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At least 19 records

Protecting the Health of Astronauts: Enhancing Occupational Health Monitoring and Surveillance for Former NASA Astronauts to Understand Long-Term Outcomes of Spaceflight-Related Exposures

The astronaut community is unique, and may be disproportionately exposed to occupational hazards not commonly seen in other communities. The extent to which the demands of the astronaut occupation and exposure to spaceflight-related hazards affect the health of the astronaut population over the life course is not completely known. A better understanding of the individual, population, and mission impacts of astronaut occupational exposures is critical to providing clinical care, targeting occupational surveillance efforts, and planning for future space exploration. The ability to characterize the risk of latent health conditions is a significant component of this understanding. Provision of health screening services to active and former astronauts ensures individual, mission, and community health and safety. Currently, the NASA-Johnson Space Center (JSC) Flight Medicine Clinic (FMC) provides extensive medical monitoring to active astronauts throughout their careers. Upon retirement, astronauts may voluntarily return to the JSC FMC for an annual preventive exam. However, current retiree monitoring includes only selected screening tests, representing an opportunity for augmentation. The potential long-term health effects of spaceflight demand an expanded framework of testing for former astronauts. The need is two-fold: screening tests widely recommended for other aging populations are necessary to rule out conditions resulting from the natural aging process (e.g., colonoscopy, mammography); and expanded monitoring will increase NASA's ability to better characterize conditions resulting from astronaut occupational exposures. To meet this need, NASA has begun an extensive exploration of the overall approach, cost, and policy implications of e an Astronaut Occupational Health program to include expanded medical monitoring of former NASA astronauts. Increasing the breadth of monitoring services will ultimately enrich the existing evidence base of occupational health risks to astronauts. Such an expansion would therefore improve the understanding of the health of the astronaut population as a whole, and the ability to identify, mitigate, and manage such risks in preparation for deep space exploration missions.

Rossi, Meredith

Achieving Quality in Occupational Health

The conference convened approximately 100 registered participants of invited guest speakers, NASA presenters, and a broad spectrum of the Occupational Health disciplines representing NASA Headquarters and all NASA Field Centers. Centered on the theme, "Achieving Quality in Occupational Health," conferees heard presentations from award winning occupational health program professionals within the Agency and from private industry; updates on ISO 9000 status, quality assurance, and information technologies; workshops on ergonomics and respiratory protection; an overview from the newly commissioned NASA Occupational Health Assessment Team; and a keynote speech on improving women's health. In addition, NASA occupational health specialists presented 24 poster sessions and oral deliveries on various aspects of current practice at their field centers.

Michele O'Donnell

NASA Occupant Protection Standards Development

Current National Aeronautics and Space Administration (NASA) occupant protection standards and requirements are based on extrapolations of biodynamic models, which were based on human tests performed under pre-Space Shuttle human flight programs where the occupants were in different suit and seat configurations than is expected for the Multi Purpose Crew Vehicle (MPCV) and Commercial Crew programs. As a result, there is limited statistical validity to the occupant protection standards. Furthermore, the current standards and requirements have not been validated in relevant spaceflight suit, seat configurations or loading conditions. The objectives of this study were to develop new standards and requirements for occupant protection and rigorously validate these new standards with sub-injurious human testing. To accomplish these objectives we began by determining which critical injuries NASA would like to protect for. We then defined the anthropomorphic test device (ATD) and the associated injury metrics of interest. Finally, we conducted a literature review of available data for the Test Device for Human Occupant Restraint New Technology (THOR-NT) ATD to determine injury assessment reference values (IARV) to serve as a baseline for further development. To better understand NASA s environment, we propose conducting sub-injurious human testing in spaceflight seat and suit configurations with spaceflight dynamic loads, with a sufficiently high number of subjects to validate no injury during nominal landing loads. In addition to validate nominal loads, the THOR-NT ATD will be tested in the same conditions as the human volunteers, allowing correlation between human and ATD responses covering the Orion nominal landing environment and commercial vehicle expected nominal environments. All testing will be conducted without the suit and with the suit to ascertain the contribution of the suit to human and ATD responses. In addition to the testing campaign proposed, additional data analysis is proposed to mine existing human injury and response data from other sources, including military volunteer testing, automotive Crash Injury Research Engineering Network (CIREN), and IndyCar impact and injury data. These data sources can allow a better extrapolation of the ATD responses to off-nominal conditions above the nominal range that can safely be tested. These elements will be used to develop injury risk functions for each of the injury metrics measured from the ATD. These risk functions would serve as the basis for the NASA standards. Finally, we propose defining standard test methodology for evaluating future spacecraft designs against the IARVs, including developing a star-rating system to allow crew safety comparisons between vehicles.

Somers, Jeffrey T.

Safeguarding the Health of the NASA Astronaut Community: the Need for Expanded Medical Monitoring for Former NASA Astronauts Under the Astronaut Occupational Health Program

The astronaut community is unique, and may be disproportionately exposed to occupational hazards not commonly seen in other communities. The extent to which the demands of the astronaut occupation and exposure to spaceflight-related hazards affect the health of the astronaut population over the life course is not completely known. Provision of health screening services to active and former astronauts ensures individual, mission, and community health and safety. Currently, the NASA Johnson Space Center (JSC) Flight Medicine Clinic (FMC) provides extensive medical monitoring to active astronauts throughout their careers. Upon retirement, astronauts may voluntarily return to the JSC FMC for an annual preventive exam. However, current retiree monitoring includes only selected screening tests, representing an opportunity for augmentation. The potential latent health effects of spaceflight demand an expanded framework of testing for former astronauts. The need is two-fold: screening tests widely recommended for other aging communities are necessary for astronauts to rule out conditions resulting from the natural aging process (e.g., colonoscopy, mammography), as opposed to conditions resulting directly from the astronaut occupation; and increased breadth of monitoring services will improve the understanding of occupational health risks and longitudinal health of the astronaut community, past, present, and future. To meet this need, NASA has begun an extensive exploration of the overall approach, cost, and policy implications of expanding existing medical monitoring under the Astronaut Occupational Health program for former NASA astronauts.

Rossi, Meredith

NASA Occupational Health Program FY98 Self-Assessment

The NASA Functional Management Review process requires that each NASA Center conduct self-assessments of each functional area. Self-Assessments were completed in June 1998 and results were presented during this conference session. During FY 97 NASA Occupational Health Assessment Team activities, a decision was made to refine the NASA Self-Assessment Process. NASA Centers were involved in the ISO registration process at that time and wanted to use the management systems approach to evaluate their occupational health programs. This approach appeared to be more consistent with NASA's management philosophy and would likely confer status needed by Senior Agency Management for the program. During FY 98 the Agency Occupational Health Program Office developed a revised self-assessment methodology based on the Occupational Health and Safety Management System developed by the American Industrial Hygiene Association. This process was distributed to NASA Centers in March 1998 and completed in June 1998. The Center Self Assessment data will provide an essential baseline on the status of OHP management processes at NASA Centers. That baseline will be presented to Enterprise Associate Administrators and DASHO on September 22, 1998 and used as a basis for discussion during FY 99 visits to NASA Centers. The process surfaced several key management system elements warranting further support from the Lead Center. Input and feedback from NASA Centers will be essential to defining and refining future self assessment efforts.

Brisbin, Steven G.

Rollout and Turnoff (ROTO) Guidance and Information Displays: Effect on Runway Occupancy Time in Simulated Low-Visibility Landings

This report examines a rollout and turnoff (ROTO) system for reducing the runway occupancy time for transport aircraft in low-visibility weather. Simulator runs were made to evaluate the system that includes a head-up display (HUD) to show the pilot a graphical overlay of the runway along with guidance and steering information to a chosen exit. Fourteen pilots (airline, corporate jet, and research pilots) collectively flew a total of 560 rollout and turnoff runs using all eight runways at Hartsfield Atlanta International Airport. The runs consisted of 280 runs for each of two runway visual ranges (RVRs) (300 and 1200 ft). For each visual range, half the runs were conducted with the HUD information and half without. For the runs conducted with the HUD information, the runway occupancy times were lower and more consistent. The effect was more pronounced as visibility decreased. For the 1200-ft visibility, the runway occupancy times were 13% lower with HUD information (46.1 versus 52.8 sec). Similarly, for the 300-ft visibility, the times were 28% lower (45.4 versus 63.0 sec). Also, for the runs with HUD information, 78% (RVR 1200) and 75% (RVR 300) had runway occupancy times less than 50 sec, versus 41 and 20%, respectively, without HUD information.

Hueschen, Richard M.

Occupant Protection Project

Topics include occupant protection overview with a focus on crew protection during dynamic phases of flight; occupant protection collaboration; modeling occupant protection; occupant protection considerations; project approach encompassing analysis tools, injury criteria, and testing program development; injury criteria update methodology, unique effects of pressure suits and other factors; and a summary.

Bopp, Genie

Multi-Agency Annual Southeastern Beach Mouse Habitat Occupancy Monitoring

The southeastern beach mouse (Peromyscus polionotus niveiventris, hereafter SEBM), a federally threatened species was identified by Merritt Island National Wildlife Refuge (MINWR) as one of the top five priorities for management. The Kennedy Space Center (KSC) Environmental Management Branch was asked to provide support in the form of population monitoring for SEBM on KSC and the surrounding properties. When we began the project, the SEBM was known to occupy sites ranging from Volusia through Brevard and Indian River Counties, but the exact distribution within the Federal lands encompassing the Cape Canaveral Barrier Island Complex (CCBIC) was not well known. The broad range of habitat conditions encompassing the species’ historical range and the diversity of sites historically known to contain SEBM required a landscape-scale approach for both monitoring the population and for investigating species habitat relationships. We designed a monitoring plan for the SEBM with the goal of estimating the habitat occupancy of beach mice annually each winter/spring throughout the entire area of suitable coastal habitat (approximately 72 km linear distance along the beach). Methods were tested in a 2008 pilot study, and during 2010-2018 we monitored the proportion of coastal habitat occupied by the SEBM on the CCBIC. Monitoring was focused on using dynamic habitat occupancy surveys with data collected with rapid assessment techniques (i.e., track tubes or live-traps) to detect SEBM occurrence at sampling stations. An important component of the study design was the use of repeated samples that provided the information needed to estimate detectability. Measuring detectability was required to account for the fact that surveys could fail to detect animals at sites at which they were actually present (Mackenzie et al., 2002). This monitoring framework is very flexible, allowing numerous hypothesis to be tested about how various factors influence beach mouse occupancy using habitat, geographic, and environmental covariates. Our survey has been the longest survey conducted for any of the seven extant beach mouse subspecies and has encompassed nearly the entire remaining range of the SEBM. Although occupancy surveys of other beach mouse subspecies via track tubes have been conducted on the Gulf coast of Florida by Florida Fish and Wildlife Conservation Commission (FWC), United States Fish and Wildlife Service (USFWS), and various universities, we expanded previous methods to fit unique aspects of the SEBM, and thus our study was very different from any of the previous studies. To achieve this specificity, we employed an adaptive approach throughout the study, with all activities aimed at providing managers with information related to environmental compliance and natural resource management on KSC and the surrounding Federal lands.

Eric Douglas Stolen

Measuring Metapopulation Characteristics of the Southeastern Beach Mouse on Kennedy Space Center using a Dynamic Habitat Occupancy Approach

The Cape Canaveral Barrier Island Complex (CCBIC) represents the largest (72 km) continuous coastal habitat supporting the core population of the threatened southeastern beach mouse (Peromyscus polionotus niveiventris) in Florida. Despite protection throughout the subspecies’ remaining range, storm activity during the past two decades has de-stabilized coastal dune and coastal strand habitat required for beach mouse survival. Our long-term goal is to provide information to the management process to ensure a sustainable population on the CCBIC in light of sea-level rise, extreme storm events, and continued land development supporting the multi-user spaceport.Because beach mice populations are affected by storms (hurricanes, tropical storms, nor’easters), it is important to understand the species-habitat relations during periods with and without storm impacts. Conventional wisdom is that coastal dune and coastal strand are the preferred habitats, but coastal scrub habitat may be important because it is less affected by storm impacts (e.g., overwash, escarpment, sand deposition, etc.) and thus may serve as a refugia. In addition, genetic studies have shown some evidence for reduced dispersal between regions on CCBIC (Kalkvik et al., 2012; Zimmerman et al., 2015). We compared site occupancy dynamics for coastal dune, coastal strand, and coastal scrub habitat over three quarters (seasons) and determined the pattern of spatial correlation in habitat occupancy dynamics for locations at a range of distances in coastal dune, coastal strand, and coastal scrub habitats along the Kennedy Space Center (KSC) coastline (Figures1 and 2). Although habitat occupancy is very useful for understanding species-habitat relationships,in its simplest form it ignores differences in abundance between sites. Because information on abundance may inform management efforts and provide knowledge regarding status of the population, we tested measuring abundance state based on the number of detections in tracking tubes. Small mammal populations often fluctuate in a cyclic manner over time. These fluctuations make populations more susceptible to extinction and make trend detection more difficult. Efficient methods of measuring abundance across time and space are needed for monitoring trends.The purpose of this project was to:1.Estimate southeastern beach mouse habitat occupancy parameters in coastal dune, coastal strand, and coastal scrub habitats using a combination of tracking tubes and traps; 2.Model the spatial relationships of the effect of habitat (coastal dune, coastal strand, and coastal scrub) on parameters as a function of distance; and 3.Compare the reliability and efficiency of our survey methods and evaluate the potential to develop an abundance index.

Eric Douglas Stolen

Numerical Investigation of Occupant Injury Risks During A Realistic Transport Aircraft Crash Conditions

Researchers at the National Aeronautics and Space Administration (NASA) Langley Research Center (LaRC) have conducted a full-scale crash test of a Fokker F28 MK1000 aircraft to investigate the performance of transport aircraft under realistic crash conditions. This crash test was computationally recreated using finite element (FE) human body models (HBMs) to further explore potential injury risks to occupants and analyze the utilization of HBMs in the aerospace crash environment. The Global Human Body Model Consortium (GHBMC) male 50th percentile occupant detailed model (v6.0) and the Toyota Human Model for Safety (THUMS) male 50th percentile occupant model (v6.1) were selected to be used in the crash simulations. The HBMs were simulated in conditions matching those of anthropomorphic test device (ATD) experiments included within the aircraft cabin during the crash test. Seven occupant locations within the cabin were simulated utilizing each of the models. The models were positioned in a neutral upright posture with hands resting on the legs and the feet contacting the floor. Head, brain, neck, and lumbar vertebra injury metrics were calculated for all trials. Both HBM models required minor modifications to stabilize these simulations. The GHBMC model required added erosion for six parts while the THUMS model only required one in order to complete the full simulation. The THUMS model, however, required a much smaller timestep for stability and therefore took significantly more computational time. In addition the GHBMC model includes integrated instrumentation while the THUMS model requires development and implementation of instrumentation. Both models predicted 100% injury risk for lumbar vertebra fracture in all test conditions. This prediction was in family with high lumbar load values measured by the ATDs during the crash test. The THUMS model consistently predicted lower injury risks than the GHBMC model in all three other metrics varying depending on the crash pulse. Overall, the THUMS model required less modifications to allow for this study. However, the GHBMC models significantly faster run time and integrated instrumentation make it a more intuitive model for this research.

Crashworthiness

Study of Advanced Occupant Models to Quantify Injury Risk for eVTOL Vehicles

Urban transportation is currently evolving from traditional ground-based vehicles (cars, taxis, and buses) to include air-based electric vertical take-off and landing (eVTOL) vehicles which can be utilized for on-demand transportation, cargo transport, and emergency services. These new eVTOL vehicles are designed to be small, lightweight, and able to operate autonomously without user intervention. Safety is a big part of eventual eVTOL adoption, however gaps in the consideration of safety features exist. Anthropomorphic test devices (ATDs) are used in aerospace crashworthiness standards to quantify occupant injury risk and develop improved safety designs for emergency landing situations, but the ATDs currently used in aircraft certification requirements were developed many decades ago. Developments have occurred over the years involving ATD technology, which includes a host of newer and more biofidelic ATDs such as the Test Device for Human Occupant Restraint (THOR). Increased computing power has also allowed for detailed computational human body models (HBMs) to be created, such as the Global Human Body Model Consortium (GHBMC). This study aims to assess the capability of both HBMs and new ATD designs to identify injury mechanisms within eVTOL relevant emergency landing conditions. Finite element (FE) analysis was used to expand upon full-scale and seat level impact testing conducted by researchers at the National Aeronautics and Space Administration (NASA) to look at effects of occupant model configurations on prediction of injury. The GHBMC HBM and THOR ATD models were simulated in the seat level test conditions to characterize differences between these advanced assessment tools and traditional ATDs in the isolated seat loading environment. Results identified key differences in the responses from each of the models utilized and compared their impact response in head, neck, and spinal injury metrics. The THOR model identified potential risks for head injuries due to head impacts on the seat, however it predicted lower spinal loads than the other occupant surrogates. The GHBMC showed distinctly different biomechanical responses compared to the ATD. The GHBMC model is much more deformable than the ATDs and it exhibited higher distribution of forces and increased sensitivity to the duration of acceleration pulses. Both models incorporated into this study identified key mechanisms for injury that should be considered for passenger safety in the development of these novel aircraft. In addition, this study demonstrated the value of FE modeling for running a variety of complex human surrogates to identify potential injury mechanisms for consideration in regulation and development of new aircraft. Continued research in this field to improve validation these models will only lead to safer aircraft and more comprehensive safety measures.

Crashworthiness

Study of Advanced Occupant Models to Quantify Injury Risk for eVTOL Vehicles

Urban transportation is currently evolving from traditional ground-based vehicles (cars, taxis, and buses) to include air-based electric vertical take-off and landing (eVTOL) vehicles which can be utilized for on-demand transportation, cargo transport, and emergency services. These new eVTOL vehicles are designed to be small, lightweight, and able to operate autonomously without user intervention. Safety is a big part of eventual eVTOL adoption, however gaps in the consideration of safety features exist. Anthropomorphic test devices (ATDs) are used in aerospace crashworthiness standards to quantify occupant injury risk and develop improved safety designs for emergency landing situations, but the ATDs currently used in aircraft certification requirements were developed many decades ago. Developments have occurred over the years involving ATD technology, which includes a host of newer and more biofidelic ATDs such as the Test Device for Human Occupant Restraint (THOR). Increased computing power has also allowed for detailed computational human body models (HBMs) to be created, such as the Global Human Body Model Consortium (GHBMC). This study aims to assess the capability of both HBMs and new ATD designs to identify injury mechanisms within eVTOL relevant emergency landing conditions. Finite element (FE) analysis was used to expand upon full-scale and seat level impact testing conducted by researchers at the National Aeronautics and Space Administration (NASA) to look at effects of occupant model configurations on prediction of injury. The GHBMC HBM and THOR ATD models were simulated in the seat level test conditions to characterize differences between these advanced assessment tools and traditional ATDs in the isolated seat loading environment. Results identified key differences in the responses from each of the models utilized and compared their impact response in head, neck, and spinal injury metrics. The THOR model identified potential risks for head injuries due to head impacts on the seat, however it predicted lower spinal loads than the other occupant surrogates. The GHBMC showed distinctly different biomechanical responses compared to the ATD. The GHBMC model is much more deformable than the ATDs and it exhibited higher distribution of forces and increased sensitivity to the duration of acceleration pulses. Both models incorporated into this study identified key mechanisms for injury that should be considered for passenger safety in the development of these novel aircraft. In addition, this study demonstrated the value of FE modeling for running a variety of complex human surrogates to identify potential injury mechanisms for consideration in regulation and development of new aircraft. Continued research in this field to improve validation these models will only lead to safer aircraft and more comprehensive safety measures.

Crashworthiness

An improved human display model for occupant crash simulation programs

An improved three-dimensional display model of a human being which can be used to display the results of three-dimensional simulation programs that predict the positions of an occupant during impact of a vehicle was presented. The model allows the user to view the occupant from any orientation in any position during the crash. The display model assumes the usual break up of the body into rigid segments which is normal for occupant crash simulation programs, but the shape of the segments in the display model are not necessarily the same as those used in the crash simulation. The display model is proportioned so as to produce a realistic drawing of the human body in any position. Joints connecting the segments are also drawn to improve realism.

Willmert, K. D.

Developing space occupancy - Perspectives on NASA future space programme planning

NASA planning aspects of potential future manned space flight missions are examined and the necessity of long-range planning is pointed out. A listing of desirable future activities is considered, taking into account the permanent occupancy of near-earth orbit space, the permanent occupancy of earth-moon space, the full self-sufficiency of man in geolunar space, and the permanent occupancy of heliocentric space. The technological requirements for the considered activities are discussed, giving attention to transportation, habitation, engineering technology, life sciences, operations technology, and advanced management concepts. A description of future program phasing and advanced studies requirements is also given.

Von Puttkamer, J.

Developing space occupancy - Perspectives on NASA future space program planning

Potential future manned space flight missions for the time after the development of the space transportation system with the space shuttle are considered, taking into account a sequence of activities concerning a gradually increasing penetration of space by man. The activities are related to the permanent occupancy of near-earth space, the permanent occupancy of near-moon space, the full self-sufficiency of man in earth-moon space, and the permanent occupancy of heliocentric space. Attention is given to Mars orbiting stations, the exploration of the asteroids, comet exploration, planet engineering programs, heliocentric orbit installation, the evolution of the earth orbit space community, space industrialization technology, lunar base development, and evolutionary paths to far-future space endeavors.

Von Puttkamer, J.

Prototype Input and Output Data Elements for the Occupational Health and Safety Information System

The National Aeronautics and Space Administration plans to implement a NASA-wide computerized information system for occupational health and safety. The system is necessary to administer the occupational health and safety programs and to meet the legal and regulatory reporting, recordkeeping, and surveillance requirements. Some of the potential data elements that NASA will require as input and output for the new occupational health and safety information system are illustrated. The data elements are shown on sample forms that have been compiled from various sources, including NASA Centers and industry.

Whyte, A. A.

Engineered Solutions to Reduce Occupational Noise Exposure at the NASA Glenn Research Center: A Five-Year Progress Summary (1994-1999)

At the NASA John H. Glenn Research Center at Lewis Field (formerly the Lewis Research Center), experimental research in aircraft and space propulsion systems is conducted in more than 100 test cells and laboratories. These facilities are supported by a central process air system that supplies high-volume, high-pressure compressed air and vacuum at various conditions that simulate altitude flight. Nearly 100,000 square feet of metalworking and specialized fabrication shops located on-site produce prototypes, models, and test hardware in support of experimental research operations. These activities, comprising numerous individual noise sources and operational scenarios, result in a varied and complex noise exposure environment, which is the responsibility of the Glenn Research Center Noise Exposure Management Program. Hearing conservation, community noise complaint response and noise control engineering services are included under the umbrella of this Program, which encompasses the Occupational Safety and Health Administration (OSHA) standard on occupational noise exposure, Sec. 29CFR 1910.95, as well as the more stringent NASA Health Standard on Hearing Conservation. Prior to 1994, in the absence of feasible engineering controls, strong emphasis had been placed on personal hearing protection as the primary mechanism for assuring compliance with Sec. 29CFR 1910.95 as well as NASA's more conservative policy, which prohibits unprotected exposure to noise levels above 85 dB(A). Center policy and prudent engineering practice required, however, that these efforts be extended to engineered noise controls in order to bring existing work areas into compliance with Sec. 29CFR 1910.95 and NASA's own policies and to ensure compliance for new installations. Coincident with the establishment in 1995 of a NASA wide multi-year commitment of funding for environmental abatement projects, the Noise Exposure Management Program was established, with its focus on engineering approaches to reducing occupational and community noise exposure. The organization and mission of this Program were documented shortly after its inception, and individual programmatic components have been the subject of subsequent papers. This paper summarizes the status and accomplishments of the engineering aspects of the Program from a five-year retrospective viewpoint and includes a review of retrofit noise control solution strategies, which have not been previously documented.

Cooper, Beth A.

Proceedings from the 2001 NASA Occupational Health Conference: Risk Assessment and Management in 2001

This Conference convened approximately 86 registered participants of invited guest speakers, NASA presenters, and a broad spectrum of the Occupational Health disciplines representing NASA Headquarters and all NASA Field Centers. Two days' Professional Development Courses on Exposure Assessment Strategies and Statistics and on Advanced Cardiac Life Support training and recertification preceded the Conference. With the theme, 'Risk Assessment and Management in 2001,' conferees were first provided updates from the Program Principal Center Office and the Headquarters Office. Plenary sessions elaborated on several topics: biological terrorism, OSHA recordability, Workers' Compensation issues, Federal ergonomic standards, bridging aerospace medicine and occupational health-especially in management of risk in spaceflight, and EAP operations with mission failures. A keynote address dealt with resiliency skills for 21st century workers and two NASA astronaut speakers highlighted a tour of the Johnson Space Center. During discipline specific breakout sessions, current issues in occupational health management and policy, credentialing and privileging, health risk assessment, measurement and standardization, audits, database development, prevention and rehabilitation, international travel and infection control, employee assistance, nursing process, and environmental health were presented.

Roberson, Sheri