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Search indexed NASA NTRS and DOE OSTI research on propulsion, heat transfer, battery materials and energy systems. Follow report and document links to the original sources.

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At least 127 records · Page 7
All sourcesNASA NTRSDOE OSTI
NASA NTRS2007

Artificial Gravity: Effects on Bone Turnover

The impact of microgravity on the human body is a significant concern for space travelers. Since mechanical loading is a main reason for bone loss, artificial gravity might be an effective countermeasure to the effects of microgravity. In a 21-day 6 head-down tilt bed rest (HDBR) pilot study carried out by NASA, USA, the utility of artificial gravity (AG) as a countermeasure to immobilization-induced bone loss was tested. Blood and urine were collected before, during, and after bed rest for bone marker determinations. Bone mineral density was determined by DXA and pQCT before and after bed rest. Urinary excretion of bone resorption markers (n-telopeptide and helical peptide) were increased from pre-bed rest, but there was no difference between the control and the AG group. The same was true for serum c-telopeptide measurements. Bone formation markers were affected by bed rest and artificial gravity. While bone-specific alkaline phosphatase tended to be lower in the AG group during bed rest (p = 0.08), PINP, another bone formation marker, was significantly lower in AG subjects than CN before and during bed rest. PINP was lower during bed rest in both groups. For comparison, artificial gravity combined with ergometric exercise was tested in a 14-day HDBR study carried out in Japan (Iwase et al. J Grav Physiol 2004). In that study, an exercise regime combined with AG was able to significantly mitigate the bed rest-induced increase in the bone resorption marker deoxypyridinoline. While further study is required to more clearly differentiate bone and muscle effects, these initial data demonstrate the potential effectiveness of short-radius, intermittent AG as a countermeasure to the bone deconditioning that occurs during bed rest and spaceflight. Future studies will need to optimize not only the AG prescription (intensity and duration), but will likely need to include the use of exercise or other combined treatments.

Heer, M.↗
DOE OSTI2020

From Prevention to Disease Perturbations: A Multi-Omic Assessment of Exercise and Myocardial Infarctions

While a molecular assessment of the perturbations and injury arising from diseases is essential in their diagnosis and treatment, understanding changes due to preventative strategies is also imperative. Currently, complex diseases such as cardiovascular disease (CVD), the leading cause of death worldwide, suffer from a limited understanding of how the molecular mechanisms taking place following preventive measures (e.g., exercise) differ from changes occurring due to the injuries caused from the disease (e.g., myocardial infarction (MI)). Therefore, this manuscript assesses lipidomic changes before and one hour after exercise treadmill testing (ETT) and before and one hour after a planned myocardial infarction (PMI) in two separate patient cohorts. Strikingly, unique lipidomic perturbations were observed for these events, as could be expected from their vastly different stresses on the body. The lipidomic results were then combined with previously published metabolomic characterizations of the same patients. This integration provides complementary insights into the exercise and PMI events, thereby giving a more holistic understanding of the molecular changes associated with each.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2021

Verification of Maximal Oxygen Uptake in Active Military Personnel During Treadmill Running

Figueiredo, PS, Looney, DP, Pryor, JL, Doughty, EM, McClung, HL, Vangala, SV, Santee, WR, Beidleman, BA, and Potter, AW. Verification of maximal oxygen uptake in active military personnel during treadmill running. J Strength Cond Res 36(4): 1053–1058, 2022—It is unclear whether verification tests are required to confirm “true” maximal oxygen uptake ($\dot{V}_{o2}$max) in modern warfighter populations. Our study investigated the prevalence of $\dot{V}_{o2}$max attainment in U.S. Army soldiers performing a traditional incremental running test. In addition, we examined the utility of supramaximal verification testing as well as repeated trials for familiarization for accurate $\dot{V}_{o2}$max assessment. Sixteen U.S. Army soldiers (1 woman, 15men; age, 21±2 years; height, 1.73±0.06m; body mass, 71.6±10.1 kg) completed 2 laboratory visits, each with an incremental running test (modified Astrand protocol) and a verification test (110% maximal incremental test speed) on a motorized treadmill. We evaluated $\dot{V}_{o2}$max attainment during incremental testing by testing for the definitive $\dot{V}_{o2}$ plateau using a linear least-squares regression approach. Peak oxygen uptake ($\dot{V}_{o2}$peak) was considered statistically equivalent between tests if the 90% confidence interval around the mean difference was within 62.1 ml·kg -1 ·min -1 . Oxygen uptake plateaus were identified in 14 of 16 volunteers for visit 1 (87.5%) and all 16 volunteers for visit 2 (100%). Peak oxygen uptake was not statistically equivalent, apparent from the mean difference in $\dot{V}_{o2}$peak measures between the incremental test and verification test on visit 1 (2.3 ml·kg -1 ·min -1 , [1.3–3.2]) or visit 2 (1.1 ml·kg -1 ·min -1 [0.2–2.1]). Interestingly, $\dot{V}_{o2}$peak was equivalent, apparent from the mean difference in $\dot{V}_{o2}$peak measures between visits for the incremental tests (0.0ml·kg -1 ·min -1 [-0.8to 0.9]) but not the verification tests (-1.2 ml·kg -1 ·min -1 [-2.2 to -0.2]). Modern U.S. Army soldiers can attain $\dot{V}_{o2}$max by performing a modified Astrand treadmill running test. Additional familiarization and verification tests for confirming $\dot{V}_{o2}$max in healthy active military personnel may be unnecessary.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2021

Comprehensive Assessment of On-And Off-Board Vehicle-To-Grid Technology Performance and Impacts on Battery and the Grid

This project defined, developed, and tested the open standards-based requirements, engineering design and system integration of on and off-vehicle Vehicle-to-Grid technologies both on the grid and on the PEV, to assess their effectiveness in implementing the use cases that create value for the grid, which in turn, can be passed on to the ratepayers and the PEV owners. The project comprised of three key categories of work and four key sub-areas of work. The three key categories were: On-Vehicle V2G, Off-Vehicle V2G, and impact of V2G operation on the battery capacity degradation. The four key sub-areas of work under each of these categories were: defining requirements, implementing the technology, performing system integration testing, and estimating the value of each of the grid services under specific assumptions, on a per-vehicle and on an aggregated basis. The technical implementation demonstrated the validity of standards-based approach to grid integration that led to interoperability, in addition to assessing the operational details with grid constraints imposed at the transformer level. The technology implementation also identified the subtle gaps in the standards definition to close the feedback loop on the accuracy of the standards as written, which are being implemented as revisions to the appropriate protocols. The battery impacts assessment developed a test cycle that the batteries from a real PHEV were subjected to for both the mobility-only and mobility with V2G specific energy cycling. While the battery impact results show a clear incremental degradation in response to additional throughput for V2G application purposes, the amount of additional kWh that can be made available without exceeding the end-of-life capacity definition of the battery at its 10-year warranty period was found to be significant. Given that the PEV battery being exercised during testing was a PHEV battery (smaller energy capacity), and 44% of its usable energy (i.e., SOC) was utilized daily for V2G applications, the EVs with much larger batteries will fare much better, either in terms of extracting more value in terms of incremental kWh for V2G, or in terms of relative incremental degradation of the capacity through the battery lifespan. Further, this battery was the second-generation Lithium-Ion chemistry circa 2015, which is at least two generations ago. Continual improvements in electrochemistry and manufacturing techniques as well as on-board capacity will enable the future batteries to provide even more energy for non-mobility-related services. Finally, the valuation of V2G energy services at the premise, distribution, and the ISO/market level was carried out for both the on-vehicle and off-vehicle cases, to understand both the GHG mitigation and operational efficiency improvements in quantitative terms. The analysis indicates that between $\$400$ and $\$1400$ per year of total value to the grid can be realized. When netted of costs to implement V2G either on or off-vehicle, the net value is available to be shared between the ratepayers and the EV owners. Over the life of the EV, therefore, this value becomes significant and can easily provide both ratepayer and EV owner benefits more than the cost of the equipment, either on or off-board, in addition to providing GHG mitigation benefits both on the grid and on the mobility sides. For these benefits to accrue, the key learnings from both the on- and off-vehicle V2G parts of the project indicate the need for at-scale demonstrations through involvement of real EV owners to validate both the technical feasibility, interoperability, as well as real grid benefits by performing extensive data collection and analysis. This will help inform the grid planners, the program designs, and tariff designers, as well as automotive and equipment manufacturers how best to create their products to maximize grid, ratepayer, and EV owner value.

30 DIRECT ENERGY CONVERSION↗
NASA NTRS1992

Influences of chemical sympathectomy, demedullation, and hindlimb suspension on the VO2max of rats

Results from previous studies have shown that the reduction in maximal oxygen consumption (VO2max) with simulated microgravity is attenuated in chemically sympathectomized rats. To determine the contributions of the catecholamines from the adrenal medulla in this process, investigations were conducted with 65 saline injected (SAL) and chemically sympathectomized (SX) female rats that were either surgically demedullated (DM), or intact (IN). Microgravity conditions were simulated by head-down suspension (HDS) while controls were assigned to individual cages (CC). The experimental period was 14 d. The rats were tested for VO2max, treadmill run time (RT), and submaximal mechanical efficiency (ME) prior to suspension and on days 7 and 14. Saline injected rats that had intact adrenal medullas (SAL-IN) exhibited significantly reduced measures of VO2max after 7 and 14 d by 15% and 21%, respectively. No significant reduction in VO2max was observed with HDS in the SX-IN animals. Sympathectomized rats that were demedullated (SX-DM) also exhibited a significant reduction in VO2max (12%). In addition, HDS was associated with a marked and significant reduction in RT in all groups. ME for submaximal exercise was significantly reduced after HDS in SAL-IN rats but not in the SX-IN rats. SX-DM rats experienced significant reductions in ME similar in magnitude to the SAL-IN rats. These results confirm that chemical sympathectomy attenuates the expected decrease in VO2max with HDS and suggests that circulating epinephrine contributes to this response.

Non-NASA Center↗
NASA NTRS2001

Effects of 3-day bed rest on physiological responses to graded exercise in athletes and sedentary men

To test the hypotheses that short-term bed-rest (BR) deconditioning influences metabolic, cardiorespiratory, and neurohormonal responses to exercise and that these effects depend on the subjects' training status, 12 sedentary men and 10 endurance- and 10 strength-trained athletes were submitted to 3-day BR. Before and after BR they performed incremental exercise test until volitional exhaustion. Respiratory gas exchange and heart rate (HR) were recorded continuously, and stroke volume (SV) was measured at submaximal loads. Blood was taken for lactate concentration ([LA]), epinephrine concentration ([Epi]), norepinephrine concentration ([NE]), plasma renin activity (PRA), human growth hormone concentration ([hGH]), testosterone, and cortisol determination. Reduction of peak oxygen uptake (VO(2 peak)) after BR was greater in the endurance athletes than in the remaining groups (17 vs. 10%). Decrements in VO(2 peak) correlated positively with the initial values (r = 0.73, P < 0.001). Resting and exercise respiratory exchange ratios were increased in athletes. Cardiac output was unchanged by BR in all groups, but exercise HR was increased and SV diminished in the sedentary subjects. The submaximal [LA] and [LA] thresholds were decreased in the endurance athletes from 71 to 60% VO(2 peak) (P < 0.001); they also had an earlier increase in [NE], an attenuated increase in [hGH], and accentuated PRA and cortisol elevations during exercise. These effects were insignificant in the remaining subjects. In conclusion, reduction of exercise performance and modifications in neurohormonal response to exercise after BR depend on the previous level and mode of physical training, being the most pronounced in the endurance athletes.

NASA Center ARC↗
NASA NTRS2000

[Correction of autonomic reactions parameters in organism of cosmonaut with adaptive biocontrol method]

Presented are results of testing the method of adaptive biocontrol during preflight training of cosmonauts. Within the MIR-25 crew, a high level of controllability of the autonomous reactions was characteristic of Flight Commanders MIR-23 and MIR-25 and flight Engineer MIR-23, while Flight Engineer MIR-25 displayed a weak intricate dependence of these reactions on the depth of relaxation or strain.

Flight Experiment↗
DOE OSTI2025

Employing MACS/ViBRANT as a Surrogate MARVEL Reactor for Startup Reactivity Tuning and Supervisory Control Processes

Advanced nuclear reactors are a key part of the future of nuclear energy both in the United States and globally. They offer unique benefits for various energy-demanding applications, including use in remote locations, compact size, modular manufacturing, remote monitoring, low and/or variable power rating operation, and reliance on novel technologies to enhance operational safety. To achieve economic feasibility, advanced reactors must significantly reduce their workforces in comparison with the current fleet. Achieving this reduction will occur through reducing staff workloads using technology to achieve autonomous or semi-autonomous operations, demonstrated by comprehensive testing and validation activities. These operations will require both software and hardware platforms during the design and testing phases. While simulations are useful during the design phase, their performance can significantly deviate during actual deployment on hardware. This report presents the outcomes of a collaborative technical initiative between the U.S. Department of Energy (DOE) Microreactor Program (MRP) and Advanced Sensors and Instrumentation (ASI) Program. The collaboration utilized the Microreactor Automated Control System (MACS) hardware platform to bridge the gap between theoretical reactor design and actual startup and control operations. Two key use cases were investigated: facilitating the startup testing period and demonstrating supervisory control. The first use case details the key Microreactor Applications Research Validation and Evaluation (MARVEL) reactor startup physics testing activities conducted using the MACS platform. These activities included drum worth measurements, shutdown margin assessment, temperature feedback analysis, and scram time evaluation, as well as unique testing that would apply to the MARVEL reactor to demonstrate the testing methodologies in a low-risk environment. The MACS platform, serving as a surrogate representation of the MARVEL reactor, proved instrumental in performing these tests. The exercise revealed aspects that led to optimized processes, refined hardware design, and enhanced base software capabilities. By maturing methods and technologies in this manner, the initiative promises to reduce wasted time in the actual on-site reactor deployment effort, thereby saving significant time and resources. The second use case focuses on the development and implementation of supervisory control methods aimed at managing core tilt, which can result from asymmetrical operations or manufacturing imperfections in fuel rods or reactivity control devices. A key objective was to assess and compare the use of artificial intelligence (AI) for supervisory control. The effort aimed to define the role of supervisory control to enhance performance without risking control instability. This effort explored three distinct approaches: rules-based (RB) methods, optimization techniques, and reinforcement learning (RL) algorithms. Each approach was evaluated for its ease of implementation, its usability, and its effectiveness in responding to asymmetries in neutron flux. Comparative analysis of these approaches provided valuable insights into their applicability and effectiveness, offering a robust framework for advanced reactor operations. Together, these two use cases highlight the potential of hardware test beds to help streamline the design, operation, and control of advanced nuclear reactors. This collaborative effort underscores the importance of continued innovation and experimentation in achieving the next generation of safe, reliable, and economically viable nuclear energy solutions.

22 - GENERAL STUDIES OF NUCLEAR REACTORS↗
NASA NTRS2004

Dynamic visual acuity using "far" and "near" targets

CONCLUSIONS: DVA may be useful for assessing the functional consequences of an impaired gaze stabilization mechanism or for testing the effectiveness of a rehabilitation paradigm. Because target distance influences the relative contributions of canal and otolith inputs, the ability to measure DVA at near and far viewing distances may also lead to tests that will independently assess canal and otolith function. OBJECTIVE: To present and test a methodology that uses dynamic visual acuity (DVA) to assess the efficacy of compensatory gaze mechanisms during a functionally relevant activity that differentially measures canal and otolith function. MATERIAL AND METHODS: The effect of treadmill walking at a velocity of 1.79 m/s on subjects' visual acuity was assessed at each of two viewing distances. A custom-written threshold determination program was used to display Landolt C optotypes on a laptop computer screen during a "far" (4 m) target condition and on a micro-display for a "near" (50 cm) target condition. The walking acuity scores for each target distance were normalized by subtracting a corresponding acuity measure obtained while standing still on the treadmill belt. RESULTS: As predicted by subjective reports of relative target motion, the decrease in visual acuity was significantly greater (p < 0.00001) for the near compared to the far condition.

Pattern Recognition, Visual/physiology↗
NASA NTRS1998

Cardiovascular function following reduced aerobic activity

PURPOSE: The aim of this study was to test the hypothesis that a sustained reduction of physical activity (deconditioning) would alter the cardiovascular regulatory function. METHODS: Nineteen young, healthy volunteers participated in physical deconditioning for a period of 8 wk. Before (pre) and following (post) physical deconditioning, the responses of heart rate (HR), mean arterial pressure (MAP, measured by Finapres), central venous pressure (CVP), stroke volume (SV, Doppler), and forearm blood flow (FBF, plethysmography) were determined during lower body negative pressure (LBNP). The carotid baroreflex (CBR) function was assessed using a train of pulsatile neck pressure (NP) and suction, and the aortic baroreflex control of HR was assessed during steady-state phenylephrine (PE) infusion superimposed by LBNP and NP to counteract the PE increased CVP and carotid sinus pressure, respectively. RESULTS: Active physical deconditioning significantly decreased maximal oxygen uptake (-7%) and LBNP tolerance (-13%) without a change in baseline hemodynamics. Plasma volume (-3% at P = 0.135), determined by Evans Blue dilution, and blood volume (-4% at P = 0.107) were not significantly altered. During LBNP -20 to -50 torr, there was a significantly greater drop of SV per unit decrease in CVP in the post- (14.7 +/- 1.6%/mm Hg) than predeconditioning (11.2 +/- 0.7%/mm Hg) test accompanied by a greater tachycardia. Deconditioning increased the aortic baroreflex sensitivity (pre vs post: -0.61 +/- 0.12 vs -0.84 +/- 0.14 bpm.mm-1 Hg, P = 0.009) and the slope of forearm vascular resistance (calculated from [MAP-CVP]/FBF) to CVP (-2.75 +/- 0.26 vs -4.94 +/- 0.97 PRU/mm Hg, P = 0.086). However, neither the CBR-HR (-0.28 +/- 0.03 VS -0.39 +/- 0.10 bpm.mm-1 Hg) nor the CBR-MAP (-0.37 +/- 0.16 vs -0.25 +/- 0.07 mm Hg/mm Hg) gains were statistically different between pre- and postdeconditioning. CONCLUSIONS: We concluded that the functional modification of the cardiac pressure-volume relationship resulted in the reduced LBNP tolerance, despite the accentuated aortic and cardiopulmonary baroreflex function following deconditioning.

Non-NASA Center↗
DOE OSTI2023

Characterization of LAPPD timing at CERN PS testbeam

Large Area Picosecond PhotoDetectors (LAPPDs) are photosensors based on microchannel plate technology with about 400 cm 2 sensitive area. The external readout plane of a capacitively coupled LAPPD can be segmented into pads providing a spatial resolution down to 1 mm scale. The LAPPD signals have about 0.5 ns rise time followed by a slightly longer fall time and their amplitude reaches a few dozens of mV per single photoelectron. In this article, we report on the measurement of the time resolution of an LAPPD prototype in a test beam exercise at CERN PS. Most of the previous measurements of LAPPD time resolution had been performed with laser sources. In this article we report time resolution measurements obtained through the detection of Cherenkov radiation emitted by high energy hadrons. Our approach has been demonstrated capable of measuring time resolutions as fine as 25-30 ps. The available prototype had performance limitations, which prevented us from applying the optimal high voltage setting. Finally, the measured time resolution for single photoelectrons is about 80 ps r.m.s.

73 NUCLEAR PHYSICS AND RADIATION PHYSICS↗
NASA NTRS1971

Biomedical findings on American astronauts participating in space missions.

Zero-gravity adaptive responses of man are discussed on the basis of biomedical data for 54 American astronauts, covering performance, locomotion, orientation, sleep and physiological and functional characteristics. Figures and diagrams are given for cardiovascular adaptation, weight loss, endocrine and electrolyte responses, fluid balance, skeletal responses, muscular and neuromuscular changes, exercise response tests and work capacity indicators. A review is given of current hypotheses concerning the processes involved in human adaptation to zero gravity. It is concluded that the immediate response of the body to weightlessness is a redistribution of the total circulating blood volume, leading to a loss of water, sodium and potassium through the kidneys and, thus, to a loss in total body weight.

Berry, C. A.↗
NASA NTRS1972

Heat transfer and pressure distributions at M equals 8 on 0.029 scale models of the Viking entry vehicle

An investigation in the Langley Research Center Mach-8 Variable Density Hypersonic Tunnel was made of the pressure distributions and heat transfer rate distributions on two 0.029 scale Viking Entry Vehicle models. Comparable ranges of test Reynolds number were exercised for the two tests between run conditions around 4 million and conditions of about 1.6 million. At angles of attack less than 20 degrees the pressure ratio distribution referenced to stagnation pressure appeared invariant with Reynolds number. Increasing angle of attack results in a flatter distribution of both the windward and leeward pressure distributions; in addition, the stagnation point shifted into the windward plane. A subsequent rise in the heating rate profile on the leeward side with further increase in angle of attack is attributed to boundary layer natural transition to turbulent flow. Schlieren photographs were taken for flow field visualization and to correct model angle of attack.

Faye-Petersen, R.↗
NASA NTRS1974

Hydrocortisone and ACTH levels in manned spaceflight

The plasma hydrocortisone, plasma ACTH, and urinary hydrocortisone values were recorded for each man of the crews of Apollo flights eight through fifteen, 30, 14, and 5 days before flight, immediately after spaceflight recovery, and on future days until the return of most variables to preflight values. The plasma and urinary preflight hydrocortisone values were significantly higher than the postflight values. This result is discussed in terms of three possible explanations: (1) the adrenal-cortical function is suppressed during spaceflight; (2) the activity in flight may amount to stressful exercise, which tests have shown can cause a decrease in plasma adrenocortical hormones; and (3) the in-flight work-rest cycles may be such as to affect the circadian periodicity of the pituitary-adrenal function.

Leach, C. S.↗
NASA NTRS1974

Evaluation of the electromechanical properties of the cardiovascular system

Cardiovascular electromechanical measurements were collected on returning Skylab crewmembers at rest and during both lower body negative pressure and exercise stress testing. These data were compared with averaged responses from multiple preflight tests. Systolic time intervals and first heart sound amplitude changes were measured. Clinical cardiovascular examinations and clinical phonocardiograms were evaluated. All changes noted returned to normal within 30 days postflight so that the processes appear to be transient and self limited. The cardiovascular system seems to adapt quite readily to zero-g, and more importantly it is capable of readaptation to one-g after long duration space flight. Repeated exposures to zero-g also appear to have no detrimental effects on the cardiovascular system.

Bergman, S. A., Jr.↗
NASA NTRS1988

Comparison of aerobic fitness and space motion sickness during the Shuttle program

Space motion sickness (SMS) is an important problem for short-duration space flight; 71 percent of STS crewmembers develop SMS symptoms. The search for effective countermeasures and factors that correlate with sensitivity has been extensive. Recently, several investigators have linked aerobic fitness with motion sickness sensitivity in the 1-G or high-G environment. This paper compares the aerobic fitness of 125 Shuttle crewmembers with their SMS symptom category. Aerobic fitness data were obtained from the exercise tolerance test conducted nearest the time of launch. SMS data were derived from the medical debrief summaries. Mean maximum oxygen consumption values for crewmembers in four SMS categories (none, mild, moderate, severe) were 44.55, 44.08, 46.5, and 44.24 ml/kg per min, respectively. Scattergrams with linear regression analysis, comparing aerobic fitness and SMS symptom classification are presented. Correlation coefficients comparing SMS categories vs. aerobic fitness for men and women reveal no definite relationship between the two factors.

Jennings, Richard T.↗
NASA NTRS1991

Effect of 29 days of simulated microgravity on maximal oxygen consumption and fat-free mass of rats

Effects of a 29-days exposure to simulated microgravity on the values of maximal oxygen consumption and fat-free mass (FFM) and on the mechanical efficiency of running were investigated in rats randomly assigned to one of three regimens: head-down suspension (HDS) at 45 deg, horizontal suspension (HS), or cage control (CC). Before suspension and on days 7, 14, 21, and 28, five exercise performance tests were carried out, with measurements related to maximal oxygen consumption, treadmill run time, and mechanical efficiency. It was found that maximal oxygen consumption of both HDS and HS groups decreased significantly at day 7, after which the HDS rats remained decreased while the HS rats returned to presuspension values. Apparent mechanical efficiency in the HDS and HS groups decreased by 22-35 percent during the experimental period, and FFM decreased significantly.

Woodman, Christopher R.↗
NASA NTRS1998

Medical Practice Makes Perfect

Cedaron Medical Inc., was founded in 1990 as a result of a NASA SBIR (Small Business Innovative Research) grant from Johnson Space Center to develop a Hand Testing and Exercise Unit for use in space. From that research came Dexter, a comprehensive workstation that creates a paperless environment for medical data management.

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