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NASA space life sciences research and education support program

USRA's Division of Space Life Sciences (DSLS) was established in 1983 as the Division of Space Biomedicine to facilitate participation of the university community in biomedical research programs at the NASA Johnson Space Center (JSC). The DSLS is currently housed in the Center for Advanced Space Studies (CASS), sharing quarters with the Division of Educational Programs and the Lunar and Planetary Institute. The DSLS provides visiting scientists for the Johnson Space Center; organizes conferences, workshops, meetings, and seminars; and, through subcontracts with outside institutions, supports NASA-related research at more than 25 such entities. The DSLS has considerable experience providing visiting scientists, experts, and consultants to work in concert with NASA Life Sciences researchers to define research missions and goals and to perform a wide variety of research administration and program management tasks. The basic objectives of this contract have been to stimulate, encourage, and assist research and education in the NASA life sciences. Scientists and experts from a number of academic and research institutions in this country and abroad have been recruited to support NASA's need to find a solution to human physiological problems associated with living and working in space and on extraterrestrial bodies in the solar system.

Jones, Terri K.

Life Science Research Facility materials management requirements and concepts

The Advanced Programs Office at NASA Ames Research Center has defined hypothetical experiments for a 90-day mission on Space Station to allow analysis of the materials necessary to conduct the experiments and to assess the impact on waste processing of recyclable materials and storage requirements of samples to be returned to earth for analysis as well as of nonrecyclable materials. The materials include the specimens themselves, the food, water, and gases necessary to maintain them, the expendables necessary to conduct the experiments, and the metabolic products of the specimens. This study defines the volumes, flow rates, and states of these materials. Process concepts for materials handling will include a cage cleaner, trash compactor, biological stabilizer, and various recycling devices.

Johnson, Catherine C.

Advanced Technologies for Space Life Science Payloads on the International Space Station

SENSORS 2000! (S2K!) is a specialized, high-performance work group organized to provide advanced engineering and technology support for NASA's Life Sciences spaceflight and ground-based research and development programs. In support of these objectives, S2K! manages NASA's Advanced Technology Development Program for Biosensor and Biotelemetry Systems (ATD-B), with particular emphasis on technologies suitable for Gravitational Biology, Human Health and Performance, and Information Technology and Systems Management. A concurrent objective is to apply and transition ATD-B developed technologies to external, non-NASA humanitarian (medical, clinical, surgical, and emergency) situations and to stimulate partnering and leveraging with other government agencies, academia, and the commercial/industrial sectors. A phased long-term program has been implemented to support science disciplines and programs requiring specific biosensor (i.e., biopotential, biophysical, biochemical, and biological) measurements from humans, animals (mainly primates and rodents), and cells under controlled laboratory and simulated microgravity situations. In addition to the technology programs described above, NASA's Life and Microgravity Sciences and Applications Office has initiated a Technology Infusion process to identify and coordinate the utilization and integration of advanced technologies into its International Space Station Facilities. This project has recently identified a series of technologies, tasks, and products which, if implemented, would significantly increase the science return, decrease costs, and provide improved technological capability. This presentation will review the programs described above and discuss opportunities for collaboration, leveraging, and partnering with NASA.

Hines, John W.

GeneLab: Multi-Omics Investigation of Rodent Research-1 Bio-Banked Tissues

NASAs Rodent Research (RR) project is playing a critical role in advancing biomedical research on the physiological effects of space environments. Due to the limited resources for conducting biological experiments aboard the International Space Station (ISS), it is imperative to use crew time efficiently while maximizing high-quality science return. NASAs GeneLab project has as its primary objectives to 1) further increase the value of these experiments using a multi-omics, systems biology-based approach, and 2) disseminate these data without restrictions to the scientific community. The current investigation assessed viability of RNA, DNA, and protein extracted from archived RR-1 tissue samples for epigenomic, transcriptomic, and proteomic assays. During the first RR spaceflight experiment, a variety of tissue types were harvested from subjects, snap-frozen or RNAlater-preserved, and then stored at least a year at -80OC after return to Earth. They were then prioritized for this investigation based on likelihood of significant scientific value for spaceflight research. All tissues were made available to GeneLab through the bio-specimen sharing program managed by the Ames Life Science Data Archive and included mouse adrenal glands, quadriceps, gastrocnemius, tibialis anterior, extensor digitorum longus, soleus, eye, and kidney. We report here protocols for and results of these tissue extractions, and thus, the feasibility and value of these kinds of omics analyses. In addition to providing additional opportunities for investigation of spaceflight effects on the mouse transcriptome and proteome in new kinds of tissues, our results may also be of value to program managers for the prioritization of ISS crew time for rodent research activities. Support from the NASA Space Life and Physical Sciences Division and the International Space Station Program is gratefully acknowledged.

GeneLab

An Overview of the NASA Sounding Rocket and Balloon Programs

The U.S. National Aeronautics and Space Administration (NASA) Sounding Rockets and Balloon Programs conduct a total of 50 to 60 missions per year in support of the NASA scientific community. These missions support investigations sponsored by NASA's Offices of Space Science, Life and Microgravity Sciences & Applications, and Earth Science. The Goddard Space Flight Center has management and implementation responsibility for these programs. The NASA Sounding Rockets Program provides the science community with payload development support, environmental testing, launch vehicles, and launch operations from fixed and mobile launch ranges. Sounding rockets continue to provide a cost-effective way to make in situ observations from 50 to 1500 km in the near-earth environment and to uniquely cover the altitude regime between 50 km and 130 km above the Earth's surface. New technology efforts include GPS payload event triggering, tailored trajectories, new vehicle configuration development to expand current capabilities, and the feasibility assessment of an ultra high altitude sounding rocket vehicle. The NASA Balloon Program continues to make advancements and developments in its capabilities for support of the scientific ballooning community. The Long Duration Balloon (LDB) is capable of providing flight durations in excess of two weeks and has had many successful flights since its development. The NASA Balloon Program is currently engaged in the development of the Ultra Long Duration Balloon (ULDB), which will be capable of providing flight times up to 100-days. Additional development efforts are focusing on ultra high altitude balloons, station keeping techniques and planetary balloon technologies.

Eberspeaker, Philip J.

An Overview of the NASA Sounding Rockets and Balloon Programs

The U.S. National Aeronautics and Space Administration (NASA) Sounding Rockets and Balloon Programs conduct a combined total of approximately fifty to sixty missions per year in support of the NASA scientific community. These missions are provided in support of investigations sponsored by NASA'S Offices of Space Science, Life and Microgravity Sciences & Applications, and Earth Science. The Goddard Space Flight Center has management and implementation responsibility for these programs. The NASA Sounding Rockets Program has continued to su,pport the science community by integrating their experiments into the sounding rocket payload and providing the rocket vehicle and launch operations necessary to provide the altitude/time required obtain the science objectives. The sounding rockets continue to provide a cost-effective way to make in situ observations from 50 to 1500 km in the near-earth environment and to uniquely cover the altitude regime between 50 km and 130 km above the Earth's surface, which is physically inaccessible to either balloons or satellites. A new architecture for providing this support has been introduced this year with the establishment of the NASA Sounding Rockets Contract. The Program has continued to introduce improvements into their operations and ground and flight systems. An overview of the NASA Sounding Rockets Program with special emphasis on the new support contract will be presented. The NASA Balloon Program continues to make advancements and developments in its capabilities for support of the scientific ballooning community. Long duration balloon (LDB) is a prominent aspect of the program with two campaigns scheduled for this calendar year. Two flights are scheduled in the Northern Hemisphere from Fairbanks, Alaska, in June and two flights are scheduled from McMurdo, Antarctica, in the Southern Hemisphere in December. The comprehensive balloon research and development (R&D) effort has continued with advances being made across the spectrum of balloon related disciplines. As a result of these technology advancements a new ultra long duration balloon project (ULDB) for the development of a 100- day duration balloon capability has been initiated. The ULDB will rely upon new balloon materials and designs to accomplish its goals. The Program has also continued to introduce new technology and improvements into flights systems, ground systems and operational techniques. An overview of the various aspects of the NASA Balloon Program will be presented.

Flowers, Bobby J.

Acquisition of and Access to Research Omics Data

Omics data are essential for understanding the myriad and complex effects of space environments on humans. To assure maximum benefit from these kinds of data, the NASA Human Research Program Data Management Plan stipulates that human omics data should be archived within and accessed through the NASA Life Sciences Portal (NLSP). The NLSP has the capability to acquire and provision access to omics (and other kinds of) research results for individual and ad-hoc groups of subjects at the direction of institutional review boards, or other authorizing bodies or individuals, per institutional, program and investigation-specific policies and procedures. However, because some single-subject omics data, like CT scans and other kinds of large, complex biomedical data, could be used to identify heretofore unknown risks to the subject’s health, or, in certain cases, be used to identify a subject, NASA Policy Directive 7170.1 describes various policies regarding the management of and access to “research genetic testing” data, which includes many kinds of omics data. For example, NPD 7170.1 prohibits access to human research genetic data by NASA personnel who make employment decisions for the subjects from whom the data were obtained. To meet the objective of acquiring research omics data for NLSP in compliance with the policies in NPD 7170.1 and other applicable NASA policies, we designed NOMADS (the NLSP Omics Multimodal Acquisition of Data System), a new component that supports the transfer of large research data files, including research genetic testing data, using one of several different transfer mechanisms. The choice of mechanism is made by the submitter of the data, with guiding information from the system, and is likely to often be determined in large part by the nature and source location of the data. For example, for small files where the source data files are not already stored in a cloud storage system, users are likely to prefer to transfer their data to the NLSP via a web browser. Conversely, for large sets of files already organized and stored in a cloud storage system, users may opt for NOMAD’s cloud-to-cloud transfer method. All omics datasets targeted for the NASA Life Sciences Data Archive must pass a variety of quality checks to ensure data integrity and adherence to the standards defined by the LSDA Data Submission Guidelines (DSG) (see https://nlsp.nasa.gov/explore/lsdahome/datasubmit). These include requirements that data are consistent with open standards established by the omics community. Non-compliant data will not be accepted however archivists are available to advise submitters on how to revise data submissions and re-submit until compliance is achieved. Following compliance with the LSDA DSG, omics data next undergo a variety of additional quality checks to ensure the data meet omics community standards. Domain specific Omics data quality control tools and techniques are continually evolving and linked to the advancements in omics assays utilized and thus, the tools and techniques utilized by the LSDA for data quality control and validation will need to be sustained accordingly. All human omics data will be access controlled according to the policies described above, and requiring IRB approval for any additional access grants once the data are acquired (including access for analysis using the NLSP workspace tools).

Omics

Acquisition of and Access to Research Omics Data

Omics data are essential for understanding the myriad and complex effects of space environments on humans. To assure maximum benefit from these kinds of data, the NASA Human Research Program Data Management Plan stipulates that human omics data should be archived within and accessed through the NASA Life Sciences Portal (NLSP). The NLSP has the capability to acquire and provision access to omics (and other kinds of) research results for individual and ad-hoc groups of subjects at the direction of institutional review boards, or other authorizing bodies or individuals, per institutional, program and investigation-specific policies and procedures. However, because some single-subject omics data, like CT scans and other kinds of large, complex biomedical data, could be used to identify heretofore unknown risks to the subject’s health, or, in certain cases, be used to identify a subject, NASA Policy Directive 7170.1 describes various policies regarding the management of and access to “research genetic testing” data, which includes many kinds of omics data. For example, NPD 7170.1 prohibits access to human research genetic data by NASA personnel who make employment decisions for the subjects from whom the data were obtained. To meet the objective of acquiring research omics data for NLSP in compliance with the policies in NPD 7170.1 and other applicable NASA policies, we designed NOMADS (the NLSP Omics Multimodal Acquisition of Data System), a new component that supports the transfer of large research data files, including research genetic testing data, using one of several different transfer mechanisms. The choice of mechanism is made by the submitter of the data, with guiding information from the system, and is likely to often be determined in large part by the nature and source location of the data. For example, for small files where the source data files are not already stored in a cloud storage system, users are likely to prefer to transfer their data to the NLSP via a web browser. Conversely, for large sets of files already organized and stored in a cloud storage system, users may opt for NOMAD’s cloud-to-cloud transfer method. All omics datasets targeted for the NASA Life Sciences Data Archive must pass a variety of quality checks to ensure data integrity and adherence to the standards defined by the LSDA Data Submission Guidelines (DSG) (see https://nlsp.nasa.gov/explore/lsdahome/datasubmit). These include requirements that data are consistent with open standards established by the omics community. Non-compliant data will not be accepted however archivists are available to advise submitters on how to revise data submissions and re-submit until compliance is achieved. Following compliance with the LSDA DSG, omics data next undergo a variety of additional quality checks to ensure the data meet omics community standards. Domain specific Omics data quality control tools and techniques are continually evolving and linked to the advancements in omics assays utilized and thus, the tools and techniques utilized by the LSDA for data quality control and validation will need to be sustained accordingly. All human omics data will be access controlled according to the policies described above, and requiring IRB approval for any additional access grants once the data are acquired (including access for analysis using the NLSP workspace tools).

Omics

Crystal Growth Furnace System Configuration and Planned Experiments on the Second United States Microgravity Laboratory Mission

The Crystal Growth Furnace (CGF) is currently undergoing modifications and refurbishment and is currently undergoing modifications and refurbishment and is manifested to refly on the Second United States Microgravity Laboratory (USML-2) mission scheduled for launch in September 1995. The CGF was developed for the National Aeronautics and Space Administration (NASA) under the Microgravity Science and Applications Division (MSAD) programs at NASA Headquarters. The refurbishment and reflight program is being managed by the Marshall Space Flight Center (MSFC) in Huntsville, Alabama. Funding and program support for the CGF project is provided to MSFC by the office of Life and Microgravity Sciences and Applications at NASA Headquarters. This paper presents an overview of the CGF system configuration for the USML-2 mission, and provides a brief description of the planned on-orbit experiment operation.

Srinivas, R.

Accelerating Space Life Sciences: Successes and Challenges of Biospecimen and Data Sharing

NASA's current human space flight research is directed towards enabling human space exploration beyond Low Earth Orbit (LEO). To that end, NASA Space Flight Payload Projects; Rodent Research, Cell Science, and Microbial Labs, flown on the International Space Station (ISS), benefit the global life sciences and commercial space communities. Verified data sets, science results, peer-reviewed publications, and returned biospecimens, collected and analyzed for flight and ground investigations, are all part of the knowledge base collected by NASA's Human Exploration and Operations Mission Directorate's Space Life and Physical Sciences Research and Applications (SLPSRA) Division, specifically the Human Research and Space Biology Programs. These data and biospecimens are made available through the public Life Sciences Data Archive (LSDA) website to promote basic discovery, pre-clinical and clinical science.The NASA Institutional Scientific Collection (ISC), stores flight and ground biospecimens from Space Shuttle and ISS programs. These specimens are curated and managed by the Ames Life Sciences Data Archive (ALSDA), an internal node of NASA's LSDA. The ISC stores over 30,000 specimens from experiments dating from 1984 to present. Currently available specimens include tissues from the circulatory, digestive, endocrine, excretory, integumentary, muscular, neurosensory, reproductive, respiratory and skeletal systems.NASA's biospecimen collection represents a unique and limited resource of unique spaceflight payload and ground control research subjects. These specimens are harvested according to well established SOPs that maintain their quality and integrity. Once the primary scientific objectives have been met, the remaining specimens are made available to provide secondary opportunities for complementary studies or new investigations to broaden research without large expenditures of time or resources. Website: https://lsda.jsc.nasa.gov/

Scott, Ryan T.

Medical and surgical applications of space biosensor technology

Researchers in space life sciences are rapidly approaching a technology impasse. Many of the critical questions on the impact of spaceflight on living systems simply cannot be answered with the limited available technologies. Research subjects, particularly small animal models like the rat, must be allowed to function relatively untended and unrestrained for long periods to fully reflect the impact of microgravity and spaceflight on their behavior and physiology. These requirements preclude the use of present hard-wired instrumentation techniques and limited data acquisition systems. Implantable sensors and miniaturized biotelemetry are the only means of capturing the fundamental and critical data. This same biosensor and biotelemetry technology has direct application to Earth-based medicine and surgery. Continuous, on-line data acquisition and improved measurement capabilities combined with the ease and flexibility offered by automated, wireless, and portable instruments and data systems, should provide a boon to the health care industry. Playing a key role in this technology revolution is the Sensors 2000! (S2K!) Program at NASA Ames Research Center. S2K!, in collaboration with space life sciences researchers and managers, provides an integrated capability for sensor technology development and applications, including advanced biosensor technology development, spaceflight hardware development, and technology transfer and commercialization. S2K! is presently collaborating on several spaceflight projects with dual-use medical applications. One prime example is a collaboration with the Fetal Treatment Center (FTC) at the University of California at San Francisco. The goal is to develop and apply implantable chemical sensor and biotelemetry technology to continuously monitor fetal patients during extra-uterine surgery, replacement into the womb, through birth and beyond. Once validated for ground use, the method will be transitioned to spaceflight applications to remotely monitor key biochemical parameters in flight animals. Successful application of NASA implantable biosensor and biotelemetry technologies should accelerate the advancement of this and other modern medical procedures while furthering the exploration of life in space.

NASA Discipline General Space Life Sciences

NASA Ames Institutional Scientific Collection (ISC)

NASA's current human space flight research is directed towards enabling human space exploration beyond Low Earth Orbit (LEO). The Space Flight Payload Projects; Rodent Research, Cell Science, and Microbial Labs, flown on the International Space Station (ISS), benefit both the global life sciences and commercial space communities. Verified data sets, science results, peer-reviewed publications, and returned biospecimens, collected and analyzed for flight and ground investigations, are all part of the knowledge base within NASA’s Human Exploration and Operations Mission Directorate’s Space Life and Physical Sciences Research and Applications (SLPSRA) Division, specifically the Human Research and Space Biology Programs. These data and biospecimens are made available through the public LSDA website. The Ames Institutional Scientific Collection (ISC), or ARC Biobank, stores flight and ground biospecimens from Space Shuttle and ISS programs. These specimens are curated and managed by the Ames Life Sciences Data Archive (ALSDA), an internal node of NASA's Life Sciences Data Archive (LSDA). The ARC Biolbank stores over 15,000 specimens from experiments dating from 1984 to present. Currently available specimens include tissues from the circulatory, digestive, endocrine, excretory, integumentary, muscular, neurosensory, reproductive, respiratory and skeletal systems. The most recent contributions include RNA, DNA and protein extracts from Rodent Research 1 and tissues from Rodent Research 4. NASA's biospecimen collection represents a unique and limited resource. The use of these biospecimens maximizes utilization and scientific return from these unique spaceflight payload and ground control research subjects. These biospecimens are harvested following complex, costly NASA research activities to meet primary scientific objectives. Once the primary scientific objectives have been met, the remaining specimens are made available to provide secondary opportunities for complementary studies or new investigations to broaden research without large expenditures of time or resources. Innovative ways of sharing this information ultimately advances the frontiers of human space exploration as well as scientific understanding of the effects of gravity on life on earth.

French, Alison J.

Optimizing Sample Collection and Accessibility through the Biospecimen and Tissue Sharing Collection (BTSC) Program

The Space Radiation Element (SRE) of the Human Research Program (HRP) is dedicated to establishing a robust biospecimen and tissue sharing collection (BTSC) program that enhances sample collection, tracking, access, distribution, and usability, with the goal of maximizing scientific return. By leveraging biospecimens and tissues from previous experiments, HRP effectively achieves its scientific objectives in characterizing and mitigating the human health impacts of spaceflight while optimizing resource utilization. To further improve the usability and accessibility of the current biospecimen archive, the project aims to expand upon NASA's existing resources and institutional knowledge, ensuring ongoing modernization. To facilitate seamless navigation of the program's workflow, an educational series on the BTSC program is provided to Principal Investigators (PIs). This comprehensive series equips PIs with crucial information on submitting their inventory via the BTSC Metadata Intake Form, ultimately leading to the public availability of their data on NASA's Life Science Portal (NLSP). Covering various aspects such as metadata submission instructions and backend processes for transferring metadata to the Laboratory Information Management System (LIMS), the series incorporates guidance from NASA's Biological Institutional Scientific Collection (NBISC) and Ames Life Sciences Data Archive (ALSDA). The BTSC program represents a significant stride towards enhancing the usability and accessibility of biospecimens for space research. By enabling NASA to deepen its understanding of the health implications of long-term spaceflight, this initiative plays a pivotal role in ensuring the safety and well-being of astronauts.

Shelita Renee Augustus

Budget estimates: Fiscal year 1994. Volume 3: Research and program management

The research and program management (R&PM) appropriation provides the salaries, other personnel and related costs, and travel support for NASA's civil service workforce. This FY 1994 budget funds costs associated with 23,623 full-time equivalent (FTE) work years. Budget estimates are provided for all NASA centers by categories such as space station and new technology investments, space flight programs, space science, life and microgravity sciences, advanced concepts and technology, center management and operations support, launch services, mission to planet earth, tracking and data programs, aeronautical research and technology, and safety, reliability, and quality assurance.

Source record

Risk as a Driver for Innovation

The Space Life Sciences directorate (SLSD) and Human Research Program (HRP) at NASA Johnson Space Center has implemented a system for managing human systems risks. These risks are defined as the health and performance risks posed to crew during and after spaceflight. Identification and evaluation of these risks has led to the identification of gaps in knowledge about the risks as well as gaps in technology needed to mitigate them. Traditional routes of closing technology gaps have, in some cases, proven to be too slow when a solution was required quickly. Therefore, certain gaps were used to drive the development of "challenges" for the scientific community. Partnering with open innovation service providers such as InnoCentive and Yet2.com, SLSD and HRP have decreased the amount of time from identification of a need to the evaluation of a solution. Although not all proposed solutions will result in a risk mitigation strategy or tool, the process has allowed faster evaluation of proposed solutions providing the researcher the ability to move to another possible solution if the first does not sufficiently address the problem. Moreover, this process engages the community outside of NASA and broadens the population from which to draw solutions. In the traditional grant funding structure, only those in the specific field will apply for the grant. However, using open innovation, solutions can come from individuals in many different fields. This can expand the general view of a field (way of thinking within a field) and the application of solutions form new fields while providing a pathway for the acquisition of novel solutions or refinements of current mitigations. Identification of the human systems risks has helped drive the development and evaluation of innovative solutions as well as engaging a broader scientific audience in working with NASA.

Davis, Jeff

Applying Satellite Data to Support Disaster Response and Emergency Management Decision Making

Using the vantage point of space, satellite observations provide information about the Earth that can serve a critical role in building situational awareness and filling in data gaps during disaster response. NASA’s Earth Science Division ( studies the Earth as a system and develops technologies to improve the quality of life here on our home planet. Within NASA ESD, the Disasters Program and its Disasters Response Coordination System (DRCS) aims to advance Earth science data and information to support management decisions that prevent or mitigate the impacts of disasters. Using a whole-of-NASA approach to coordinate and mobilize the Agency’s assets and expertise to provide geospatial information during disasters, this work brings the utility of Earth observation information to emergency management and disaster response and reduces the impacts of disasters on lives and livelihoods .This poster will introduce the utility of satellite and geospatial information to disaster response through examples of recent DRCS incident response activations and highlight the DRCS model that employs a user-centered activation framework beginning with direct requests from responders and ending with after-action assessments that feed lessons learned and process improvements.

Remote Sensing

Space Life Sciences Research and Education Program

Since 1969, the Universities Space Research Association (USRA), a private, nonprofit corporation, has worked closely with the National Aeronautics and Space Administration (NASA) to advance space science and technology and to promote education in those areas. USRA's Division of Space Life Sciences (DSLS) has been NASA's life sciences research partner for the past 18 years. For the last six years, our Cooperative Agreement NCC9-41 for the 'Space Life Sciences Research and Education Program' has stimulated and assisted life sciences research and education at NASA's Johnson Space Center (JSC) - both at the Center and in collaboration with outside academic institutions. To accomplish our objectives, the DSLS has facilitated extramural research, developed and managed educational programs, recruited and employed visiting and staff scientists, and managed scientific meetings.

Coats, Alfred C.

Earthbound applications for NASA's physician workstation

The dream of a space probe to Mars or an astronaut colony on the moon persists. Despite years of setbacks and delays, NASA continues to lay the foundation for a new frontier in space. The necessity of a self contained health maintenance facility is an integral part of this stellar venture. As a subsystem of this health maintenance facility, the physician or astronaut workstation was envisioned as the vehicle of interface between the computer resources of the space station and the care provider. Our efforts to define and build this interface have resulted in a series of programs which can now be tested and refined using earth-based applications. The modules which have dual-use application from the NASA workstation include: patient scheduling and master patient index, pharmacy, laboratory, medical library, problem list/progress notes, and digital medical records. Our current plan is to develop these tools as objects that can be assembled in a variety of configurations. This will allow the technology to be used by the private sector where each doctor can select the starting point of his outpatient office system and add modules as he makes progress in system integration and training.

NASA Discipline Number 70-30