Ground and Space-Based Measurement of Rocket Engine Burns in the Ionosphere

On-orbit firings of both liquid and solid rocket motors provide localized disturbances to the plasma in the upper atmosphere. Large amounts of energy are deposited to ionosphere in the form of expanding exhaust vapors which change the composition and flow velocity. Charge exchange between the neutral exhaust molecules and the background ions (mainly O+) yields energetic ion beams. The rapidly moving pickup ions excite plasma instabilities and yield optical emissions after dissociative recombination with ambient electrons. Line-of-sight techniques for remote measurements rocket burn effects include direct observation of plume optical emissions with ground and satellite cameras, and plume scatter with UHF and higher frequency radars. Long range detection with HF radars is possible if the burns occur in the dense part of the ionosphere. The exhaust vapors initiate plasma turbulence in the ionosphere that can scatter HF radar waves launched from ground transmitters. Solid rocket motors provide particulates that become charged in the ionosphere and may excite dusty plasma instabilities. Hypersonic exhaust flow impacting the ionospheric plasma launches a low-frequency, electromagnetic pulse that is detectable using satellites with electric field booms. If the exhaust cloud itself passes over a satellite, in situ detectors measure increased ion-acoustic wave turbulence, enhanced neutral and plasma densities, elevated ion temperatures, and magnetic field perturbations. All of these techniques can be used for long range observations of plumes in the ionosphere. To demonstrate such long range measurements, several experiments were conducted by the Naval Research Laboratory including the Charged Aerosol Release Experiment, the Shuttle Ionospheric Modification with Pulsed Localized Exhaust experiments, and the Shuttle Exhaust Ionospheric Turbulence Experiments

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council