Presentation Topics Background Progress and status Candidate investigations Specific investigations Milestones progress Future 1-year missions 22 July 2014 Grand Rounds 2 Multilateral Human Research Panel for Exploration What is MHRPE? Created by ISS Expert Working Group, Sep. 2011 Chartered by Space Station Control Board, Oct. 2013 MULTILATERAL HUMAN RESEARCH PANEL EXPLORATION 22 July 2014 CSA, ESA, JAXA, NASA, Roskosmos Not ASI, CNES, DLR, NSAU Humans (astronauts) Not animals, plants, cells, etc., except as relevant to human risk Not clinical Research-oriented, for (but collaborate with clinical risk reduction for risk reduction research) Coordination Not board, not working group, not implementation Risk reduction for human missions beyond LEO; application Not basic research, “discovery” Grand Rounds 3 Multilateral Human Research Panel for Exploration • Created by ISS Expert Working Group, Sep. 2011 • Chartered by Space Station Control Board, Oct. 2013 22 July 2014 Grand Rounds 4 Role of International Science Office of NASA Human Research Program (HRP) Facilitate multilateral collaborations. NASA co-chair of MHRPE. Oversee NASA implementation of bilateral research program for One-Year Mission. Grand Rounds HRP International Science Office ISLSWG Bilateral JWGs John B. Charles, Ph.D. – Chief john.b.charles@nasa.gov Jon McFather – Coordination jon.c.mcfather@nasa.gov Igor A. Savelev, Ph.D. – Russia Coordination igor.a.savelev@nasa.gov Cynthia P. Haven, P.E. – Integration Coordination cynthia.p.haven@nasa.gov 22 July 2014 NASA CSA JAXA ESA ASI CNES DLR MHRPE MMOP HRMRB ICMRWG IARWG Bilateral JWG Roscosmos 5 MHRPE Organization: POCs and working groups Agency NASA Roscosmos ESA CSA JAXA Co-chair Charles Bogomolov Overall lead Charles Bogomolov Ngo-Anh Buckley Mukai Biomedical research Charles Morukov Medical Operations Watkins (was Senter) Bogomolov Damann Kuyumjian Miki Coordinator McFather Savelev (Russia) Morgun TBD TBD TBD Data sharing WG Haven, Hasbrook Bogomolov Ngo-Anh TBD TBD Medical hardware sharing WG Fogarty (to transition to Haven) Bogomolov (biomedical) Pochuev (medical, GCTC) Sundblad, Damann 1YM Direct Return Montalbano Kharlamov Research subject sharing WG: Cosmonaut participation in biomedical research Haven Kharlamov Ngo-Anh TBD TBD Operational WG: implementation for 1YM and long duration mission Morshedi Samarin Ngo-Anh Role 22 July 2014 Grand Rounds 6 MULTILATERAL HUMAN RESEARCH PANEL FOR EXPLORATION (MHRPE) Began as ISS Experts Working Group (IEWG) Team 5, late 2011 Team 1 ISS Deorbit Considerations Team 2 Major Anomaly Recovery Team 3 ISS Demonstration of Generic Technologies and Capabilities for Space Exploration Team 4 Using Parts of ISS for Exploration Team 5 Human Health Management for Long Duration Space Travel Team 6 ISS-based operations simulations and techniques [including One-year Mission] Strategy White Paper, May 2012: “Enhancing ISS Human Research, An International Strategy of Risk Reduction for Exploration” Lifetime limited by “sunset” of IEWG, Oct. 2013 Chartered by SSCB, Nov. 2013 22 July 2014 Grand Rounds 7 TEAM 5 / HUMAN HEALTH AND PERFORMANCE SCOPE AND FUNCTION Team 5 tasked by the IEWG to: Identify the top human health risks for a Mars mission across the partners, emphasizing those requiring ISS for study and closure – Decision to carry risk status for interim exploration scenarios as well Discuss ISS partner plans for mitigation of these risks Discuss Partner coordination of process and findings Identify barriers to effective coordination of research across the Partners Coordinate solutions and provide recommendations to ISS Program Management 22 July 2014 Grand Rounds 8 Human Health and Performance Risks Across All Partners Not mission limiting Not mission limiting, but increased risk GO Mission limiting Mission NO GO GO ISS 6 mo Lunar 6 mo NEA (1yr) Mars (3yr) Musculoskeletal: Long-Term health risk of Early Onset Osteoporosis Mission risk of reduced muscle strength and aerobic capacity Sensorimotor: mission Risk of sensory changes/dysfunctions Ocular Syndrome: Mission and long-term health risk of Microgravity-Induced Visual Impairment and/or elevated Intracranial Pressure (VIIP) Nutrition: Mission risk of behavioral and nutritional health due to inability to provide appropriate quantity, quality and variety of food Autonomous Medical Care: Mission and long-term health risk due to inability to provide adequate medical care throughout the mission (Includes onboard training, diagnosis, treatment, and presence/absence of onboard physician) Behavioral Health and Performance: Mission and long-term behavioral health risk. Radiation: Long-term risk of carcinogenesis and degenerative tissue disease due to radiation exposure – Largely addressed with ground-based research Toxicity: Mission risk of exposure to a toxic environment without adequate monitoring, warning systems or understanding of potential toxicity (dust, chemicals, infectious agents) Autonomous emergency response: Medical risks due to life support system failure and other emergencies (fire, depressurization, toxic atmosphere, etc.), crew rescue scenarios Hypogravity: Long-term risk associated with adaptation during IVA and EVA on the Moon, asteroids, Mars (vestibular and performance dysfunctions) and postflight rehabilitation 22 July 2014 Grand Rounds 9 Example Musculoskeletal International Fly-off Plan Associated Tasks IRP Rev C Title Bisphosphonates as a Countermeasure to Space Flight Induced Bone Loss: SMO-021- NASA/JAXA Dietary Intake Can Predict and Protect Against Changes in Bone Metabolism During Space Flight and Recovery (Pro-K) - NASA Integrated Resistance and Aerobic Training Study - NASA Fly-off Plan Title FY 2012 2013 2014 2015 2016 2017 2018 2019 2020 "N" Subj 129-32 133-36 137-40 141-44 145-48 149-52 153-56 157-60 161-64 Unmet Req Bisphosphonates Controls/E255SMO021/Matsumoto-Leblanc 17 0 2 1 2 1 Pro K/Smith 16 2 3 3 3 0 1 1 1 1 0 1 0 Sprint (Active Subjects)/Ploutz-Snyder 12 Occupational Risk Surveillance for Bone - NASA Bone Risk Surveillance (p/p) (NxPCM) 6 Bone Countermeasure Study -NASA Bone Countermeasure Study (NxPCM) 12 Exercise Plus Nutritional Supplement Studies - NASA Exercise + Supplements (ECP) 12 Bone Loss Therapy - TBD - NASA Bone Loss Therapy (NxPCM) 24 Ground-based Biomechanical Analyses of Resistance Exercise Using the Advanced Resistive Exercise Device - ESA Study of dynamics of bone mass in cosmonauts during SF - IBMP Biomechanical Analysis of Treadmill Locomotion on the International Space Station - NASA Development of New Exercise Hardware for Exploration Missions - NASA Treadmill Kinematics/DeWitt 6 3 2 1 0 1 2 1 2 1 2 1 0 1 0 0 0 2 2 2 0 0 6 12 24 0 Risk of Intervertebral Disc Damage After Prolonged Spaceflight - NASA Sonographic Astronaut Vertebral Examination - NASA Intervertebral Disk Damage/Hargens (p/p) Sonogram-Vertebral/Dulchavsky (NxPCM) 12 12 0 0 0 0 1 0 1 3 Functional Task Test (FTT)/Bloomberg 13 1 2 1 2 MARES Neuromuscular (ECP) 12 Muscle Adaptation Time Course (ECP) 22 July 2014 0 0 12 Neurophysiological analysis of human motility according the adjusted models of motion under microgravity conditions - SSC RF – IBMP Effects of prolonged micro-gravity on the musculoskeletal system of young adult rats - IBMP 0 0 12 Effect of microgravity on cartilage morphology and biology (Pre & post only) ESA Mechanisms of action and efficiency of different countermeasures aimed at the prevention of disorders in musculoskeletal system - IBMP Assessment of architecture and functions of human skeletal muscles - IBMP 0 Osteodensitometer Sprint Optimization w/New Exer HW (ECP) Ground-based Biomechanical Analyses of Resistance Exercise Using the Advanced Resistive Exercise Device - ESA Effect of Spaceflight on Human Skeletal Muscle Force Per Cross-Sectional Area: Architectural, Contactile and Neutral Determinants - ESA Effect of the Hybrid Training Method on the disuse atrophy of the musculoskeletal system of the astronauts staying in the ISS for a long term - Initial verification in ISS - ESA Early Detection of Osteoporosis in Space - ESA 1 ARED Kinematics Exercise + Supplements (ECP) Exercise Plus Nutritional Supplement Studies - NASA 1 0 Exercise Plus Nutritional Supplement Studies - NASA Physiological Factors Contributing to Postflight Changes in Functional Performance (Bloomberg) - NASA In-flight monitoring of neuromuscular function using the Muscle Atrophy Research and Exercise System (MARES) - NASA Determination of the Time Course of Muscle Adaptations to Long Duration Space Flight - NASA Determination of Muscle Protein Turnover During Long Duration Space Flight 2 0 0 0 0 L 0 1 2 2 1 3 2 2 1 2 2 0 1 1 0 1 2 0 0 1 2 1 2 1 2 2 12 0 0 0 0 0 0 1 1 1 1 1 1 1 1 4 12 0 0 0 1 2 3 2 1 2 1 Muscle Protein Turnover (ECP) 12 0 0 0 1 2 3 2 1 2 Exercise + Supplements (ECP) 12 1 12 ARED Kinematics 0 0 SARCOLAB 6 Hybrid (TBD) 1 EDOS 14 Cartilage 10 1 1 4 2 1 Prophylaxis Architecture Myomotoscan ISS-BMS Grand Rounds 11 MHRPE 1-Year Mission (1YM): Progress and Status 2012 Sep. 14: Agency level bilateral agreement 2012 Nov. 3: Program-level implementation agreement 2012 Nov. 30: Candidate investigation lists exchanged 2013 Feb. 25, IBMP: MHRPE 1YM meeting NASA HRP, IBMP, GCTC, TsNIIMash Finalized candidate lists 2013 Apr. 3, IBMP: MHRPE 1YM meeting NASA HRP, IBMP, GCTC, TsNIIMash, Zvezda Field Test, Fluid Shifts discussions 2013 May 15: Multilateral investigations solicited 2013 July15, IBMP: MHRPE 1YM meeting NASA HRP, IBMP, GCTC, TsNIIMash, Zvezda, Roscosmos o Training, protocol discussions for Field Test, Fluid Shifts o multilateral investigations o develop schedule milestones for hardware, data, subject sharing 22 July 2014 2013 Aug. 22 & 2014 Jan. JSC: NASA astronaut ICBs 2013 Oct. 9, and 2014 Mar. 31, Apr. 1, JSC: Roscosmos cosmonaut ICBs 2013 Oct. 30, RAS (IBMP 50th): MHRPE 1YM meeting NASA HRP, IBMP o Data sharing for PFT 2014 Jan., IBMP (MMOP): NASA HRP, IBMP 2014 Mar. 17, JSC: Fluid Shifts meeting 2014 Apr. 16, IBMP (16th JWG) 2014 June, Houston (post-ISMS): investigator meetings Behavioral Health &Performance Space Human Factors & Habitability Metabolism &Immunology All new investigations are on track for implementation on one-year mission, if selected as final complement Available crew time and cold stowage capacity are primary issues Grand Rounds 12 Candidate Joint Biomedical Investigations on 1YM • Scott Kelly performed these 6 (or something close) on his previous 6-month mission • Possible match for one or more of 7 Russian investigations NASA HRP Element Category US study ActiWatch Behavioral Health and Performance Human Health and Countermeasures 22 July 2014 Behavior and Performance Cost of Adaptation, Evaluation of Countermeasures US investigator Suggested Type of Collaboration Possible Russian matches Barger Cross-participation 1 Pilot-T Stuster Joint investigation 2 Interactions-2, Content Biochemical Profile Surveillance Pietrzyk Data sharing 3 Morze, Immuno-2 QCT for Regional Bone Architecture Sibonga Data sharing 1 Korrektsia Functional Task Test Bloomberg Data sharing 1 Functional Task TestRussian(TBD) Reaction Self-Test Dinges Astronaut Journals Grand Rounds 13 Candidate Joint Biomedical Investigations on 1YM • Scott Kelly did not perform them on his previous 6-month mission • Possible match for one or more of 17 Russian studies NASA HRP Element Category Risks Currently Not Resolved Evaluation of Countermeasures Human Health and Countermeasures Cost of Adaptation, Evaluation of Countermeasures US Study US Investigator Suggested Type of Collaboration Possible Russian Matches Stenger, Hargens, Dulchavsky Joint investigation Ocular Health Otto Cross-participation 1 (Med Ops mandatory) Sprint (including Maximal Oxygen Consumption) Ploutz-Snyder, Moore Data sharing 3 Profilaktika-2, Motokard, Korrektsia Integrated Immune Crucian Salivary Simpson Data sharing 2 Morze, Immuno-2 Integrated Cardiovascular (ICV) Bungo, Levine, Platts Data sharing 1 Kardiovektor, Kosmokard (TBD) Cardiovascular Oxidative Damage Platts Data sharing 1 Antioxidant System in OneYear Spaceflight (AOZ) Fluid Shifts (formerly IFV) 3 Data sharing Morze Joint investigation Behavioral Health and Performance 22 July 2014 Behavior and Performance (Hardware only: Chibis, Braslet) (IBMP support at landing site) Efficacy, Human Sensori-Motor Function after Long Duration Microgravity, Virtual, Vector MB-1 Neuroscience Operational and Functional Field Test Reschke Cognitive Performance (NeuroCATS Basner Cross-participation 1 Pilot-T Neuromapping (fMRI) Seidler Cross-participation 1 TBD Grand Rounds Data sharing 4 14 Possible Coordinated Multilateral Investigations on ISS One-Year Mission (13 Nov. 2013) Partner JAXA ESA CSA PI Title Mukai NASA Roscosmos Biological Rhythms – 48 hours Sleep Monitoring Pilot-T Mukai ICP – 1 year Ocular Health (Medical mandatory) Mukai Myco Microbiome TBD Blanc Energy Fluid Shifts Chibis Chouker Immuno-2 (co-investigator) Biochemical Profile Surveillance Immuno-2 Trudel Marrow Integrated Immune; Salivary Markers Morze, Immuno-2 Boyd T-Bone QCT for Regional Bone Architecture Korrektsia Johnson Space Culture Journal Content, Interactions-2 CardiOx Anti-oxidant System in One-year Spaceflight (AOZ) Hughson 22 July 2014 Possible match CV Structure Grand Rounds …plus EDOS (ESA) 15 Candidate Multilateral Investigations for 1YM “Candidate” pending • Crew consent • Russian program • ISSP crew time allocations Cooperative efforts already in work • Field Test • Fluid Shifts • Functional Task Test Cooperative efforts commencing in June • Cognition • Neuromapping • Sleep Monitoring • Reaction Self Test • Journals • Biochemical Profile • Integrated Immune • Fine Motor Control • Habitability • Training Retention Work re: sharing • Crew time • Data 22 July 2014 Grand Rounds 16 Fluid Shifts M. Stenger (NASA), A. Hargens (UCSD), S. Dulchavsky (HFH), V. Bogomolov (IBMP) I. Characterize body fluid distribution pre/in/post spaceflight. II. Correlate in-flight alterations of eye structure, ocular vascular parameters, vision with headward fluid shifts, vascular dimensions, flow patterns. III. Determine systemic, ocular factors of individual susceptibility to development of ICP elevation, vision alterations. Day 3 Day 4 Chibis Tonopen 2 additional laptops for video routing 22 July 2014 Grand Rounds OCT and laptop USND2 CCFP DPOAE Manometer HRF laptop 17 Fluid Shifts: Russian Segment Connectivity OCT Firewire 400 & 800 GFE GFCI Cable USND2 28V Brick USOS Data in RS 28V Connector CCFP 28V HRF Common Power Cable RS Cabin Video for USND2 Remote Guidance, Tonometer & OCT USOS Resource RS I/F OCT Remote Guidance Using Screen Sharing OCT Laptop GFE GFCI Cable DPOAE SSC (Existing in RS) Digitized Video To Ground (Cabin) T61P Video Adapter COTS Power Adapter (to 120V A/C) USOS Ethernet (Downlink) USOS Ethernet (Downlink) 28V Inverter CCFP Analyzer Adapter Cable PS-28 Outlet Strip 28V Connector Ethernet HRF Laptop USND2/VPC SSC (Existing in RS) Digitized Video To Ground (USND2) 28V Brick USOS Ethernet (Downlink) RS Inverter (future) VPC Adapter Cable 28V Connector 28V Connector 28V Brick (Tonometer, Manometer – No connections required) Ground Resource Legend: 22 July 2014 Existing Digital Video Decoder Existing Digital Video Decoder Power Video Grand Rounds Device I/F Data 18 Metabolism and Immunity Possible collaboration between Russia and US investigations IBMP: Morze, Nevroimmunitet HRP: Integrated Immune, Salivary Markers, Biochemical Profile Lists of experiment parameters exchanged Russian parameters delivered to US side in July 2013 US parameters delivered to Russian side April 2014 Investigators agree in principle with collaboration, details to be assessed Commence with 1YM, continue on other missions as appropriate Pre/post flight only, or inflight too? Sample exchange for cross-analysis, data exchange, or other? Data sharing agreements and plans Cold stowage requirements Ambient return requirements Publication plan 22 July 2014 Grand Rounds 19 1YM Implementation Concerns Increment 43-44 USOS crew time issues Oversubscribed by 81% • Does not include new NASA HRP requirements for Twins investigation Per TsNIIMash, also true for Russian segment Also true for Increment 45-46 (2nd half of 1YM) Cold stowage Storage capacity on ISS Sample accommodation on Dragon, Soyuz Sample transfer and handover after Earth return HRP allocation already strained • On-going requirements • Does not include new “Twins” requirements 22 July 2014 Grand Rounds 20 1YM Increment 43-44 USOS Crew Time Available Requested Excess Total 1022 1827 825 Commercial 18 18 0 CSA 20 25 5 ESA 83 149 66 JAXA 107 147 40 NASA 793 1489 694 Notes MSPR2 Rack National Laboratory (CASIS) 318 First significant request HRP 622 Does not include Twins Non-HRP 334 ASI bilateral Tech Demo 157 NASA Research Cold Stowage Other IP Agreements 22 July 2014 Grand Rounds 48 Operation, maintenance 9 EML, JEMAL 21 Year-long Mission: Pre-flight Milestones 2012 2013 2014 30 Nov. L-28 February L-25 March L-24 June L-21 August L-19 November L-16 December L-15 NASA IRB approval of investigation modifications Jan. L-14 Crewmembers informed consent briefing #2 February L-13 ISS Partners IRB mission complement approval March L-12 ISS Increment Research Team baseline of mission complement early April L-11 NASA IRB mission complement approval April L-11 May L-10 Test Readiness Review approval (prior to training or data collection) June L-9 Begin crewmember training and baseline data collection … 2015 30 Mar. 22 July 2014 NASA and IBMP exchange lists of candidate investigations Joint US / Russian human research program science complement to be identified Investigators tasked to develop modified and new proposals International Partner solicitation, selection New proposals scientific peer review start NASA IRB approves modified investigation proposals Modified investigations selected for flight Crewmembers informed consent briefing #1 New proposals submitted for IRB review ISS Partner IRBs approve Partner investigations HRMRB mission complement approval Present final proposed set of investigations to crewmembers Resolution of crew time issues; data- and hardware-sharing sharing agreements L-0 42S Soyuz launch, start of Expedition 43-44-45-46 Grand Rounds 22 Additional year-long ISS missions? 6-month ISS flights may not reduce risk sufficiently for health, safety, and performance on future exploration missions Unexpected physiological events with temporal threshold (VIIP) Duration not dictated by biomedical requirements - Driven by Soyuz availability Longer ISS missions may help resolve uncertainties What are critical unknowns for exploration missions? What ISS duration(s) are needed? Assuming availability of 1-year ISS missions, how many? How best to leverage 6-month database? 22 July 2014 Grand Rounds 23 Major Areas of Concern for Future Exploration Missions Medical events Establish likelihood of events with temporal trend Characterize response with known medical conditions Physiological deconditioning Establish efficacy of countermeasures Behavior & Performance Characterize trends Validate countermeasures 22 July 2014 Grand Rounds 24 Questions What combination of ISS durations provide best data to resolve uncertainties related to human health and performance during exploration missions beyond LEO? What number(s) of crewmember-participants will be required? What is optimal timing for missions? How effective will this data be in certifying crewmembers for exploration missions? How to offset loss of crewmembers available for 6-month mission investigations? Currently projected shortfall of 135 crewmember data-sets after 2024, 0 after 2028 Each 1-year crewmember = 2@ 6-month crewmembers 22 July 2014 Grand Rounds 25 Assumptions ISS available through 2028: Continuously staffed by 6 (until 2018), then 7 (2018-2028) crewmembers (3 Russian, 3-4 USOS) - Baseline mission duration = 6 months (“6MM”) - Up to 5 missions of 1 year (“1YM”) for 2 crewmembers (1 Russian, 1USOS) alternating with 6MM starting 2017 - 1 Soyuz taxi mission of 30-45 days during each 1-year ISS mission (“6WM”) • A-line: 2 Russian, 1 USOS crewmembers • Short-duration crewmembers offset N lost due to 1-year crewmembers Crew, Hardware, Data Sharing agreements will permit research access to all crewmembers during year-long missions N = 10 for 1YM N = 10-20 for 6MM N = 10 for 6WM Common measurements at 3 mission durations to reveal trends for 2-3 year exploration missions Fully-integrated joint US-Russian research program Standard measures, primarily pre/post flight, with in-flight as appropriate - Medical events - Countermeasure validation - Behavior and performance trends 6WM emphasize space human factors investigations not requiring longer durations 22 July 2014 Grand Rounds 26 DRAFT Crew Rotation Plan (3 April 2014) 22 July 2014 Grand Rounds 27 NASA Twins Study 10 proposals from 7 states selected 7 March 2014, to receive total $1.5M over 3 years Investigators Working Group April 2-3, USRA, Houston Attendees - Representatives from 10 proposals - NASA: HRP, geneLAB project, astronauts, ethics, data archives - NSBRI, CASIS. Solicitation: "Human Exploration Investigators developed principles for Research Opportunities - Differential publication plan, data sharing plan for Effects on Homozygous Twin integrated “Twins Study” Astronauts Associated with Differences Investigators developed sample in Exposure to Spaceflight Factors." collection plan - Reduced aggregate requirements for Released 30 July 2013 limiting in-flight resources to Received 40 proposals by due date 17 manageable levels Sep 2013 - New approach to blood sample Peer reviewed January 2014, 3 collection categories - Sleep, Metabolism, Microbiome - Omics, Epigenetics, Chromosomes - Cardiovascular 22 July 2014 Grand Rounds 28 Twins Study selected proposals Andrew Feinberg, Johns Hopkins University Emmanuel Mignot, Stanford University School of Medicine, HERO Twin Astronaut School of Medicine, Comprehensive whole genome analysis of differential epigenetic Study Consortium (TASC): Immunome effects of space travel on monozygotic Changes in Space twins Michael Snyder, Stanford University, HERO Twin Astronaut Study Consortium Christopher Mason, Weill Medical College of Cornell University, The Landscape of (TASC) Project: Longitudinal integrated DNA and RNA Methylation Before, During, multi-omics analysis of the biomolecular and After Human Space Travel effects of space travel Mathias Basner, University of Pennsylvania Brinda Rana, University of California, Proteomic Assessment of Fluid Shifts and School of Medicine, HERO Twin Astronaut Study Consortium (TASC) Project: Association with Visual Impairment and Cognition on Monozygotic Twin on Earth Intracranial Pressure in Twin Astronauts Susan Bailey, Colorado State University, Stuart Lee, Wyle Laboratories, Metabolomic And Genomic Markers Of Atherosclerosis Differential effects on telomeres and As Related To Oxidative Stress, telomerase in twin astronauts associated Inflammation, And Vascular Function In with spaceflight Twin Astronauts Fred Turek, Northwestern University, HERO Twin Astronaut Study Consortium Scott Smith, NASA Johnson Space Center, (TASC) Project: Metagenomic Sequencing Biochemical Profile: Homozygous Twin control for a 12 month Space Flight of the Bacteriome in GI Tract of Twin Exposure Astronauts 22 July 2014 Grand Rounds 29 Recommendations for 1-Year Crewmembers 1YM1 1YM2 1YM3 22 July 2014 Up to 5 additional 1-year missions, no more than 12 crewmembersubjects Enhance return through reduced variance by selecting similar crewmembers • Genetically similar is impossible • Phenotypically similar may be possible Grand Rounds 30 Recommendations for 1-Year Crewmembers 1YM1 1YM2 1YM3 22 July 2014 Grand Rounds 31