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NASA NTRS2002

Biosensors for Real-Time Monitoring of Radiation-Induced Biologic Effects in Space

This proposal seeks to develop cellular biosensors based on dendritic polymers. Nanoscale polymer structures less than 20 nm in diameter will be used as the basis of the sensor/actuators. The structures will be designed to target into specific cells of an astronaut and be able to monitor health issues such as the exposure to radiation or infectious agents. Multiple components can be assembled on the polymers including target directors, analytical devices (such as molecular probes), magnetic particles and metals, and imaging agents. The design and assembly of these devices has been pioneered at the Center for Biologic Nanotechnology in the University of Michigan. These molecules would also be able to administer therapeutics in response to the needs of the astronaut, and act as actuators to remotely manipulate an astronaut as necessary to ensure their safety. The reporting will be accomplished either through fluorescence signal monitoring, with the use of multispectral analysis for signal interpretation, or through functional MRI. These nanosensors coupled to NEMS devices could facilitate the success and increase the safety of extended space flight.

Baker, James R., Jr.↗
NASA NTRS2002

Air Purification in Closed Environments: An Overview of Spacecraft Systems

The primary goal for a collective protection system and a spacecraft environmental control and life support system (ECLSS) are strikingly similar. Essentially both function to provide the occupants of a building or vehicle with a safe, habitable environment. The collective protection system shields military and civilian personnel from short-term exposure to external threats presented by toxic agents and industrial chemicals while an ECLSS sustains astronauts for extended periods within the hostile environment of space. Both have air quality control similarities with various aircraft and 'tight' buildings. This paper reviews basic similarities between air purification system requirements for collective protection and an ECLSS that define surprisingly common technological challenges and solutions. Systems developed for air revitalization on board spacecraft are discussed along with some history on their early development as well as a view of future needs. Emphasis is placed upon two systems implemented by the National Aeronautics and Space Administration (NASA) onboard the International Space Station (ISS): the trace contaminant control system (TCCS) and the molecular sieve-based carbon dioxide removal assembly (CDRA). Over its history, the NASA has developed and implemented many life support systems for astronauts. As the duration, complexity, and crew size of manned missions increased from minutes or hours for a single astronaut during Project Mercury to days and ultimately months for crews of 3 or more during the Apollo, Skylab, Shuttle, and ISS programs, these systems have become more sophisticated. Systems aboard spacecraft such as the ISS have been designed to provide long-term environmental control and life support. Challenges facing the NASA's efforts include minimizing mass, volume, and power for such systems, while maximizing their safety, reliability, and performance. This paper will highlight similarities and differences among air purification systems. Additional information is included in the original extended abstract.

Perry, Jay L.↗
NASA NTRS2002

From Milk to Bones, Moving Calcium Through the Body: Calcium Kinetics During Space Flight

Did you know that when astronauts are in space, their height increases about two inches? This happens because the weightlessness of space allows the spine, usually compressed in Earth's gravity, to expand. While this change is relatively harmless, other more serious things can happen with extended stays in weightlessness, notably bone loss. From previous experiments, scientists have observed that astronauts lose bone mass at a rate of about one percent per month during flight. Scientists know that bone is a dynamic tissue - continually being made and repaired by specialized bone cells throughout life. Certain cells produce new bone, while other cells are responsible for removing and replacing old bone. Research on the mechanisms of bone metabolism and the effects of space flight on its formation and repair are part of the exciting studies that will be performed during STS-107. Calcium plays a central role because 1) it gives strength and structure to bone and 2) all types of cells require it to function normally. Ninety-nine percent of calcium in the body is stored in the skeleton. However, calcium may be released, or resorbed, from bone to provide for other tissues when you are not eating. To better understand how and why weightlessness induces bone loss, astronauts will participate in a study of calcium kinetics - that is, the movement of calcium through the body, including absorption from food, and its role in the formation and breakdown of bone.

Scott Smith↗
NASA NTRS2002

Letting Our Cells Do the Fighting: Flight-Induced Changes in the Immune Response

The organisms that make us ill, such as bacteria, viruses, and fungi, are like attacking armies. We now know a great deal more about this unseen world of microscopic invaders. Fortunately for us, the human immune system is ever vigilant against them. Microorganisms such as bacteria, viruses, and fungi occupy almost every corner of the Earth, and even parts of the human body. Some organisms are beneficial to us, helping to produce milk, cheese or yogurt. Others are potentially harmful, yet we don#t always develop illnesses from them; they are kept in check by the sentinels of our immune system. Our immune system is routinely challenged by these organisms every day. When the immune response is diminished, our ability to fight off these "bugs" is lowered. And that's when we become ill. Space flight presents a challenge to the immune system. Scientists believe that the stressful conditions of space flight - launch into orbit, adapting to microgravity, heavy workloads, and isolation from family and friends, to name but a few - reduce the astronauts' immunity. This immune suppression makes them more susceptible to common illnesses from bacteria and to re-infections from latent viruses in the body. In addition, risk of spreading illness in the confined environment of the Space Shuttle is high. Understanding changes in immune function will help scientists develop ways to keep astronauts healthy in space. This knowledge can also benefit earthbound populations. This experiment will give scientists insight into the immune system by comparing how certain cells of astronauts' innate immune system - the first line of defense against invaders - function after flight compared to before flight.

Pierson, Duane↗
NASA NTRS2002

Building Muscles, Keeping Muscles: Protein Turnover During Space Flight

As we age we lose muscle mass and strength. The problem is a matter of use it or lose it and more - a fact to which any active senior can attest. An imbalance in the natural cycle of protein turnover may be a contributing factor to decreased muscle mass. But the answer is not so simple, since aging is associated with changes in hormones, activity levels, nutrition, and often, disease. The human body constantly uses amino acids to build muscle protein, which then breaks down and must be replaced. When protein turnover gets out of balance, so that more protein breaks down than the body can replace, the result is muscle loss. This is not just the bane of aging, however. Severely burned people may have difficulty building new muscle long after the burned skin has been repaired. Answers to why we lose muscle mass and strength - and how doctors can fix it - may come from space. Astronauts usually eat a well-balanced diet and maintain an exercise routine to stay in top health. During long-duration flight, they exercise regularly to reduce the muscle loss that results from being in a near-weightless environment. Despite these precautions, astronauts lose muscle mass and strength during most missions. They quickly recover after returning to Earth - this is a temporary condition in an otherwise healthy population. Members of the STS-107 crew are participating in a study of the effects of space flight, hormone levels, and stress on protein turnover. When we are under stress, the body responds with a change in hormone levels. Researchers hypothesize that this stress-induced change in hormones along with the near-weightlessness might result in the body synthesizing less muscle protein, causing muscles to lose their strength and size. Astronauts, who must perform numerous duties in a confined and unusual environment, experience some stress during their flight, making them excellent candidates for testing the researchers' hypothesis.

Arny Ferrando↗
NASA NTRS2002

Exploring Heart and Lung Function in Space: ARMS Experiments

The Advanced Respiratory Monitoring System (ARMS) is a suite of monitoring instruments and supplies used to study the heart, lungs, and metabolism. Many experiments sponsored by the European Space Agency (ESA) will be conducted using ARMS during STS-107. The near-weightless environment of space causes the body to undergo many physiological adaptations, and the regulation of blood pressure is no exception. Astronauts also experience a decrease in blood volume as an adaptation to microgravity. Reduced blood volume may not provide enough blood pressure to the head during entry or landing. As a result, astronauts often experience light-headedness, and sometimes even fainting, when they stand shortly after returning to Earth. To help regulate blood pressure and heart rate, baroreceptors, sensors located in artery walls in the neck and near the heart, control blood pressure by sending information to the brain and ensuring blood flow to organs. These mechanisms work properly in Earth's gravity but must adapt in the microgravity environment of space. However, upon return to Earth during entry and landing, the cardiovascular system must readjust itself to gravity, which can cause fluctuation in the control of blood pressure and heart rate. Although the system recovers in hours or days, these occurrences are not easily predicted or understood - a puzzle investigators will study with the ARMS equipment. In space, researchers can focus on aspects of the cardiovascular system normally masked by gravity. The STS-107 experiments using ARMS will provide data on how the heart and lungs function in space, as well as how the nervous system controls them. Exercise will also be combined with breath holding and straining (the Valsalva maneuver) to test how heart rate and blood pressure react to different stresses. This understanding will improve astronauts' cardiopulmonary function after return to Earth, and may well help Earthbound patients who experience similar effects after long-term bed rest.

Andre Kuipers↗
NASA NTRS2003

STS-107 Flight Day 15 Highlights

This video shows the activities of the STS-107 crew on flight day 15 of the Columbia orbiter's final mission. The crew includes Commander Rick Husband, Pilot William McCool, Mission Specialists Michael Anderson, David Brown, Laurel Clark, and Kalpana Chawla, and Payload Specialist Ilan Ramon. The primary activities of flight day 15 are crew interviews, and operating the Water Mist Fire Suppression (MIST) experiment. Early in the video, astronauts McCool and Ramon respond together to a question. Much of the video is taken up by an interview of astronauts Brown, Anderson, and McCool. Two parts of the video show the MIST experiment in operation, operated the first time by astronaut Brown. Another part of the video is narrated by Mission Specialist Clark, who identifies views of Mount Vesuvius, and an atoll in the south Pacific. In this part, Payload Specialist Ramon is seen on an exercise machine, Commander Husband shows body fluid samples from the crew taken during the mission, and Clark demonstrates how the crew eats meals. The video ends with footage from earlier in the mission which shows a deployed radiator in the shuttle's payload bay that reflects an image of the Earth.

Source record↗
NASA NTRS2003

The Role of Visual Cues in Microgravity Spatial Orientation

In weightlessness, astronauts must rely on vision to remain spatially oriented. Although gravitational down cues are missing, most astronauts maintain a subjective vertical -a subjective sense of which way is up. This is evidenced by anecdotal reports of crewmembers feeling upside down (inversion illusions) or feeling that a floor has become a ceiling and vice versa (visual reorientation illusions). Instability in the subjective vertical direction can trigger disorientation and space motion sickness. On Neurolab, a virtual environment display system was used to conduct five interrelated experiments, which quantified: (a) how the direction of each person's subjective vertical depends on the orientation of the surrounding visual environment, (b) whether rolling the virtual visual environment produces stronger illusions of circular self-motion (circular vection) and more visual reorientation illusions than on Earth, (c) whether a virtual scene moving past the subject produces a stronger linear self-motion illusion (linear vection), and (d) whether deliberate manipulation of the subjective vertical changes a crewmember's interpretation of shading or the ability to recognize objects. None of the crew's subjective vertical indications became more independent of environmental cues in weightlessness. Three who were either strongly dependent on or independent of stationary visual cues in preflight tests remained so inflight. One other became more visually dependent inflight, but recovered postflight. Susceptibility to illusions of circular self-motion increased in flight. The time to the onset of linear self-motion illusions decreased and the illusion magnitude significantly increased for most subjects while free floating in weightlessness. These decreased toward one-G levels when the subject 'stood up' in weightlessness by wearing constant force springs. For several subjects, changing the relative direction of the subjective vertical in weightlessness-either by body rotation or by simply cognitively initiating a visual reorientation-altered the illusion of convexity produced when viewing a flat, shaded disc. It changed at least one person's ability to recognize previously presented two-dimensional shapes. Overall, results show that most astronauts become more dependent on dynamic visual motion cues and some become responsive to stationary orientation cues. The direction of the subjective vertical is labile in the absence of gravity. This can interfere with the ability to properly interpret shading, or to recognize complex objects in different orientations.

Oman, Charles M.↗
NASA NTRS2003

The Effect of Mission Location on Mission Costs and Equivalent System Mass

Equivalent System Mass (ESM) is used by the Advanced Life Support (ALS) community to quantify mission costs of technologies for space applications (Drysdale et al, 1999, Levri et al, 2000). Mass is used as a cost measure because the mass of an object determines propulsion (acceleration) cost (i.e. amount of fuel needed), and costs relating to propulsion dominate mission cost. Mission location drives mission cost because acceleration is typically required to initiate and complete a change in location. Total mission costs may be reduced by minimizing the mass of materials that must be propelled to each distinct location. In order to minimize fuel requirements for missions beyond low-Earth orbit (LEO), the hardware and astronauts may not all go to the same location. For example, on a Lunar or Mars mission, some of the hardware or astronauts may stay in orbit while the rest of the hardware and astronauts descend to the planetary surface. In addition, there may be disposal of waste or used hardware at various mission locations to avoid propulsion of mass that is no longer needed in the mission. This paper demonstrates how using location factors in the calculation of ESM can account for the effects of various acceleration events and can improve the accuracy and value of the ESM metric to mission planners. Even a mission with one location can benefit from location factor analysis if the alternative technologies under consideration consume resources at different rates. For example, a mission that regenerates resources will have a relatively constant mass compared to one that uses consumables and vents/discards mass along the way. This paper shows examples of how location factors can affect ESM calculations and how the inclusion of location factors can change the relative value of technologies being considered for development.

Fisher, John W.↗
NASA NTRS2003

Risk of Skin Cancer from Space Radiation

We review the methods for estimating the probability of increased incidence of skin cancers from space radiation exposure, and describe some of the individual factors that may contribute to risk projection models, including skin pigment, and synergistic effects of combined ionizing and UV exposure. The steep dose gradients from trapped electrons, protons, and heavy ions radiation during EVA and limitations in EVA dosimetry are important factors for projecting skin cancer risk of astronauts. We estimate that the probability of increased skin cancer risk varies more than 10-fold for individual astronauts and that the risk of skin cancer could exceed 1 % for future lunar base operations for astronauts with light skin color and hair. Limitations in physical dosimetry in estimating the distribution of dose at the skin suggest that new biodosimetry methods be developed for responding to accidental overexposure of the skin during future space missions.

Cucinotta, Francis A.↗
NASA NTRS2004

Decreased Estrogen May Contribute to Osteopenia in Unloaded Bones

Progressive loss of weight-bearing bone in astronauts is one of the most serious impediments to long-duration spaceflight. Estrogen deficiency in women is an established factor in bone loss. Reduced sex hormone levels have been reported in male astronauts, but no data is available regarding spaceflight effects on female sex hormones. The objective of our study was to determine the role of estrogen in disuse osteopenia. The NASA developed hindlimb suspension (HLS) model was used to simulate the unloading disuse of weight-bearing bones experienced in space. Female Sprague-Dawley rats (age 77d; n = 20/group) were HLS or kept ambulatory (AMB) for 38 d and endocrine and bone indices determined. HLS of rats resulted in lower (p less than 0.01) bone mass (9%0), bone mineral content (BMC 13%) and mechanical strength (28%) compared to AMB animals. Plasma estradiol (E2) was lower (p = 0.03) in HLS (10.1 +/- 1.4 pg/ml) compared to AMB rats (16.7 +/- 2.6 pg/ml). E2 was positively correlated to BMC r(sup 2) = 0.67 and mechanical strength r(sup 2) = 0.61. These results suggest that reduced E2 plays a role in disuse osteopenia induced by HLS. Plasma or pituitary lutenizing hormone (LH) and follicle stimulating hormone (FSH) levels were not different in HLS versus AMB rats. However, pituitary LH was correlated to E2 (r(sup 2) = 0.57), suggesting changes in E2 were exerted at the level of the hypothalamus-pituitary axis. Understanding the role of estrogen in disuse osteopenia is necessary to the development of efficacious therapies for female astronauts, bed rest patients and the increasing number of individuals in our sedentary population suffering bone loss.

Tou, Janet↗
NASA NTRS2004

Applications of Intelligent Tutoring Systems to Human-Robotic Exploration of Mars

Space missions with small crews extending over several years with time-delay preventing normal conversations with people on earth will raise many challenges for training. Of special interest are possible three-year missions to Mars, requiring refresher instruction and learning new skills based on unexpected problems with machines and environmental conditions. For example, the crew will be required to monitor and repair more complex life support systems for air and water recycling than we even know how to build today. Highly educated astronauts, often with several doctorate degrees, require a very different mode of interaction than we have developed for school children or even typical college students. Explanation methods may need to differ-using analogies and techniques from different domains-depending on whether the astronaut is an astrophysicist, a pilot, or a geologist.Virtual reality (e.g., for Hubble repair missions) and "integrated" simulations (involving role-playing and emphasizing failure scenarios) are the most common advanced forms of instruction used in space flight today. The emphasis is on collaborative, embodied interaction with the same workstations and tools used in practice (e.g., a cockpit simulator). Otherwise, computerized instructional technology used by NASA is not model-based or tutorial in nature. This discussion will review some of the key instructional methods used at NASA over the past two decades and consider why ITS methods have not been exploited. Some of the problems and opportunities for training for Mars missions are examined, including how using robots in exploration activities will help but raise new training problems. These ideas will be illustrated with examples from the BrahmsVE system in which a browser- based virtual reality display with avatars allows interacting with a distributed multiagent system, in which agents can be people, robots, or software programs. Using BrahmsVE may provide a way for astronauts to interact with proxies of people who serve as instructional coaches on Mars.

Clancey, William J.↗
NASA NTRS2003

Cardiovascular effects of anti-G suit and cooling garment during space shuttle re-entry and landing

BACKGROUND: Many cardiovascular changes associated with spaceflight reduce the ability of the cardiovascular system to oppose gravity on return to Earth, leaving astronauts susceptible to orthostatic hypotension during re-entry and landing. Consequently, an anti-G suit was developed to protect arterial pressure during re-entry. A liquid cooling garment (LCG) was then needed to alleviate the thermal stress resulting from use of the launch and entry suit. METHODS: We studied 34 astronauts on 22 flights (4-16 d). Subjects were studied 10 d before launch and on landing day. Preflight, crewmembers were suited with their anti-G suits set to the intended inflation for re-entry. Three consecutive measurements of heart rate and arterial pressure were obtained while seated and then again while standing. Three subjects who inflated the anti-G suits also donned the LCG for landing. Arterial pressure and heart rate were measured every 5 min during the de-orbit maneuver, through maximum G-loading (max-G) and touch down (TD). After TD, crew-members again initiated three seated measurements followed by three standing measurements. RESULTS: Astronauts with inflated anti-G suits had higher arterial pressure than those who did not have inflated anti-G suits during re-entry and landing (133.1 +/- 2.5/76.1 +/- 2.1 vs. 128.3 +/- 4.2/79.3 +/- 2.9, de-orbit; 157.3 +/- 4.5/102.1 +/- 3.6 vs. 145.2 +/- 10.5/95.7 + 5.5, max-G; 159.6 +/- 3.9/103.7 +/- 3.3 vs. 134.1 +/- 5.1/85.7 +/- 3.1, TD). In the group with inflated anti-G suits, those who also wore the LCG exhibited significantly lower heart rates than those who did not (75.7 +/- 11.5 vs. 86.5 +/- 6.2, de-orbit; 79.5 +/- 24.8 vs. 112.1 +/- 8.7, max-G; 84.7 +/- 8.0 vs. 110.5 +/- 7.9, TD). CONCLUSIONS: The anti-G suit is effective in supporting arterial pressure. The addition of the LCG lowers heart rate during re-entry.

NASA Center JSC↗
NASA NTRS2003

Bursting into space: alterations of sympathetic control by space travel

AIM: Astronauts return to Earth with reduced red cell masses and hypovolaemia. Not surprisingly, when they stand, their heart rates may speed inordinately, their blood pressures may fall, and some may experience frank syncope. We studied autonomic function in six male astronauts (average +/- SEM age: 40 +/- 2 years) before, during, and after the 16-day Neurolab space shuttle mission. METHOD: We recorded electrocardiograms, finger photoplethysmographic arterial pressures, respiration, peroneal nerve muscle sympathetic activity, plasma noradrenaline and noradrenaline kinetics, and cardiac output, and we calculated stroke volume and total peripheral resistance. We perturbed autonomic function before and during spaceflight with graded Valsalva manoeuvres and lower body suction, and before and after the mission with passive upright tilt. RESULTS: In-flight baseline sympathetic nerve activity was increased above pre-flight levels (by 10-33%) in three subjects, in whom noradrenaline spillover and clearance also were increased. Valsalva straining provoked greater reductions of arterial pressure, and proportionally greater sympathetic responses in space than on Earth. Lower body suction elicited greater increases of sympathetic nerve activity, plasma noradrenaline, and noradrenaline spillover in space than on Earth. After the Neurolab mission, left ventricular stroke volume was lower and heart rate was higher during tilt, than before spaceflight. No astronaut experienced orthostatic hypotension or pre-syncope during 10 min of post-flight tilting. CONCLUSION: We conclude that baseline sympathetic outflow, however measured, is higher in space than on earth, and that augmented sympathetic nerve responses to Valsalva straining, lower body suction, and post-flight upright tilt represent normal adjustments to greater haemodynamic stresses associated with hypovolaemia.

NASA Program Biomedical Research and Countermeasur↗
NASA NTRS2001

Invited review: gender issues related to spaceflight: a NASA perspective

This minireview provides an overview of known and potential gender differences in physiological responses to spaceflight. The paper covers cardiovascular and exercise physiology, barophysiology and decompression sickness, renal stone risk, immunology, neurovestibular and sensorimotor function, nutrition, pharmacotherapeutics, and reproduction. Potential health and functional impacts associated with the various physiological changes during spaceflight are discussed, and areas needing additional research are highlighted. Historically, studies of physiological responses to microgravity have not been aimed at examining gender-specific differences in the astronaut population. Insufficient data exist in most of the discipline areas at this time to draw valid conclusions about gender-specific differences in astronauts, in part due to the small ratio of women to men. The only astronaut health issue for which a large enough data set exists to allow valid conclusions to be drawn about gender differences is orthostatic intolerance following shuttle missions, in which women have a significantly higher incidence of presyncope during stand tests than do men. The most common observation across disciplines is that individual differences in physiological responses within genders are usually as large as, or larger than, differences between genders. Individual characteristics usually outweigh gender differences per se.

NASA Discipline General Space Life Sciences↗
NASA NTRS2001

Decreased non-MHC-restricted (CD56+) killer cell cytotoxicity after spaceflight

Cytotoxic activity of non-major histocompatibility complex-restricted (CD56+) (NMHC) killer cells and cell surface marker expression of peripheral blood mononuclear cells were determined before and after spaceflight. Ten astronauts (9 men, 1 woman) from two space shuttle missions (9- and 10-day duration) participated in the study. Blood samples were collected 10 days before launch, within 3 h after landing, and 3 days after landing. All peripheral blood mononuclear cell preparations were cryopreserved and analyzed simultaneously in a 4-h cytotoxicity (51)Cr release assay using K562 target cells. NMHC killer cell lytic activity was normalized per 1,000 CD56+ cells. When all 10 subjects were considered as one study group, NMHC killer cell numbers did not change significantly during the three sampling periods, but at landing lytic activity had decreased by approximately 40% (P < 0.05) from preflight values. Nine of ten astronauts had decreased lytic activity immediately after flight. NMHC killer cell cytotoxicity of only three astronauts returned toward preflight values by 3 days after landing. Consistent with decreased NMHC killer cell cytotoxicity, urinary cortisol significantly increased after landing compared with preflight levels. Plasma cortisol and ACTH levels at landing were not significantly different from preflight values. No correlation of changes in NMHC killer cell function or hormone levels with factors such as age, gender, mission, or spaceflight experience was found. After landing, expression of the major lymphocyte surface markers (CD3, CD4, CD8, CD14, CD16, CD56), as determined by flow cytometric analysis, did not show any consistent changes from measurements made before flight.

NASA Center JSC↗
NASA NTRS2000

Life in extreme environments: how will humans perform on Mars?

This review of astronaut extravehicular activity (EVA) and the details of American and Soviet/Russian spacesuit design focuses on design recommendations to enhance astronaut safety and effectiveness. Innovative spacesuit design is essential, given the challenges of future exploration-class missions in which astronauts will be called upon to perform increasingly complex and physically demanding tasks in the extreme environments of microgravity and partial gravity.

Non-NASA Center↗
NASA NTRS2004

The Local Tissue Environment During the September 29, 1989 Solar Particle Event

The solar particle event (SPE) of September 29, 1989, produced an iron-rich spectrum with energies approaching 1 GeV/amu with an energy power index of 2.5. These high charge and energy (HZE) ions of the iron-rich SPEs challenge conventional methods of SPE shield design and assessment of astronaut risks. Shield and risk assessments are evaluated using the HZETRN code with computerized anatomical man (CAM) model for astronaut s body tissues. Since the HZE spectra decline rapidly with energy and HZE attenuation in materials is limited by their penetration power, details of the mass distributions about the sensitive tissues (shielding materials and the astronaut's body) are important determining factors of the exposure levels. Typical space suit and lightly shielded structures allow significant contributions from HZE components to some critical body tissues and have important implications on the models for risk assessment. Only a heavily shielded equipment room of a space vehicle or habitat provides sufficient shielding for the early response at sensitive organs from this event. The February 23, 1956 event of similar spectral characteristics and ten times this event may have important medical consequences without a well-shielded region.

Kim, M.-H. Y.↗