Development and Qualification of the Primary Structure of the Orion European Service Module

This paper presents an overview of the development and qualification test campaign for the primary structure of the European Service Module of ORION, the NASA spacecraft which will serve the future human exploration missions to the Moon, Mars and beyond. Under an agreement between NASA and ESA, the ORION will be powered by a European Service Module (ESM), providing also water and oxygen for astronauts' life sustainability. The development and qualification of the European Service Module (ESM) is under ESA responsibility with Airbus Defense and Space as the prime contractor. Thales Alenia Space Italia is responsible for design development, manufacturing, assembly and qualification of the Structure subsystem. The European Service Module, installed onto the launch adapter, shall support the crew module with its adapter and a launch abort system. It shall sustain: - A combination of global and local launch loads during lift off and ascent phases, - On orbit loads induced by engine firing for orbital transfers and attitude control. The ESM structure is based on a core made of Composite Fiber Reinforced Polymer (CFRP) sandwich panels complemented by aluminum alloy platforms, longerons and secondary structures. A development campaign has been implemented in order to define and validate composite parts' strength allowable values for design: coupon tests at material level, test at component level up to breadboards tests performed on main structural components (composite to metallic joints, and at panels' discontinuities). An incremental approach as defined in [1] has been followed. A qualification static test campaign at primary structure assembly level has been implemented in order to validate the design against static stiffness and ultimate strength as well as to correlate the structural Finite Element Model (FEM) used for sizing and confirm the margins of safety. The tests have been performed successfully by Thales Alenia Space Italia (TAS-I) on two flight representative structural models (STA1, STA2), in Turin facilities (Italy) between August 2015 and March 2017, with engineering support of technical representatives from Airbus, ESA, NASA and LMCO. The main development and qualification test activities and associated results are presented and discussed in the pape

Design Optimisation and Mass Saving of the Structure of the Orion-MPCV European Service Module

This paper presents an overview of the design optimisation measures that have been proposed and analysed in order to reduce the mass of the structure, including the MMOD (Micro-Meteoroid and Orbital Debris) protection system, of the ESM (European Service Module) for the Orion MPCV (Multi-Purpose Crew Vehicle). Under an agreement between NASA and ESA, the NASA Orion MPCV for human space exploration missions will be powered by a European Service Module, based on the design and experience of the ATV (Automated Transfer Vehicle). The development and qualification of the European Service Module is managed and implemented by ESA. The ESM prime contractor and system design responsible is Airbus Defence and Space. Thales Alenia Space Italia is responsible for the design and integration of the ESM Structure and MMOD protection system in addition to the Thermal Control System and the Consumable Storage System. The Orion Multi-Purpose Crew Vehicle is a pressurized, crewed spacecraft that transports up to four crew members from the Earths surface to a nearby destination or staging point. Orion then brings the crew members safely back to the Earths surface at the end of the mission. Orion provides all services necessary to support the crew members while on-board for short duration missions (up to 21 days) or until they are transferred to another orbiting habitat. The ESM supports the crew module from launch through separation prior to re-entry by providing: in-space propulsion capability for orbital transfer, attitude control, and high altitude ascent aborts; water and oxygen/nitrogen needed for a habitable environment; and electrical power generation. In addition, it maintains the temperature of the vehicle's systems and components and offers space for unpressurized cargo and scientific payloads. The ESM has been designed for the first 2 Lunar orbit missions, EM-1 (Exploration mission 1) is an un-crewed flight planned around mid-2020, and EM-2, the first crewed flight, is planned in 2022. At the time where the first ESM is about to be weighted, the predicted mass lies slightly above the initial requirement. For future builds, mass reduction of the Service Module has been considered necessary. This is being investigated, together with other design improvements, in order to consolidate the ESM design and increase possible future missions beyond the first two Orion MPCV missions. The mass saving study has introduced new optimised structural concepts, optimisation of the MMOD protection shields, and optimised redesign of parts for manufacturing through AM (Additive Manufacturing)

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

International consensus: What else can we do to improve diagnosis and therapeutic strategies in patients affected by autoimmune rheumatic diseases (rheumatoid arthritis, spondyloarthritides, systemic sclerosis, systemic lupus erythematosus, antiphospholipid syndrome and Sjogren's syndrome)?: The unmet needs and the clinical grey zone in autoimmune disease management

Autoimmune diseases are a complex set of diseases characterized by immune system activation and, although many progresses have been done in the last 15 years, several unmet needs in the management of these patients may be still identified. Recently, a panel of international Experts, divided in different working groups according to their clinical and scientific expertise, were asked to identify, debate and formulate a list of key unmet needs within the field of rheumatology, serving as a roadmap for research as well as support for clinicians. After a systematic review of the literature, the results and the discussions from each working group were summarised in different statements. Due to the differences among the diseases and their heterogeneity, a large number of statements was produced and voted by the Experts to reach a consensus in a plenary session. At all the steps of this process, including the initial discussions by the steering committee, the identification of the unmet needs, the expansion of the working group and finally the development of statements, a large agreement was attained. This work confirmed that several unmet needs may be identified and despite the development of new therapeutic strategies as well as a better understanding of the effects of existing therapies, many open questions still remain in this field, suggesting a research agenda for the future and specific clinical suggestions which may allow physicians to better manage those clinical conditions still lacking of scientific clarity. © 201

International consensus: what else can we do to improve diagnosis and therapeutic strategies in patients affected by autoimmune rheumatic diseases (rheumatoid arthritis, spondyloarthritides, systemic sclerosis, systemic lupus erythematosus, antiphospholipid syndrome and Sjogren's syndrome)?: The unmet needs and the clinical grey zone in autoimmune disease management

Autoimmune diseases are a complex set of diseases characterized by immune system activation and, although many progresses have been done in the last 15 years, several unmet needs in the management of these patients may be still identified. Recently, a panel of international Experts, divided in different working groups according to their clinical and scientific expertise, were asked to identify, debate and formulate a list of key unmet needs within the field of rheumatology, serving as a roadmap for research as well as support for clinicians. After a systematic review of the literature, the results and the discussions from each working group were summarised in different statements. Due to the differences among the diseases and their heterogeneity, a large number of statements was produced and voted by the Experts to reach a consensus in a plenary session. At all the steps of this process, including the initial discussions by the steering committee, the identification of the unmet needs, the expansion of the working group and finally the development of statements, a large agreement was attained. This work confirmed that several unmet needs may be identified and despite the development of new therapeutic strategies as well as a better understanding of the effects of existing therapies, many open questions still remain in this field, suggesting a research agenda for the future and specific clinical suggestions which may allow physicians to better manage those clinical conditions still lacking of scientific clarity.status: publishe

International consensus: What else can we do to improve diagnosis and therapeutic strategies in patients affected by autoimmune rheumatic diseases (rheumatoid arthritis, spondyloarthritides, systemic sclerosis, systemic lupus erythematosus, antiphospholipid syndrome and Sjogren's syndrome)?: The unmet needs and the clinical grey zone in autoimmune disease management

Autoimmune diseases are a complex set of diseases characterized by immune system activation and, although many progresses have been done in the last 15years, several unmet needs in the management of these patients may be still identified. Recently, a panel of international Experts, divided in different working groups according to their clinical and scientific expertise, were asked to identify, debate and formulate a list of key unmet needs within the field of rheumatology, serving as a roadmap for research as well as support for clinicians. After a systematic review of the literature, the results and the discussions from each working group were summarised in different statements. Due to the differences among the diseases and their heterogeneity, a large number of statements was produced and voted by the Experts to reach a consensus in a plenary session. At all the steps of this process, including the initial discussions by the steering committee, the identification of the unmet needs, the expansion of the working group and finally the development of statements, a large agreement was attained. This work confirmed that several unmet needs may be identified and despite the development of new therapeutic strategies as well as a better understanding of the effects of existing therapies, many open questions still remain in this field, suggesting a research agenda for the future and specific clinical suggestions which may allow physicians to better manage those clinical conditions still lacking of scientific clarity. Copyright © 2017. Published by Elsevier B.V

Post-stroke depression: Research methodology of a large multicentre observational study (DESTRO)

The heterogeneity of published data regarding post-stroke depression (PSD) prompted an Italian multicenter observational study (DESTRO), which took place in 2000-2003. The investigation involved 53 Italian neurology centers: of these, 50 treat acute patients and 3 provide rehabilitation care; 21 centres are in Northern Italy, 20 are in Central Italy, and 12 are in Southern Italy. The time schedule was articulated into three phases: registration of 6289 stroke patients; selection of 1817 cases and enrolment of 1074 patients; and follow-up for two years (1064 patients). Mood assessment was performed by evaluating depressive symptoms according to DSM IV and the Beck depression inventory (visual analog mood scale for aphasic patients). Depressed patients were also administered the Montgomery-Asberg depression rating scale. Scores were related to function (Barthel index, modified Rankin scale), cognition (MMSE), quality of life (SF-36), and clinical data. Data analysis will provide information on PSD prevalence, onset and evolution, correlation with ischemic clinical syndrome, impact on activities of daily living, cognitive level and quality of life. The few data available at the present time concern PSD prevalence in the first six months after stroke (33.6%). DESTRO is a longitudinal investigation of a large patient sample and is expected to provide insights into the relationship of PDS with the functional and clinical consequences of stroke