SIMULATING CONSUMABLE ORDER FULFILLMENT VIA ADDITIVE MANUFACTURING TECHNOLOGIES

Operational availability of naval aircraft through material readiness is critical to ensuring combat power. Supportability of aircraft is a crucial aspect of readiness, influenced by several factors including access to 9B Cognizance Code (COG) aviation consumable repair parts at various supply echelons. Rapidly evolving additive manufacturing (AM) technologies are transforming supply chain dynamics and the traditional aircraft supportability construct. As of June 2022, there are 595 AM assets within the Navy’s inventory—all for research and development purposes. This report simulates 9B COG aviation consumable fulfillment strategies within the U.S. Indo-Pacific sustainment network for a three-year span, inclusive of traditional supply support avenues and a developed set of user-variable capability inputs. Simulated probabilistic demand configurations are modeled from historical trends that exploit a heuristic methodology to assign a “printability” score to each 9B COG requirement, accounting for uncertainty, machine failure rates, and other continuous characteristics of the simulated orders. The results measure simulated lead time across diverse planning horizons in both current and varied operationalized AM sustainment network configurations. This research indicates a measurable lead time reduction of approximately 10% across all 9B order lead times when AM is employed as an order fulfillment source for only 0.5% of orders.NPS Naval Research ProgramThis project was funded in part by the NPS Naval Research Program.Lieutenant Commander, United States NavyApproved for public release. Distribution is unlimited

Effects of Weather on Foraging Success and Hunting Frequency in Winter-Irruptive Snowy Owls (\u3ci\u3eBubo scandiacus\u3c/i\u3e) in Upstate New York

The effects of weather on an individual can often alter the population dynamics of a species. Knowledge of how weather influences individual behavior is therefore essential in understanding its full impact in the context of population ecology. Snowy Owls (Bubo scandiacus) exhibit expensive long-distance migrations in winters following population irruptions. During irruptive movements, many owls migrate past the southernmost extent of their traditional wintering grounds, the mechanism for which is still debated. We propose and test the “milder climate” hypothesis; Snowy Owls wintering in lower latitudes are better able to meet their metabolic demands due to higher temperatures and lower snow cover. During the Snowy Owl irruption of 2014–2015, we examined this hypothesis by assessing the influence of local weather variables on foraging success, frequency of prey capture attempts, and overall activity budgets in a sample of wintering Snowy Owls in New York, USA. We used eBird, an online citizen science resource, to help locate Snowy Owls, which we observed from an automobile. We found that none of the weather variables tested affected foraging success. However, the lack of effect of snow depth on foraging success may suggest that hearing is more important for hunting in Snowy Owls than previously thought. Hunting frequency decreased with increasing temperatures, suggesting Snowy Owls were better able to meet their metabolic demands in higher temperatures. We thus offer support for the milder climate hypothesis; Snowy Owls wintering in lower latitudes may be able to offset the energetic expenses of long-distance movements

Extravehicular activity at geosynchronous earth orbit

The basic contract to define the system requirements to support the Advanced Extravehicular Activity (EVA) has three phases: EVA in geosynchronous Earth orbit; EVA in lunar base operations; and EVA in manned Mars surface exploration. The three key areas to be addressed in each phase are: environmental/biomedical requirements; crew and mission requirements; and hardware requirements. The structure of the technical tasks closely follows the structure of the Advanced EVA studies for the Space Station completed in 1986

Advanced extravehicular activity systems requirements definition study. Phase 2: Extravehicular activity at a lunar base

The focus is on Extravehicular Activity (EVA) systems requirements definition for an advanced space mission: remote-from-main base EVA on the Moon. The lunar environment, biomedical considerations, appropriate hardware design criteria, hardware and interface requirements, and key technical issues for advanced lunar EVA were examined. Six remote EVA scenarios (three nominal operations and three contingency situations) were developed in considerable detail

Evaluating associations between the benefits and risks of drug therapy in type 2 diabetes:A joint modelling approach

This is the author accepted manuscript. The final version is available from Dove Medical Press via the DOI in this record.Data statement: No additional data are available from the authors although the individual participant data from the ADOPT trial used in this study are available from GlaxoSmithKline on application via www.clinicalstudydatarequest.comObjective: Precision medicine drug therapy seeks to maximise efficacy and minimise harm for individual patients. This will be difficult if drug response and side-effects are positively associated, meaning patients likely to respond best are at increased risk of side-effects. We applied joint longitudinal-survival models to evaluate associations between drug response (longitudinal outcome) and risk of side-effects (survival outcome) for patients initiating type 2 diabetes therapy. Study Design and Setting: Participants were randomised to metformin, sulfonylurea or thiazolidinedione therapy in the ADOPT drug-efficacy trial (n=4,351). Joint models were parameterised for: 1) current HbA1c response (change from baseline in HbA1c); 2) cumulative HbA1c response (total HbA1c change). Results: With metformin, greater HbA1c response did not increase risk of gastrointestinal events (Hazard ratio (HR) per 1% absolute greater current response 0.82 (95% confidence interval 0.67,1.01); HR per 1% higher cumulative response 0.90 (0.81,1.00)). With sulfonylureas, greater current response was associated with increased risk of hypoglycaemia (HR 1.41 (1.04,1.91)). With thiazolidinediones, greater response was associated with increased risk of oedema (current HR 1.45 (1.05,2.01); cumulative 1.22 (1.07,1.38)) but not fracture. Conclusion: Joint modelling provides a useful framework to evaluate the association between response to a drug and risk of developing side-effects. There may be great potential for widespread application of joint modelling to evaluate the risks and benefits of both new and established medications.This work was supported by the Medical Research Council (UK) (Grant MR/N00633X/1). ATH is a NIHR Senior Investigator and a Wellcome Trust Senior Investigator. ERP is a Wellcome Trust New Investigator (102820/Z/13/Z). AGJ is supported by an NIHR Clinician Scientist award. ATH and BMS are supported by the NIHR Exeter Clinical Research Facility. WEH received additional support from IQVIA and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula)

Development of extinction imagers for the determination of atmospheric optical extinction: final report

The primary goals of this project for JTO and ONR (Grant N00014-07-1-1060) were to further develop Extinction Imagers for use in the ocean environment, and to extend the capabilities into the Short Wave IR (SWIR). Extinction Imaging is a method for determining the effective extinction coefficient over an extended path using a sensor at one end of the path. It uses calibrated imagers to acquire the relative radiance of a dark target near the other the end of the path and the horizon sky in the direction of the dark target. It is completely passive and thus covert, and the hardware is robust and relatively inexpensive. It uses rigorous equations, which determine the extinction coefficient from the measured apparent contrast of the radiance of the dark target with respect to the horizon sky. The project was very successful. We found that the ocean surface could readily be used as a dark target in red and SWIR wavelengths. Both the red and the SWIR measurement results were excellent for daytime. Comparisons with standard instruments, as well as uncertainty analysis, indicated that extinction imagers provide better measurements of the atmospheric extinction losses over extended paths than other methods of which we are aware. Our secondary goals were to address the night regime, and to address slanted paths above the horizontal. Regarding night, we found that the visible sensor acquired excellent data, but the ocean surface was not a good dark target in our wavelengths. Recommendations on the handling of night are given in the report. Regarding the lines of sight above the horizon, we developed a slant path algorithm that determines beam transmittance. It performed very well. Recommendations are made regarding integration of these techniques for military applications.Joint Technology Office via Office of Naval ResearchGrant N00014-07-1-106

Racial Categories in Medical Practice: How Useful Are They?

Is it good medical practice for physicians to "eyeball" a patient's race when assessing their medical status or even to ask them to identify their race

Changing individual-level risk factors for malaria with declining transmission in southern Zambia: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Malaria elimination will require that both symptomatic- and asymptomatic-infected persons be identified and treated. However, well-characterized, individual-level risk factors for malaria may not be valid in regions with declining malaria transmission. Changes in individual-level correlates of malaria infection were evaluated over three years in a region of declining malaria transmission in southern Zambia.</p> <p>Methods</p> <p>Malaria surveys were conducted in two study areas within the catchment area of Macha Hospital, Zambia in 2007 and 2008/2009. A random sample of households was identified from a digitized satellite image of the study areas. Cross-sectional surveys were conducted approximately five times throughout the year in each of the two study areas. During study visits, adults and caretakers of children were administered questionnaires and a blood sample was obtained for a rapid diagnostic test (RDT) for malaria.</p> <p>Results</p> <p>In the 2007 study area, 330 individuals were surveyed. 40.9% of participants lived in a household with at least one insecticide-treated bed net (ITN); however, only 45.2% reported sleeping under the ITN. 23.9% of participants were RDT positive. Correlates of RDT positivity included younger age, the presence of symptoms, testing during the rainy season, using an open water source, and not sleeping under an ITN. In the 2008 study area, 435 individuals were surveyed. 77.0% of participants lived in a household with at least one ITN; however, only 56.4% reported sleeping under the ITN. 8.1% of participants were RDT positive. RDT positivity was negatively correlated with the presence of symptoms within the last two weeks but positively correlated with documented fever. In 2009, 716 individuals were surveyed in the same area as 2008. 63.7% of participants lived in a household with at least one ITN; however, only 57.7% reported sleeping under the ITN. 1.5% of participants were RDT positive. Only self-reported fever was significantly correlated with RDT positivity.</p> <p>Conclusions</p> <p>With declining malaria prevalence, few individual-level characteristics were correlated with RDT positivity. This lack of correlation with individual characteristics hampers identification of individuals infected with malaria. Strategies based on ecological or environmental risk factors may be needed to target control efforts and achieve further reductions and elimination.</p

Mortality Rate in Veterans with Multiple Chronic Conditions

Background: Among patients with multiple chronic conditions, there is increasing appreciation of the complex interrelatedness of diseases. Previous studies have focused on the prevalence and economic burden associated with multiple chronic conditions, much less is known about the mortality rate associated with specific combinations of multiple diseases. Objective: Measure the mortality rate in combinations of 11 chronic conditions. Design: Cohort study of veteran health care users. Participants Veterans between 55 and 64 years that used Veterans Health Administration health care services between October 1999 and September 2000. Measurements: Patients were identified as having one or more of the following: COPD, diabetes, hypertension, rheumatoid arthritis, osteoarthritis, asthma, depression, ischemic heart disease, dementia, stroke, and cancer. Mutually exclusive combinations of disease based on these conditions were created, and 5-year mortality rates were determined. Results: There were 741,847 persons included. The number in each group by a count of conditions was: none = 217,944 (29.34%); 1 = 221,111 (29.8%); 2 = 175,228 (23.6%); 3 = 86,447 (11.7%); and 4+ = 41,117 (5.5%). The 5-year mortality rate by the number of conditions was: none = 4.1%; 1 = 6.0%; 2 = 7.8%; 3 = 11.2%; 4+ = 16.7%. Among combinations with the same number of conditions, there was significant variability in mortality rates. Conclusions: Patients with multiple chronic conditions have higher mortality rates. Because there was significant variation in mortality across clusters with the same number of conditions, when studying patients with multiple coexisting illnesses, it is important to understand not only that several conditions may be present but that specific conditions can differentially impact the risk of mortality

Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors:a retrospective analysis of primary care data, 2010-2017

This is the author accepted manuscript. The final version is available on open access from Wiley via the DOI in this recordAim: Prescribing in type 2 diabetes has changed markedly in recent years, with increasing use of newer, more expensive glucose-lowering drugs. We aimed to describe population-level time trends in both prescribing patterns and short-term patient outcomes (HbA1c, weight, blood pressure, hypoglycemia and treatment discontinuation) after initiating new therapy. Materials and methods: We studied 81,532 UK patients with type 2 diabetes initiating a first to fourth line drug in primary care between 2010-2017 inclusive (Clinical Practice Research Datalink). Trends in new prescriptions and subsequent six and twelve-month adjusted changes in glycemic response (reduction in HbA1c), weight, blood pressure, and rates of hypoglycemia and treatment discontinuation were examined. Results: DPP4-inhibitor use second-line near doubled (41% of new prescriptions in 2017 vs. 22% 2010), replacing sulfonylureas as the most common second-line drug (29% 2017 vs. 53% 2010). SGLT2-inhibitors, introduced in 2013, comprised 17% of new first-fourth line prescriptions by 2017. First-line use of metformin remained stable (91% of new prescriptions in 2017 vs. 91% 2010). Over the study period there was little change in average glycemic response and treatment discontinuation. There was a modest reduction in weight second and third-line (second line 2017 vs. 2010: -1.5 kg (95%CI -1.9;-1.1), p<0.001), and a slight reduction in systolic blood pressure first to third-line (2017 vs. 2010 difference range -1.7 to -2.1 mmHg, all p<0.001). Hypoglycemia rates decreased second-line (incidence rate ratio 0.94 per-year (95%CI 0.88;1.00, p=0.04)), mirroring the decline in use of sulfonylureas. 4 Conclusions: Recent changes in prescribing of therapy in type 2 diabetes have not led to a change in glycemic response and have resulted in modest improvements in other population-level short-term patient outcomes.Medical Research Council (MRC)National Institute for Health Research (NIHR)Wellcome Trus