X-43 Hypersonic Vehicle Technology Development

NASA recently completed two major programs in Hypersonics: Hyper-X, with the record-breaking flights of the X-43A, and the Next Generation Launch Technology (NGLT) Program. The X-43A flights, the culmination of the Hyper-X Program, were the first-ever examples of a scramjet engine propelling a hypersonic vehicle and provided unique, convincing, detailed flight data required to validate the design tools needed for design and development of future operational hypersonic airbreathing vehicles. Concurrent with Hyper-X, NASA's NGLT Program focused on technologies needed for future revolutionary launch vehicles. The NGLT was "competed" by NASA in response to the President s redirection of the agency to space exploration, after making significant progress towards maturing technologies required to enable airbreathing hypersonic launch vehicles. NGLT quantified the benefits, identified technology needs, developed airframe and propulsion technology, chartered a broad University base, and developed detailed plans to mature and validate hypersonic airbreathing technology for space access. NASA is currently in the process of defining plans for a new Hypersonic Technology Program. Details of that plan are not currently available. This paper highlights results from the successful Mach 7 and 10 flights of the X-43A, and the current state of hypersonic technology

Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy

Background Surgery performed to improve or replace the function of the diseased urinary bladder has been carried out for over a century. Main reasons for improving or replacing the function of the urinary bladder are bladder cancer, neurogenic bladder dysfunction, detrusor overactivity and chronic inflammatory diseases of the bladder (such as interstitial cystitis, tuberculosis and schistosomiasis). There is still much uncertainty about the best surgical approach. Options available at the present time include: (1) conduit diversion (the creation of various intestinal conduits to the skin) or continent diversion (which includes either a rectal reservoir or continent cutaneous diversion), (2) bladder reconstruction and (3) replacement of the bladder with various intestinal segments. Objectives To determine the best way of improving or replacing the function of the lower urinary tract using intestinal segments when the bladder has to be removed or when it has been rendered useless or dangerous by disease. Search methods We searched the Cochrane Incontinence Group Specialised Trials Register (searched 28 October 2011), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings, and the reference lists of relevant articles. Selection criteria All randomised or quasi-randomised controlled trials of surgery involving transposition of an intestinal segment into the urinary tract. Data collection and analysis Trials were evaluated for appropriateness for inclusion and for risk of bias by the review authors. Three review authors were involved in the data extraction. Data were combined in a meta-analysis when appropriate. Main results Five trials met the inclusion criteria with a total of 355 participants. These trials addressed only five of the 14 comparisons pre-specified in the protocol. One trial reported no statistically significant differences in the incidence of upper urinary tract infection, uretero-intestinal stenosis and renal deterioration in the comparison of continent diversion with conduit diversion. The confidence intervals were all wide, however, and did not rule out important clinical differences. In a second trial, there was no reported difference in the incidence of upper urinary tract infection and uretero-intestinal stenosis when conduit diversions were fashioned from either ileum or colon. A meta-analysis of two trials showed no statistically significant difference in daytime or nocturnal incontinence amongst participants who were randomised to ileocolonic/ileocaecal segment bladder replacement compared to an ileal bladder replacement. However, one small trial suggested that bladder replacement using an ileal segment compared to using an ileocolonic segment may be better in terms of lower rates of nocturnal incontinence. There were no differences in the incidence of dilatation of upper tract, daytime urinary incontinence or wound infection using different intestinal segments for bladder replacement. However the data were reported for 'renal units', but not in a form that allowed appropriate patient-based paired analyses. No statistically significant difference was found in the incidence of renal scarring between anti-refluxing versus freely refluxing uretero-intestinal anastomotic techniques in conduit diversions and bladder replacement groups. Again, the outcome data were not reported as paired analysis or in form to carry out paired analysis. Authors' conclusions The evidence from the included trials was very limited. Only five studies met the inclusion criteria; these were small, of moderate or poor methodological quality, and reported few of the pre-selected outcome measures. This review did not find any evidence that bladder replacement (orthotopic or continent diversion) was better than conduit diversion following cystectomy for cancer. There was no evidence to suggest that bladder reconstruction was better than conduit diversion for benign disease. The clinical significance of data from one small trial suggesting that bladder replacement using an ileal segment compared to using an ileocolonic segment is better in terms of lower rates of nocturnal incontinence is uncertain. The small amount of usable evidence for this review suggests that collaborative multi centre studies should be organised, using random allocation where possible. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2012, Issue 2. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.</p

Habitat preferences, intraspecific variation, and restoration of a rare soil specialist in northern Nevada

Edaphic specialization in plants is associated with the development of novel adaptations that frequently lead to speciation, causing unique edaphic environments to be associated with rare and endemic plant species worldwide. These species contribute significantly to global biodiversity, but are especially vulnerable to disturbance and climate change because of their inherently patchy distributions and locally adapted populations. Successful conservation of these species depends upon understanding their habitat requirements and the amounts and distributions of genetic and phenotypic diversity among populations. Little is known about the habitat requirements or levels of genetic and phenotypic diversity of edaphic specialists in the Great Basin of the western United states. Therefore, to improve understanding of edaphic specialization in this region, and to create a foundation of knowledge for species conservation, we used phenotypic measurements in the field, greenhouse common garden studies, and next-generation genetic sequencing techniques to investigate the associations between soil variation and plant phenotypes, and between genetic and phenotypic diversity in Eriogonum crosbyae, a rare edaphic specialist on soils developed from hydrothermally altered volcanic ash in the north-western Great Basin. We found that soil properties were poor predictors of site occupation among outcrops of known or potential habitat in our study area, and that site occupation could change over time. E. crosbyae showed phenotypically plastic responses to soil variation in the greenhouse, and there were associations between soil properties and plant form in the field. Growth was generally better in relatively milder and more fertile field soils when grown without competition, and differences in seedlings’ ability to establish in different soil types may partially explain the species’ patchy distribution in potential habitat. Our genetic analyses revealed high levels of nucleotide diversity and the presence of three highly differentiated genetic groups that often co-occurred within individual sites. The distribution of these groups across the landscape may be consistent with periods of allopatric diversification and subsequent secondary contact. Phenotypic diversity varied more clearly among groups than among sites dominated by a single group, and this variation was more apparent in seedlings grown in the greenhouse than in mature plants measured in the wild. Further studies exploring growth responses to variation in individual soil properties and plant performance in the presence of competition would improve understanding of the mechanisms underlying edaphic specialization in this species. Additionally, more information on the evolutionary history and taxonomy of the genetic groups and how they relate to other edaphically specialized Eriogonum in this region would improve understanding of diversity in these unique edaphic habitats in the Great Basin. Our results highlight the potential for simple-seeming systems to contain significant levels of cryptic diversity, and suggest that caution is warranted when considering potential impacts to these unique habitats

A core outcome set for localised prostate cancer effectiveness trials

Objective: To develop a core outcome set (COS) applicable for effectiveness trials of all interventions for localised prostate cancer. Background: Many treatments exist for localised prostate cancer, although it is unclear which offers the optimal therapeutic ratio. This is confounded by inconsistencies in the selection, definition, measurement and reporting of outcomes in clinical trials. Subjects and methods: A list of 79 outcomes was derived from a systematic review of published localised prostate cancer effectiveness studies and semi-structured interviews with 15 prostate cancer patients. A two-stage consensus process involving 118 patients and 56 international healthcare professionals (HCPs) (cancer specialist nurses, urological surgeons and oncologists) was undertaken, consisting of a three-round Delphi survey followed by a face-to-face consensus panel meeting of 13 HCPs and 8 patients. Results: The final COS included 19 outcomes. Twelve apply to all interventions: death from prostate cancer, death from any cause, local disease recurrence, distant disease recurrence/metastases, disease progression, need for salvage therapy, overall quality of life, stress urinary incontinence, urinary function, bowel function, faecal incontinence, sexual function. Seven were intervention-specific: perioperative deaths (surgery), positive surgical margin (surgery), thromboembolic disease (surgery), bothersome or symptomatic urethral or anastomotic stricture (surgery), need for curative treatment (active surveillance), treatment failure (ablative therapy), and side effects of hormonal therapy (hormone therapy). The UK-centric participants may limit the generalisability to other countries, but trialists should reason why the COS would not be applicable. The default position should not be that a COS developed in one country will automatically not be applicable elsewhere. Conclusion: We have established a COS for trials of effectiveness in localised prostate cancer, applicable across all interventions which should be measured in all localised prostate cancer effectiveness trials

Using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) to Decrease Length of Stay: A Scoping Review

Purpose/Background Delirium is a prevalent challenge among ICU patients, impacting approximately 30% of admissions (Brennan et al., 2023). If left untreated, delirium can increase use of restraints, hospital length of stay, intensive care unit length of stay, and ultimately, morbidity and mortality. This scoping review assesses the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) to gauge its efficacy in reducing the length of stay in the ICU for adult patients with delirium. Methods A literature review from 2018 and 2023, using PubMed, CINAHL, and Medline were utilized for the search along with key words such as: length of stay, confusion assessment method (CAM), intensive care unit, and delirium bundle. Ten articles consisting of meta-analyses, systematic reviews, controlled trials, and observational studies met our inclusion criteria. The focus was on CAM-ICU\u27s role in identifying delirium and its impact on the ICU length of stay. Results CAM-ICU, with 94% sensitivity and 89% specificity, emerged as an effective tool for delirium identification in the ICU setting (Mailhot et al., 2022). The selected articles revealed diverse outcomes regarding ICU length of stay. Three studies reported a decrease, while five indicated an increase in ICU stays when delirium was present. Importantly, CAM-ICU consistently operated within comprehensive delirium bundles challenging assumptions that CAM alone decreases length of stay without other interventions in the bundles. Implications for Nursing The findings underscore the effectiveness of CAM-ICU for delirium identification. With its high sensitivity, CAM-ICU proves valuable in early detection of delirium. However, the varied impact on ICU length of stay emphasizes the necessity for nursing involvement in the execution of CAM-ICU assessments within the broader framework of delirium management. Ultimately, nurses can play a pivotal role in contributing to enhanced patient outcomes by utilizing CAM-ICU as part of comprehensive delirium interventions in the ICU

Evaluating the Effectiveness of a Non-Pharmacological Sleep Bundle for the Prevention of Delirium in Geriatric Patients in the Intensive Care Unit: A Scoping Review

Purpose/Background Delirium is an acute disorder yielding cognitive deficits, such as disruption in attention and awareness. It impacts approximately 50% of individuals over the age of 65 who are admitted to the hospital and is prevalent with patients in the intensive care unit (ICU). ICU delirium is associated with adverse outcomes, including higher morbidity, prolonged hospital stays, and chronic neurocognitive deficits. Research demonstrates that implementation of a non-pharmacological sleep bundle can reduce the overall occurrence of delirium. The purpose of this scoping review is to examine the efficacy of a non-pharmacological sleep bundle on the incidence of ICU delirium in geriatric patients. Methods Between August 2022 and November 2024, a scoping literature review was conducted using the following keywords: ICU delirium in geriatric patients and non-pharmacological sleep aids for ICU delirium. The four primary outcomes for analysis were implementation of age-appropriate treatments (IAAT), incidence of delirium associated with non-pharmacological sleep interventions (IDNST), ICU sleep quality (ICUSQ), and length of stay in the ICU (ICULOS). 12 articles were chosen for inclusion in this review based on quality and relevance to the topic. Results This review shows that non-pharmacological sleep bundles can decrease the incidence of ICU delirium and create a marginal improvement in sleep quality in the ICU. There was not enough relevant research to show if non-pharmacological sleep bundles can decrease ICU length of stay or whether these bundles have any specific impact on the geriatric population. Implications for Nursing Practice Implementing a non-pharmacological sleep bundle in the ICU for geriatric patients above the age of 65 is associated with a lower incidence of ICU delirium. Further research is needed to examine the effectiveness of non-pharmacological sleep bundles on the quality of sleep in the ICU and the length of stay in the ICU, specifically in geriatric populations

Ultrasound-Guided Epidural Placement vs. Conventional Technique - Evaluating Effectiveness: A Scoping Review

Purpose/Background Epidural anesthesia is a cornerstone of perioperative pain management, offering effective analgesia and reduced opioid dependency. However, traditional landmark-based epidural placement (EP) techniques often result in variable first-pass success rates (FPSR) and increased risks of complications. Ultrasound-guided (USG) EP has emerged as an alternative, providing real-time anatomical visualization to improve accuracy and safety. This scoping review synthesizes evidence on the comparative efficacy of USG EP and conventional techniques in adult patients undergoing perioperative epidural anesthesia. Methods This review commenced September 2023 and included full-access, peer-reviewed journal articles published in English between 2014-2023. Databases searched included PubMed, CINAHL, Cochrane Library, or literature made accessible through the UTHSC Library’s Interlibrary Loan. Primarily utilized MeSH terms included: conventional techniques, ultrasound-guided epidural placement, and first-pass success. Studies were selected if they evaluated USG versus conventional EP techniques, focusing on FPSR, needle passes or redirections, skin punctures, and procedural time. Articles involving pediatric populations or patients with contraindications to epidural anesthesia were excluded. Data from eight high-evidence articles, including one systematic review and seven randomized controlled trials, were analyzed. Results USG EP demonstrated higher FPSR, reduced needle passes and skin punctures, and improved patient satisfaction in six out of eight studies reviewed. However, procedural time was prolonged in cases involving providers inexperienced with USG techniques. These findings suggest that USG EP may offer significant advantages over conventional techniques, particularly in improving accuracy and reducing complications. Implications for Nursing Practice Integrating USG EP into clinical practice can enhance the quality and safety of epidural anesthesia. Its implementation may require training programs to address proficiency gaps, particularly for novice providers. By adopting evidence-based practices, anesthesia providers can contribute to better patient outcomes, reduce procedural risks, and optimize perioperative care

Selective COX-2 inhibition affects fatty acids, but not COX mRNA expression in patients with FAP

Familial adenomatous polyposis (FAP) provides a model for sporadic colorectal cancer development. Cyclooxygenase (COX) inhibition may ameliorate polyp development, but rofecoxib was withdrawn due to cardiovascular side effects. Although this selective COX-2 inhibitor, like diet, may alter the fatty acid and eicosanoid pattern, data on the potential alteration in tissues after use, are scarce. The aims were to study if rofecoxib might influence the fatty acid distribution in serum phospholipids and duodenal lesions, mRNA for COX-1 and COX-2 in leucocytes and duodenal lesions, and finally plasma levels of PGE2 in a randomized, double-blind, placebo controlled study (n = 38). Significant reductions were found for essential fatty acid index both in serum phospholipids (P = 0.01, 95% CI = −0.9; −0.1), and in duodenal lesions (P = 0.04, 95 CI % = −0.9; −0.1) after treatment. No treatment effects were found on the COX mRNA expression, or in the plasma PGE2 levels. Dietary AA/EPA ratio was inversely associated with all the indicators of EFA status (all P < 0.01). These findings suggest that the effects of COX chemoprevention should be further investigated in FAP and that dietary needs should be included in the treatment of FAP