Inspection of the Math Model Tools for On-Orbit Assessment of Impact Damage Report

In Spring of 2005, the NASA Engineering Safety Center (NESC) was engaged by the Space Shuttle Program (SSP) to peer review the suite of analytical tools being developed to support the determination of impact and damage tolerance of the Orbiter Thermal Protection Systems (TPS). The NESC formed an independent review team with the core disciplines of materials, flight sciences, structures, mechanical analysis and thermal analysis. The Math Model Tools reviewed included damage prediction and stress analysis, aeroheating analysis, and thermal analysis tools. Some tools are physics-based and other tools are empirically-derived. Each tool was created for a specific use and timeframe, including certification, real-time pre-launch assessments, and real-time on-orbit assessments. The tools are used together in an integrated strategy for assessing the ramifications of impact damage to tile and RCC. The NESC teams conducted a peer review of the engineering data package for each Math Model Tool. This report contains the summary of the team observations and recommendations from these reviews

Inspection of the Math Model Tools for On-Orbit Assessment of Impact Damage Report

In Spring of 2005, the NASA Engineering Safety Center (NESC) was engaged by the Space Shuttle Program (SSP) to peer review the suite of analytical tools being developed to support the determination of impact and damage tolerance of the Orbiter Thermal Protection Systems (TPS). The NESC formed an independent review team with the core disciplines of materials, flight sciences, structures, mechanical analysis and thermal analysis. The Math Model Tools reviewed included damage prediction and stress analysis, aeroheating analysis, and thermal analysis tools. Some tools are physics-based and other tools are empirically-derived. Each tool was created for a specific use and timeframe, including certification, real-time pre-launch assessments. In addition, the tools are used together in an integrated strategy for assessing the ramifications of impact damage to tile and RCC. The NESC teams conducted a peer review of the engineering data package for each Math Model Tool. This report contains the summary of the team observations and recommendations from these reviews

NESC Peer-Review of the Flight Rationale for Expected Debris Report

Since the loss of Columbia on February 1, 2003, the Space Shuttle Program (SSP) has significantly improved the understanding of launch and ascent debris, implemented hardware modifications to reduce debris, and conducted tests and analyses to understand the risks associated with expected debris. The STS-114 flight rationale for expected debris relies on a combination of all three of these factors. A number of design improvements have been implemented to reduce debris at the source. The External Tank (ET) thermal protection system (TPS) foam has been redesigned and/or process improvements have been implemented in the following locations: the bipod closeout, the first ten feet of the liquid hydrogen (LH2) tank protuberance air load (PAL) ramp, and the LH2 tank-to-intertank flange closeout. In addition, the forward bipod ramp has been eliminated and heaters have been installed on the bipod fittings and the liquid oxygen (LO2) feedline forward bellows to prevent ice formation. The Solid Rocket Booster (SRB) bolt catcher has been redesigned. The Orbiter reaction control system (RCS) thruster cover "butcher paper" has been replaced with a material that sheds at a low velocity. Finally, the pad area has been cleaned to reduce debris during lift-off

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570