This report discusses the National Aeronautics and Space
Administration’s (NASA) contract with Boeing Reusable Space
Systems to build the now-canceled follow-on propulsion module for
the International Space Station. GAO found that the initial
propulsion module project did not meet performance, cost, and
schedule goals largely because NASA proceeded with Boeing’s
proposal without following fundamental processes involving
project planning and execution. Once it was determined that
Boeing’s proposal was inadequate, NASA began to assess
alternatives to the Boeing-proposed propulsion module. The
assessment team defined mission success criteria, identified key
design assumptions, and performed comparative analysis on
competing designs. On the basis of its analyses, the team
recommended a follow-on design. NASA acknowledged that its
initial approach to developing a propulsion module was inadequate
and contributed to the project’s unsuccessful conclusion. NASA
officials sought to learn lessons from the project in order to
avoid similar problems in managing future programs.


Report to Congressional Requesters

United States General Accounting Office


June 2001 SPACE STATION Inadequate Planning and Design Led to Propulsion
Module Project Failure


Page i GAO-01-633 Space Station Letter 1

Appendix I Comments From the National Aeronautics and Space Administration

Appendix II Staff Acknowledgments 17


Figure 1: Diagram of Node X Option 11 Contents

Page 1 GAO-01-633 Space Station

June 20, 2001 The Honorable Ernest F. Hollings Chairman The Honorable John
McCain Ranking Minority Member Committee on Commerce, Science, and
Transportation United States Senate

The Honorable Sherwood L. Boehlert Chairman The Honorable Ralph M. Hall
Ranking Minority Member Committee on Science House of Representatives

The National Aeronautics and Space Administration (NASA) faces many
challenges in developing and supporting the International Space Station.
These challenges, such as Russian difficulty in completing its components on
schedule, led NASA to pursue development of a U. S. propulsion capability
for the space station to serve as an alternative to the planned Russian
capability. In 1998, NASA accepted a proposal from Boeing Reusable Space
Systems for a U. S. propulsion module. NASA’s initial effort to develop this
module was not successful in meeting the program’s performance, cost, and
schedule goals. The effort failed to produce a design that met mission
requirements, increased its estimated cost by $265 million (from $479 to
$744 million), and slipped its schedule by about 2 years. NASA eventually
canceled the program and initiated a follow-on effort.

Although the follow-on propulsion module has since been terminated due to
projected cost increases in the space station as a whole, you asked that we
analyze the initial propulsion module project to help NASA avoid similar
problems in the future. Specifically, we assessed NASA’s processes for
program planning and ensuring that the proposed design met technical
requirements. In addition, this report describes NASA’s evaluation of
alternative approaches for the follow-on propulsion module effort and the
results of NASA’s lessons learned studies from the failed initial program.

United States General Accounting Office Washington, DC 20548

Page 2 GAO-01-633 Space Station

We have reported separately on NASA’s decision to develop the initial
propulsion module under the Boeing space station prime contract. 1

The initial propulsion module project did not meet performance, cost, and
schedule goals largely because NASA proceeded with Boeing’s proposal without
following fundamental processes involving project planning and execution.
NASA officials stated that, had these processes been followed, they would
have determined earlier in the program that the Boeing proposal would not
meet project goals. For example, NASA did not complete a project plan or
develop sufficient information in areas such as systems analysis and risk
management to guide the program. Having such basic information is
fundamental to sound project management. In addition, Boeing’s design was
accepted and implemented before the propulsion module’s detailed technical
requirements were fully established. NASA later found that the design was
not as mature as anticipated and that it required substantial changes. This
led to significant delays, cost increases, and ultimately, project

In May 2000, NASA began to assess alternatives to the Boeing-proposed
propulsion module. The assessment team defined mission success criteria,
identified key design assumptions, and performed comparative analyses on
competing designs. Based on its analyses, the team recommended a follow-on
design. According to NASA officials, this effort brought early analytical
rigor to requirements definition, which NASA had failed to do in the initial

NASA acknowledged that its initial approach to developing a propulsion
module was inadequate and contributed to the project’s unsuccessful
conclusion. NASA officials performed lessons learned efforts on the project
in general and on one specific component-on-orbit fuel transfer-hoping to
avoid similar problems in managing future programs. In all cases, NASA
concluded that the lack of an early systems analysis contributed to project
failure. Regarding the failed attempt to design an on-orbit fuel transfer
component into the propulsion module, NASA cited difficulty in establishing
requirements, estimating cost and schedule, and providing adequate

1 International Space Station Propulsion Module Procurement Process (GAO-
01-576R, Apr. 26, 2001).

Results in Brief

Page 3 GAO-01-633 Space Station

NASA commented on a draft of this report and agreed with our findings. We
are not making recommendations at this time because NASA has canceled its
effort to develop a propulsion module and is recognizing the need to avoid
similar problems in the future by identifying lessons learned.

NASA and its international partners (Japan, Canada, the European Space
Agency, and Russia) are building the space station as a permanently orbiting
laboratory to conduct materials and life sciences research and earth
observation and provide for commercial utilization and related uses under
nearly weightless conditions. Each partner is providing station hardware and
crew members and each is expected to share operating costs and use of the

Russia became a partner in 1993. As a partner, Russia agreed to provide
hardware, such as the Service Module to provide station propulsion, supply
vehicles, and related launch services throughout the station’s life.
However, Russia’s funding problems delayed the launch of the Service Module
by more than 2 years and raised questions about Russia’s ability to support
the station during and after assembly.

Shortly after Russia came into the program, NASA began studying ways to
provide the required propulsion using existing designs and hardware. Later,
in response to continuing problems in the Russian space program, such as
declining launch rates and funding shortages, NASA initiated additional
studies at the Marshall Space Flight Center in Alabama. In the spring of
1995, it focused on satisfying the space station’s command and control and
propulsion requirements. In 1996, Marshall proposed building a propulsion
module in-house, and in 1997, NASA considered using existing Russian
hardware to provide the needed propulsion.

In 1997, in response to continuing concerns over Russia’s ability to fulfill
its station commitments, NASA developed a contingency plan, which included a
strategy to mitigate the risk of both further delay on the Service Module
propulsion capabilities and Russia not being able to meet station propulsion
needs. Key elements of the plan involved developing an interim control
module for near-term needs and a propulsion module to provide a permanent
U. S. capability.


Page 4 GAO-01-633 Space Station

In 1998, Boeing Reusable Space Systems proposed a propulsion module concept
that was to rely heavily on existing shuttle hardware, provide for on-orbit
refueling, and cost about $330 million. 2 This proposal coincided with
renewed concern that Russia would not be able to fulfil its commitment to
provide station propulsion capability. NASA decided to move ahead with the
proposal based on a strategy that included refining the design during
subsequent requirements and design reviews. It adopted this strategy based
on its assumption that a propulsion module would be required by early 2002
if Russia failed to launch the Service Module. In July 2000, Russia
successfully launched the Service Module, thus mitigating NASA’s immediate
concern that the space station would not have adequate propulsion
capability. However, the agency still proceeded with the propulsion module
project because of long-term concerns with Russia’s ability to fulfil its

NASA proceeded with Boeing’s proposal without following fundamental
processes involving project planning and execution. Specifically, project
management never finalized its project plan or operational concept and did
not receive timely approval for its risk management plan. The design
ultimately required substantial changes.

To prudently manage the project, NASA should have prepared and completed a
number of planning documents and established baseline goals. 3 Specifically,
NASA did not do the following:

Complete a project plan. 4 Documented project plans help to define
realistic time frames for system acquisition and development and identify
responsibilities for key tasks, resources, and performance measures. Without
them, there is no yardstick by which to measure the progress of the
developmental effort.

2 This initial estimate did not include the cost for on-orbit fuel transfer
or costs associated with integrating the module into the station. In
February 1999, the estimate was revised to $479 million to include all
programmatic costs.

3 NASA Procedures and Guidelines 7120.5A. This document establishes the
management system for processes, requirements, and responsibilities for
implementing NASA programs and projects. This management system governs the
formulation, approval, implementation, and evaluation of all agency programs
and projects.

4 A draft project plan was in the process of being finalized when the
project was canceled. Basic Project

Management and Requirements Principles Not Followed Propulsion Module
Project Planning Was Inadequate

Page 5 GAO-01-633 Space Station

Fully develop a concept of operations document. This document describes
the range of operational scenarios under which project hardware will have to
function. This document is necessary to define requirements, operational
plans, and associated training. The project began with a rudimentary concept
that was continually refined during the course of the project.

Complete an approved risk management plan in a timely manner. 5 A formal
risk management plan helps management identify, assess, and document risk
associated with the cost, resource, schedule, and technical aspects of the
project. Without such a plan, organizations do not have a disciplined means
to predict and mitigate risks.

Develop realistic cost and schedule estimates for the life of the project.
NASA guidance states that life-cycle cost estimates shall be developed as a
part of the project’s planning activity.

Because of its concerns that Russia would be unable to provide space station
propulsion capability, NASA approached the effort with a sense of urgency.
Its analysis indicated that the U. S. propulsion capability would be needed
by early 2002 if Russia did not meet its commitment. Given the initial
estimate of the time that would be needed to develop and launch the
propulsion module, NASA believed it was necessary to expedite the project.
As a result, NASA chose to simultaneously plan and execute the project,
thereby inhibiting use of fundamental planning documents during project

According to NASA officials, the absence of approved planning documentation
and the urgency NASA perceived in executing the project made it difficult to
effectively guide the project or measure its progress. For example, roles
and responsibilities continued to change, impeding the flow of information.
In addition, the absence of accurate technical, cost, and schedule estimates
early in the project made it difficult for NASA to track cost variances. As
a result, NASA officials told us that the estimated $265 million cost
increase announced just before the program was suspended came as a surprise.
They also stated that, had more analytical

5 While a risk management plan was needed early in the project, it was not
formally approved until 3 months before the project ended. However,
officials did provide evidence of risk identification, assessment, and
mitigation strategies prior to the plan’s approval. Project officials
recognized that the risk management process was incomplete and that the
possibility existed that an unnoticed risk could arise affecting
performance, cost, and schedule. Some of the steps NASA undertook to
mitigate identified risks included establishing assessment teams, imposing
additional testing, and canceling high-risk development activity.

Page 6 GAO-01-633 Space Station

rigor been applied, they would have determined earlier in the program that
the Boeing proposal would not meet project goals.

This procurement strategy also caused NASA to purchase long-lead items
before the project’s requirements, concept of operations, and costs were
fully understood. According to NASA, prior to the decision to cancel the
project, it had obligated about $40 million for the purchase of various
longlead items. Some of these items could be used on the space station or
other NASA projects. However, other items were unique to the propulsion
module project.

Our findings on lapses in project planning are consistent with results from
a NASA independent assessment team, which reviewed the propulsion module
project between September 1999 and March 2000. This team concluded that the
project was at high risk due, in part, to the fact that these critical
project management processes were not followed. Specifically, the team
concluded that (1) the project would not be ready to proceed through the
design reviews until the project plan was fully developed and approved, (2)
a well-integrated risk management program was not in place, and (3) the
project could not be completed within the budget or achieve its planned
delivery date.

NASA proceeded to implement Boeing’s proposal before it determined whether
the design would fully meet the project’s technical requirements. The
following top-level requirements were established at the beginning of the

Provide reboost and attitude control capability.

Provide up to 50 percent of total on-orbit space station propulsion
needs. 6

Provide 12-year on-orbit life.

Maintain orbiter compatibility and transfer capability (pressurized
transfer tunnel for crew and supplies).

Provide capability to be launched and returned by the shuttle.

Conform to NASA safety provisions. Even though the top-level requirements
provided a framework to guide propulsion module development, NASA’s reviews
of the module’s detailed technical requirements identified major concerns.
For example, an April

6 According to NASA, under this design concept a second module would be
required to provide a fully independent U. S. propulsion capability. NASA
Reviews Identified Deficiencies in the Propulsion Module Design

Page 7 GAO-01-633 Space Station

1999 systems requirements review found that NASA did not have detailed
analyses to quantify the amount of propulsion capability that would be
required. NASA space station program personnel later determined the
definition of what propulsive capability was required; however, this
definition was not available until a few months before the initial design
review and could not, therefore, be used to judge the design’s suitability.
Subsequent reviews found deficiencies with the design elements of the module

Although technical requirements were never finalized and continued to
change, NASA accepted and began to implement Boeing’s design. Typically,
technical requirements are determined prior to selecting a design to ensure
that it can satisfy established technical and safety needs. NASA accepted
Boeing’s proposed design and began to implement it because the agency
believed (1) the design was stable and mature because some of the proposed
hardware had been used on the space shuttle and (2) costs were essentially
fixed because the required development activities were understood and would
not change.

As NASA implemented the design-establishing the organization for and
responsibilities of the project office, purchasing long-lead items, etc.-
it discovered a number of unexpected technical complexities and other
obstacles in the design. These problems put into question the ability of the
design to meet the technical requirements, as indicated in the following

A central requirement was for the propulsion module to be refueled while
in orbit. NASA began to question Boeing’s ability to incorporate on-orbit
fuel transfer into the design, citing significant cost, safety, operational,
and system design issues. Ultimately, NASA eliminated this requirement and
reduced the module’s on-orbit life expectancy from 12 to 6 years.
Eliminating these requirements meant that the propulsion module had to
return to earth for refueling; the concept of returnability had not been
fully analyzed; thus, a new design team had to be established to assess
these impacts.

The design also proposed a tunnel diameter that proved too small to
accommodate crew operations and did not meet space station minimum diameter
requirements. In addition to crew passage, the tunnel served as the primary
path for equipment/ supply movement from the shuttle to the station. The
tunnel size was later increased based on NASA’s concerns.

The design made extensive use of existing shuttle flight hardware that had
not been designed for a 12-year application, and Boeing assumed NASA would
accept the hardware based on prior shuttle experience. However,

Page 8 GAO-01-633 Space Station

NASA assessed the hardware and found that much of it could not meet a 12-
year life requirement. In addition, the development specification did not
fully address testing requirements because Boeing assumed a simplified level
of testing. However, testing requirements were later expanded.

The propulsion module project failed to successfully complete its
preliminary design review in December 1999, despite the fact that it had
been considered a mature design. 7 The review concluded, in part, that the
initial propulsion system design did not meet the space station and space
shuttle safety requirements and that another review of propulsion related
issues was needed. In March 2000, NASA’s independent assessment team
concluded that the design was not mature, requirements were not adequately
defined, and major design impacts were likely.

The process by which NASA and Boeing attempted to execute the project
resulted in design changes, added effort, schedule slippage, and purchase of
long-lead items before the design was fully understood. As a result, the
project’s total cost estimate increased significantly. In February 1999,
Boeing estimated that total program cost would be $479 million and
maintained that estimate until April 2000. At that time, Boeing increased
its estimate by $265 million-from $479 million to $744 million. 8 Over this
period, the scheduled launch date slipped by almost 2 years-from August
2002 to July 2004. Based on Boeing’s revised estimates, NASA began to
question the project’s viability, and in July 2000 it informed Boeing that
it would not authorize any additional work on the project. 9

7 The preliminary design review is the project’s initial formal review to
establish a design baseline. This is followed by the critical design review,
after which the design is ready for manufacture, assembly, and integration
of subsystems.

8 The cost estimate of $744 million did not include any contingency funding.

9 At the time NASA decided to stop work on the propulsion module effort,
NASA and Boeing had not negotiated the final terms of the development
contract. Boeing was expected to submit a proposal by the end of May 2000,
but the module design continued to change significantly and the contractor
was unable to meet that target date. When the project was stopped, NASA had
obligated about $135 million for the development effort.

Page 9 GAO-01-633 Space Station

Prior to abandoning its original propulsion module design, NASA established
an Alternative Propulsion Module Assessment Team in May 2000 to review
design concepts for their potential to meet the space station program’s
propulsion requirements. According to NASA officials, this effort brought
early analytical rigor to requirements definition, which NASA had failed to
do in the initial project. During the preliminary phase of the assessment,
team members considered many diverse options. These options varied in design
factors such as module location, number of propulsion elements, and
propellant systems. Each option also had to meet the basic top-level
requirements. Specifically, the alternative propulsion module had to provide
space station attitude and orbit maneuver control, be located on the U. S.
segment of the station, leave two ports available for other vehicles to dock
to the station, meet space station safety requirements, and initially
provide 50 percent of the space station’s propulsion needs. In addition, the
design had to be adaptable to eventually provide 100 percent of the
station’s propulsion needs.

The assessment team identified five potential concepts, including two
modified versions of Boeing’s baseline propulsion module design; the Z1
truss option, which attached to the station’s truss system; the split
element option with separate propulsion and avionics elements; and the Node
X option that had the propulsion elements attached to the Node 1 structural
test article. 10 The team designated a subteam to refine each option’s
design. In addition, the subteams consulted with a cost assessment group to
develop cost estimates for each option. The cost assessment group considered
both initial capability costs, such as development and integration, and
additional life-cycle cost elements, such as shuttle launches, labor, and
spare parts.

Using the subteams? analyses, the assessment team ranked the propulsion
module alternatives in three categories-programmatic (composed of schedule,
cost, and risk), technical (including safety, design, and performance), and
integration issues (such as International Space Station and shuttle impacts
and logistics issues). The team weighted programmatic issues the highest at
60 percent and technical and integration issues at 20 percent each. NASA
officials told us that these

10 The structural test article was built to undergo various pressure and
leak tests to support Node 1 construction. Node 1 is a pressurized element
that serves as the connecting passageway for the space station’s other
modules, and it was the first U. S. station element launched. Follow-on

Module Effort Included Comparative Analyses of Alternative Designs

Page 10 GAO-01-633 Space Station

weightings, typical for this kind of analysis, were approved by the space
station program management.

The assessment team concluded that the Z1 truss option was the best choice.
This option did not require the construction of a pressurized element and
was estimated to cost $515 million to develop. The next best alternative was
the Node X option, with an estimated cost of $700 million to develop.
According to NASA, this option was already well understood because Boeing
had already integrated a similar structure, Node 1, into the space station.

Although the assessment team found the Z1 truss option superior, it
recommended a follow-on study because issues associated with this option’s
integration into the space station were not well understood. Consequently,
in July 2000, a joint NASA and Boeing integration evaluation team examined
integration risks and identified possible design improvements for the Z1
truss and Node X options. NASA believed Boeing’s involvement was important
because as the prime contractor, it would be responsible for integrating the
alternative propulsion module into the space station.

The methodology that the integration evaluation team used was similar to
that used by NASA’s assessment team in reviewing the propulsion module
options. The integration team designated individual teams to evaluate the ZI
truss and Node X options from various functional perspectives, such as
power; structures and mechanisms; guidance, navigation, and control; and
contamination. The functional teams developed criteria for their particular
discipline and evaluated the two options accordingly. For example, the
structures and mechanisms team evaluated the two options for peak loads and
structural fatigue, and the power team for average and peak power
consumption. Based on its evaluation, each team recommended a preferred
option. The integration team’s project manager then led an effort to compile
and analyze the functional teams? recommendations.

Based on this analysis, the team selected the Node X option, which had the
highest overall mission suitability and lowest integration risk. In
contrast, the Z1 truss option created structural stress, station
controllability, and propellant inefficiency issues. The integration team
then concluded that Node X was the preferred choice as a follow-on effort
to the initial propulsion module project. Figure 1 depicts the Node X
propulsion module configuration.

Page 11 GAO-01-633 Space Station

Figure 1: Diagram of Node X Option

Source: Marshall Space Flight Center. The cost assessment group incorporated
the results of the integration evaluation team into a new cost analysis for
the ZI truss and Node X options. According to the new cost analysis, the Z1
truss option’s integration issues increased its estimated cost to $729
million. In contrast, the cost estimate for the Node X option decreased to
$675 million, primarily because the outfitting costs for the structural test
article were lower than expected.

NASA accepted the integration team’s findings and issued a request for
proposal on the Node X option in January 2001. However, 2 months later, NASA
canceled the follow-on effort because of cost increases in the space
station program as a whole. In addition, NASA believed that the risk of
Russian nonperformance was reduced because of the Service Module’s

Page 12 GAO-01-633 Space Station

NASA acknowledged that problems with the management of the initial
propulsion module project contributed to its unsuccessful conclusion, and it
is undertaking lessons learned efforts to help avoid similar problems in
managing future programs. These assessments include top down and systems
engineering reviews at the Marshall Space Flight Center and an assessment by
an engineer at the Johnson Space Center in Texas related specifically to the
on-orbit fuel transfer component of the module.

According to NASA officials, drafts of the Marshall assessments identified
the lack of early systems analysis and good teamwork as contributing to
project failure. For example, key components of the design-use of existing
hardware, on-orbit fuel transfer, and tunnel size-were never tested for
feasibility, partly because Boeing believed that NASA had fully accepted the
assumptions inherent in its design. Later, when these assumptions became
invalidated or retracted, it became apparent that the original concept was
no longer feasible.

The top down assessment also cited a lack of cooperation between NASA and
Boeing as inhibiting the timely completion of required design and risk
management analyses. In many cases, when NASA and Boeing teams tried to work
together, they became confrontational and nonproductive. It concluded, in
part, that, in the future, NASA should ensure that (1) early planning
documents define what roles the various project teams have and how they
interact, (2) government and contractor counterparts are established to
encourage collaboration, and (3) NASA and contractor management monitor the
interaction of the overall project team and intercede if conflicts interfere
with the project’s success.

Another lessons learned assessment was performed on the on-orbit fuel
transfer component of the Boeing proposal, a basic requirement of the
proposed design. This assessment concluded that, while some project
communication was good, internal contractor communication on this part was
less than desirable. For example, center-to-center communication was aided
by daily conversations between the on-orbit fuel transfer and propulsion
module project managers. However, contractor participation in working group
activities was not supported. The assessment also cited NASA’s lack of
systems analysis early in the program and its difficulty in establishing
requirements, estimating cost and schedule, and providing human capital
resources as contributing to the on-orbit fuel transfer project failure.
NASA Recently

Identified Lessons Learned to Apply to Future Programs

Page 13 GAO-01-633 Space Station

The themes cited in NASA’s propulsion module project lessons learned studies
are consistent with those cited in previous program failure assessments. In
December 2000, NASA issued a report synthesizing the findings and
recommendations from earlier reports, arriving at five themes it considered
necessary for sound project management. The five themes were developing and
supporting exceptional people and teams, delivering advanced technology,
understanding and controlling risk, ensuring formulation rigor and
implementation discipline, and improving communication. 11

In commenting on a draft of this report, NASA stated that while it was in
agreement with the findings of the report, the project’s urgency
necessitated its management approach. However, NASA acknowledges that its
project execution could have been improved and that it will now strive to
apply lessons learned from the propulsion module project experience.

Even though NASA perceived a schedule urgency in starting and completing the
project, it should have followed sound management practices. The early
analytical rigor NASA was applying to the follow-on propulsion module
effort would have served the agency well in its execution of the initial

To assess the adequacy of project planning, we reviewed, analyzed, and
compared internal NASA guidance and project planning documents. We also
discussed planning requirements with cognizant project officials and
independent assessment team officials to obtain their views.

To assess the extent to which NASA had defined the technical requirements
for the propulsion module, we reviewed the results of requirements meetings
and approved requirements lists to gain an understanding of the evolution of
requirements determinations. We also held discussions with NASA and Boeing
officials to obtain their perspectives on the validity of the technical
requirements, as well as reasons for requirements changes over the course of
the program.

11 Enhancing Mission Success -A Framework for the Future, a report by the
NASA Chief Engineer and the NASA Integrated Action Team (Dec. 2000). Agency

Scope and Methodology

Page 14 GAO-01-633 Space Station

To describe NASA’s process for reviewing alternative designs, we reviewed
NASA briefing materials and other products related to the establishment of
the Alternative Propulsion Module Assessment Team and others. We also
discussed the teams? charter, methodology, and results with team members and
other cognizant officials.

To describe lessons learned by NASA from the initial program, we reviewed
the results of NASA’s efforts and discussed their significance with
cognizant officials.

We conducted our review from July 2000 to April 2001 in accordance with
generally accepted government auditing standards.

Unless you publicly announce its contents earlier, we plan no further
distribution of this report until 10 days from its issue date. At that time,
we will send copies to the NASA Administrator; the Director, Office of
Management and Budget; and other interested parties. We will also make
copies available to others on request.

Please contact me at (202) 512-4841 if you or your staff have any questions
about this report. Other key contributors to this report are acknowledged in
appendix II.

Allen Li Director, Acquisition and Sourcing Management

Appendix I: Comments From the National Aeronautics and Space Administration

Page 15 GAO-01-633 Space Station

Appendix I: Comments From the National Aeronautics and Space Administration

Appendix I: Comments From the National Aeronautics and Space Administration

Page 16 GAO-01-633 Space Station

Appendix II: Staff Acknowledgments Page 17 GAO-01-633 Space Station

Jerry Herley, John Gilchrist, James Beard, Fred Felder, Belinda LaValle,
Vijay Barnabas, Diane Berry, Rick Eiserman, Susan Woodward, and Cristina
Chaplain made key contributions to this report. Appendix II: Staff