, confined environment (ICE)? To address this gap, we conducted an extensive and exhaustive literature review to identify the following: 1) psychosocial characteristics that predict success in ICE environments; 2) characteristics that are most malleable; and 3) specific countermeasures that could enhance malleable characteristics.

Palinkas, Lawrence A.↗
NASA NTRS2010

Survey of On-Orbit Sleep Quality: Short-Duration Flyers

The NASA Human Research Program (HRP) Behavioral Health and Performance Element (BHP), in conjunction with the NASA Space Medicine Division, is currently completing the largest systematic, subjective assessment of shuttle astronauts sleep behaviors and sleep quality on Earth, during training periods, and during space flight missions. Since July 2009, a total of 66 astronauts have completed a secure online survey regarding specific sleep strategies, crew policies, and mitigation effectiveness. In addition to the survey, each astronaut participant met individually with trained BHP and SD representatives for a structured, follow-up interview. Data are currently being assessed and the study s principal investigator will be providing some preliminary findings at the Investigators Workshop. Additional analyses will be conducted in the following months to examine predictors of optimal sleep in space, and to evaluate the differences in countermeasure effectiveness between groups based on their sleep experience on the ground and on orbit. A revised survey for a subsequent investigation on the experiences of long-duration flyers will be developed in the Spring and implemented in the Summer of 2010. Findings from both of these investigations will inform countermeasure strategies for astronauts, medical operations, and habitat designers for future exploration missions, as well as upcoming shuttle and ISS missions.

Locke, J.↗
NASA NTRS2010

Expedition 23/24 - Critical Readiness Review

This slide presentation reports on the critical readiness review for Expeditions 23 and 24. It includes information on medical operations and environmental monitoring.

Hunter, Norwood↗
NASA NTRS2010

Acoustics Critical Readiness Review

This presentation reviews the status of the acoustic equipment from the medical operations perspective. Included is information about the acoustic dosimeters, sound level meter, and headphones that are planned for use while on orbit. Finally there is information about on-orbit hearing assessments.

Ballard, Kenny↗
NASA NTRS2010

Workshop on Spaceflight Alterations in Host-Microorganism Interactions

On June 11, 2009, a workshop that included internal and external experts was convened to determine the risk of changes in microorganisms that could alter host-microorganism interactions during a mission. The evidence is based in part on multiple flight experiments which indicate altered virulence in Salmonella typhimurium when cultured in flight. The workshop participants were tasked to determine if adequate information was available to initiate changes in NASA's current approach to infectious disease risk assessment and medical operations. The consensus of the participants is that the current evidence was not adequate to provide direction for operational changes; however, the evidence is compelling and clearly indicates that changes to microorganisms were occurring during spaceflight and further research is required.

Ott, C. Mark↗
NASA NTRS2010

Visual Impairment and Intracranial Hypertension: An Emerging Spaceflight Risk

During recent long duration missions to the International Space Station (ISS) crewmembers have reported changes in visual acuity or visual field defects. Exams in the postflight period revealed changes to the visual system and elevated intracranial pressures. As a result, NASA Space Medicine has added a number of tests to be performed in the preflight, inflight and postflight periods for ISS and shuttle missions with the goal of determining the processes at work and any potential mitigation strategies. This discussion will acquaint you with the changes that NASA has made to its medical requirements in order to address the microgravity induced intracranial hypertension and associated visual changes. Key personnel have been assembled to provide you information on this topic. Educational Objectives: Provide an overview of the current Medical Operations requirements and the mitigation steps taken to operationally address the issue.

Taddeo, Terrance A.↗
NASA NTRS2011

Which Way is Up? Lessons Learned from Space Shuttle Sensorimotor Research

The Space Shuttle Program provided the opportunity to examine sensorimotor adaptation to space flight in unprecedented numbers of astronauts, including many over multiple missions. Space motion sickness (SMS) severity was highly variable across crewmembers. SMS generally lasted 2-3 days in-flight with approximately 1/3 of crewmembers experiencing moderate to severe symptoms, and decreased incidence in repeat flyers. While SMS has proven difficult to predict from susceptibility to terrestrial analogs, symptoms were alleviated by medications, restriction of early activities, maintaining familiar orientation with respect to the visual environment and maintaining contact cues. Adaptive changes were also reflected by the oculomotor and perceptual disturbances experienced early inflight and by the perceptual and motor coordination problems experienced during re-entry and landing. According to crew self-reports, systematic head movements performed during reentry, as long as paced within one's threshold for motion tolerance, facilitated the early readaptation process. The Shuttle provided early postflight crew access to document the initial performance decrements and time course of recovery. These early postflight measurements were critical to inform the program of risks associated with extending the duration of Shuttle missions. Neurological postflight deficits were documented using a standardized subjective rating by flight surgeons. Computerized dynamic posturography was also implemented as a quantitative means of assessing sensorimotor function to support crew return-to-duty assessments. Towards the end of the Shuttle Program, more emphasis has been placed on mapping physiological changes to functional performance. Future commercial flights will benefit from pre-mission training including exposures to launch and entry G transitions and sensorimotor adaptability assessments. While SMS medication usage will continue to be refined, non-pharmacological countermeasures (e.g., sensory aids) will have both space and Earth-based applications. Early postflight field tests are recommended to provide the evidence base for best practices for future commercial flight programs. Learning Objective: Overview of the Space Shuttle Program regarding adaptive changes in sensorimotor function, including what was learned from research, what was implemented for medical operations, and what is recommended for commercial flights.

Wood, S. J.↗
NASA NTRS2011

A Data Mining Project to Identify Cardiovascular Related Factors That May Contribute to Changes in Visual Acuity Within the US Astronaut Corps

Many of the cardiovascular-related adaptations that occur in the microgravity environment are due, in part, to a well-characterized cephalad-fluid shift that is evidenced by facial edema and decreased lower limb circumference. It is believed that most of these alterations occur as a compensatory response necessary to maintain a "normal" blood pressure and cardiac output while in space. However, data from both flight and analog research suggest that in some instances these microgravity-induced alterations may contribute to cardiovascular-related pathologies. Most concerning is the potential relation between the vision disturbances experienced by some long duration crewmembers and changes in cerebral blood flow and intra-ocular pressure. The purpose of this project was to identify cardiovascular measures that may potentially distinguish individuals at risk for visual disturbances after long duration space flight. Toward this goal, we constructed a dataset from Medical Operation tilt/stand test evaluations pre- (days L-15-L-5) and immediate post-flight (day R+0) on 20 (3 females, 17 males). We restricted our evaluation to only crewmembers who participated in both shuttle and space station missions. Data analysis was performed using both descriptive and analytical methods (Stata 11.2, College Station, TX) and are presented as means +/- 95% CI. Crewmembers averaged 5207 (3447 - 8934) flight hours across both long (MIR-23 through Expedition16) and short (STS-27 through STS-101) duration missions between 1988 and 2008. The mean age of the crew at the time of their most recent shuttle flight was 41 (34-44) compared to 47 (40-54) years during their time on station. In order to focus our analysis (we did not have codes to separate out subjects by symptomotology) , we performed a visual inspection of each cardiovascular measures captured during testing and plotted them against stand time, pre- to post-flight, and between mission duration. It was found that pulse pressure most clearly differentiated the two mission types. Statistical analysis confirmed that pulse pressure was significantly higher before [45.6; (42.1 to 49.1)] and after [50.7; (46.9 to 54.6)] time on station compared with their most recent shuttle flight [31.6 (27.8 to 35.4), and 32.2 (28.3 to 36.0) respectively] even after correcting differences in age and cumulative number of mission hours. Without knowing the identity of which long duration crewmembers demonstrated visual changes, we were limited to examining whether certain crew regulate components of pulse pressure, systolic and diastolic blood pressure, differently due to microgravity exposure. To that end, we stratified crew into tertiles based on either their pre-flight measure of systolic or diastolic blood pressure. Those crew in the highest tertile for both systolic (lower tertile (n=8; 103-111), middle tertile (n=7; 113-121), and upper tertile (n=5; 125-136) and diastolic blood pressure (lower tertile (n=8; 58-64), middle tertile (n=7; 67-73), and upper tertile (n=5; 75-81) demonstrated less variability in pulse pressure between R+0 and L-10 (Figure 2). Interestingly, those crewmembers with the highest resting systolic blood pressure demonstrated either no change or in some instances an increase in total peripheral resistance, where those in the lower tertiles had lower values of total peripheral resistance compared to pre-flight levels. In this study, it was found that crewmembers in the highest tertile for both systolic and diastolic blood pressure demonstrated less variability in pulse pressure and that the decrease in variability was due in part to lower levels of compliance as indicated by similar or higher levels of total peripheral resistance after compared with before flight levels. Whether there is a relation between blood pressure regulation and total peripheral resistance in crew presenting with negative changes in visual acuity remains unknown.

Westby, Christian M.↗
NASA NTRS2012

Advances in Nanotechnology for Efficacious and Stable Formulation Development

Current operational medical kits aboard the International Space Station (ISS) include an array of medications intended for the treatment of minor ambulatory care symptoms, first aid, and basic life support. All medications contained in the flight kits are commercially available off-the-shelf formulations used for treatment of illnesses on Earth. However, transport and stowage of supplies including medications for space missions are exposed to adverse environmental conditions and extended shelf-life demands. Proposed missions to Mars and near-Earth objects such as asteroid 1999 AO10 will present crew health risk that is different both quantitatively and qualitatively from those encountered on ISS missions. Few drug options are available at the present time for mitigation of crew health risk of planned space exploration missions. Alternatives to standard oral formulations that include sustained and targeted delivery technologies for preventive healthcare in space will be a welcome addition to the space formulary and may include controlled release topical, sub-cutaneous, intranasal and inhalation dosage forms. An example of such a technology development endeavor can be nanotechnology-based multi-stage drug cocktail and vaccine delivery systems. Nanostructures also have the ability to protect drugs encapsulated within them from physiologic degradation, target their delivery with sustained release and are suitable for per oral routes of administration. The use of nanostructures such as polymeric nanoparticles offers a non-invasive approach for penetrating the blood brain barrier. Finally, nanotechnology offers great potential for the development of safe and efficacious drug delivery systems for preventive health care in space and on Earth.

Putcha, Lakshimi↗
NASA NTRS2014

Identification of Medical Training Methods for Exploration Missions

As the National Aeronautics and Space Administration (NASA) and its international partner agencies anticipate eventual exploration missions of longer duration, there is a need to plan for the medical capabilities necessary to maximize crew health and provide the best likelihood of mission success. Current spaceflights consist of 5- to 6-month excursions to the International Space Station (ISS) in low-Earth orbit (LEO), and a 12-month ISS mission is currently in planning stages. However, missions to a near-Earth asteroid (NEA), a return to the moon, or even a mission to Mars will demand unprecedented medical capabilities, particularly relating to the training of the crew medical officers (CMOs). In its attempts to address the questions about medical preparation for spaceflight beyond LEO, the Exploration Medical Capability (ExMC) element within NASA's Human Research Program (HRP) defines a series of gaps. These gaps are shortcomings in knowledge, training, or technology that require resolution before an exploration mission can be undertaken. The ExMC element maintains current information about measures to close these gaps while developing plans for further investigation and research. Data pertaining to the gaps and their present status are available to the general public on the NASA Human Research Wiki and the NASA Human Research Roadmap Web sites (34, 36). One such gap, Gap 3.01, identifies a lack of knowledge about the optimal training methods for in-flight medical conditions identified on the Exploration Medical Condition List (EMCL), taking into account the crew medical officer s (CMOs) clinical background (33). This broad statement encompasses several related issues with the current methods of training CMOs and the medical ground support staff, specifically flight surgeons and biomedical engineers (BMEs) located in mission control, in addition to questions pertaining to the ways in which training will need to be adapted for the medical contingencies unique to exploration missions. To determine the optimal methods of medical training for an exploration medical crew and their ground support team, the historical context of medical operations, the current CMO training methods, and potential alternative training methods were identified.

Long duration space flight↗
NASA NTRS2014

Innovative Technologies for Efficient Pharmacotherapeutic Management in Space

Current and future Space exploration missions and extended human presence in space aboard the ISS will expose crew to risks that differ both quantitatively and qualitatively from those encountered before by space travelers and will impose an unknown risk of safety and crew health. The technology development challenges for optimizing therapeutics in space must include the development of pharmaceuticals with extended stability, optimal efficacy and bioavailability with minimal toxicity and side effects. Innovative technology development goals may include sustained/chronic delivery preventive health care products and vaccines, low-cost high‐efficiency noninvasive, non‐oral dosage forms with radio‐protective formulation matrices and dispensing technologies coupled with self‐reliant tracking technologies for quality assurance and quality control assessment. These revolutionary advances in pharmaceutical technology will assure human presence in space and healthy living on Earth. Additionally, the Joint Commission on Accreditation of Healthcare Organizations advocates the use of health information technologies to effectively execute all aspects of medication management (prescribing, dispensing, and administration). The advent of personalized medicine and highly streamlined treatment regimens stimulated interest in new technologies for medication management. Intelligent monitoring devices enhance medication accountability compliance, enable effective drug use, and offer appropriate storage and security conditions for dangerous drug and controlled substance medications in remote sites where traditional pharmacies are unavailable. These features are ideal for Exploration Medical Capabilities. This presentation will highlight current novel commercial off‐the‐shelf (COTS) intelligent medication management devices for the unique dispensing, therapeutic drug monitoring, medication tracking, and drug delivery demands of exploration space medical operations.

Putcha, Lakshmi↗
NASA NTRS2015

Aerospace Medicine Talk

The presentation is next Sunday, May 10th. It will be to the Civil Aviation Medical Association, for 2 hours at Disney World in Orlando. It is a high level talk on space medicine, including history, the role of my office, human health risks of space flight, general aspects of space medicine practice, human health risk management (including integrated activities of medical operations and the Human Research Program, and thoughts concerning health risks for long duration exploration class space missions. No proprietary data or material will be used, all is readily available in the public sector. There is also a short (30 min) talk on Monday at the CAMA lunch. There we will describe the Visual Impairment and Intracranial Pressure syndrome, with possible etiologies and plans for research (already selected studies). Again, nothing proprietary will be discussed.

Aerospace Medicine Overview↗
NASA NTRS2015

Capabilities, Calibration, and Impact of the ISS-RAD Fast Neutron Detector

In the current NASA crew radiation health risk assessment framework, estimates for the neutron contributions to crew radiation exposure largely rely on simulated data with sizeable uncertainties due to the lack of experimental measurements inside the ISS. Integrated in the ISS-RAD instrument, the ISS-RAD Fast Neutron Detector (FND) will deploy to the ISS on one of the next cargo supply missions. Together with the ISS-RAD Charged Particle Detector, the FND will perform, for the first time, routine and precise direct neutron measurements inside the ISS between 0.5 and 80 MeV. The measurements will close the NASA Medical Operations Requirement to monitor neutrons inside the ISS and impact crew radiation health risk assessments by reducing uncertainties on the neutron contribution to crew exposure, enabling more efficient mission planning. The presentation will focus on the FND detection mechanism, calibration results and expectations about the FND's interaction with the mixed radiation field inside the ISS.

Leitgab, Martin↗
NASA NTRS2017

Tracking Historical NASA EVA Training: Lifetime Surveillance of Astronaut Health (LSAH) Development of the EVA Suit Exposure Tracker (EVA SET)

During a spacewalk, designated as extravehicular activity (EVA), an astronaut ventures from the protective environment of the spacecraft into the vacuum of space. EVAs are among the most challenging tasks during a mission, as they are complex and place the astronaut in a highly stressful environment dependent on the spacesuit for survival. Due to the complexity of EVA, NASA has conducted various training programs on Earth to mimic the environment of space and to practice maneuvers in a more controlled and forgiving environment. However, rewards offset the risks of EVA, as some of the greatest accomplishments in the space program were accomplished during EVA, such as the Apollo moonwalks and the Hubble Space Telescope repair missions. Water has become the environment of choice for EVA training on Earth, using neutral buoyancy as a substitute for microgravity. During EVA training, an astronaut wears a modified version of the spacesuit adapted for working in water. This high fidelity suit allows the astronaut to move in the water while performing tasks on full-sized mockups of space vehicles, telescopes, and satellites. During the early Gemini missions, several EVA objectives were much more difficult than planned and required additional time. Later missions demonstrated that "complex (EVA) tasks were feasible when restraints maintained body position and underwater simulation training ensured a high success probability".1,2 EVA training has evolved from controlling body positioning to perform basic tasks to complex maintenance of the Hubble Space Telescope and construction of the International Space Station (ISS). Today, preparation is centered at special facilities built specifically for EVA training, such as the Neutral Buoyancy Laboratory (NBL) at NASA's Johnson Space Center ([JSC], Houston) and the Hydrolab at the Gagarin Cosmonaut Training Centre ([GCTC], Star City, outside Moscow). Underwater training for an EVA is also considered hazardous duty for NASA astronauts. This activity places astronauts at risk for decompression sickness and barotrauma as well as various musculoskeletal disorders from working in the spacesuit. The medical, operational and research communities over the years have requested access to EVA training data to better understand the risks. As a result of these requests, epidemiologists within the Lifetime Surveillance of Astronaut Health (LSAH) team have compiled records from numerous EVA training venues to quantify the exposure to EVA training. The EVA Suit Exposure Tracker (EVA SET) dataset is a compilation of ground-based training activities using the extravehicular mobility unit (EMU) in neutrally buoyant pools to enhance EVA performance on orbit. These data can be used by the current ISS program and future exploration missions by informing physicians, researchers, and operational personnel on the risks of EVA training in order that future suit and mission designs incorporate greater safety. The purpose of this technical report is to document briefly the various facilities where NASA astronauts have performed EVA training while describing in detail the EVA training records used to generate the EVA SET dataset.

Laughlin, Mitzi S.↗
NASA NTRS2016

Analysis of the Ability of United States and Russian Trace Contaminant Control Systems to Meet U.S. 180-Day and Russian 360-Day Spacecraft Maximum Allowable Concentrations

As the Space Station Freedom program transitioned to become the International Space Station (ISS), uncertainty existed concerning the performance capabilities for U.S.- and Russian-provided trace contaminant control (TCC) equipment. In preparation for the first dialogue between NASA and Russian Space Agency personnel in Moscow, Russia, in late April 1994, an engineering analysis was conducted to serve as a basis for discussing TCC equipment engineering assumptions as well as relevant assumptions on equipment offgassing and cabin air quality standards. The analysis presented was conducted as part of the efforts to integrate Russia into the ISS program via the early ISS Multilateral Medical Operations Panel's Air Quality Subgroup deliberations. This analysis, served as a basis for technical deliberations that established a framework for TCC system design and operations among the ISS program's international partners that has been instrumental in successfully managing the ISS common cabin environment.

Perry, J. L.↗