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Approximating Dose and Risk for Contaminants in Groundwater from the Underground Nuclear Test Areas of the Nevada National Security Site (NNSS)

As part of the Environmental Management Program at the Nevada National Security Site (NNSS), the Underground Test Area (UGTA) Activity investigates the potential impacts of radionuclides that were introduced into groundwater from the underground nuclear tests conducted near or below the NNSS water table between 1951 and 1992. Groundwater models are being used to simulate contaminant transport and forecast contaminant boundaries that encompass areas where the groundwater has a five percent or greater probability of containing contaminants above the Safe Drinking Water Act Maximum Contaminant Levels (SDWA MCLs) at any time during the next 1,000 years. Transport modeling conducted for the Frenchman Flat Corrective Action Unit (CAU) at the NNSS identified the beta/photon-emitting radionuclides tritium (3H), carbon-14 ( 14 C), chlorine-36 ( 36 Cl), technetium-99 ( 99 Tc), and iodine-129 ( 129 I) as having the greatest influence in defining the farthest extent of the modeled CAU contaminant boundary. These same radionuclides are assumed here as the contaminants of concern (COCs) for all underground nuclear tests at the NNSS because models are not yet complete for the other CAUs. Potential public exposure to the COCs will only occur and be of concern if the COCs migrate into the groundwater beneath public or private lands at levels that exceed either individual SDWA MCLs or dose and risk limits. Groundwater flow directions strongly suggest that any contaminant boundary predicted by contaminant fate and transport modeling to overlap public or private lands is more likely to occur to the west and/or southwest of the NNSS and the adjacent Nevada Test and Training Range (NTTR). Well-established, rural communities exist in these directions. Estimates of representative activity concentrations at the applicable SDWA MCL were developed for the five COCs. It is assumed that these COC concentrations may collectively occur at some public or private location in the future, but that situation does not exist today. These representative activity concentrations are evaluated with respect to conforming collectively to a modern annual committed effective dose (CED) and lifetime excess cancer morbidity risk for a hypothetical reasonably maximally exposed individual (RMEI). This approach goes beyond the SDWA MCL focus of the contaminant boundary because individual COC concentrations may comply with the SDWA MCL but not collectively meet the modern health-protection metrics and the SDWA language, especially if future modeling studies or monitoring activities show multiple radionuclides from different SDWA MCL categories to be COCs. For the drinking water exposure pathway alone, the annual committed effective dose (CED) for the RMEI from all five COCs that are collectively at estimated activity concentrations equal to their SDWA MCL is well below the U.S. Department of Energy health-protective CED limit of 100 millirem (mrem)/yr. This is consistent using both the NNSS unclassified, 1992 decay-corrected radionuclide atom inventory and the atom inventory based on radionuclides measured in groundwater obtained from the ALMENDRO cavity in 2009 to calculate the SDWA MCL activity concentrations in groundwater. The RMEI’s total lifetime excess cancer risk from the drinking water exposure pathway for both atom inventories is within the range of 1 × 10 -4 to ≤ 1 × 10 -6 , which is considered health protective according to modern SDWA MCL regulatory language. The biosphere exposure pathways are drinking water, garden produce, animal products, inadvertent soil ingestion, and indoor and outdoor air inhalation. The exposure parameters for communities west and southwest of the NNSS were developed when the Yucca Mountain high-level, nuclear-waste disposal facility was under consideration. For all biosphere exposure pathways, calculations of the annual CED and lifetime excess cancer morbidity risk for the RMEI revealed that: 1) The annual CED is well within health-protective guidance (<< 100 mrem CED /yr) for the COC activity concentrations at the SDWA MCL, regardless of the atom inventory used. 2) The calculated 70-year lifetime excess cancer morbidity risk (6 x 10 -5 ) is within the health-protective range when the five COC activity concentrations are derived using the NNSS 1992 atom inventory, but it is at the upper limit of the acceptable range (1 x 10 -4 ) using the ALMENDRO 2009 atom inventory. 3) Tritium (3H) is the principal COC for producing annual dose and lifetime excess cancer risk, regardless of the atom inventory used. 4) Overall, the drinking water ingestion pathway is the dominant exposure pathway contributing to the total annual CED and lifetime excess cancer risk, followed by eating locally grown produce and animal products. 5) When tritium completely decays (after about 100 years), the RMEI’s lifetime risk will fall well within the health-protective range (i.e., 1 × 10-4 to ≤ 1 × 10 -6 ) and 36Cl will then become the most important contributor to the RMEI’s total annual CED and lifetime excess cancer morbidity risk from eating local produce and animal products. In the event that radionuclide concentrations begin to approach SDWA MCLs, a reasonable risk-management strategy for keeping lifetime risk more in compliance with regulatory guidance would be to use local sources of groundwater that are below SDWA MCLs or to limit the consumption of local produce and animal products that have ingested COC-contaminated groundwater. The viability of the latter strategy increases where the annual CED due to 36Cl approaches that of 3H.The dose and risk values calculated here for an RMEI are specific to the assumption that the five COCs occur in groundwater beneath public or private lands at concentrations that are collectively at the SDWA MCL. Currently, these COCs are essentially absent from groundwater beneath public or private lands beyond the boundaries of the NNSS and NTTR other than at very low, naturally occurring concentrations. The analyses presented here can be readily applied to determine dose and risk for COC concentrations actually measured in future monitoring samples.

54 ENVIRONMENTAL SCIENCES↗

Enhanced Capabilities for Subcritical Experiments (ECSE) Risk Management Plan

Risk is a factor, element, constraint, or course of action that introduces an uncertainty of outcome that could impact project objectives. Risk is an inherent part of all activities, whether the activity is simple and small, or large and complex. Risk management is a process that identifies, evaluates, handles, and monitors risks that have the potential to affect project success. The risk management process spans the entire project, from its initiation to its successful completion and closeout, including both technical and programmatic (non-technical) risks. This Risk Management Plan (RMP) defines the process to be used for identifying, evaluating, handling, and monitoring risks as part of the overall management of the Enhanced Capabilities for Subcritical Experiments (ECSE) ‘Project’. Given the changing nature of the project environment, risk management is essentially an ongoing and iterative process, which applies the best efforts of a knowledgeable project staff to a suite of focused and prioritized concerns. The risk management process itself must be continually applied throughout the project life cycle. This document was prepared in accordance with DOE O 413.3B, Program and Project Management for the Acquisition of Capital Assets, its associated guide for risk management DOE G 413.3-7, Risk Management Guide, and LANL ADPM AP-350-204, Risk and Opportunity Management.

42 ENGINEERING↗

Using Probability of Exceedance to Compare the Resource Risk of Renewable and Gas-Fired Generation

Of the myriad risks surrounding long-term investments in power plants, resource risk is one of the most difficult to mitigate, and is also perhaps the risk that most-clearly distinguishes renewable generation from natural gas-fired generation. For renewable generators like wind and solar projects, resource risk manifests as a quantity risk—i.e., the risk that the quantity of wind and insolation will be less than expected.i For gas-fired generators (i.e., a combined-cycle gas turbine or “CCGT”), resource risk manifests primarily as a price risk—i.e., the risk that natural gas will cost more than expected. Most often, resource risk—and natural gas price risk in particular—falls disproportionately on utility ratepayers, who are typically not well-equipped to manage this risk. As such, it is incumbent upon utilities, regulators, and policymakers to ensure that resource risk is taken into consideration when making or approving resource decisions, or enacting policies that influence the development of the electricity sector more broadly.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

PCOR Partnership Best Practices Manual for Subsurface Technical Risk Assessment of Geologic CO 2 Storage Projects

In 2003, the U.S. Department of Energy established the Regional Carbon Sequestration Partnerships (RCSP) Initiative to help develop technology, infrastructure, and regulations needed to facilitate large-scale carbon dioxide (CO 2 ) geologic storage (herein “storage”) and support deployment of commercial carbon capture and storage projects. The Plains CO 2 Reduction (PCOR) Partnership, led by the Energy & Environmental Research Center (EERC), is one of seven partnerships created by this program. The PCOR Partnership is publishing a series of best practices manuals for each of the four PCOR Partnership-defined primary technical elements of a storage site: site characterization; modeling and simulation; risk assessment; and monitoring, verification, and accounting. This document describes the risk assessment process for evaluating subsurface technical risks associated with a CO 2 storage project. This best practices manual identifies the key elements comprising a risk assessment for a CO 2 storage complex and defines important risk management terminology and technical factors that are unique to the geologic storage of CO 2 . It also provides best practices for implementing a risk assessment based on lessons learned from conducting risk assessments for storage complexes within the PCOR Partnership region. Case studies of these real-world examples, which highlight key aspects of applying the risk assessment process to storage projects, are provided to support the proposed best practices. The development of a best practice requires the execution of multiple projects where the knowledge gained and lessons learned are accumulated over time and integrated to yield a best practice. This development progression is an adaptive management process whereby best practices constantly evolve over time in response to knowledge gained and lessons learned. This document encompasses the current body-of-knowledge and best practices for applying a standardized risk assessment approach within risk management for storage projects. Application of these best practices will provide reliable and consistent standards for identifying project-related risks, analyzing the probabilities and potential impacts of these risks, evaluating which risks require treatment, and determining priority for treatment implementation. These best practices will continue to evolve and be refined over time as commercialization of the CO 2 storage industry proceeds.

54 ENVIRONMENTAL SCIENCES↗

Integrated Risk Management Within NASA Programs/Projects

As NASA Project Risk Management activities continue to evolve, the need to successfully integrate risk management processes across the life cycle, between functional disciplines, stakeholders, various management policies, and within cost, schedule and performance requirements/constraints become more evident and important. Today's programs and projects are complex undertakings that include a myriad of processes, tools, techniques, management arrangements and other variables all of which must function together in order to achieve mission success. The perception and impact of risk may vary significantly among stakeholders and may influence decisions that may have unintended consequences on the project during a future phase of the life cycle. In these cases, risks may be unintentionally and/or arbitrarily transferred to others without the benefit of a comprehensive systemic risk assessment. Integrating risk across people, processes, and project requirements/constraints serves to enhance decisions, strengthen communication pathways, and reinforce the ability of the project team to identify and manage risks across the broad spectrum of project management responsibilities. The ability to identify risks in all areas of project management increases the likelihood a project will identify significant issues before they become problems and allows projects to make effective and efficient use of shrinking resources. By getting a total team integrated risk effort, applying a disciplined and rigorous process, along with understanding project requirements/constraints provides the opportunity for more effective risk management. Applying an integrated approach to risk management makes it possible to do a better job at balancing safety, cost, schedule, operational performance and other elements of risk. This paper will examine how people, processes, and project requirements/constraints can be integrated across the project lifecycle for better risk management and ultimately improve the chances for mission success.

Connley, Warren↗

Evaluating Shielding Effectiveness for Reducing Space Radiation Cancer Risks

We discuss calculations of probability distribution functions (PDF) representing uncertainties in projecting fatal cancer risk from galactic cosmic rays (GCR) and solar particle events (SPE). The PDF s are used in significance tests of the effectiveness of potential radiation shielding approaches. Uncertainties in risk coefficients determined from epidemiology data, dose and dose-rate reduction factors, quality factors, and physics models of radiation environments are considered in models of cancer risk PDF s. Competing mortality risks and functional correlations in radiation quality factor uncertainties are treated in the calculations. We show that the cancer risk uncertainty, defined as the ratio of the 95% confidence level (CL) to the point estimate is about 4-fold for lunar and Mars mission risk projections. For short-stay lunar missions (<180 d), SPE s present the most significant risk, however one that is mitigated effectively by shielding, especially for carbon composites structures with high hydrogen content. In contrast, for long duration lunar (>180 d) or Mars missions, GCR risks may exceed radiation risk limits, with 95% CL s exceeding 10% fatal risk for males and females on a Mars mission. For reducing GCR cancer risks, shielding materials are marginally effective because of the penetrating nature of GCR and secondary radiation produced in tissue by relativistic particles. At the present time, polyethylene or carbon composite shielding can not be shown to significantly reduce risk compared to aluminum shielding based on a significance test that accounts for radiobiology uncertainties in GCR risk projection.

Cucinotta, Francis A.↗

Space Radiation Cancer Risks

Space radiation presents major challenges to astronauts on the International Space Station and for future missions to the Earth s moon or Mars. Methods used to project risks on Earth need to be modified because of the large uncertainties in projecting cancer risks from space radiation, and thus impact safety factors. We describe NASA s unique approach to radiation safety that applies uncertainty based criteria within the occupational health program for astronauts: The two terrestrial criteria of a point estimate of maximum acceptable level of risk and application of the principle of As Low As Reasonably Achievable (ALARA) are supplemented by a third requirement that protects against risk projection uncertainties using the upper 95% confidence level (CL) in the radiation cancer projection model. NASA s acceptable level of risk for ISS and their new lunar program have been set at the point-estimate of a 3-percent risk of exposure induced death (REID). Tissue-averaged organ dose-equivalents are combined with age at exposure and gender-dependent risk coefficients to project the cumulative occupational radiation risks incurred by astronauts. The 95% CL criteria in practice is a stronger criterion than ALARA, but not an absolute cut-off as is applied to a point projection of a 3% REID. We describe the most recent astronaut dose limits, and present a historical review of astronaut organ doses estimates from the Mercury through the current ISS program, and future projections for lunar and Mars missions. NASA s 95% CL criteria is linked to a vibrant ground based radiobiology program investigating the radiobiology of high-energy protons and heavy ions. The near-term goal of research is new knowledge leading to the reduction of uncertainties in projection models. Risk projections involve a product of many biological and physical factors, each of which has a differential range of uncertainty due to lack of data and knowledge. The current model for projecting space radiation cancer risk relies on the three assumptions of linearity, additivity, and scaling along with the use of population averages. We describe uncertainty estimates for this model, and new experimental data that sheds light on the accuracy of the underlying assumptions. These methods make it possible to express risk management objectives in terms of quantitative metrics, i.e., the number of days in space without exceeding a given risk level within well defined confidence limits. The resulting methodology is applied to several human space exploration mission scenarios including lunar station, deep space outpost, and a Mars mission. Factors that dominate risk projection uncertainties and application of this approach to assess candidate mitigation approaches are described.

Cucinotta, Francis A.↗

PRA (Probabilistic Risk Assessments) Participation versus Validation

Probabilistic Risk Assessments (PRAs) are performed for projects or programs where the consequences of failure are highly undesirable. PRAs primarily address the level of risk those projects or programs posed during operations. PRAs are often developed after the design has been completed. Design and operational details used to develop models include approved and accepted design information regarding equipment, components, systems and failure data. This methodology basically validates the risk parameters of the project or system design. For high risk or high dollar projects, using PRA methodologies during the design process provides new opportunities to influence the design early in the project life cycle to identify, eliminate or mitigate potential risks. Identifying risk drivers before the design has been set allows the design engineers to understand the inherent risk of their current design and consider potential risk mitigation changes. This can become an iterative process where the PRA model can be used to determine if the mitigation technique is effective in reducing risk. This can result in more efficient and cost effective design changes. PRA methodology can be used to assess the risk of design alternatives and can demonstrate how major design changes or program modifications impact the overall program or project risk. PRA has been used for the last two decades to validate risk predictions and acceptability. Providing risk information which can positively influence final system and equipment design the PRA tool can also participate in design development, providing a safe and cost effective product.

DeMott, Diana↗

2014 Bone and Muscle Risks Standing Review Panel

The 2014 Bone and Muscle Risks Standing Review Panel (from here on referred to as the SRP) met for a site visit in Houston, TX on December 17 - 18, 2014. The SRP reviewed the updated research plans for the Risk of Impaired Performance Due to Reduced Muscle Mass, Strength and Endurance (Muscle Risk) and the Risk of Reduced Physical Performance Capabilities Due to Reduced Aerobic Capacity (Aerobic Risk). The SRP also received a status update on the Risk of Bone Fracture (Bone Risk), the Risk of Early Onset Osteoporosis Due To Spaceflight (Osteo Risk), the Risk of Intervertebral Disc Damage (IVD Risk), and the Risk of Renal Stone Formation (Renal Risk).

Steinberg, Susan↗

Post-Flight Back Pain Following International Space Station Missions: Evaluation of Spaceflight Risk Factors

INTRODUCTION Back pain during spaceflight has often been attributed to the lengthening of the spinal column due to the absence of gravity during both short and long-duration missions. Upon landing and re-adaptation to gravity, the spinal column reverts back to its original length thereby causing some individuals to experience pain and muscular spasms, while others experience no ill effects. With International Space Station (ISS) missions, cases of back pain and injury are more common post-flight, but little is known about the potential risk factors. Thus, the purpose of this project was to perform an initial evaluation of reported post-flight back pain and injury cases to relevant spaceflight risk factors in United States astronauts that have completed an ISS mission. METHODS All US astronauts who completed an ISS mission between Expeditions (EXP) 1 and 41 (2000-2015) were included in this evaluation. Forty-five astronauts (36 males and 9 females) completed 50 ISS missions during the study time period, as 5 astronauts completed 2 ISS missions. Researchers queried medical records of the 45 astronauts for occurrences of back pain and injury. A case was defined as any reported event of back pain or injury to the cervical, thoracic, lumbar, sacral, or coccyx spine regions. Data sources for the cases included the Flight Medicine Clinic's electronic medical record; Astronaut Strength, Conditioning and Rehabilitation electronic documentation; the Private Medical Conference tool; and the Space Medicine Operations Team records. Post-flight cases were classified as an early case if reported within 45 days of landing (R + 45) or a late case if reported from R + 46 to R + 365 days after landing (R + 1y). Risk factors in the astronaut population for back pain include age, sex, prior military service, and prior history of back pain. Additionally, spaceflight specific risk factors such as type of landing vehicle and onboard exercise countermeasures were included to evaluate their contribution to post-flight cases. Prior history of back pain included back pain recorded in the medical record within 3 years prior to launch. Landing vehicle was included in the model to discern if more astronauts experienced back pain or injury following a Shuttle or Soyuz landing. Onboard exercise countermeasures were noted for those astronauts who had a mission following 2009 deployment of the Advanced Resistive Exercise Device (aRED) (EXP 19 to 41). T-test and chi-squared tests were performed to evaluate the association between each individual risk factor and post-flight case. Logistic regression was used to evaluate the combined contribution of all the risk factors on post-flight cases. Separate models were calculated for cases reported by R + 45 and R + 1y. RESULTS During the study time period, there were 13 post-flight cases reported by R + 45 and an additional 5 reported by R + 1y. Most of these cases have been reported since EXP 19 with 10 cases by R + 45 and 4 by R + 1y. Individual risk factors of age, sex, landing vehicle, and prior military service were not significantly associated with post-flight cases identified at R + 45 or R + 1y (p greater than 0.05). Having back pain or injury within 3 years prior to launch significantly increased the likelihood of becoming a case by R + 1y (p = 0.041), but not at R+45 (p=0.204). Additionally, astronauts who experienced onboard exercise countermeasures that included aRED had a significantly increased risk of becoming a case at R + 45 (p = 0.024) and R + 1y (p=0.003). Multiple logistic regression evaluating all the risk factors for cases identified no significant risk factors at either the R + 45 or R + 1y time period (p greater than 0.05). Overall model fit was poor for both the R + 45 (R(exp 2) = 0.132) and R + 1y (R(exp 2) = 0.186) cases showing that there are risk factors not represented in our model. CONCLUSIONS Regardless of cause, post-flight cases are reported more often since aRED was deployed in 2009. This may reflect improved documentation or unidentified risk factors. No spaceflight risk factor explains the data fully. Post-flight cases are probably due to multi-faceted factors that are not easily elucidated in the medical data.

Laughlin, M. S.↗

NASA's Identified Risk of Adverse Outcomes due to Inadequate Human Systems Integration Architecture

The NASA Human System Risk Board (HSRB) is responsible for tracking the evolution of the top ~30 human system risks identified to be associated with human spaceflight. As part of this process, the Board is charged with maintaining a consistent, integrated process to evaluate those risks and developing evidence-based risk posture recommendations. Risks are ranked by likelihood and consequence. Intermediate causal relationships between risk contributing factors and countermeasures that link hazards to outcomes are described using Directed Acyclic Graphs (DAGs). The DAGs are also useful for identifying common factors and countermeasures across the top 30 risks as well as communicating how astronaut exposure to spaceflight hazards leads to meaningful mission-level health and performance outcomes. One of the top risks tracked by the HSRB is The Risk of Adverse Outcomes Due to Inadequate Human-Systems Integration Architecture (HSIA). This risk captures the possibility that due to decreasing real-time ground support during missions beyond LEO, crew will be unable to adequately respond to unanticipated critical malfunctions or detect safety-critical procedural errors. The HSIA risk is ranked red (high) for Lunar surface and Mars missions due to the probability of Loss of Crew and Loss of Mission consequences. This paper describes the evidence that supports the HSIA risk ranking and presents the central narrative of the HSIA risk DAG-- i.e., anomaly detection, diagnosis, intervention, and task performance. Characterizations of the current state of practice for each of the DAG’s central nodes and the future tools needed for successful anomaly response are provided.

human-systems integration architecture↗

Alignment of NASA’s Human System Risks with Technological Capability Gaps to Enable Integrated Research and Technology Development Strategic Planning

BACKGROUND: Radiation, reduced gravity, distance from earth, isolation and confinement, and habitation within artificially created and controlled life support environments are hazards that present risk to human space explorers. NASA’s Human System Risk Board (HSRB) maintains a set of twenty-nine different Human System Risks with subject matter experts from across the agency providing regular updates to the estimated likelihood and consequence associated with each risk. The Human Research Program (HRP) has historically used these risk classifications as a primary basis for identifying and prioritizing human research investments aimed at characterizing and/or mitigating the respective human system risks. In many cases, technology development is required to mature and validate risk mitigation strategies, however, NASA’s primary technology development programs have not typically used Human System Risks as a basis for strategic planning. A primary function of the Environmental Control and Life Support Systems (ECLSS) – Crew Health and Performance (CHP) System Capability Leadership Team (SCLT) is to continually identify, review, and update technological capability gaps and to establish and oversee multiyear strategic roadmaps aimed at guiding NASA’s technology development priorities in these areas. These roadmaps are intended to be agency-wide and independent of any program, directorate, or other organization within NASA. DESCRIPTION: The SCLT and HRP collaborated to establish a set of Human System Capability Gaps, which establish a formal linkage between the capability gaps used to prioritize investments across much of NASA, and the Human System Risks that are primarily used to inform and prioritize human research. This set of twenty-eight gaps was developed by subject matter experts, and each gap mapped to the primary associated Human System Risks. The gaps and risk mapping were then reviewed and approved via the HSRB, thereby formally aligning the research-focused Human System Risks with the technology-focused capability gaps. DISCUSSION: This effort has enabled development of integrated roadmaps and budget coordination with research and technology development activities that are formally linked to agency-recognized capability gaps and Human System Risks. Close and ongoing coordination between the SCLT, HRP, Mars Campaign Office, and the Health & Medical Technical Authority (HMTA) is essential to ensure alignment and prioritization of CHP-related research and technology development to enable NASA’s future exploration missions.

Andrew F J Abercromby↗

The Future of Integrated Performance Modeling in the Crew Health and Performance – Probabilistic Risk Assessment Project

The NASA engineering community utilizes event-driven and fault-tree probabilistic techniques to classify risks in the space environment by taking advantage of the inherent knowledge of complex spaceflight system design and testing to quantify failure risk. In harmonizing the risk of human space flight, answering the question of ‘How do we balance health, performance and resource risks with other engineering risks on long duration space missions?’ remains a deeply challenging and largely qualitative practice. The Human Research Program’s Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) was a significant step forward in efforts to robustly quantify the risk to crew health for exploration missions. However, there remains a significant gap in the ability to comprehensively assess and characterize risk across the disparate functionalities and capabilities which comprise the Crew Health and Performance (CHP) system. The Crew Health and Performance – Probabilistic Risk Assessment (CHP-PRA) project seeks to characterize CHP risks by expanding beyond the foundation established by its PRA predecessors like IMM and MEDPRAT, that simulate medical risk metrics like loss of crew life and evacuations. One of the new risk measures in the CHP-PRA system is embodied in our Performance Risk Model (PRisM). PRisM provides a novel way of assessing crew performance on mission tasks, using a generalized framework which relates back to NASA-STD-3001. This approach allows PRisM to capture and integrate data from a variety of different domains into a single, unified, reproducible representation of astronaut performance. In this presentation, we discuss the motivation for the CHP-PRA work and give a high level overview of the goals of the project, outline the forward work for PRisM, and discuss collaboration opportunities for the community who might explore if their domain knowledge and data could be represented, integrated, and quantified with these tools, whose outcomes are metrics useful for supporting operational mission planning and decision making.

Lauren McIntyre↗

Incorporation of Human Risk Directed Acyclic Graphs (DAG) With Mishap Investigations to Un-Silo Knowledge

NASA’s Human System Risk Board (HSRB) has been a central driver in efforts to understand, mitigate, and communicate the 29 human systems risks monitored by the board. As a result of the collaboration between research, operations, and technical authorities, large bodies of knowledge have been collected and digested to represent the current understanding of the risks. As a part of these bodies of knowledge, directed acyclic graphs (DAGs) have been developed to communicate the current understanding of the causal relationship of the hazards, contributing factors, countermeasures, other risks, and outcomes that contribute to the overall risk. This risk knowledge is applied in a theoretical sense for potential incidents during exploration even while informed by surveillance data. However, there have been mishaps and close calls during past space exploration that intersect with one or more of the Human System Risks DAGs and knowledge bases. The purpose of this exercise was to un-silo this risk knowledge and connect it to the close call of EVA 23 through the development of a DAG representing the intersection of the HSRB Risks and the events of the close call. The development of the DAG occurred through an iterative process, with each iteration expanding and/or refining the nodes and connections described by the source materials. In addition to the risk documentation developed by the HSRB, lessons learned and other mishap investigation documents were utilized to understand the events that led to water entering the helmet of a crewmember on the EVA. New nodes specific to the events of EVA 23 were interconnected with existing HSRB DAG nodes and edges. Nodes within the DAG were defined within a “DAG-tionary” with any updates to a definition that may have previously existed from the HSRB DAGs, and edges were recorded in a matrix. Both the DAG-tionary and matrix describe where nodes and edges are present across the Risk and Mishap DAG. This DAG will then be reviewed by experts outside of HSRB and HRP to confirm that interpretations of the non-health related events (such as the engineering nodes) are represented accurately. DISCUSSION This process highlighted a method by which the knowledge generated among the contributing members of the HSRB Risks can be effectively adapted and utilized through the tools employed by the Risk Custodian teams. By leveraging these tools, new context and insights to the information at hand can be brought forward to address current spaceflight challenges. Moreover, un-siloing this knowledge through future DAGs and other efforts can drive interprofessional collaboration and foster communication. This will enable teams to work together more effectively, leveraging their diverse expertise to tackle the complex challenges of space exploration and human research. Ultimately, this collaboration will bring NASA closer to achieve agency goals and contribute to the overall shared mission and vision.

Samuel Jacobs↗

The Meaning of Risk for Safety, Security, and Safeguards in the Design of Advanced Nuclear Reactors

What is the meaning of risk as it applies to the design of advanced reactors in the disciplines of safety, security, and safeguards? How can we find common terminology for the concept of risk and how can we find interfaces between these disciplines? These are important questions that should be explored in order that they may be applied in an integrated manner for the most effective and efficient design approaches. Eliminating or minimizing risks is a key design driver that motivates and informs the development of nuclear reactors. For safety, risk is well understood and applied in Probabilistic Risk Assessments. For security, the risk-based concepts of vulnerability assessments and vital areas are all considered in designing security systems. For safeguards, the concept of risk is not formally defined, as it relates to the design and operation of nuclear reactors. International nuclear safeguards seek to reduce the risk of proliferation in the nuclear fuel cycle and as such the concept of risk does exist. Therefore, the current understanding of the “3S’ approach, which seeks to find the interfaces and conflicts between safety, security, and safeguards requires a thorough understanding of the role that the reduction of risk plays in all three disciplines. The intersection of risk for safety and security is now being developed as there is a strong correlation between reactor design and operations and their vulnerability to sabotage. The intersection of risk for security and safeguards has to date chiefly been focused on the nuclear material control and accounting systems, which are relied on by both the operator (State) and the IAEA. This paper explores the concept of risk in each of the three disciplines, how they interact, potential conflicts and interfaces , how these might be addressed and leveraged, and a notional framework for how this could be achieved.

Kovacic, Donald N↗

Review of Qualitative Approaches for the Construction Industry: Designing a Risk Management Toolbox

Objectives: This paper presents the framework and protocol design for a construction industry risk management toolbox. The construction industry needs a comprehensive, systematic approach to assess and control occupational risks. These risks span several professional health and safety disciplines, emphasized by multiple international occupational research agenda projects including: falls, electrocution, noise, silica, welding fumes, and musculoskeletal disorders. Yet, the International Social Security Association says, “whereas progress has been made in safety and health, the construction industry is still a high risk sector.” Methods: Small- and medium-sized enterprises (SMEs) employ about 80% of the world’s construction workers. In recent years a strategy for qualitative occupational risk management, known as Control Banding (CB) has gained international attention as a simplified approach for reducing work-related risks. CB groups hazards into stratified risk ‘bands’, identifying commensurate controls to reduce the level of risk and promote worker health and safety. We review these qualitative solutions-based approaches and identify strengths and weaknesses toward designing a simplified CB ‘toolbox’ approach for use by SMEs in construction trades. Results: This toolbox design proposal includes international input on multidisciplinary approaches for performing a qualitative risk assessment determining a risk ‘band’ for a given project. Risk bands are used to identify the appropriate level of training to oversee construction work, leading to commensurate and appropriate control methods to perform the work safely. Conclusion: The Construction Toolbox presents a review-generated format to harness multiple solutions-based national programs and publications for controlling construction-related risks with simplified approaches across the occupational safety, health and hygiene professions.

60 APPLIED LIFE SCIENCES↗

Current Management of High-Risk Breast Lesions

Purpose of review: The purpose of this review is to describe recent updates in the management of high-risk breast lesions. We review the various high-risk breast lesions and evaluate the collective literature regarding the rates of upgrade to invasive cancer or ductal carcinoma in situ with excisional biopsy as well as the increased risk for future breast cancer development that a diagnosis of a high-risk breast lesion may portend. For those lesions associated with an increased risk of breast cancer, we discuss the appropriate surveillance regimens as well as risk reduction opportunities available to patients. Recent findings: Recent studies may suggest a role for close imaging observation in certain clinical settings when a benign intraductal papilloma or flat epithelial atypia is identified by core needle breast biopsy. Ongoing prospective clinical trials should reveal valuable data to help answer this question. Summary: Clinical management of high-risk breast lesions identified and determined to be concordant after image-guided core needle biopsy varies and prospective data are needed to better guide management decisions. High-risk breast lesions require close radiologic-pathologic correlation when diagnosed by image-guided breast core needle biopsy. Excisional biopsy can exclude a higher-grade lesion such as DCIS or invasive cancer; however, in certain cases, close observation with follow-up may be appropriate. Additionally, women who have certain high-risk lesions such as lobular carcinoma in situ, atypical ductal hyperplasia, or atypical lobular hyperplasia are at an increased risk for the future development of breast cancer and should undergo risk assessment and discussion of risk reduction measures. Ongoing and future prospective trials may provide data to better guide these management decisions and optimize patient care.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Risk to ecological resources following remediation can be due mainly to increased resource value of successful restoration: A case study from the Department of Energy's Hanford Site

Several nations are faced with the need to remediate large contaminated sites following World War II, the Cold War, and abandoned industrial sites, and to return them to productive land uses. In the United States, the Department of Energy (DOE) has the largest cleanup challenge, and its Hanford Site in the state of Washington has the most extensive and most expensive cleanup task. Ideally, the risk to ecological resources on remediation sites is evaluated before, during, and after remediation, and the risk from, or damage to, ecological resources from contaminants should be lower following remediation. In this paper, we report the risk to ecological resources before, during, and as a consequence of remediation on contaminated units requiring cleanup, and then examine the causes for changes in risk by evaluating 56 cleanup evaluation units (EUs) at the Hanford Site. In this case, remediation includes a restoration phase. In general, the risk to ecological and eco-cultural resources is currently not discernible or low at most contaminated units, increases during remediation, and decreases thereafter. Remediation often causes physical disruption to ecosystems as it reduces the risk from exposure to contaminants. Most new remediation projects at the Hanford Site include ecological restoration. Ecological restoration results in the potential for the presence of higher quality resources after remediation than currently exists on these contaminated lands and facilities. Although counter-intuitive, our evaluation of the risk to ecological resources following remediation indicated that a significant percentage of units (61%) will be at increased risk in the post-remediation period. This increased risk is due to DOE's successful remediation and restoration that results in a higher percent of native vegetation and higher ecological value on the sites in the post-remediation period than before. These newly-created resources can then be at risk from post-remediation activities. Risks to these new higher quality resources include the potential for spread of invasive species and of noxious grasses used in previous cleanup actions, disruption of ecosystems (including those with state or federally listed species and unique ecosystems), compaction of soil, use of pesticides to control invasive species, and the eventual need for continued monitoring activities. Thus, by greatly improving the existing habitat and health of eco-receptors, and maintaining habitat corridors between high quality habitats, the ecological resources in the post-remediated units are at risk unless care is taken to protect them. Many of the negative effects of both remediation and future monitoring (or other future land uses) can be avoided by planning and management early in the remediation process. We suggest DOE and other agencies convene a panel of managers, remediation scientists, regulators, environmental and ecological scientists, Native Americans, economists, and the public to develop a generic list of performance metrics for the restoration phase of remediation, including evaluation of success, which could be applied across the DOE complex.

54 ENVIRONMENTAL SCIENCES↗