Joint Polar Satellite System (JPSS) Micrometeoroid and Orbital Debris (MMOD) Assessment

The Joint Polar Satellite System (JPSS) Project requested the NASA Engineering and Safety Center (NESC) conduct an independent evaluation of the Micrometeoroid and Orbital Debris (MMOD) models used in the latest JPSS MMOD risk assessment. The principal focus of the assessment was to compare Orbital Debris Engineering Model version 3 (ORDEM 3.0) with the Meteoroid and Space Debris Terrestrial Environment Reference version 2009 (MASTER-2009) and Aerospace Debris Environment Projection Tool (ADEPT) and provide recommendations to the JPSS Project regarding MMOD protection. The outcome of the NESC assessment is contained in this report

Phase 3 trials of ixekizumab in moderate-to-severe plaque psoriasis

BACKGROUND Two phase 3 trials (UNCOVER-2 and UNCOVER-3) showed that at 12 weeks of treatment, ixekizumab, a monoclonal antibody against interleukin-17A, was superior to placebo and etanercept in the treatment of moderate-to-severe psoriasis. We report the 60-week data from the UNCOVER-2 and UNCOVER-3 trials, as well as 12-week and 60-week data from a third phase 3 trial, UNCOVER-1. METHODS We randomly assigned 1296 patients in the UNCOVER-1 trial, 1224 patients in the UNCOVER-2 trial, and 1346 patients in the UNCOVER-3 trial to receive subcutaneous injections of placebo (placebo group), 80 mg of ixekizumab every 2 weeks after a starting dose of 160 mg (2-wk dosing group), or 80 mg of ixekizumab every 4 weeks after a starting dose of 160 mg (4-wk dosing group). Additional cohorts in the UNCOVER-2 and UNCOVER-3 trials were randomly assigned to receive 50 mg of etanercept twice weekly. At week 12 in the UNCOVER-3 trial, the patients entered a long-term extension period during which they received 80 mg of ixekizumab every 4 weeks through week 60; at week 12 in the UNCOVER-1 and UNCOVER-2 trials, the patients who had a response to ixekizumab (defined as a static Physicians Global Assessment [sPGA] score of 0 [clear] or 1 [minimal psoriasis]) were randomly reassigned to receive placebo, 80 mg of ixekizumab every 4 weeks, or 80 mg of ixekizumab every 12 weeks through week 60. Coprimary end points were the percentage of patients who had a score on the sPGA of 0 or 1 and a 75% or greater reduction from baseline in Psoriasis Area and Severity Index (PASI 75) at week 12. RESULTS In the UNCOVER-1 trial, at week 12, the patients had better responses to ixekizumab than to placebo; in the 2-wk dosing group, 81.8% had an sPGA score of 0 or 1 and 89.1% had a PASI 75 response; in the 4-wk dosing group, the respective rates were 76.4% and 82.6%; and in the placebo group, the rates were 3.2% and 3.9% (P<0.001 for all comparisons of ixekizumab with placebo). In the UNCOVER-1 and UNCOVER-2 trials, among the patients who were randomly reassigned at week 12 to receive 80 mg of ixekizumab every 4 weeks, 80 mg of ixekizumab every 12 weeks, or placebo, an sPGA score of 0 or 1 was maintained by 73.8%, 39.0%, and 7.0% of the patients, respectively. Patients in the UNCOVER-3 trial received continuous treatment of ixekizumab from weeks 0 through 60, and at week 60, at least 73% had an sPGA score of 0 or 1 and at least 80% had a PASI 75 response. Adverse events reported during ixekizumab use included neutropenia, candidal infections, and inflammatory bowel disease. CONCLUSIONS In three phase 3 trials involving patients with psoriasis, ixekizumab was effective through 60 weeks of treatment. As with any treatment, the benefits need to be weighed against the risks of adverse events. The efficacy and safety of ixekizumab beyond 60 weeks of treatment are not yet known

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Comment on the Reimerdes Ballistic Limit Equation for Dual-Wall Structural Systems

The fundamental components of any micrometeoroid and orbital debris (MMOD) risk assessment are MMOD environment models, damage response predictor equations, and failure criteria. A damage response predictor equation, such as a ballistic limit equation (BLE), is developed to characterize the performance of a hypervelocity impact shield. Such an equation defines the threshold particle size that causes, for example, perforation or detached spall from the inner wall of a multiwall system as a function of velocity, impact angle, particle density, shield and inner-wall thicknesses, and particle shape. BLEs are typically drawn as lines of demarcation between regions of inner-wall failure and no failure in two-dimensional projectile-diameter—impact-velocity space

On the Effect of Considering More Realistic Particle Shape and Mass Parameters in MMOD Risk Assessments

One of the primary mission risks tracked in the development of all spacecraft is that due to micro-meteoroids and orbital debris (MMOD). Both types of particles, especially those larger than 0.1 mm in diameter, contain sufficient kinetic energy due to their combined mass and velocities to cause serious damage to crew members and spacecraft. The process used to assess MMOD risk consists of three elements: environment, damage prediction, and damage tolerance. Orbital debris risk assessments for the Orion vehicle, as well as the Shuttle, Space Station and other satellites use ballistic limit equations (BLEs) that have been developed using high speed impact test data and results from numerical simulations that have used spherical projectiles. However, spheres are not expected to be a common shape for orbital debris; rather, orbital debris fragments might be better represented by other regular or irregular solids. In this paper we examine the general construction of NASA\u27s current orbital debris (OD) model, explore the potential variations in orbital debris mass and shape that are possible when using particle characteristic length to define particle size (instead of assuming spherical particles), and, considering specifically the Orion vehicle, perform an orbital debris risk sensitivity study taking into account variations in particle mass and shape as noted above. While the results of the work performed for this study are preliminary, they do show that continuing to use aluminum spheres in spacecraft risk assessments could result in an over-design of its MMOD protection systems. In such a case, the spacecraft could be heavier than needed, could cost more than needed, and could cost more to put into orbit than needed. The results obtained in this study also show the need to incorporate effects of mass and shape in mission risk assessment prior to first flight of any spacecraft as well as the need to continue to develop/refine BLEs so that they more accurately reflect the shape and material density variations inherent to the actual debris environment