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NASA Astronaut Selection 2009: Behavioral Overview

Behavioral Health and Performance (BHP) is an operational group under medical sciences at NASA/Johnson Space Center. Astronaut applicant screening and assessment is one function of this group, along with psychological training, inflight behavioral support and family services. Direct BHP assessment spans 6-7 months of a 17-month overall selection process.

Holland, A.↗

Volumetric 3D Display System with Static Screen

Current display technology has relied on flat, 2D screens that cannot truly convey the third dimension of visual information: depth. In contrast to conventional visualization that is primarily based on 2D flat screens, the volumetric 3D display possesses a true 3D display volume, and places physically each 3D voxel in displayed 3D images at the true 3D (x,y,z) spatial position. Each voxel, analogous to a pixel in a 2D image, emits light from that position to form a real 3D image in the eyes of the viewers. Such true volumetric 3D display technology provides both physiological (accommodation, convergence, binocular disparity, and motion parallax) and psychological (image size, linear perspective, shading, brightness, etc.) depth cues to human visual systems to help in the perception of 3D objects. In a volumetric 3D display, viewers can watch the displayed 3D images from a completely 360 view without using any special eyewear. The volumetric 3D display techniques may lead to a quantum leap in information display technology and can dramatically change the ways humans interact with computers, which can lead to significant improvements in the efficiency of learning and knowledge management processes. Within a block of glass, a large amount of tiny dots of voxels are created by using a recently available machining technique called laser subsurface engraving (LSE). The LSE is able to produce tiny physical crack points (as small as 0.05 mm in diameter) at any (x,y,z) location within the cube of transparent material. The crack dots, when illuminated by a light source, scatter the light around and form visible voxels within the 3D volume. The locations of these tiny voxels are strategically determined such that each can be illuminated by a light ray from a high-resolution digital mirror device (DMD) light engine. The distribution of these voxels occupies the full display volume within the static 3D glass screen. This design eliminates any moving screen seen in previous approaches, so there is no image jitter, and has an inherent parallel mechanism for 3D voxel addressing. High spatial resolution is possible with a full color display being easy to implement. The system is low-cost and low-maintenance.

Geng, Jason↗

Operational Evaluation of VEGGIE Food Production System in the Habitat Demonstration Unit

The 2010 Desert Research and Technology Studies (DRATS) of the VEGGIE Food Production System in the Habitat Demonstration Unit (HDU) Pressurized Excursion Module (PEM) was the first operational evaluation of salad crop production technology in a NASA analog test. A systematic evaluation of rooting media and nutrient delivery systems were evaluated for three lettuce cultivars that have shown promise as candidates for a surface based food production system. The VEGGIE nutrient delivery system worked well, was able to be maintained by multiple operators with a minimum of training, and supported excellent lettuce growth for the duration of the test. A Hazard Analysis and Critical Control Point (HACCP) evaluation was performed using ProSan(tm) as sanitation agent prior to consumption was approved, and the crew was allowed to consume the lettuce grown using the VEGGIE light cap and gravity based nutrient delivery system at the completion of the 14-day DRAT field test. The DRAT field test validated the crew operations; Growth of all lettuce cultivars was excellent. The operational DRAT field testing in the HDU identified light quality issues related to morphology and pigment development that will need to be addressed through additional testing. Feedback from the crew, ground support personnel, and human factors leads was uniformly positive on the psychological value of having the crop production system in the excursion module. A number of areas have been identified for future work, to minimize the "footprint" of the Food Production system through creative use of unused wall and floor space in the unit.

Stutte, Gary W.↗

Operation Evaluation of the VEGGIE Food Production System in the Habitat Demonstration Unit

The 2010 Desert Research and Technology Studies (DRATS) of the VEGGIE Food Production System in the Habitat Demonstration Unit (HDU) Pressurized Excursion Module (PEM) was the first operational evaluation of salad crop production technology in a NASA analog test. A systematic evaluation of rooting media and nutrient delivery systems were evaluated for three lettuce cultivars that have shown promise as candidates for a surface based food production system. The VEGGIE nutrient delivery system worked well, was able to be maintained by multiple operators with a minimum of training, and supported excellent lettuce growth for the duration of the test. A Hazard Analysis and Critical Control Point (HACCP) evaluation was performed using ProSantm as sanitation agent prior to consumption was approved, and the crew was allowed to consume the lettuce grown using the VEGGIE light cap and gravity based nutrient delivery system at the completion of the 14-day DRAT field test. The DRAT field test validated the crew operations; Growth of all lettuce cultivars was excellent. The operational DRAT field testing in the HDU identified light quality issues related to morphology and pigment development that will need to be addressed through additional testing. Feedback from the crew, ground support personnel, and human factors leads was uniformly positive on the psychological value of having the crop production system in the excursion module. A number of areas have been identified for future work, to minimize the "footprint" of the Food Production system through creative use of unused wall and floor space in the unit.

Stutte, Gary W.↗

Human Research Program Integrated Research Plan

Crew health and performance are critical to successful human exploration beyond low Earth orbit. The Human Research Program (HRP) is essential to enabling extended periods of space exploration because it provides knowledge and tools to mitigate risks to human health and performance. Risks include physiological effects from radiation and hypogravity environments, as well as unique challenges in medical support, human factors, and behavioral or psychological factors. The Human Research Program (HRP) delivers human health and performance countermeasures, knowledge, technologies and tools to enable safe, reliable, and productive human space exploration. Without HRP results, NASA will face unknown and unacceptable risks for mission success and post-mission crew health. This Integrated Research Plan (IRP) describes (1) HRP's approach and research activities that are intended to address the needs of human space exploration and serve HRP customers and (2) the method of integration for risk mitigation. The scope of the IRP is limited to the activities that can be conducted with the resources available to the HRP; it does not contain activities that would be performed if additional resources were available. The timescale of human space exploration is envisioned to take many decades. The IRP illustrates the program s research plan through the timescale of early lunar missions of extended duration.

Steinberg, Susan↗

Growth of Three Lettuce Cultivars in NASA's HDU PEM During the 2010 DRATS Test

NASA's 2010 Desert Research and Technology Studies (DRATS) of the VEGGIE Food Production System in the Habitat Demonstration Unit (HDU) Pressurized Excursion Module (PEM) was the first operational evaluation of salad crop production technology in a NASA analog test. Rooting media and slow release fertilizers were evaluated for three lettuce cultivars that had shown promise as candidates for a surface based food production system. These tests involved comparing growth, color and quality of the lettuce cultivars grown under VEGGIE LED array (Orbitec, Madison, WI) or Biomass Production System for Education ((BSEe), Orbitec, Madison, WI) compact fluorescent lamps using a gravity feed water delivery system. Mission relevant conditions of CO2, temperature and RH were maintained using controlled environment chambers (EGC, Chagrin Falls, OH). Growth data was obtained for the two red leaf lettuce cultivars, Outredgeous and Firecracker, and the green Bibb lettuce cultivar, Flandria. Growth and quality was evaluated using different concentrations (7.5 g/L and 15 g/L) of commercial slow release fertilizer (Osmocote Plus 15-9-12, Scotts, Maryville, OH) and Nutricote 18-6-8 (Florikan, Sarasota, FL) in either a peat/vermiculite media (sunshine LP5 MiX, Sungro, Bellview, WA) or calcined montmorillonite clay [(arcillite,)Turface Proleague, Profile LLC, Buffalo Grove, IL]. The commercial peat/vermiculite mix generally resulted in larger plants than those grown in arcillite. Increasing the concentration of Osmocote from 7.5 to 15 g/L increased the height, dry mass, and leaf area of lettuce cultivars. In contrast, there was a decrease in growth parameters when concentration of Nutricote was increased from 7.5 to 15 g/L. The best growth was obtained with the 7.5 g/L Nutricote using a commercial peat/vermiculite mixture. This media was used for field testing VEGGIE plant system in the 2010 DRAT test. The VEGGIE nutrient delivery system worked well, was able to be maintained by multiple operators with a minimum of training, and supported excellent lettuce growth for the duration of the 14-day test. The operational DRAT field testing in the HDU identified light quality issues related to morphology and pigment development that will need to be addressed through additional testing. Feedback from the crew, ground support personnel, and human factors leads was uniformly positive on the psychological value of having the crop production system in the pressurized excursion module. Data are being used to design a plant atrium with LED lighting to evaluate salad crop growth during NASA's 2011 DRATS test.

Stutte, Gary W.↗

VEGGIE Pillow Testing: Microbial Analysis of Cut-and-Come-Again Species Testing

With NASA focused on researching and developing technology for deep space missions, the need for a reliable supplementary food source must also be considered. For the ISS, resupplying the food source is more practical and cost effect since the facility is in low Earth orbit. However, as NASA attempts to push the frontier in space, the costs and distance for resupply will surely increase. Plants would contribute to the proportion of food and reduce the dependency on food from Earth. In addition, plants would provide oxygen production, carbon dioxide removal, and psychological benefits. As a result, a vegetable production system, VEGGIE, was developed for NASA to produce salad crops with minimal resources and study the beneficial effects. The VEGGIE pillow is a single use bag for growing crops that is used with the VEGGIE hardware. The VEGGIE pillow was tested with four different species of plants with the cut-and-come-again harvest method to determine the greatest yield. Instead of harvesting the entire plant, the harvest consisted of cutting leaves to allow the plant to regrow leaves. The harvest methods included cutting the plants weekly, bi-weekly, and monthly. A fifth plant species, radishes, was also harvested and replanted. Microbial load analysis and an ANOVA significance test were utilized. The data suggest that the two Brassica plants have the greatest yields; however, the microbial load is also greatest for the two plants per gram of fresh weight. Furthermore, the results support the reuse of pillows for multiple harvests as shown by the replanted radishes.

Nguyen, Bao-Thang↗

Cognitive Behavioral Training and Education for Spaceflight Operations

Cognitive behavioral-training (CBT) is an evidence-based practice commonly used to help treat insomnia, and is part of NASA's countermeasure regimen for Fatigue Management. CBT addresses the life style and habits of individuals that are maladaptive to managing stress and fatigue. This includes addressing learned behavioral responses that may cause stress and lead to an increased sense of fatigue. While the initial cause of onset of fatigue in the individual may be no longer present, the perception and engrained anticipation of fatigue persist and cause an exaggerated state of tension. CBT combined with relaxation training allows the individual to unlearn the maladaptive beliefs and behaviors and replace them with routines and techniques that allow cognitive restructuring and resultant relief from stress. CBT allows for elimination in individuals of unwanted ruminating thoughts and anticipatory anxiety by, for example, training the individuals to practice stressful situations in a relaxed state. As a result of CBT, relaxation can be accomplished in many ways, such as progressive muscle relaxation, meditation and guided imagery. CBT is not therapy, but rather the synthesis of behavioral countermeasures. CBT utilizes progressive relaxation as a means of reinforcing educational and cognitive countermeasures. These countermeasures include: masking, elimination of distracting thoughts, anxiety control, split attention, cognitive restructuring and other advanced psychological techniques.

Moonmaw, Ronald↗

Defining the Relationship Between Biomarkers of Oxidative and Inflammatory Stress and the Risk for Atherosclerosis in Astronauts During and After Long-Duration Spaceflight

Future human space travel will primarily consist of long-duration missions aboard the International Space Station (ISS) or exploration class missions to Mars, its moons, or nearby asteroids. These missions will expose astronauts to increased risk of oxidative and inflammatory damage primarily from radiation, but also from psychological stress, reduced physical activity, diminished nutritional status, and, in the case of extravehicular activity, hyperoxic exposure. There is evidence that increased oxidative damage and inflammation can accelerate the development of atherosclerosis. PURPOSE The purpose of this proposal is to identify biomarkers of oxidative and inflammatory stress and to correlate them to indices of atherosclerosis risk before, during, and after long-duration spaceflight. METHODS To meet the objectives of the study, we will study astronauts before, during, and up to 5 years after long-duration missions aboard ISS. Biomarkers of oxidative and inflammatory stress, some of which we have previously shown to be elevated with spaceflight, will be measured before, during, and after spaceflight. Arterial structure will be monitored using ultrasound to measure carotid intima-medial thickness before, during, and after weightlessness. Carotid intima-medial thickness has been shown to be a better indicator than Framingham Risk scores for prediction of atherosclerosis. Arterial function will be monitored using brachial flow-mediated dilation before flight and after landing. Brachial flow-mediated dilation is a good index of endothelium-dependent vasodilation, which is a sensitive predictor of atherosclerotic risk. This is the first study to propose assessing atherosclerotic risk using biochemical, structural, and functional measures before, during, and immediately after spaceflight and structural functional measures for up to 5 years after landing. EXPECTED RESULTS We hypothesize that these biomarkers of oxidative and inflammatory stress will be increased with spaceflight and will correlate with increased carotid intima-medial thickness in- and postflight and with decreased flow-mediated dilation after the mission. Furthermore, we hypothesize that measures of oxidative stress will return to baseline after flight, but that biomarkers of inflammatory stress and vascular indices of atherosclerosis risk will remain elevated.

Lee, Stuart M. C.↗

Self-Supervised Dynamical Systems

Some progress has been made in a continuing effort to develop mathematical models of the behaviors of multi-agent systems known in biology, economics, and sociology (e.g., systems ranging from single or a few biomolecules to many interacting higher organisms). Living systems can be characterized by nonlinear evolution of probability distributions over different possible choices of the next steps in their motions. One of the main challenges in mathematical modeling of living systems is to distinguish between random walks of purely physical origin (for instance, Brownian motions) and those of biological origin. Following a line of reasoning from prior research, it has been assumed, in the present development, that a biological random walk can be represented by a nonlinear mathematical model that represents coupled mental and motor dynamics incorporating the psychological concept of reflection or self-image. The nonlinear dynamics impart the lifelike ability to behave in ways and to exhibit patterns that depart from thermodynamic equilibrium. Reflection or self-image has traditionally been recognized as a basic element of intelligence. The nonlinear mathematical models of the present development are denoted self-supervised dynamical systems. They include (1) equations of classical dynamics, including random components caused by uncertainties in initial conditions and by Langevin forces, coupled with (2) the corresponding Liouville or Fokker-Planck equations that describe the evolutions of probability densities that represent the uncertainties. The coupling is effected by fictitious information-based forces, denoted supervising forces, composed of probability densities and functionals thereof. The equations of classical mechanics represent motor dynamics that is, dynamics in the traditional sense, signifying Newton s equations of motion. The evolution of the probability densities represents mental dynamics or self-image. Then the interaction between the physical and metal aspects of a monad is implemented by feedback from mental to motor dynamics, as represented by the aforementioned fictitious forces. This feedback is what makes the evolution of probability densities nonlinear. The deviation from linear evolution can be characterized, in a sense, as an expression of free will. It has been demonstrated that probability densities can approach prescribed attractors while exhibiting such patterns as shock waves, solitons, and chaos in probability space. The concept of self-supervised dynamical systems has been considered for application to diverse phenomena, including information-based neural networks, cooperation, competition, deception, games, and control of chaos. In addition, a formal similarity between the mathematical structures of self-supervised dynamical systems and of quantum-mechanical systems has been investigated.

Zak, Michail↗

Active State Model for Autonomous Systems

The concept of the active state model (ASM) is an architecture for the development of advanced integrated fault-detection-and-isolation (FDI) systems for robotic land vehicles, pilotless aircraft, exploratory spacecraft, or other complex engineering systems that will be capable of autonomous operation. An FDI system based on the ASM concept would not only provide traditional diagnostic capabilities, but also integrate the FDI system under a unified framework and provide mechanism for sharing of information between FDI subsystems to fully assess the overall health of the system. The ASM concept begins with definitions borrowed from psychology, wherein a system is regarded as active when it possesses self-image, self-awareness, and an ability to make decisions itself, such that it is able to perform purposeful motions and other transitions with some degree of autonomy from the environment. For an engineering system, self-image would manifest itself as the ability to determine nominal values of sensor data by use of a mathematical model of itself, and selfawareness would manifest itself as the ability to relate sensor data to their nominal values. The ASM for such a system may start with the closed-loop control dynamics that describe the evolution of state variables. As soon as this model was supplemented with nominal values of sensor data, it would possess self-image. The ability to process the current sensor data and compare them with the nominal values would represent self-awareness. On the basis of self-image and self-awareness, the ASM provides the capability for self-identification, detection of abnormalities, and self-diagnosis.

Park, Han↗

Astronaut Biography Project for Countermeasures of Human Behavior and Performance Risks in Long Duration Space Flights

This final report will summarize research that relates to human behavioral health and performance of astronauts and flight controllers. Literature reviews, data archival analyses, and ground-based analog studies that center around the risk of human space flight are being used to help mitigate human behavior and performance risks from long duration space flights. A qualitative analysis of an astronaut autobiography was completed. An analysis was also conducted on exercise countermeasure publications to show the positive affects of exercise on the risks targeted in this study. The three main risks targeted in this study are risks of behavioral and psychiatric disorders, risks of performance errors due to poor team performance, cohesion, and composition, and risks of performance errors due to sleep deprivation, circadian rhythm. These three risks focus on psychological and physiological aspects of astronauts who venture out into space on long duration space missions. The purpose of this research is to target these risks in order to help quantify, identify, and mature countermeasures and technologies required in preventing or mitigating adverse outcomes from exposure to the spaceflight environment

Banks, Akeem↗

The Feasibility of Multipole Electrostatic Radiation Shielding

Although passive shielding appears to be the only workable solution for galactic cosmic radiation (GCR), active shielding may play an important augmenting role to control the dose from solar particle events (SPEs). It has been noted that, to meet the guidelines of NCRP Report No. 98 through the six SPEs of 1989, a crew member would need roughly double the passive shielding that is necessary to control the GCR dose . This would dramatically increase spacecraft mass, and so it has been proposed that a small but more heavily shielded storm shelter may be used to protect the crew during SPEs. Since a gradual SPE may last 5 or more days, staying in a storm shelter may be psychologically and physiologically distressing to the crew. Storm shelters do not provide shielding for the spacecraft itself against the SPE radiation, and radiation damage to critical electronics may result in loss of mission and life. Single-event effects during the radiation storm may require quick crew response to maintain the integrity of the spacecraft, and confining the crew to a storm shelter prohibits their attending to the spacecraft at the precise time when that attention is needed the most. Active shielding cannot protect against GCR because the particle energies are too high. Although lower energy particles are easier to stop in a passive shield, such shielding is more satisfactory against GCR than against SPE radiation because of the tremendous difference in their initial fluences. Even a small fraction of the SPE fluence penetrating the passive shielding may result in an unacceptably high dose. Active shielding is more effective than passive shielding against SPE radiation because it offers 100% shielding effectiveness up to the cutoff energy, and significant shielding effectiveness beyond the cutoff as well.

Metzger, Philip T.↗

From Kennedy, to Beyond: Growing Plants in Space

Astronauts cannot have their cake and eat it too, but what about growing a salad and eating it? As NASA continues to push the envelope on Space exploration and inhabitance the need for a fresh food source becomes more vital. The Life Support team at NASA is using a system developed by ORBITEC the VEGGIE, in which astronauts aboard the ISS, and potentially the Moon and Mars, will be capable of growing food. The introduction of plants not only gives astronauts a means of independently supplying food, but also recreation, oxygen replenishment and psychological benefits. The plants were grown in "pillows", the system used for growing plants within the VEGGIE. This test included 4 types of media mixtures that are composed of a clay based media called Arcilite and Fafard #2, which is a peat moss-based media ( <1 mm Arcilite, 1-2 mm of Arcilite, 1:1 <1 mm & 1-2 mm mixture and 1:1 Arcilite & Fafard mixture). Currently, 3 lettuce cultivars are being grown in 4 mixtures of media. Tests were being conducted to see which form of media has the ratio of best growth and least amount of microbes that are harmful. That is essential because a person's body becomes more susceptible to illness when they leave Earth. As a result, test must be conducted on the "pillow" system to assess the levels of microbial activity. The cultivars were tested at different stages during their growing process for microbes. Datum show that the mix of Fafard and Arcilite had the best growth, but also the most microbes. This was due to the fact that Fafard is an organic substance so it contains material necessary for microbes to live. Data suggest that the <1 mm Arcilite has an acceptable amount of growth and a lower level of microbes, because it is non-organic.

Flemming, Cedric, II↗

Waveforms and Sonic Boom Perception and Response (WSPR): Low-Boom Community Response Program Pilot Test Design, Execution, and Analysis

The Waveforms and Sonic boom Perception and Response (WSPR) Program was designed to test and demonstrate the applicability and effectiveness of techniques to gather data relating human subjective response to multiple low-amplitude sonic booms. It was in essence a practice session for future wider scale testing on naive communities, using a purpose built low-boom demonstrator aircraft. The low-boom community response pilot experiment was conducted in California in November 2011. The WSPR team acquired sufficient data to assess and evaluate the effectiveness of the various physical and psychological data gathering techniques and analysis methods.

Page, Juliet A.↗

Challenges to Health During Deep Space Exploration Missions

Long duration missions outside of low Earth orbit will present unique challenges to the maintenance of human health. Stressors with physiologic and psychological impacts are inherent in exploration missions, including reduced gravity, increased radiation, isolation, limited habitable volume, circadian disruptions, and cabin atmospheric changes. Operational stressors such as mission timeline and extravehicular activities must also be considered, and these varied stressors may act in additive or synergistic fashions. Should changes to physiology or behavior manifest as a health condition, the rendering of care in an exploration environment must also be considered. Factors such as the clinical background of the crew, inability to evacuate to Earth in a timely manner, communication delay, and limitations in available medical resources will have an impact on the assessment and treatment of these conditions. The presentations associated with this panel will address these unique challenges from the perspective of several elements of the NASA Human Research Program, including Behavioral Health and Performance, Human Health Countermeasures, Space Radiation, and Exploration Medical Capability.

Watkins, S.↗

Defining the Relationship between Biomarkers of Oxidative and Inflammatory Stress and the Risk for Atherosclerosis in Astronauts during and after Long-duration Spaceflight

Future human space travel will consist primarily of long-duration missions onboard the International Space Station (ISS) or exploration-class missions to Mars, its moons, or nearby asteroids. These missions will expose astronauts to increased risk of oxidative and inflammatory damage from a variety of sources, including radiation, psychological stress, reduced physical activity, diminished nutritional status, and hyperoxic exposure during extravehicular activity. Evidence exists that increased oxidative damage and inflammation can accelerate the development of atherosclerosis. PURPOSE The purpose of this investigation is to determine whether biomarkers of oxidative and inflammatory stress are elevated during and after long-duration spaceflight and investigate if a relation exists between levels of these biomarkers and structural and functional indices of atherosclerotic risk measured in the carotid and brachial arteries. This is the first study to propose assessing atherosclerotic risk using biochemical, structural, and functional measures before, during, and immediately after spaceflight, and structural and functional measures for up to 5 years after landing. METHODS We will study 12 astronauts before, during, and up to 5 years after long-duration ISS missions. A panel of biomarkers of oxidative and inflammatory stress will be measured twice before flight, early (flight days 15 and 60) and late (2 weeks before landing) during the mission, and early in the postflight recovery phase (approx 3 days after landing). Arterial structure and vascular compliance will be measured at the same times and also at 1, 3, and 5 years after landing (surveillance). Arterial function will be measured using the same preflight, postflight, and surveillance schedule as arterial structure and vascular compliance measures, but will not be measured inflight. Biomarkers, some of which we have previously shown to be elevated with spaceflight, will be measured in venous blood samples and 24-h (in-flight) and 48-h (pre- and post-flight) urine pools. Arterial structure will be assessed from measures of carotid intima-media thickness, which have been shown to be better indicators of atherosclerotic than the Framingham Risk Score. Arterial function will be assessed using brachial flow-mediated dilation, a well-validated measure used to assess endothelium-dependent vasodilation and is a sensitive predictor of atherosclerotic risk. Arterial pulse pressure measured in the brachial artery and stroke volume measured from cardiac ultrasound will be used to assess hemodynamic status, cardiac function, and systemic vascular compliance. Three astronauts are actively participating in the preflight data collection and training activities. One astronaut has completed all preflight activities and will participate in the first in-flight data collection sessions by the end of 2013. The first post-flight data collection sessions will occur in the spring of 2014. EXPECTED RESULTS We hypothesize that biomarkers of oxidative and inflammatory stress will increased with spaceflight and will correlate with increased carotid intima-media thickness during and after flight and with decreased flow-mediated dilation after the mission. Furthermore, we hypothesize that measures of oxidative stress will return to baseline after flight, but biomarkers of inflammatory stress and vascular indices of atherosclerotic risk will remain elevated.

Lee, Stuart M. C.↗

Benefits for Health; NASA

The goal of HRP is to provide human health and performance countermeasures, knowledge, technologies, and tools to enable safe, reliable, and productive human space exploration. Presentation discusses (1) Bone Health: Vitamin D, Fish Consumption and Exercise (2) Medical Support in Remote Areas (3) ISS Ultrasound 4) Dry electrode EKG System (5) Environmental Factors and Psychological Health.

Perchonok, Michele↗