Feasibility analysis of cislunar flight using the Shuttle Orbiter

A first order orbital mechanics analysis was conducted to examine the possibility of utilizing the Space Shuttle Orbiter to perform payload delivery missions to lunar orbit. In the analysis, the earth orbit of departure was constrained to be that of Space Station Freedom. Furthermore, no enhancements of the Orbiter's thermal protection system were assumed. Therefore, earth orbit insertion maneuvers were constrained to be all propulsive. Only minimal constraints were placed on the lunar orbits and no consideration was given to possible landing sites for lunar surface payloads. The various phases and maneuvers of the mission are discussed for both a conventional (Apollo type) and an unconventional mission profile. The velocity impulses needed, and the propellant masses required are presented for all of the mission maneuvers. Maximum payload capabilities were determined for both of the mission profiles examined. In addition, other issues relating to the feasibility of such lunar shuttle missions are discussed. The results of the analysis indicate that the Shuttle Orbiter would be a poor vehicle for payload delivery missions to lunar orbit

Report of the Nuclear Propulsion Mission Analysis, Figures of Merit Subpanel: Quantifiable figures of merit for nuclear thermal propulsion

The results of an inquiry by the Nuclear Propulsion Mission Analysis, Figures of Merit subpanel are given. The subpanel was tasked to consider the question of what are the appropriate and quantifiable parameters to be used in the definition of an overall figure of merit (FoM) for Mars transportation system (MTS) nuclear thermal rocket engines (NTR). Such a characterization is needed to resolve the NTR engine design trades by a logical and orderly means, and to provide a meaningful method for comparison of the various NTR engine concepts. The subpanel was specifically tasked to identify the quantifiable engine parameters which would be the most significant engine factors affecting an overall FoM for a MTS and was not tasked with determining 'acceptable' or 'recommended' values for the identified parameters. In addition, the subpanel was asked not to define an overall FoM for a MTS. Thus, the selection of a specific approach, applicable weighting factors, to any interrelationships, for establishing an overall numerical FoM were considered beyond the scope of the subpanel inquiry

Minimum accommodation for aerobrake assembly, phase 2

A multi-element study was done to assess the practicality of a Space Station Freedom-based aerobrake system for the Space Exploration Initiative. The study was organized into six parts related to structure, aerodynamics, robotics and assembly, thermal protection system, inspection, and verification, all tied together by an integration study. The integration activity managed the broad issues related to meeting mission requirements. This report is a summary of the issues addressed by the integration team

Status, Plans, and Initial Results for ARES 1 Crew Launch Vehicle Aerodynamics

Following the completion of NASA's Exploration Systems Architecture Study in August 2004 for the NASA Exploration Systems Mission Directorate (ESMD), the Exploration Launch Office at the NASA Marshall Space Flight Center was assigned project management responsibilities for the design and development of the first vehicle in the architecture, the Ares I Crew Launch Vehicle (CLV), which will be used to launch astronauts to low earth orbit and rendezvous with either the International Space Station or the ESMD s earth departure stage for lunar or other future missions beyond low Earth orbit. The primary elements of the Ares I CLV project are the first stage, the upper stage, the upper stage engine, and vehicle integration. Within vehicle integration is an effort in integrated design and analysis which is comprised of a number of technical disciplines needed to support vehicle design and development. One of the important disciplines throughout the life of the project is aerodynamics. This paper will present the status, plans, and initial results of Ares I CLV aerodynamics as the project was preparing for the Ares I CLV Systems Requirements Review. Following a discussion of the specific interactions with other technical panels and a status of the current activities, the plans for aerodynamic support of the Ares I CLV until the initial crewed flights will be presented

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Status, Plans, and Initial Results for Crew Launch Vehicle Aerodynamics

Following the completion of NASA s Exploration Systems Architecture Study in August 2004 for the NASA Exploration Systems Mission Directorate (ESMD), the Exploration Launch Office at the NASA Marshall Space Flight Center began design and development of the first vehicle in the architecture, the Crew Launch Vehicle (CLV), which will be used to launch astronauts to low earth orbit and rendezvous with either the International Space Station or the ESMD s earth departure stage for lunar missions. The primary elements of the CLV project are the first stage, the upper stage, the upper stage engine, and vehicle integration. Within vehicle integration is an effort in integrated design and analysis which is comprised of a number of technical disciplines needed to support vehicle design and development. One of the important disciplines throughout the life of the project is aerodynamics. This paper will present the status, plans, and initial results of CLV aerodynamics as the project was preparing for the CLV Systems Requirements Review. Following a status of the current activities and a discussion of the specific interactions with other technical panels, the plans for aerodynamic support of the CLV until the initial crewed flights will be presented. The paper will conclude with a review of initial results acquired since project inception, including engineering-code vehicle assessment, computational fluid dynamics analysis, and wind tunnel test data