ISS Medical Program (ISSMP) Inc. 39/40 Training Strategy Team (TST) Sondra Fabian Inc. 39/40 Training Coordinator May 8, 2013

Agenda Increment Overview Assumptions In-flight HRP Experiments/Facility Activities IP Experiments w/ ISSMP training, HRP Pre/Post flight Experiments Current Efficiencies Training Schedule Considerations Notes, Issues, & Concerns Inc. 39/40 Training Plan 2

ISS INCREMENT 39/40 OVERVIEW* Mission Duration: Approximately 6 months * Per OZ working launch dates 4/18/13 36S 3/12/14 37S CDR (Wakata) JAXA 37S FE (Mastracchio) US 37S FE (Tyurin) RSA 38S FE (Artemyev) RSA 38S CDR (Swanson) US 39S FE (Wiseman) US 39S FE (Gerst) ESA 39S CDR (Suraev) RSA Increment 38Increment 40Increment 39 38S FE (Skvortsov) RSA Indirect handover 38S 3/26/14 37S 5/14/14 39S 5/28/14 38S 9/16/14 40S 9/30/14 3

Increment 39/40 Assumptions Prime Crewmembers  American- Steve Swanson (38S CDR)  Russian- Oleg Artemyev (38S FE & CMO)  Russian- Alexander Skvortsov (38S FE)  Russian- Maxim Suraev (39S CDR)  American- Reid Wiseman (39S FE)  ESA - Alexander Gerst (39S FE) Steve Swanson Reid Wiseman Alexander Gerst 4 Oleg Artemyev

Increment 39/40 Assumptions (Cont.) All crew rotations via Soyuz. Launch dates are within 1 month of those listed on previous page. Crew swaps between backup and prime crewmembers should not necessitate a replan. Crew participation based on unofficial results from prime March ICB. Signed consents are pending; expected mid-May,

In-Flight Experiments w/Training Swanson 38S US CDR Skvortsov 38S RSA FE Artemyev 38S RSA CMO Suraev 39S RSA CDR Wiseman 39S US FE Gerst 39S ESA FE Biochemical Profile ***Subj/Op Body MeasuresSubj/Op Cardio OxSubj/Op JournalsSubj/Op MicrobiomeSubj/Op Ocular HealthSubj/Op ProKSubj/Op RepositorySubj/Op Salivary MarkersSubj/Op SprintSubj/Op Facility Activities GDS/PFS gauge photo** Operator HRF Supply Kit logistics * Operator HRF Rack Operator Ultrasound 2 Subj/OpOperatorSubj/Op PFS Maintenance ** Subj/Op SLAMMD control runs Subj/Op Legend: ± Included as Supply Kit training with any of ProK, Repo, Biochem Profile, Microbiome, Salivary Markers, Cardio Ox. ** Trained in PFS class. *** Not trained if ProK or Repository has been trained. 6

IP Activities (ISSMP Trng. Component) SwansonWisemanGerst ESA Energy (PFS)Subj/Op CSA BP Reg (PFS)Subj/Op Pre/Post Only SwansonWisemanGerst IVD (Intervertebral Disk Damage)Subj/Op Manual ControlSubj/Op In-flight Ops, No Training SwansonWisemanGerst Comm Delay AssessmentSubj NeuromappingSubj/Op 7 ISSMP Activity Requiring IP Training SwansonWisemanGerst Sprint/VO2Max (Portable PFS)Subj/Op MedOps SwansonWisemanGerst Ocular Scan – Ultrasound 2Subj/Op

Current Training Efficiencies  Philosophy of ISSMP is to look at the complement as a whole and to train a given skill set in an effort to avoid repetitious training of same skills.  All ISSMP payloads that involve phlebotomy share a common phlebotomy flow: Biochemical Profile, Cardio Ox, Microbiome, ProK, Repository, Salivary Markers.  ProK, Repository, Biochemical Profile have same training skill set; therefore, these classes can be combined as is logical.  Refrigerated Centrifuge training is taught as part of an existing experiment specific class rather than as stand alone. Other payloads reliant upon RC: Biochemical Profile, Cardio Ox, Microbiome, Salivary Markers.  MELFI training supports Biochemical Profile, Cardio Ox, Microbiome, ProK, Repository, Salivary Markers.  PFS Ov/Task training supports ESA Energy, CSA BP Reg, and a valve check done every 3 years as maintenance.  SLAMMD training supports ProK and Body Measures.  Crewmembers are given credit for training received as backups. 8

Current Training Efficiencies 9 MicrobiomeBiochemical ProfileRepositoryProKSalivary MarkersCardio OxOcular Health Supply Kits Urine Refrigerated Centrifuge Standard blood tubes ACD (Acid Citrate Dextrose) Blood Tube Swabs Fecal Sampling Potable Water Collection Saliva Session Pack - Rolled Saliva Session Pack - Sublingual Timed Saliva Session Pack - Sublingual Cardiac scan - pericardial Cardiac scan - apical Brachial scan Carotid scan The shaded areas represent items taught in the skills-based classes for each of these experiments. Credit is given for previous instruction, with an appropriate reduction in time from future classes in order to avoid repetition and to improve efficient use of pre- flight crew training time.

Steve Swanson’s Training Efficiencies 10 Knowledge/Skill Set RequiredBio ProfileRepositorySalivary Markers OverviewNot req’dTBS Supply Kits, Ref.Centrifuge, St’d Blood Tubes Will receive in Salivary Markers TBS Urine CollectionWill receive in Salivary Markers TBS Saliva Session Pack - RolledTBS Saliva Session Pack - SublingualTBS Timed Saliva Session Pack - SublingualTBS ACD Blood TubesTBS

Reid Wiseman’s Training Efficiencies 11 Knowledge/Skill Set Required Biochemical ProfileRepositoryProK OverviewNot required TBS Supply Kits, Ref.Centrifuge, St’d Blood TubesWill receive in ProK TBS Urine CollectionWill receive in ProK TBS

Alex Gerst’s Training Efficiencies 12 Knowledge/Skill Set Required BioProfile / RepoMicrobiomeSalivary Markers Cardio OxOcular Health OverviewNot requiredTBS Supply Kits, Ref.Centrifuge, St’d Blood Tubes Will receive in Salivary Markers TBSWill receive in Salivary Markers Urine CollectionWill receive in Salivary Markers TBSWill receive in Salivary Markers SwabsTBS ACD Blood TubesTBS Fecal SamplingTBS Potable Water CollectionTBS Saliva Session Pack - RolledTBS Saliva Session Pack - SublingualTBS Timed Saliva Session - Sublingual TBS Cardiac scan - pericardialTBSWill receive in Cardio Ox Cardiac scan - apicalTBSWill receive in Cardio Ox Unique ultrasound scansTBS

ISSMP Training Schedule Considerations May 6, P/L training week (38S and 39S) July 8 - P/L training week (39S) July 15- P/L training week (38S) Sept 9 - P/L training week (39S) Nov. 4 - P/L training week (38S) Dec. 9 - P/L training week (39S) Jan. 6, Last US rotation for 38S crew Mar.10, Last US rotation for 39S crew 13

Experiments New to 39/40 Neuromapping  No training required.  Consists of pre- and post- MRI’s with pre-, post-, and in-flight behavioral assessment tests.  Payload name is registered. Comm Delay Assessment  No training required.  Examines impact of induced communication delays on individual and team outcomes including performance and perceptions of autonomy.  Payload name is registered. 14

Notes, Issues, & Concerns SLAMMD is trained only in support of experiments. It should be scheduled later in the flow:  To align it better with crew complement  To enhance knowledge retention  To avoid invoking currency requirement Microbiome training must occur prior to first BDC session. Salivary Markers Overview training must occur prior to first BDC session. 15

Notes, Issues, Concerns Body Measures Clarifications since 37/38 TST:  Subject training is to be scheduled concurrent with BDC session.  Full 60 min. Nom Ops class to occur in backup flow.  Proficiency class to occur in prime flow. Rationale: Crew at PTDR for Nom Ops class requested 15 min. proficiency class. Exact class duration is to be determined - 15 minutes is the goal but ITDR has not been completed for this class. PI team will be reviewing camera settings because the video received is the data. If the field of view is incorrect, or the settings are incorrect such that the subject data is not captured, then science loss will occur. 16

Notes, Issues, Concerns More Body Measures Clarifications since 5/22/2013 :  On 5/22 we conducted a PTDR to certify additional instructors. Knowing that the crew like to train together if they will be on-orbit together, we treated this PTDR as if we had 2 crew who were flying together and who are each subjects and operators, training together. The session flow was science overview, kit review, each crewmember setup one of the two cameras in use for this experiment, then each crew member took turns putting markers on the other and receiving markers from the other, each took turns with Neutral Body Posture. Time for this was 1:15 min. We’d like to request this as strategy for those times when we have crew who are both subjects and operators and who are on-orbit together.  We developed a table of scenarios for training and training times and have attached it as the next slide. 17

Notes, Issues, Concerns Training Scenarios 18 Operator only crew w/ test subject (1:00) Body Markers Instrument Poses Circumferences 15 min Overview Kit Camera Setup 35 min 10 min NBP 15 min Overview Kit Camera Setup 35 min 10 min NBP 15 min Overview Kit Camera Setup 50 min 10 min NBP Body Markers Instrument Poses Circumferences Body Markers Instrument Poses Circumferences Body Markers Instrument Poses Circumferences Subject/Operator crew and Operator only crew Subject/Op crew (1:15) Operator Only crew (1:00) Op only crew and Subject /Op crew Subject/Op crew and test subject 15 min Two crew who are each Subject/ Operator (1:15) Practice on each other Proficiency (0:15) 15 min Proficiency Objectives: Brief Ops Overview Brief Kit Overview Camera Settings Brief Review of Markers/Poses/Measurements Neutral Body Posture

Notes, Issues, Concerns Still More Body Measures Clarifications since 5/22/2013 :  We also conducted a run through of the proposed Proficiency Class as proposed for purpose of setting time for that content which is worthy of second exposure. The time was 15 min. as was suggested by Kate. Kate also suggested that the proficiency be tied to BDC if possible. Content:  Brief overview of ops, timeline, kits  Camera settings and field of view review  Review tricky marker placements; measurements: hip & shoulder; chest, calf & thigh  Summary Rationale for in-person on-ground proficiency rather than in-flight: Highest fidelity of confirming the field of view, camera settings, and marker placements is when the trainer is present to confirm, rather than having to interpret fam material while on-orbit. Correction can be made in person on ground, adding a kinesthetic memory to the appropriate action while under supervision. 19

Inc. 39/40 Training Requirements See Excel file with Inc. 39/40 Training Requirements Plans 20