System Engineering for J-2X Development: The Simpler, the Better

The Ares I and Ares V Vehicles will utilize the J-2X rocket engine developed for NASA by the Pratt and Whitney Rocketdyne Company (PWR) as the upper stage engine (USE). The J-2X is an improved higher power version of the original J-2 engine used for Apollo. System Engineering (SE) facilitates direct and open discussions of issues and problems. This simple idea is often overlooked in large, complex engineering development programs. Definition and distribution of requirements from the engine level to the component level is controlled by Allocation Reports which breaks down numerical design objectives (weight, reliability, etc.) into quanta goals for each component area. Linked databases of design and verification requirements help eliminate redundancy and potential mistakes inherent in separated systems. Another tool, the Architecture Design Description (ADD), is used to control J-2X system architecture and effectively communicate configuration changes to those involved in the design process. But the proof of an effective process is in successful program accomplishment. SE is the methodology being used to meet the challenge of completing J-2X engine certification 2 years ahead of any engine program ever developed at PWR. This paper describes the simple, better SE tools and techniques used to achieve this success

Children’s Perspectives on Living With a Sibling With a Chronic Illness

CONTEXT: Clinical guidance emphasizes the importance of considering the whole family when caring for a child with a pediatric chronic illness (PCI). However, there is a lack of research specific to sibling experience. Parental accounts are used in studies to examine family experiences; consequently, the direct voices of siblings are neglected. OBJECTIVE: The meta-synthesis was used to explore the experiences of siblings of children with PCIs to understand their perspectives; in particular, we observed what they feel had influenced their emotional well-being, to target interventions. DATA SOURCES: We searched PsychInfo, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Academic Search Complete databases from inception to April 2016. STUDY SELECTION: We selected qualitative articles used to examine children’s perspectives of living with a sibling with a PCI. Twelve articles were reviewed. DATA EXTRACTION: We observed participants’ characteristics, qualitative methodology, analysis, and themes. RESULTS: The thematic synthesis identified 2 overarching themes providing new insights. The first theme, “changing relationships,” had 2 subthemes: “changing family relationships” and “changing relationship to self.” The second theme, “managing changes,” had 3 subthemes: “coping and acceptance,” “support from friends, peers, and support groups,” and “negative reactions from others.” LIMITATIONS: Studies were often descriptive with little explicit qualitative analysis. CONCLUSIONS: The findings are used to outline how changes in family relationships often result in reduced communication and a suppression of healthy siblings’ needs. Siblings develop strategies to help them cope with and accept their circumstances, including finding new prosocial ways of meeting their needs in the form of skills and roles they develop

Understanding resilience in young people with complex mental health needs:A Delphi study

Background: Resilience is a term used to describe an individual’s adaptive coping following an adverse experience; it is important for gaining insight into the development of mental health difficulties in young people and their ability to manage adversity, informing both preventive and reactive clinical practice. Methods: The Delphi method was used whereby a panel of 15 clinical psychologists rated 67 statements, generated from focus groups with young people and interviews with multi-disciplinary staff, in terms of their importance relating to resilience for young people with complex mental health needs. A consensus level of 85% across the panel was set to include/exclude statements in terms of their importance for resilience. Results: Nineteen statements were included in the final list. These were grouped into the following four themes: (1) understanding the self, (2) agency in recovery, (3) interpersonal relationships and (4) therapeutic setting and relationships. Conclusions: The results highlight specific resilience factors for young people with complex mental health needs, based upon ratings by clinical psychologists. Recommendations are made which focus upon how to promote resilience within this specific population. These include offering secure therapeutic relationships and a safe environment for young people to make decisions, develop a greater understanding of themselves, and build relationships and a sense of connection with others, both within the specialist mental health service and upon discharge

Impact of CKD Progression on Cardiovascular Disease Risk in a Contemporary UK Cohort of Individuals With Diabetes

Introduction: It remains unclear whether an increased progression rate of chronic kidney disease (CKD) adds predictive information regarding cardiovascular disease (CVD) risk. The aim of this study was to evaluate the association between CKD progression, based on estimated glomerular filtration rate (eGFR) slope estimates and the risk for CVD. Methods: We compared the updated eGFR slope calculated over multiple overlapping 2-year periods and the updated mean eGFR. Incident CKD subjects were selected from a prevalent population with diabetes (T2DM). Subjects from the UK Clinical Practice Research Data Link GOLD (CPRD) were followed from CKD diagnosis (n = 30,222) until heart failure (HF), myocardial infarction (MI), ischemic stroke (IS), or a composite end point including all 3 event types (MACE plus), mortality, database dropout, or end of study follow-up. Results: Both the updated eGFR slope and updated mean eGFR were associated with MACE plus and HF. Updated eGFR slope decline of > –3 ml/min/1.73 m2 increased the risk for MACE plus (adjusted hazard ratio [HR] = 1.45; 95% confidence interval [CI], 1.26–1.67), HF (HR = 1.50; 95% CI, 1.27–1.76), and MI (HR = 1.39; 95% CI, 1.01–1.91). Conclusions: This study strongly supports current evidence that CKD is an independent risk factor for CVD. From a clinical perspective, both rate of progression and cumulative status of CKD describe distinct aspects of the cardiorenal risk among persons with diabetes. This evidence is essential to enable more timely and improved use of treatments in this population

Correction of anemia by dapagliflozin in patients with type 2 diabetes

Aims: Anemia is common in type 2 diabetes (T2D), particularly in patients with kidney impairment, and often goes unrecognized. Dapagliflozin treatment increases hemoglobin and serum erythropoietin levels. We investigated the effect of dapagliflozin 10-mg/day on hemoglobin in T2D patients with and without anemia. Methods: Data from 5325 patients from 14 placebo-controlled, dapagliflozin-treatment studies of at least 24-weeks duration were pooled. Dapagliflozin's effects (vs. placebo) on hemoglobin, serum albumin, estimated glomerular filtration rate (eGFR), systolic blood pressure, body weight, and safety in patients with and without anemia were evaluated. Results: At baseline, 13% of all T2D patients and 28% of those with chronic kidney disease (eGFR Conclusions: Treatment with dapagliflozin can correct and prevent anemia in T2D patients. A gradual increase in hemoglobin beyond week 4 may indicate an erythropoiesis-stimulating effect of sodium-glucose cotransporter 2 inhibition. (c) 2020 Published by Elsevier Inc

Effects of the sodium-glucose co-transporter-2 inhibitor dapagliflozin on estimated plasma volume in patients with type 2 diabetes

Aims To compare the effects of the sodium-glucose co-transporter-2 (SGLT2) inhibitor dapagliflozin on estimated (ePV) and measured plasma volume (mPV) and to characterize the effects of dapagliflozin on ePV in a broad population of patients with type 2 diabetes. Materials and methods The Strauss formula was used to calculate changes in ePV. Change in plasma volume measured with I-125-human serum albumin (mPV) was compared with change in ePV in 10 patients with type 2 diabetes randomized to dapagliflozin 10 mg/d or placebo. Subsequently, changes in ePV were measured in a pooled database of 13 phase 2b/3 placebo-controlled clinical trials involving 4533 patients with type 2 diabetes who were randomized to dapagliflozin 10 mg daily or matched placebo. Results The median change in ePV was similar to the median change in mPV (-9.4% and -9.0%) during dapagliflozin treatment. In the pooled analysis of clinical trials, dapagliflozin decreased ePV by 9.6% (95% confidence interval 9.0 to 10.2) compared to placebo after 24 weeks. This effect was consistent in various patient subgroups, including subgroups with or without diuretic use or established cardiovascular disease. Conclusions ePV may be used as a proxy to assess changes in plasma volume during dapagliflozin treatment. Dapagliflozin consistently decreased ePV compared to placebo in a broad population of patients with type 2 diabetes