Impacts of the Robotics Age on Naval Force Design,Effectiveness, and Acquisition

The twenty-first century will see the emergence of maritime powers that have the capacity and capability to challenge the U.S. Navy for control of the seas. Unfortunately, the Navy’s ability to react to emerging maritime powers’ rapid growth and technological advancement is constrained by its own planning, ac- quisition, and political processes. Introducing our own technology advances is hindered as well.

Navy Force Structure Review Strategic Risk Workshop and Technical Review

Prepared for: OPNAV N81 Navy Force Structure Review Team Lead This research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098) NRP Project ID: NPS-22-363AThe OPNAV Lead for the 2022-2023 Navy Force Structure Review requested an interdisciplinary NPS team conduct an independent strategic risk and technical risk of the current programmed force structure and three alternatives. Two week-long efforts by thirty NPS faculty and officer scholars from various disciplines produced classified assessments and delivered them to the Navy Force Structure Review study team in narrated briefing style. This report describes the process these two risk assessments used, without providing the classified results.OPNAV N81 Navy Force Structure Review Team LeadNaval Postgraduate School, Naval Research Program(PE 0605853N/2098)Approved for public release; distribution is unlimited

Urine metabolomic analysis to detect metabolites associated with the development of contrast induced nephropathy.

ObjectiveContrast induced nephropathy (CIN) is a result of injury to the proximal tubules. The incidence of CIN is around 11% for imaging done in the acute care setting. We aim to analyze the metabolic patterns in the urine, before and after dosing with intravenous contrast for computed tomography (CT) imaging of the chest, to determine if metabolomic changes exist in patients who develop CIN.MethodsA convenience sample of high risk patients undergoing a chest CT with intravenous contrast were eligible for enrollment. Urine samples were collected prior to imaging and 4 to 6 hours post imaging. Samples underwent gas chromatography/mass spectrometry profiling. Peak metabolite values were measured and data was log transformed. Significance analysis of microarrays and partial least squares was used to determine the most significant metabolites prior to CT imaging and within subject. Analysis of variance was used to rank metabolites associated with temporal change and CIN. CIN was defined as an increase in serum creatinine level of ≥ 0.5 mg/dL or ≥ 25% above baseline within 48 hours after contrast administration.ResultsWe sampled paired urine samples from 63 subjects. The incidence of CIN was 6/63 (9.5%). Patients without CIN had elevated urinary citric acid and taurine concentrations in the pre-CT urine. Xylulose increased in the post CT sample in patients who developed CIN.ConclusionDifferences in metabolomics patterns in patients who do and do not develop CIN exist. Metabolites may be potential early identifiers of CIN and identify patients at high-risk for developing this condition prior to imaging

The Logbook, A Publication of the Wayne E. Meyer Institute of Systems Engineering / May 2004

www.nps.navy.mil/meyerinstitute Email:[email protected] Phone:(831) 656-7847 Fax:(831) 656-2336 Naval Postgraduate School, 777 Dyer Rd., Mail Code 97, Monterey, CAArticles include: Turnover Time, Joint Executive Systems Engineering and Management Program (SEM-PD21), and Integrated Campus Projects and the Meyer Institute.Naval Postgraduate School, Monterey, C

Warfare Analysis of Logistics Agility in a Contested Environment

NPS NRP Project PosterThis research will examine Naval logistics support requirements during peacetime and conflict in the South China Sea through wargaming and analysis studies. NPS student team designed wargames from the Wargaming Applications course and mini-studies from the Joint Campaign Analysis (JCA) course will be utilized to inform and underpin this program of research.N4 - Fleet Readiness & LogisticsThis research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098). https://nps.edu/nrpChief of Naval Operations (CNO)Approved for public release. Distribution is unlimited.

Warfare Analysis of Logistics Agility in a Contested Environment

NPS NRP Technical ReportThis research will examine Naval logistics support requirements during peacetime and conflict in the South China Sea through wargaming and analysis studies. NPS student team designed wargames from the Wargaming Applications course and mini-studies from the Joint Campaign Analysis (JCA) course will be utilized to inform and underpin this program of research.N4 - Fleet Readiness & LogisticsThis research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098). https://nps.edu/nrpChief of Naval Operations (CNO)Approved for public release. Distribution is unlimited.

Performance of the Mortality in emergency department Sepsis score for predicting hospital mortality among patients with severe sepsis and septic shock

Objective The aim of the study was to test if the Mortality in Emergency Department Sepsis (MEDS) score accurately predicts death among emergency department (ED) patients with severe sepsis and septic shock. Methods This study was a preplanned secondary analysis of a before-and-after interventional study conducted at a large urban ED. Inclusion criteria were suspected infection, 2 or more criteria for systemic inflammation, and either systolic blood pressure of less than 90 mm Hg after a fluid bolus or lactate 4 mmol/L or higher. Exclusion criteria were: age of less than 18 years, no aggressive care desired, or need for immediate surgery. Clinical and outcomes data were prospectively collected on consecutive eligible patients for 1 year before and 1 year after implementing early goal-directed therapy (EGDT). The MEDS scores and probabilities of in-hospital death were calculated. The main outcome was in-hospital mortality. The area under the receiver operating characteristic curve was used to evaluate score performance. Results One hundred forty-three patients, 79 pre-EGDT and 64 post-EGDT, were included. The mean age was 58 ± 17 years, and pneumonia was the source of infection in 37%. The in-hospital mortality rate was 23%. The area under the receiver operating characteristic curve for MEDS to predict mortality was 0.61 (95% confidence interval [CI], 0.50-0.72) overall, 0.69 (95% CI, 0.56-0.82) in pre-EGDT patients, and 0.53 (95% CI, 0.33-0.74) in post-EGDT patients. Conclusions The MEDS score performed with poor accuracy for predicting mortality in ED patients with sepsis. These results suggest the need for further validation of the MEDS score before widespread clinical use

The Logbook, A Publication of the Wayne E. Meyer Institute of Systems Engineering / December 2003

www.nps.navy.mil/meyerinstitute Email:[email protected] Phone:(831) 656-7847 Fax:(831) 656-2336 Naval Postgraduate School, 777 Dyer Rd., Mail Code 97, Monterey, CAArticles including: Systems Analysis Certificate Program Takes Off! etc.Naval Postgraduate School, Monterey, C

The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation

Objectives Organ failure worsens outcome in sepsis. The Sequential Organ Failure Assessment (SOFA) score numerically quantifies the number and severity of failed organs. We examined the utility of the SOFA score for assessing outcome of patients with severe sepsis with evidence of hypoperfusion at the time of emergency department (ED) presentation. Design Prospective observational study. Setting Urban, tertiary ED with an annual census of >110,000. Patients ED patients with severe sepsis with evidence of hypoperfusion. Inclusion criteria: suspected infection, two or more criteria of systemic inflammation, and either systolic blood pressure 4 mmol/L. Exclusion criteria age <18 years or need for immediate surgery. Interventions SOFA scores were calculated at ED recognition (T0) and 72 hours after intensive care unit admission (T72). The primary outcome was in-hospital mortality. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of SOFA scores at each time point. The relationship between Δ SOFA (change in SOFA from T0 to T72) was examined for linearity. Results A total of 248 subjects aged 57 ± 16 years, 48% men, were enrolled over 2 years. All patients were treated with a standardized quantitative resuscitation protocol; the in-hospital mortality rate was 21%. The mean SOFA score at T0 was 7.1 ± 3.6 points and at T72 was 7.4 ± 4.9 points. The area under the receiver operating characteristic curve of SOFA for predicting in-hospital mortality at T0 was 0.75 (95% confidence interval 0.68 - 0.83) and at T72 was 0.84 (95% confidence interval 0.77-0.90). The Δ SOFA was found to have a positive relationship with in-hospital mortality. Conclusions The SOFA score provides potentially valuable prognostic information on in-hospital survival when applied to patients with severe sepsis with evidence of hypoperfusion at the time of ED presentation

The significance of non-sustained hypotension in emergency department patients with sepsis

Objective Few studies have documented the incidence and significance of non-sustained hypotension in emergency department (ED) patients with sepsis. We hypothesized that ED non-sustained hypotension increases risk of in-hospital mortality in patients with sepsis. Methods Secondary analysis of a prospective cohort study. ED patients aged >17 years admitted to the hospital with explicitly defined sepsis were prospectively identified. Inclusion criteria Evidence of systemic inflammation (>1 criteria) and suspicion for infection. Patients with overt shock were excluded. The primary outcome was in-hospital mortality. Results Seven hundred patients with sepsis were enrolled, including 150 (21%) with non-sustained hypotension. The primary outcome of in-hospital mortality was present in 10% (15/150) of patients with non-sustained hypotension compared with 3.6% (20/550) of patients with no hypotension. The presence of non-sustained hypotension resulted in three times the risk of mortality than no hypotension (risk ratio = 2.8, 95% CI 1.5–5.2). Patients with a lowest systolic blood pressure <80 mmHg had a threefold increase in mortality rate compared with patients with a lowest systolic blood pressure ≥80 mmHg (5 vs. 16%). In logistic regression analysis, non-sustained hypotension was an independent predictor of in-hospital mortality. Conclusion Non-sustained hypotension in the ED confers a significantly increased risk of death during hospitalization in patients admitted with sepsis. These data should impart reluctance to dismiss non-sustained hypotension, including a single measurement, as not clinically significant or meaningful