Getting to First Flight: Equipping Space Engineers to Break the Start-Stop-Restart Cycle

The National Aeronautics and Space Administration s (NASA s) history is built on a foundation of can-do strength, while pointing to the Saturn/Apollo Moon missions in the 1960s and 1970s as its apex a sentiment that often overshadows the potential that lies ahead. The chronicle of America s civil space agenda is scattered with programs that got off to good starts with adequate resources and vocal political support but that never made it past a certain milestone review, General Accountability Office report, or Congressional budget appropriation. Over the decades since the fielding of the Space Shuttle in the early 1980s, a start-stop-restart cycle has intervened due to many forces. Despite this impediment, the workforce has delivered engineering feats such as the International Space Station and numerous Shuttle and science missions, which reflect a trend in the early days of the Exploration Age that called for massive infrastructure and matching capital allocations. In the new millennium, the aerospace industry must respond to transforming economic climates, the public will, national agendas, and international possibilities relative to scientific exploration beyond Earth s orbit. Two pressing issues - workforce transition and mission success - are intertwined. As this paper will address, U.S. aerospace must confront related workforce development and industrial base issues head on to take space exploration to the next level. This paper also will formulate specific strategies to equip space engineers to move beyond the seemingly constant start-stop-restart mentality to plan and execute flight projects that actually fly

NASA's Ares I and Ares V Launch Vehicles--Effective Space Operations Through Efficient Ground Operations

The United States (U.S.) is charting a renewed course for lunar exploration, with the fielding of a new human-rated space transportation system to replace the venerable Space Shuttle, which will be retired after it completes its missions of building the International Space Station (ISS) and servicing the Hubble Space Telescope. Powering the future of space-based scientific exploration will be the Ares I Crew Launch Vehicle, which will transport the Orion Crew Exploration Vehicle to orbit where it will rendezvous with the Altair Lunar Lander, which will be delivered by the Ares V Cargo Launch Vehicle (fig. 1). This configuration will empower rekindled investigation of Earth's natural satellite in the not too distant future. This new exploration infrastructure, developed by the National Aeronautics and Space Administration (NASA), will allow astronauts to leave low-Earth orbit (LEO) for extended lunar missions and preparation for the first long-distance journeys to Mars. All space-based operations - to LEO and beyond - are controlled from Earth. NASA's philosophy is to deliver safe, reliable, and cost-effective architecture solutions to sustain this multi-billion-dollar program across several decades. Leveraging SO years of lessons learned, NASA is partnering with private industry and academia, while building on proven hardware experience. This paper outlines a few ways that the Engineering Directorate at NASA's Marshall Space Flight Center is working with the Constellation Program and its project offices to streamline ground operations concepts by designing for operability, which reduces lifecycle costs and promotes sustainable space exploration

When Failure Means Success: Accepting Risk in Aerospace Development

Over the last three decades, NASA has been diligent in qualifying systems for human space flight. As the Agency transitions from operating the Space Shuttle, its employees must learn to accept higher risk levels to generate the data needed to certify its next human space flight system. The Marshall Center s Engineering workforce is developing the Ares I crew launch vehicle and designing the Ares V cargo launch vehicle for safety, reliability, and cost-effective operations. This presentation will provide a risk retrospective, using first-hand examples from the Delta Clipper-Experimental Advanced (DC-XA) and the X-33 single-stage-to-orbit flight demonstrators, while looking ahead to the upcoming Ares I-X uncrewed test flight. The DC-XA was successfully flown twice in 26 hours, setting a new turnaround-time record. Later, one of its 3 landing gears did not deploy, it tipped over, and was destroyed. During structural testing, the X-33 s advanced composite tanks were unable to withstand the forces to which it was subjected and the project was later cancelled. These are examples of successful failures, as the data generated are captured in databases used by vehicle designers today. More recently, the Ares I-X flight readiness review process was streamlined in keeping with the mission's objectives, since human lives are not at stake, which reflects the beginning of a cultural change. Failures are acceptable during testing, as they provide the lessons that actually lead to mission success. These and other examples will stimulate the discussion of when to accept risk in aerospace projects

Limited English Proficient Patients and Time Spent in Therapeutic Range in a Warfarin Anticoagulation Clinic

Background: While anticoagulation clinics have been shown to deliver tailored, high‐quality care to patients receiving warfarin therapy, communication barriers with limited English proficient (LEP) patients may lead to disparities in anticoagulation outcomes. Methods and Results: We analyzed data on 3770 patients receiving care from the Massachusetts General Hospital Anticoagulation Management Service (AMS) from 2009 to 2010. This included data on international normalized ratio (INR) tests and patient characteristics, including language and whether AMS used a surrogate for primary communication. We calculated percent time in therapeutic range (TTR for INR between 2.0 and 3.0) and time in danger range (TDR for INR 3.5) using the standard Rosendaal interpolation method. There were 241 LEP patients; LEP patients, compared with non‐LEP patients, had a higher number of comorbidities (3.2 versus 2.9 comorbidities, P=0.004), were more frequently uninsured (17.0% versus 4.3%, P<0.001), and less educated (47.7% versus 6.0% ≤high school education, P<0.001). LEP patients compared with non‐LEP patients spent less TTR (71.6% versus 74.0%, P=0.007) and more TDR (12.9% versus 11.3%, P=0.018). In adjusted analyses, LEP patients had lower TTR as compared with non‐LEP patients (OR 1.5, 95% CI [1.1, 2.2]). LEP patients who used a communication surrogate spent less TTR and more TDR. Conclusion: Even within a large anticoagulation clinic with a high average TTR, a small but significant decrease in TTR was observed for LEP patients compared with English speakers. Future studies are warranted to explore how the use of professional interpreters impact TTR for LEP patients

Altered Hyperlipidemia, Hepatic Steatosis, and Hepatic Peroxisome Proliferator-Activated Receptors in Rats with Intake of Tart Cherry

ABSTRACT Elevated plasma lipids, glucose, insulin, and fatty liver are among components of metabolic syndrome, a phenotypic pattern that typically precedes the development of Type 2 diabetes. Animal studies show that intake of anthocyanins reduces hyperlipidemia, obesity, and atherosclerosis and that anthocyanin-rich extracts may exert these effects in association with altered activity of tissue peroxisome proliferator-activated receptors (PPARs). However, studies are lacking to test this correlation using physiologically relevant, whole food sources of anthocyanins. Tart cherries are a rich source of anthocyanins, and whole cherry fruit intake may also affect hyperlipidemia and/or affect tissue PPARs. This hypothesis was tested in the Dahl Salt-Sensitive rat having insulin resistance and hyperlipidemia. For 90 days, Dahl rats were pair-fed AIN-76a-based diets supplemented with either 1% (wt:wt) freeze-dried whole tart cherry or with 0.85% additional carbohydrate to match macronutrient and calorie provision. After 90 days, the cherry-enriched diet was associated with reduced fasting blood glucose, hyperlipidemia, hyperinsulinemia, and reduced fatty liver. The cherry diet was also associated with significantly enhanced hepatic PPAR-α mRNA, enhanced hepatic PPAR-α target acyl-coenzyme A oxidase mRNA and activity, and increased plasma antioxidant capacity. In conclusion, physiologically relevant tart cherry consumption reduced several phenotypic risk factors that are associated with risk for metabolic syndrome and Type 2 diabetes. Tart cherries may represent a whole food research model of the health effects of anthocyanin-rich foods and may possess nutraceutical value against risk factors for metabolic syndrome and its clinical sequelae.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63187/1/jmf.2007.658.pd

Patient-Reported Satisfaction and Study Drug Discontinuation: Post-Hoc Analysis of Findings from ROCKET AF.

IntroductionPatient-reported outcomes (PROs) and satisfaction endpoints are increasingly important in clinical trials and may be associated with treatment adherence. In this post hoc substudy from ROCKET AF, we examined whether patient-reported satisfaction was associated with study drug discontinuation.MethodsROCKET AF (n = 14,264) compared rivaroxaban with warfarin for prevention of stroke and systemic embolism in patients with atrial fibrillation. We analyzed treatment satisfaction scores: the Anti-Clot Treatment Scale (ACTS) and Treatment Satisfaction Questionnaire for Medication version II (TSQM II). We compared satisfaction with study drug between the two treatment arms, and examined the association between satisfaction and patient-driven study drug discontinuation (stopping study drug due to withdrawal of consent, noncompliance, or loss to follow-up).ResultsA total of 1577 (11%) patients participated in the Patient Satisfaction substudy; 1181 (8.3%) completed both the ACTS and TSQM II 4 weeks after starting study drug. Patients receiving rivaroxaban did not experience significant differences in satisfaction compared with those receiving warfarin. During a median follow-up of 1.6 years, 448 premature study drug discontinuations occurred (213 rivaroxaban group; 235 warfarin group), of which 116 (26%) were patient-driven (52 [24%] rivaroxaban group; 64 [27%] warfarin group). No significant differences were observed between satisfaction level and rates of patient-driven study drug discontinuation.ConclusionsStudy drug satisfaction did not predict rate of study drug discontinuation. No significant difference was observed between satisfaction with warfarin and rivaroxaban, as expected given the double-blind trial design. Although these results are negative, the importance of PRO data will only increase, and these analyses may inform future studies that explore the relationship between drug-satisfaction PROs, adherence, and clinical outcomes. CLINICALTRIALS.GOV: NCT00403767.FundingThe ROCKET AF trial was funded by Johnson &amp; Johnson and Bayer

Device-detected atrial fibrillation and risk for stroke: an analysis of >10 000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices)

Objective: The aim of this study was to assess the association between maximum daily atrial fibrillation (AF) burden and risk of ischaemic stroke. Background: Cardiac implanted electronic devices (CIEDs) enhance detection of AF, providing a comprehensive measure of AF burden. Design, setting, and patients A pooled analysis of individual patient data from five prospective studies was performed. Patients without permanent AF, previously implanted with CIEDs, were included if they had at least 3 months of follow-up. A total of 10 016 patients (median age 70 years) met these criteria. The risk of ischaemic stroke associated with pre-specified cut-off points of AF burden (5 min, 1, 6, 12, and 23 h, respectively) was assessed. Results: During a median follow-up of 24 months, 43% of 10 016 patients experienced at least 1 day with at least 5 min of AF burden and for them the median time to the maximum AF burden was 6 months (inter-quartile range: 1.3–14). A Cox regression analysis adjusted for the CHADS2 score and anticoagulants at baseline demonstrated that AF burden was an independent predictor of ischaemic stroke. Among the thresholds of AF burden that we evaluated, 1 h was associated with the highest hazard ratio (HR) for ischaemic stroke, i.e. 2.11 (95% CI: 1.22–3.64, P = 0.008). Conclusions: Device-detected AF burden is associated with an increased risk of ischaemic stroke in a relatively unselected population of CIEDs patients. This finding may add to the basis for timely and clinically appropriate decision-making on anticoagulation treatment