Executable Architectures and their Application to a Geographically Distributed Air Operations Center

Integrated Architectures and Network Centric Warfare represent two central concepts in the Department of Defense\u27s (DoD) on-going transformation. The true power of integrated architectures is brought to bear when they are combined with simulation to move beyond a static representation and create an executable architecture. This architecture can then be used to experiment with system configurations and parameter values to guide employment decisions. The process of developing and utilizing an executable architecture will be employed to assess an Air Operations Center (AOC). This thesis applies and expands upon the methodology of Dr. Alexander Levis, former Chief Scientist of the Air Force, to the static architecture representing the Aerospace Operations Center (AOC). Using Colored Petri Nets and other simulation tools, an executable architecture for the AOC\u27s Air Tasking Order (ATO) production thread was developed. These models were then used to compare the performance of a current, forward-deployed AOC configuration to three other potential configurations that utilize a network centric environment to deploy a portion of the AOC and provide reach-back capabilities to the non-deployed units. Performance was measured by the amount of time required to execute the ATO cycle under each configuration. Communication requirements were analyzed for each configuration and stochastic delays were modeled for all transactions in which requirements could not be met due to the physical configuration of the AOC elements. All four configurations were found to exhibit statistically different behavior with regard to ATO cycle time

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)