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Changes in Oculomotor Behavior and PVT Reaction Time During One Night of Sleep Deprivation

INTRODUCTION: The Psychomotor Vigilance Test (PVT) is a widely used objective measure of sustained attention, alertness, and fatigue. Previous studies consistently show that prolonged wakefulness and disrupted sleep patterns lead to increased lapses of attention and slower reaction times. These findings have critical implications for various professions, including healthcare, aviation, transportation safety, and spaceflight. In this study, we employed linear mixed models (LMM) to investigate hourly-measured 5-minute PVT reaction times during one night of total sleep deprivation. Our goal was to characterize the contribution of homeostatic sleep pressure (time awake) and circadian phase (salivary melatonin levels) on the dynamics of PVT reaction time. MATERIALS & METHODS: Data from twelve human participants were used in the analysis. Participants were healthy non-smokers, aged 18 and 40, with normal sleep habits defined as Pittsburg Sleep Quality Index scores < 5, and Morningness – Eveningness Questionnaire scores > 42 and < 58, respectively. Participants followed a constant-routine protocol and arrived at the NASA sleep laboratory approximately 1 to 2 hours after their habitual waking time. Tympanic temperature was measured every 30 min to provide a real-time estimate of circadian phase. Participants were required to stay awake throughout the laboratory experiment, which continued until their tympanic temperature had returned to baseline levels. This approach ensured that we could capture each participant's circadian trough and recovery, typically occurring between 24 and 26 hours after waking. The PVT and saliva melatonin were measured every hour, starting approximately from 3 hours after awakening. More information about the measurement protocol can be found in the publication by Stone et al. We used PVT reaction times between 100 and 10000 ms to calculate Reciprocal Reaction Times (RRTs). LMM models were employed to assess the contribution of time awake and saliva melatonin levels on changes in RRTs. Two models were created: the first model treated time awake as a fixed effect and the second model considered both the salivary melatonin level and time awake as fixed effects. Participants were included as a random effect in both models. We compared the models using an Analysis of Variance (ANOVA). The models were computed using the 'lmer' function from the 'lme4' package in R, and LMM p-values were determined using Satterthwaite's method. RESULTS: We found that time awake had a statistically significant effect on PVT RRTs during one night of sleep deprivation [χ2 = 2132.4, df = 1, p < 0.001]. In addition, the model including both saliva melatonin levels and time awake was statistically significantly better than one that uses just time awake [χ2 = 17.4, df = 1, p < 0.001]. DISCUSSION & CONCLUSION: As expected, these preliminary results suggest that the time awake and circadian phase each contribute to performance reductions as measured by the PVT. Future analyses will explore the contributions of other factors to the model.

sleep deprivation↗

Countermeasures to Neurobehavioral Deficits from Cumulative Partial Sleep Deprivation During Space Flight

This project is concerned with identifying ways to prevent neurobehavioral and physical deterioration due to inadequate sleep in astronauts during long-duration manned space flight. The performance capability of astronauts during extended-duration space flight depends heavily on achieving recovery through adequate sleep. Even with appropriate circadian alignment, sleep loss can erode fundamental elements of human performance capability including vigilance, cognitive speed and accuracy, working memory, reaction time, and physiological alertness. Adequate sleep is essential during manned space flight not only to ensure high levels of safe and effective human performance, but also as a basic regulatory biology critical to healthy human functioning. There is now extensive objective evidence that astronaut sleep is frequently restricted in space flight to averages between 4 hr and 6.5 hr/day. Chronic sleep restriction during manned space flight can occur in response to endogenous disturbances of sleep (motion sickness, stress, circadian rhythms), environmental disruptions of sleep (noise, temperature, light), and curtailment of sleep due to the work demands and other activities that accompany extended space flight operations. The mechanism through which this risk emerges is the development of cumulative homeostatic pressure for sleep across consecutive days of inadequate sleep. Research has shown that the physiological sleepiness and performance deficits engendered by sleep debt can progressively worsen (i.e., accumulate) over consecutive days of sleep restriction, and that sleep limited to levels commonly experienced by astronauts (i.e., 4 - 6 hr per night) for as little as 1 week, can result in increased lapses of attention, degradation of response times, deficits in complex problem solving, reduced learning, mood disturbance, disruption of essential neuroendocrine, metabolic, and neuroimmune responses, and in some vulnerable persons, the emergence of uncontrolled sleep attacks. The prevention of cumulative performance deficits and neuroendocrine disruption from sleep restriction during extended duration space flight involves finding the most effective ways to obtain sleep in order to maintain the high-level cognitive and physical performance functions required for manned space flight. There is currently a critical deficiency in knowledge of the effects of how variations in sleep duration and timing relate to the most efficient return of performance per unit time invested in sleep during long-duration missions, and how the nature of sleep physiology (i.e., sleep stages, sleep electroencephalographic [EEG] power spectral analyses) change as a function of sleep restriction and performance degradation. The primary aim of this project is to meet these critical deficiencies through utilization of a response surface experimental paradigm, testing in a dose-response manner, varying combinations of sleep duration and timing, for the purpose of establishing how to most effectively limit the cumulative adverse effects on human performance and physiology of chronic sleep restriction in space operations.

Dinges, David F.↗

Collision in space

On June 25, 1997, the Russian supply spacecraft Progress 234 collided with the Mir space station, rupturing Mir's pressure hull, throwing it into an uncontrolled attitude drift, and nearly forcing evacuation of the station. Like many high-profile accidents, this collision was the consequence of a chain of events leading to the final piloting errors that were its immediate cause. The discussion in this article does not resolve the relative contributions of the actions and decisions in this chain. Neither does it suggest corrective measures, many of which are straightforward and have already been implemented by the National Aeronautics and Space Administration (NASA) and the Russian Space Agency. Rather, its purpose is to identify the human factors that played a pervasive role in the incident. Workplace stress, fatigue, and sleep deprivation were identified by NASA as contributory factors in the Mir-Progress collision (Culbertson, 1997; NASA, forthcoming), but other contributing factors, such as requiring crew to perform difficult tasks for which their training is not current, could potentially become important factors in future situations.

Mir Project↗

Oculomotor Behavior Metrics Change According to Circadian Phase and Time Awake

There is a need for non-invasive, objective measures to forecast performance impairment arising from sleep loss and circadian misalignment, particularly in safety-sensitive occupations. Eye-tracking devices have been used in some operational scenarios, but such devices typically focus on eyelid closures and slow rolling eye movements and are susceptible to the intrusion of head movement artifacts. We hypothesized that an expanded suite of oculomotor behavior metrics, collected during a visual tracking task, would change according to circadian phase and time awake, and could be used as a marker of performance impairment.

sleep deprivation↗

Validating and Verifying Biomathematical Models of Human Fatigue

Airline pilots experience acute and chronic sleep deprivation, sleep inertia, and circadian desynchrony due to the need to schedule flight operations around the clock. This sleep loss and circadian desynchrony gives rise to cognitive impairments, reduced vigilance and inconsistent performance. Several biomathematical models, based principally on patterns observed in circadian rhythms and homeostatic drive, have been developed to predict a pilots levels of fatigue or alertness. These models allow for the Federal Aviation Administration (FAA) and commercial airlines to make decisions about pilot capabilities and flight schedules. Although these models have been validated in a laboratory setting, they have not been thoroughly tested in operational environments where uncontrolled factors, such as environmental sleep disrupters, caffeine use and napping, may impact actual pilot alertness and performance. We will compare the predictions of three prominent biomathematical fatigue models (McCauley Model, Harvard Model, and the privately-sold SAFTE-FAST Model) to actual measures of alertness and performance. We collected sleep logs, movement and light recordings, psychomotor vigilance task (PVT), and urinary melatonin (a marker of circadian phase) from 44 pilots in a short-haul commercial airline over one month. We will statistically compare with the model predictions to lapses on the PVT and circadian phase. We will calculate the sensitivity and specificity of each model prediction under different scheduling conditions. Our findings will aid operational decision-makers in determining the reliability of each model under real-world scheduling situations.

fatigue↗

The Effects of Chronic Sleep Restriction on Multiple Object Tracking

The ability to simultaneously track numerous moving objects in the presence of irrelevant stimuli is essential for carrying out a variety of tasks. Sleep loss has been found to impair neurocognitive functioning and, as a result, attentional processing capacity is reduced. A common form of sleep loss is chronic sleep restriction (CSR), in which an inadequate amount of sleep is obtained over consecutive days. The objective of the current study was to determine if performance on the multiple object tracking (MOT) task was adversely impacted by a week of CSR. Twelve healthy participants (6 males, 6 females) kept a fixed sleep-wake schedule, with a constant waketime, at home for four weeks (activity monitors worn on the participant’s nondominant wrist were used to confirm compliance). Weeks one and three were deemed washout weeks, during which participants maintained a 9-hour sleep-wake schedule. Weeks two and four were deemed experimental weeks, during which participants were randomly assigned a 5-hour (CSR) and 9-hour (sleep satiation) sleep-wake schedule. Following night seven of each experimental week, participants completed a 13-hour laboratory visit under dim light (less than 15 lux) where they maintained a constant posture and were provided with hourly isocaloric snacks. MOT was presented at approximately 6 and 8 hours after waking. Participants were required to track four, five, or six moving targets in the presence of identical distractors (always 12 total objects). It was found that participants slept significantly less during the week of CSR compared to the week of sleep satiation. There was no difference in the overall proportion of correct MOT responses following the CSR and sleep satiation weeks. However, an additional analysis examining only the 6 target condition found that the proportion of correct responses was significantly lower following the week of CSR. These findings suggest that CSR has an adverse impact on tracking performance when the cognitive demand was higher. This has implications for individuals, such as air traffic controllers and truck drivers, who must visually track multiple moving objects under high workload situations, often while chronically sleep deprived.

sleep restriction↗

'And we were tired' fatigue and aircrew errors

Cooper, White, and Lauber analyzed jet-transport accidents worldwide for the period 1968 to 1976 and found more than 60 in which breakdowns of the crew-performance and decision-making process played a pivotal role. It is the contention of this paper that the results reported by Cooper, et al., are related to fatigue and that fatigue is related to sleep deprivation, circadian desynchronosis, and lack of good nutrition. It is further argued, and supporting research is cited, that fatigue does not cause loss of skill in flying the aircraft but may have disastrous effects on judgmental and decision-making functions.

Ritter, Richard D.↗

Distinct Pattern of Oculomotor Impairment Associated with Acute Sleep Loss and Circadian Misalignment

Sleep loss and circadianmisalignment have long been known to impair human cognitive and motor performance with significant societal and health consequences. It is well known that human reaction time to a visual cue is impaired following sleep loss and circadian misalignment, but it has remained unclear how more complex visuomotor control behaviour is altered under these conditions. In this study, we measured 14 parameters of the voluntary ocular tracking response of 12 human participants (six females) to systematically examine the effects of sleep loss and circadianmisalignment using a constant routine 24 h acute sleep-deprivation paradigm. The combination of state-of-the-art oculometric and sleep-research methodologies allowed us to document, for the first time, large changes in many components of pursuit, saccades and visual motion processing as a function of time awake and circadian phase. Further, we observed a pattern of impairment across our set of oculometric measures that is qualitatively different from that observed previously with other mild neural impairments. We conclude that dynamic vision and visuomotor control exhibit a distinct pattern of impairment linked with time awake and circadian phase. Therefore, a sufficiently broad set of oculometric measures could provide a sensitive and specific behavioural biomarker of acute sleep loss and circadian misalignment. We foresee potential applications of such oculometric biomarkers assisting in the assessment of readiness-to-perform higher risk tasks and in the characterization of sub-clinical neural impairment in the face of a multiplicity of potential risk factors, including disrupted sleep and circadian rhythms.

Stone, Leland S.↗

Protecting Neural Structures and Cognitive Function During Prolonged Space Flight by Targeting the Brain Derived Neurotrophic Factor Molecular Network

Brain derived neurotrophic factor (BDNF) is the main activity-dependent neurotrophin in the human nervous system. BDNF is implicated in production of new neurons from dentate gyrus stem cells (hippocampal neurogenesis), synapse formation, sprouting of new axons, growth of new axons, sprouting of new dendrites, and neuron survival. Alterations in the amount or activity of BDNF can produce significant detrimental changes to cortical function and synaptic transmission in the human brain. This can result in glial and neuronal dysfunction, which may contribute to a range of clinical conditions, spanning a number of learning, behavioral, and neurological disorders. There is an extensive body of work surrounding the BDNF molecular network, including BDNF gene polymorphisms, methylated BDNF gene promoters, multiple gene transcripts, varied BDNF functional proteins, and different BDNF receptors (whose activation differentially drive the neuron to neurogenesis or apoptosis). BDNF is also closely linked to mitochondrial biogenesis through PGC-1alpha, which can influence brain and muscle metabolic efficiency. BDNF AS A HUMAN SPACE FLIGHT COUNTERMEASURE TARGET Earth-based studies reveal that BDNF is negatively impacted by many of the conditions encountered in the space environment, including oxidative stress, radiation, psychological stressors, sleep deprivation, and many others. A growing body of work suggests that the BDNF network is responsive to a range of diet, nutrition, exercise, drug, and other types of influences. This section explores the BDNF network in the context of 1) protecting the brain and nervous system in the space environment, 2) optimizing neurobehavioral performance in space, and 3) reducing the residual effects of space flight on the nervous system on return to Earth

Schmidt, M. A.↗

Quantitative EEG Monitoring of Vigilance: Effects of Sleep Deprivation, Circadian Phase and Sympathetic Activation

Shuttle astronauts typically sleep only 6 to 6.5 hours per day while in orbit. This sleep loss is related to recurrent sleep cycle shifting--due to mission-dependent orbital mechanics and mission duration requirements-- and associated circadian displacement of sleep, the operational demands of space flight, noise and space motion sickness. Such sleep schedules are known to produce poor subjective sleep quality, daytime sleepiness, reduced attention, negative mood, slower reaction times, and impaired daytime alertness. Countermeasures to allow crew members to obtain an adequate amount of sleep and maintain adequate levels of neurobehavioral performance are being developed and investigated. However, it is necessary to develop methods that allow effective and attainable in-flight monitoring of vigilance to evaluate the effectiveness of these countermeasures and to detect and predict online critical decrements in alertness/performance. There is growing evidence to indicate that sleep loss and associated decrements in neurobehavioral function are reflected in the spectral composition of the electroencephalogram (EEG) during wakefulness as well as in the incidence of slow eye movements recorded by the electro-oculogram (EOG). Further-more, our preliminary data indicated that these changes in the EEG during wakefulness are more pronounced when subjects are in a supine posture, which mimics some of the physiologic effects of microgravity. Therefore, we evaluate the following hypotheses: (1) that during a 40-hour period of wakefulness (i.e., one night of total sleep deprivation) neurobehavioral function deteriorates, the incidence of slow eye-movements and EEG power density in the theta frequencies increases especially in frontal areas of the brain; (2) that the sleep deprivation induced deterioration of neurobehavioral function and changes in the incidence of slow eye movements and the spectral composition of the EEG are more pronounced when subjects are in a supine position; and (3) that based on assessment of slow-eye movements and quantitative on-line topographical analyses of EEG during wakefulness an EEG and or EOG parameter can be derived/constructed which accurately predicts changes in neurobehavioral function.

Dijk, Derk-Jan↗

Human Factors and Behavioral Performance Exploration Measures Harmonized Across HERA, NEK, and ISS: Teams Risk

BACKGROUNDThe Human Factors and Behavioral Performance Exploration Measures (HFBP-EM) suite is a set of standardized measures to assess behavioral health and performance risk related to future exploration class missions, and to support reduction of the Human Research Program’s (HRP) Behavioral Medicine (BMed), Team, Sleep, and Human Systems Integration Architecture risks. HFBP-EM were collected during Human Exploration Research Analogs (HERA) campaigns 4 (C4) and 5 (C5), and during SIRIUS 17 and 19 missions in the Russian Ground Based Experiment Complex, NEK, to document the feasibility, flexibility, and acceptability of these measures in analogsof the spaceflight environment. A subset of the HFBP-EM suite was collected during spaceflight as part HRP’s Standard Measures in Spaceflight Project. Whenever possible, the HFBP-EM protocol and measures are kept the same across studies, however, differences across research settings (e.g., experimental manipulations, mission scenarios, mission length) and implementation of the measures require the data are harmonized to ensure comparable views across missions. The purpose of our project is to develop a harmonized database of HFBP-EM data from different settings, and to summarize the trajectory of behavioral health and performance within and between research settings. In this presentation, we will summarize the harmonized dataset and the trajectory of measures related to the Team Risk, including team performance, team cohesion, team processes, and psychological safety, over time and between and within settings.METHODSWe followed best practices for data harmonization. Characteristics of each research setting were assessed for harmonization potential, and we deemed NEK-SIRIUS 17 as inappropriate due to study aims, length, and data quality. Common variables of interest were identified. Study characteristics and key variables with which datafiles could be merged were defined as “meta-data.” HFBP-EM data from all settings were processed under a common format. We then created a harmonized team-level database designed to facilitate analyses that address HRP research gaps related to HRP’s Team risk. In this database, team cohesion, processes, performance, psychological safety, and group living were operationalized as the team mean of the crew responses for each data collection (e.g., on mission day 7). Data collected on the International Space Station (ISS) included a subset of scale items administered to participants. Data collected from ISS team members within +/- 7 days of the first data collection and every following 30 +/-4 days were aggregated to the team level. We generated figures that display the mean and variability of team constructs across research settings. We also generated plots of changes in team constructs with mission day and with percentage of the mission completed. Where possible, we compared data from spaceflight analogs with data from astronauts aboard the ISS. RESULTS AND DISCUSSIONThe team-level harmonized database was structured such that each row represents data for a team on a specific mission day. Team constructs (e.g., team cohesion) were included as columns (i.e., wide format) with repeated measures across mission days given in rows (i.e., long format). The database included data from 18 crews: five, 4-person American crews in HERA C4, four 4-person American crews in HERA C5, one 6-person multinational crew in NEK-SIRIUS 19, and eight, 2–11-person multinational crews aboard the ISS. Results provide insights into mission and campaign differences in team functioning and performance. For example, between campaign differences were observed for team processes—the interdependent team actions that orchestrate taskwork in pursuit of the team’s goals [1]. Greater between-team variability on team processes was detected during HERA C4 than during C5, and a downward trend was observed over the duration of C4, but not C5 or SIRIUS 19. This may be due to the campaign-level differences such as the sleep deprivation implemented during C4. Responses on the subset of team process items administered on the ISS indicate between-crew variability more like those observed in C4 than C5 and NEK, with some, but not all ISS crews demonstrating a downward trend over time. Additional findings will be presented. REFERENCESMarks, M. A., et al (2001) Academy of Management Review, 26(3), 356-376.

S T Bell↗

Photic effects on sustained performance

Research is described which evaluates manipulating environmental light intensity as a means to attenuate fatigue. A counter balanced, within-subjects design was used to compare nine male subjects exposed to dim (100 lux) and bright (3000 lux) light conditions. Oral temperature values were greater for the bright light group over the dim light condition. Melatonin levels were suppressed by bright light treatment. Also, the frequency of eye blink rate was less for subjects during bright over dim light exposure. Light exposure was without effect on subjective fatigue. However, irrespective of light condition, significant effects on confusion, fatigue, and vigor mood dimensions were found as a result of 30 hour sleep deprivation. The findings suggest that bright lights may be used to help sustain nocturnal activity otherwise susceptible to fatigue. Such findings may have implications for the lighting arrangements on space flights during the subjective night for astronauts.

French, J.↗

A differential approach to microcomputer test battery development and implementation

The present microcomputer-based performance test battery emphasizes psychometric theory and utility for repeated-measures applications during extended exposure to various environmental stressors. In the menu that has been defined at the current state of this system's development, there are more than 30 'qualified' mental tests which stabilize in less than 10 min and possess test-retest reliabilities greater than 0.7 for a three-minute test/work period. The battery encompasses tests of cognition, information processing, psychomotor skill, memory, mood, etc. Several of the tests have demonstrated sensitivity to chemoradiotherapy, sleep loss, hypoxia, amphetamines, thermal stress, sensory deprivation, altitude, fatigue, and alcohol use. Recommendations are presented for 6-, 12-, and 22-min batteries.

Kennedy, R. S.↗

Slow Wave Sleep and Long Duration Spaceflight

While ground research has clearly shown that preserving adequate quantities of sleep is essential for optimal health and performance, changes in the progression, order and /or duration of specific stages of sleep is also associated with deleterious outcomes. As seen in Figure 1, in healthy individuals, REM and Non-REM sleep alternate cyclically, with stages of Non-REM sleep structured chronologically. In the early parts of the night, for instance, Non-REM stages 3 and 4 (Slow Wave Sleep, or SWS) last longer while REM sleep spans shorter; as night progresses, the length of SWS is reduced as REM sleep lengthens. This process allows for SWS to establish precedence , with increases in SWS seen when recovering from sleep deprivation. SWS is indeed regarded as the most restorative portion of sleep. During SWS, physiological activities such as hormone secretion, muscle recovery, and immune responses are underway, while neurological processes required for long term learning and memory consolidation, also occur. The structure and duration of specific sleep stages may vary independent of total sleep duration, and changes in the structure and duration have been shown to be associated with deleterious outcomes. Individuals with narcolepsy enter sleep through REM as opposed to stage 1 of NREM. Disrupting slow wave sleep for several consecutive nights without reducing total sleep duration or sleep efficiency is associated with decreased pain threshold, increased discomfort, fatigue, and the inflammatory flare response in skin. Depression has been shown to be associated with a reduction of slow wave sleep and increased REM sleep. Given research that shows deleterious outcomes are associated with changes in sleep structure, it is essential to characterize and mitigate not only total sleep duration, but also changes in sleep stages.

Whitmire, Alexandra↗

Speed of mental processing in the middle of the night

This study aimed to determine whether human mental processing actually slows down during the night hours, separately from the previously documented microsleeps, lapses in attention, and general slowing of motor responses. Eighteen healthy young adults were studied during 36 hours of constant wakeful bedrest. Every 2 hours, they performed a logical reasoning task. Items phrased in the negative voice took reliably longer to respond to than items phrased in the positive voice, indicating the need for more mental processing in those items. By subtracting "negative" from "positive" reaction times at each time of day, we were able to plot a circadian rhythm in the time taken for this extra mental processing to be done separately from microsleeps, psychomotor slowing, and inattention. The extra mental processing took longer at night and on the day following sleep loss than it did during the day before the sleep loss, suggesting that human mental processing slows down during the night under sleep deprivation.

Non-NASA Center↗

Cardiovascular Deconditioning in Humans: Human Studies Core

Major cardiovascular problems, secondary to cardiovascular deconditioning, may occur on extended space missions. While it is generally assumed that the microgravity state is the primary cause of cardiovascular deconditioning, sleep deprivation and disruption of diurnal rhythms may also play an important role. Factors that could be modified by either or both of these perturbations include: autonomic function and short-term cardiovascular reflexes, vasoreactivity, circadian rhythm of cardiovascular hormones (specifically the renin-angiotensin system) and renal sodium handling and hormonal influences on that process, venous compliance, cardiac mass, and cardiac conduction processes. The purpose of the Human Studies Core is to provide the infrastructure to conduct human experiments which will allow for the assessment of the likely role of such factors in the space travel associated cardiovascular deconditioning process and to develop appropriate countermeasures. The Core takes advantage of a newly-created Intensive Physiologic Monitoring (IPM) Unit at the Brigham and Women's Hospital, Boston, MA, to perform these studies. The Core includes two general experimental protocols. The first protocol involves a head down tilt bed-rest study to simulate microgravity. The second protocol includes the addition of a disruption of circadian rhythms to the simulated microgravity environment. Before and after each of these environmental manipulations, the subjects will undergo acute stressors simulating changes in volume and/or stress, which could occur in space and on return to Earth. The subjects are maintained in a rigidly controlled environment with fixed light/dark cycles, activity pattern, and dietary intake of nutrients, fluids, ions and calories.

Williams, Gordon↗

NASA HRP Plans for Collaboration at the IBMP Ground-Based Experimental Facility (NEK)

NASA and IBMP are planning research collaborations using the IBMP Ground-based Experimental Facility (NEK). The NEK offers unique capabilities to study the effects of isolation on behavioral health and performance as it relates to spaceflight. The NEK is comprised of multiple interconnected modules that range in size from 50-250m(sup3). Modules can be included or excluded in a given mission allowing for flexibility of platform design. The NEK complex includes a Mission Control Center for communications and monitoring of crew members. In an effort to begin these collaborations, a 2-week mission is planned for 2017. In this mission, scientific studies will be conducted to assess facility capabilities in preparation for longer duration missions. A second follow-on 2-week mission may be planned for early in 2018. In future years, long duration missions of 4, 8 and 12 months are being considered. Missions will include scenarios that simulate for example, transit to and from asteroids, the moon, or other interplanetary travel. Mission operations will be structured to include stressors such as, high workloads, communication delays, and sleep deprivation. Studies completed at the NEK will support International Space Station expeditions, and future exploration missions. Topics studied will include communication, crew autonomy, cultural diversity, human factors, and medical capabilities.

Cromwell, Ronita L.↗