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At least 361 records · Page 20

Integrated Research Plan to Assess the Combined Effects of Space Radiation, Altered Gravity, and Isolation and Confinement on Crew Health and Performance: Problem Statement

Future crewed exploration missions to Mars could last up to three years and will expose astronauts to unprecedented environmental challenges. Challenges to the nervous system during these missions will include factors of: space radiation that can damage sensitive neurons in the central nervous system (CNS); isolation and confinement can affect cognition and behavior; and altered gravity that will change the astronauts’ perception of their environment and their spatial orientation, and will affect their coordination, balance, and locomotion. In the past, effects of spaceflight stressors have been characterized individually. However, long-term, simultaneous exposure to multiple stressors will produce a range of interrelated behavioral and biological effects that have the potential to adversely affect operationally relevant crew performance. These complex environmental challenges might interact synergistically and increase the overall risk to the health and performance of the astronaut. Therefore, NASA’s Human Research Program (HRP) has directed an integrated approach to characterize and mitigate the risk to the CNS from simultaneous exposure to these multiple spaceflight factors. The proposed research strategy focuses on systematically evaluating the relationships among three existing research risks associated with spaceflight: Risk of Acute (In-flight) and Late Central Nervous System Effects from Radiation (CNS), Risk of Adverse Cognitive or Behavioral Conditions and Psychiatric Disorders (BMed), and Risk of Impaired Control of Spacecraft/Associated Systems and Decreased Mobility Due to Vestibular/Sensorimotor Alterations Associated with Spaceflight (SM). NASA’s HRP approach is intended to identify the magnitude and types of interactions as they affect behavior, especially as it relates to operationally relevant performance (e.g., performance that depends on reaction time, procedural memory, etc.). In order to appropriately characterize this risk of multiple spaceflight environmental stressors, there is a recognition of the need to leverage research approaches using appropriate animal models and behavioral constructs. Very little has been documented on the combined effects of altered gravity, space radiation, and other psychological and cognitive stressors on the CNS. Preliminary evidence from rodents suggest that a combination of a minimum of exposures to even two of three stressors of: simulated space radiation, simulated microgravity, and simulated isolation and confinement, have produced different and more pronounced biological and performance effects than exposure to these same stressors individually. Structural and functional changes to the CNS of rodents exposed to transdisciplinary combined stressors indicate that important processes related to information processing are likely altered including impairment of exploratory and risk taking behaviors, as well as executive function including learning, memory, and cognitive flexibility — all of which may be linked to changes in related operational relevant performance. The fully integrated research plan outlines approaches to evaluate how combined, potentially synergistic, impacts of simultaneous exposures to spaceflight hazards will affect an astronaut’s CNS and their operationally relevant performance during future exploration missions, including missions to the Moon and Mars. The ultimate goals are to derive risk estimates for the combined, potentially synergistic, effects of the three major spaceflight hazards that will establish acceptable maximum decrement or change in a physiological or behavioral parameters during or after spaceflight, the acceptable limit of exposure to a spaceflight factor, and to evaluate strategies to mitigate any associated decrements in operationally relevant performance.

Steinberg, Susan L.↗

International Space Station Common Cabin Air Assembly Condensing Heat Exchanger Hydrophilic Coating Failures and Lessons Learned

The ability to control the temperature and humidity of an environment or habitat is critical for human survival. These factors are important to maintaining human health and comfort, as well as maintaining mechanical and electrical equipment in good working order to support the human and to accomplish mission objectives. The temperature and humidity of the International Space Station (ISS) United States On-orbit Segment (USOS) cabin air is controlled by the Common Cabin Air Assembly (CCAA). The CCAA consists of a fan, a condensing heat exchanger (CHX), an air/water separator, temperature and liquid sensors, and electrical controlling hardware and software. The CHX is the primary component responsible for control of temperature and humidity. The CCAA CHX contains a chemical coating that was developed to be hydrophilic and thus attract water from the humid influent air. This attraction forms the basis for water removal and therefore cabin humidity control. However, there have been several instances of CHX coatings becoming hydrophobic and repelling water. When this behavior is observed in an operational CHX, the unit s ability to remove moisture from the air is compromised and the result is liquid water carryover into downstream ducting and systems. This water carryover can have detrimental effects on the cabin atmosphere quality and on the health of downstream hardware. If the water carryover is severe and widespread, this behavior can result in an inability to maintain humidity levels in the USOS. This paper will describe the operation of the five CCAAs within in the USOS, the potential causes of the hydrophobic condition, and the impacts of the resulting water carryover to downstream systems. It will describe the history of this behavior and the actual observed impacts to the ISS USOS. Information on mitigation steps to protect the health of future CHX hydrophilic coatings and potential remediation techniques will also be discussed.

Balistreri, Steven F.↗

NASA’s Galactic Cosmic Ray Simulator at Brookhaven National Laboratory: Enabling Human Exploration Missions to the Moon and Mars

With exciting new Agency plans for a sustainable return to the moon, astronauts will once again leave earth’s protective magnetosphere only to endure higher levels of radiation from galactic cosmic rays (GCR) and the possibility of a large solar particle event (SPE). Gateway, lunar landers, and surface habitats will be designed to protect crew against SPE’s with vehicle optimization, storm shelter concepts, and/or active dosimetry; however, the ever-penetrating GCR will continue to pose the most significant health risks especially as lunar missions increase in duration and as NASA sets its aspirations on Mars. The primary risks of concern include epithelial carcinogenesis and leukemia, central nervous system effects resulting in potential in-mission cognitive or behavioral impairment and/or late neurological disorders, degenerative tissue effects including cataracts, circulatory and heart disease, as well as, potential immune system decrements impacting multiple aspects of crew health. Characterization and mitigation of these risks requires a significant reduction in the large biological uncertainties of chronic (low-dose rate) heavy ion exposures and the validation of countermeasures in a relevant space environment. NASA has developed the “GCR Simulator” at Brookhaven National Laboratory to generate a spectrum of ion beams that approximates the primary and secondary GCR field experienced at human organ locations within a deep-space vehicle. The majority of the dose is delivered from protons (~65-75%) and alpha particles (~10-20%) with heavier ions (Z≤3) contributing the remainder. The “GCR Simulator” exposes state-of-the art cellular and animal model systems to 33 sequential beams including 4 proton energies plus degrader, 4 helium energies plus degrader, and the five heavy ions of C, O, Si, Ti, and Fe. A polyethylene degrader is used with the 100 MeV/n H and He beams to provide a nearly continuous distribution of low energy particles. A 500 mGy exposure, delivering doses from each of the 33 beams, requires 75-90 minutes. To more closely simulate the low dose rates found in space, sequential field exposures can be divided into daily fractions over 2-4 weeks, with individual fractions as low as 0.1-0.2 mGy. In the large beam configuration (60 x 60 cm(exp 2)), 54 special housing cages can accommodate 2-3 mice each for a 70-75 min duration or ~15 individually housed rats. Emerging research results from our 2018 runs utilizing mixed heavy ion fields and protracted space exposures are forthcoming and deepen our understanding of the numerous health risks faced by our astronauts. This paper discusses NASA’s innovative technology solution for a ground-based GCR simulator at the NASA Space Radiation Laboratory to enable future exploration missions.

Lisa C Simonsen↗

Investigating Soil Organic Matter Complexation using Spectral Induced Polarization

Spectral induced polarization (SIP) laboratory experiments were conducted to determine the sensitivity of this method to the formation of soil organic matter (SOM) complexes, with a long-term goal of field-scale monitoring. There are few SIP experiments that have explored this topic, yet understanding the dynamic behavior and interactions of SOM at the field scale could provide insight into soil fertility and health which influences crop yields, microorganisms that degrade organic pollutants, and carbon stabilization. We present the results of three experiments where the iron oxide, ferrihydrite (Fhy), was used to coat different media, and then the OM compound pentaglycine (PG) was pulse injected to form SOM complexes. SIP data was collected during these injections to capture any surface complexation changes. These experiments were performed in 1) a fluidic cell containing a micromodel, 2) a column containing Fhy coated ceramic beads and 3) a column containing Fhy coated Accusand®. Our results show a higher frequency response (defined here as > 1 Hz) in all three experiments, with the largest amplitude response after the first PG injection (Figure S.1). The repeatability of this response is encouraging and supporting data collected on the Accusand® experiment provides preliminary insight into the mechanisms controlling the SIP signatures. Sampling of fluid conductivity $σ_w$ and pH may indicate deprotonation of SOM occurring or rapid adsorption and release of protons from the Fhy sites. However additional experiments are needed to identify and confirm the primary and secondary reactions impacting the SIP response. We are looking towards other opportunities to continue this work, particularly to repeat experiments while collecting supporting datasets.

58 GEOSCIENCES↗

Winter Simulation Conference, Miami Beach, Fla., December 4-6, 1978, Proceedings. Volumes 1 & 2

The papers report on the various aspects of simulation such as random variate generation, simulation optimization, ranking and selection of alternatives, model management, documentation, data bases, and instructional methods. Simulation studies in a wide variety of fields are described, including system design and scheduling, government and social systems, agriculture, computer systems, the military, transportation, corporate planning, ecosystems, health care, manufacturing and industrial systems, computer networks, education, energy, production planning and control, financial models, behavioral models, information systems, and inventory control.

Highland, H. J.↗

La Chalupa-30: Lessons learned from a 30-day subsea mission analogue

The Behavior and Performance Laboratory (BPL) utilizes space mission analogs to study issues such as the psychological health and well-being, team characteristics, and task performance of crew members on long-duration missions. The analog used in this investigation was an underwater habitat named La Chalupa, which was selected for its similar features to a space station environment. The primary objectives of the La Chalupa-30 investigation were to evaluate the efficiency of several methods for collecting data in remote environments and to assess aspects of living and working under isolated and confined conditions.

Vanderark, Steve↗

Analytical Framework for Rodent/NHP Data Set Utilization to Inform Human CNS Risk Estimation

Objectives Review and inform on tactics to analyze & communicate data from animal research (e.g., rodents, mini-pigs, NHPs, et al) exposed to single and combinations of spaceflight hazards, using NASA’s Human System Risk Board (HSRB) process for the Behavioral Medicine Risk - To quantitatively inform Behavioral Medicine Risk posture - i.e., likelihood (L) and consequence (C) - To help inform estimation of crew health standards for operational task performance (i.e., Fitness For Duty, Space Permissible Exposure Levels, Permissible Operational Limits).

Brain↗

Screening and Brief Interventions for Alcohol Use During Pregnancy: Practices Among US Primary Care Clinicians, DocStyles 2019

Alcohol use during pregnancy can cause birth defects and developmental disabilities. From 2018 through 2020, 13.5% of pregnant women reported current drinking. The US Preventive Services Task Force recommends evidence-based tools (eg, AUDIT-C and SASQ) for implementing screening and brief interventions to reduce excessive alcohol use among adults, including pregnant people, for whom any alcohol use is considered excessive. We used DocStyles 2019 data to conduct a cross-sectional analysis to examine current screening and brief intervention practices that primary care clinicians conduct among pregnant patients; clinicians’ confidence levels in conducting screening, brief interventions, and referral to treatment; and the documentation of brief interventions in the medical record. A total of 1,500 US adult medicine clinicians completed the entire survey. Among the respondents who conduct screening (N = 1,373) and brief interventions (N = 1,357) in their practice, nearly all reported implementing screening (94.6%) and brief interventions (94.9%) with their pregnant patients for alcohol use, but fewer than half felt confident about conducting their screening practices (46.5%). Two-thirds (64%) reported using a tool that met the criteria recommended by the US Preventive Services Task Force (USPSTF). Over half documented brief interventions in electronic health record notes (51.7%) or designated space (50.7%). Pregnancy presents a unique opportunity for clinicians to incorporate screening into routine obstetric care and encourage behavior change among patients. Most providers reported always screening their pregnant patients for alcohol use, but fewer used evidence-based USPSTF-recommended screening tools. Increased clinician confidence in screening and brief intervention, the use of standardized screening tools tailored to pregnant people, and maximal use of electronic health record technology may enhance the benefits of their application to alcohol use, which ultimately can reduce adverse outcomes associated with alcohol use during pregnancy.

60 APPLIED LIFE SCIENCES↗

Exploring Electrode-Level State-of-Charge and State-of-Health Dynamics in Lithium-Ion Battery Cells: Modeling and Experimental Identification

A computationally efficient model serves as a critical prerequisite for battery performance analysis and advanced battery management algorithm design. Although battery models that capture cell-level behavior have been widely explored in existing literature, electrode-level battery models have received much lesser attention till to date. However, such electrode-level models can significantly increase battery performance and life by enabling electrode-level health-conscious control. Such electrode-level control can effectively expand usable energy and power limits of the battery cells by utilizing the knowledge of individual electrodes' charge and health. In this context, this paper presents a comprehensive battery model developed with a reference electrode insertion that captures (i) electrode-level charge/discharge dynamics, (ii) stoichiometric and temporal dependencies of electrode-level resistances, (iii) solid electrolyte interface (SEI) layer growth as key degradation phenomenon, and (iv) capacity fade and resistance rise in each electrode due to nominal battery aging. The proposed model is identified, and a preliminary validation is performed utilizing terminal voltage and negative electrode potential data collected from a pouch cell under one continuous cycling and accelerated aging conditions where the cell experienced 14% capacity loss.

aging↗

International Space Station Common Cabin Air Assembly Condensing Heat Exchanger Hydrophilic Coating Operation, Recovery, and Lessons Learned

The ability to control the temperature and humidity of an environment or habitat is critical for human survival. These factors are important to maintaining human health and comfort, as well as maintaining mechanical and electrical equipment in good working order to support the human and to accomplish mission objectives. The temperature and humidity of the International Space Station (ISS) United States On-orbit Segment (USOS) cabin air is controlled by the Common Cabin Air Assembly (CCAA). The CCAA consists of a fan, a condensing heat exchanger (CHX), an air/water separator, temperature and liquid sensors, and electrical controlling hardware and software. The CHX is the primary component responsible for control of temperature and humidity. The CCAA CHX contains a chemical coating that was developed to be hydrophilic and thus attract water from the humid influent air. This attraction forms the basis for water removal and therefore cabin humidity control. However, there have been several instances of CHX coatings becoming hydrophobic and repelling water. When this behavior is observed in an operational CHX in the ISS segments, the unit s ability to remove moisture from the air is compromised and the result is liquid water carryover into downstream ducting and systems. This water carryover can have detrimental effects on the ISS cabin atmosphere quality and on the health of downstream hardware. If the water carryover is severe and widespread, this behavior can result in an inability to maintain humidity levels in the USOS. This paper will describe the operation of the five CCAAs within the USOS, the potential causes of the hydrophobic condition, and the impacts of the resulting water carryover to downstream systems. It will describe the history of this behavior and the actual observed impacts to the ISS USOS. Information on mitigation steps to protect the health of future CHX hydrophilic coatings as well as remediation and recovery of the full heat exchanger will be discussed.

Balistreri, Steven F.↗

Advanced Downhole Acoustic Sensing for Wellbore Integrity (Final Report)

Borehole cement is used across the range of energy technologies to stabilize casing, to serve as a barrier to behind-casing fluid movement. Cement debonding and other flaws, both at cement interfaces and within the cement itself, can create leakage pathways that can threaten safety to personnel, and wellbore performance, with economic and regulatory consequences. A primary method to assess cement health and wellbore integrity is via acoustic methods. This project was designed with three aims: demonstrate a significant improvement in the interpretation of cement acoustic behavior, both during curing, and in interpreting effects of flaws and evolving interfaces; develop sensor technologies to improve signal-noise ratios and cement acoustic responses; and lastly, provide a borehole demonstration of at least one of these technologies. We have accomplished the first two objectives, and the third, delayed by pandemic health concerns, is proceeding as of this writing via a technology partner with the University of Texas Advanced Energy Consortium.

15 GEOTHERMAL ENERGY↗

Rooftop solar and energy storage programs can remediate energy-limiting behaviors of energy insecure households in the United States

Energy insecurity, or the inability to afford energy needs, affects most low-income households in the United States and leads to risky choices and additional insecurities including food and health. Although there are government programs designed to provide relief from energy insecurity, eligibility is usually determined by household income, and those with incomes close to the threshold face uncertainty or may be left out. In many cases, these households turn to energy-limiting behaviors as a strategy to lower their electric utility bills. Here we explore the relationship between energy insecurity and energy-limiting behaviors and investigate alternative solutions such as energy storage and rooftop solar. This analysis demonstrates that solar and energy storage can offset two-thirds of the bill savings that households could attain through severe energy-limiting behavior. These systems could complement existing energy assistance programs to provide long-term bill relief, enabling occupants to live in their homes with comfort and dignity.

Kerby, Jessica R. [Pacific Northwest National Labo↗

National Renewable Energy Laboratory Wildland Fire Management Plan (August 2022-August 2025): February-August 2022

The National Renewable Energy Laboratory (NREL) is located in a moderate wildfire risk region. The region has a history of damaging wildland fire activity and is also susceptible to changing environmental conditions (drought, elevated temperatures) that may lead to an increase in wildfire frequency and consequence over time. An integrated, site-wide wildland fire management plan is required by the Department of Energy and is to be consistent with the Federal Wildland Fire Management Policy. The NREL Wildland Fire Management Plan (WFMP) provides an integrated approach to reducing risk to wildland fire at NREL. The goals of the WFMP are to protect human health and safety, protect NREL facilities and research, enhance community protection, diminish risk and consequences of wildland fires, and maintain the health of the ecosystem. The WFMP accomplishes these goals through the use of tools such as fire behavior modeling, fire growth modeling, a structure ignition risk assessment, and through the application of robust fire prevention, emergency management, and environmental programs. The NREL WFMP was developed in a collaborative manner with input from regional stakeholders including cities, counties, local fire departments, and other governmental agencies. The WFMP provides for recommendations to reduce overall wildland fire risk to life safety and property at NREL.

54 ENVIRONMENTAL SCIENCES↗

In-service health monitoring of composite structures

The aerospace industry is witnessing a vast utilization of composites in critical structural applications and anticipates even more use of them in future aircraft. Therefore, a definite need exists for a composite health monitoring expert system to meet today's current needs and tomorrow's future demands. The primary goal for this conceptual health monitoring system is functional reliably for in-service operation in the environments of various composite structures. The underlying philosophy of this system is to utilize proven vibration techniques to assess the structural integrity of a fibrous composite. Statistical methods are used to determine if the variances in the measured data are acceptable for making a reliable decision on the health status of the composite. The flexible system allows for algorithms describing any composite fatigue or damage behavior characteristic to be provided as an input to the system. Alert thresholds and variances can also be provided as an input to this system and may be updated to allow for future changes/refinements in the composite's structural integrity behavior.

Pinto, Gino A.↗

Qualitative Features Extraction from Sensor Data using Short-time Fourier Transform

The information gathered from sensors is used to determine the health of a sensor. Once a normal mode of operation is established any deviation from the normal behavior indicates a change. This change may be due to a malfunction of the sensor(s) or the system (or process). The step-up and step-down features, as well as sensor disturbances are assumed to be exponential. An RC network is used to model the main process, which is defined by a step-up (charging), drift, and step-down (discharging). The sensor disturbances and spike are added while the system is in drift. The system runs for a period of at least three time-constants of the main process every time a process feature occurs (e.g. step change). The Short-Time Fourier Transform of the Signal is taken using the Hamming window. Three window widths are used. The DC value is removed from the windowed data prior to taking the FFT. The resulting three dimensional spectral plots provide good time frequency resolution. The results indicate distinct shapes corresponding to each process.

Amini, Abolfazl M.↗

Mercury Speciation via Diffusive Gradients Thin-Films Technology

Objectives: Develop and test various diffusive gradient in thin films (DGT) samplers for mercury - SRNL is developing reactive DGTS (rDGTs). Test chemistry to differentiate methylmercury from total and/or inorganic mercury in environmental samples. Fabricate and test rDGT samplers for deployment. Deploy the rDGTs in variable settings. Mercury is a persistent-bioaccumulative-toxic environmental pollutant. Mercury exists in different species such as elemental, inorganic, and methyl. Mercury speciation determine mercury behavior and toxicity. For example, methylmercury strongly accumulates in biota such as fish resulting in potential human health impacts. DGTs are innovative samplers to measure water concentration by diffusion and capture. Types of Hg DGTs used: Total Hg, Inorganic Hg, and Methyl Hg. Deployment Sites: Upper Three Runs, Lower Three Runs, Steele Creek, East Fork Poplar Creek (SRNL Sites), Horizons Creek, NOA Creek, Bruners Creek (ORNL Sites). DGT concentration estimates closely matched alternative measurements for soluble mercury at each Oak Ridge site - DGTs did not respond to particulate mercury. DGTs provide a representative measure for biota uptake since they are left out longer which allows for an average exposure concentration. DMA-80 provided an efficient and quick analysis. Variability in site location made a difference in Hg species. DGT preparations and sampling wasn't as quick and simple as microcolumn technology. Copper reagent degraded agarose gel - more work and cleaner data are needed to assess speciation in rDGTs. Future Work: Use cross-linked polyacrylamide for the collection layer for a stronger plastic. Make a copper diffusion layer without agarose. Test copper separation in lab using realistic stream conditions such as high organic carbon.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

Physiological Health Challenges for Human Missions to Mars

During the next decades, manned space missions are expected to be aiming at the Lagrange points, near Earth asteroids, and Mars flyby and/or landing. The question is therefore: Are we ready to go? To answer this with a yes, we are currently using the International Space Station to develop an integrated human physiological countermeasure suite. The integrated countermeasure suite will most likely encounter: 1) Exercise devices for aerobic, dynamic and resistive exercise training; 2) sensory‐motor computer training programs and anti‐motion sickness medication for preparing EVAs and G‐transitions; 3) lower limb bracelets for preventing and/or treating the VIIP (vision impairment and intracranial pressure) syndrome; 4) nutritional components for maintenance of bone, muscle, the cardiovascular system and preventing oxidative stress and damage and immune deficiencies (e. g. omega‐3 fatty acids, PRO/K, anti‐oxidants and less salt and iron); 5) bisphosphonates for preventing bone degradation.; 6) lower body compression garment and oral salt and fluid loading for landing on a planetary surface to combat orthostatic intolerance; 7) laboratory analysis equipment for individualized monitoring of biomarkers in blood, urine and saliva for estimation of health status in; 8) advanced ultrasound techniques for monitoring bone and cardiovascular health; and 9) computer modeling programs for individual health status assessments of efficiency and subsequent adjustments of countermeasures. In particular for future missions into deep space, we are concerned with the synergistic effects of weightlessness, radiation, operational constraints and other spaceflight environmental factors. Therefore, increased collaboration between physiological, behavioral, radiation and space vehicle design disciplines are strongly warranted. Another venue we are exploring in NASA's Human Research Program is the usefulness of artificial gravity for mitigating the health risks of long duration weightlessness.

Norsk, Peter↗

Joint Analysis of the Epidemic Evolution and Human Mobility During the First Wave of COVID-19 in Spain: Retrospective Study

Background The initial wave of the COVID-19 pandemic placed a tremendous strain on health care systems worldwide. To mitigate the spread of the virus, many countries implemented stringent nonpharmaceutical interventions (NPIs), which significantly altered human behavior both before and after their enactment. Despite these efforts, a precise assessment of the impact and efficacy of these NPIs, as well as the extent of human behavioral changes, remained elusive. Objective In this study, we conducted a retrospective analysis of the initial wave of COVID-19 in Spain to better comprehend the influence of NPIs and their interaction with human behavior. Such investigations are vital for devising future mitigation strategies to combat COVID-19 and enhance epidemic preparedness more broadly. Methods We used a combination of national and regional retrospective analyses of pandemic incidence alongside large-scale mobility data to assess the impact and timing of government-implemented NPIs in combating COVID-19. Additionally, we compared these findings with a model-based inference of hospitalizations and fatalities. This model-based approach enabled us to construct counterfactual scenarios that gauged the consequences of delayed initiation of epidemic response measures. Results Our analysis demonstrated that the pre–national lockdown epidemic response, encompassing regional measures and heightened individual awareness, significantly contributed to reducing the disease burden in Spain. The mobility data indicated that people adjusted their behavior in response to the regional epidemiological situation before the nationwide lockdown was implemented. Counterfactual scenarios suggested that without this early epidemic response, there would have been an estimated 45,400 (95% CI 37,400-58,000) fatalities and 182,600 (95% CI 150,400-233,800) hospitalizations compared to the reported figures of 27,800 fatalities and 107,600 hospitalizations, respectively. Conclusions Our findings underscore the significance of self-implemented prevention measures by the population and regional NPIs before the national lockdown in Spain. The study also emphasizes the necessity for prompt and precise data quantification prior to enacting enforced measures. This highlights the critical interplay between NPIs, epidemic progression, and human behavior. This interdependence presents a challenge in predicting the impact of NPIs before they are implemented.

Public, Environmental & Occupational Health↗