Adobe Flash Player is required to view this feature. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Original Article Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes Caroline A.

Crowther, F.R.A.N.Z.C.O.G., Janet E. Hiller, Ph.D., John R. Moss, F.C.H.S.E., Andrew J. McPhee, F.R.A.C.P., William S. Jeffries, F.R.A.C.P., and Jeffrey S. Robinson, F.R.A.N.Z.C.O.G., for the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group N Engl J Med 2005; 352:2477-2486 DOI: 10.1056/NEJMoa042973. Methods We randomly assigned women between 24 and 34 weeks' gestation who had gestational diabetes to receive dietary advice, blood glucose monitoring, and insulin therapy as needed (the intervention group) or routine care.

Primary outcomes included serious perinatal complications (defined as death, shoulder dystocia, bone fracture, and nerve palsy), admission to the neonatal nursery, jaundice requiring phototherapy, induction of labor, cesarean birth, and maternal anxiety, depression, and health status. Results The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent vs. 4 percent; relative risk adjusted for maternal age, race or ethnic group, and parity, 0.33; 95 percent confidence interval, 0.14 to 0.75; P=0.01). However, more infants of women in the intervention group were admitted to the neonatal nursery (71 percent vs. 61 percent; adjusted relative risk, 1.13; 95 percent confidence interval, 1.03 to 1.23; P=0.01). Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group (39 percent vs.

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29 percent; adjusted relative risk, 1.36; 95 percent confidence interval, 1.15 to 1.62; P. Gestational diabetes mellitus occurs in 2 to 9 percent of all pregnancies and is associated with substantial rates of maternal and perinatal complications. The risk of perinatal mortality is not increased, but the risk of macrosomia is. Other perinatal risks include shoulder dystocia, birth injuries such as bone fractures and nerve palsies, and hypoglycemia. Long-term adverse health outcomes reported among infants born to mothers with gestational diabetes include sustained impairment of glucose tolerance, subsequent obesity (although not when adjusted for size ), and impaired intellectual achievement. For women, gestational diabetes is a strong risk factor for diabetes.

Although the risks associated with gestational diabetes are well recognized, it remains uncertain whether screening and treatment to reduce maternal glucose levels reduce these risks. Given this uncertainty, professional groups disagree on whether to recommend routine screening, selective screening based on risk factors for gestational diabetes, or no screening; some recommend screening, whereas others do not. There have been repeated calls for well-designed, randomized trials to determine the efficacy of screening, diagnosis, and management of gestational diabetes. We designed the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) trial to assess whether the treatment of gestational diabetes would reduce perinatal complications and to assess the effects of treatment on maternal outcome, mood, and quality of life.

Interventions Stratification was according to center and singleton or twin gestation. Randomization was performed centrally with the use of numbers generated by computer with variable block sizes of 6, 8, and 10. The full numerical results of the oral glucose-tolerance test were not released to the women or their providers until after birth, before discharge from the hospital. Women who were randomly assigned to the intervention group received ongoing care by the attending obstetrical team with a physician's support. Outcome Variables Primary outcomes among the infants were a composite measure of serious perinatal complications (defined as one or more of the following: death, shoulder dystocia, bone fracture, and nerve palsy), admission to the neonatal nursery, and jaundice requiring phototherapy. The presence and severity of shoulder dystocia were assessed by means of a standardized checklist completed by the caregiver present at the birth.

Primary clinical outcomes among the women were the need for induction of labor and cesarean section. Maternal health status was assessed by means of the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36), which assesses eight aspects of health status: general and mental health, physical and social functioning, physical and emotional role, pain, and vitality; scores on each scale can range from 0 (worst) to 100 (best). Maternal psychological outcomes included measures of anxiety, depression, and health-related quality of life. Anxiety was assessed with the use of the short form of the Spielberger State–Trait Anxiety Inventory, a self-rating scale consisting of 6 items (scores below 15 are considered normal). The presence of depression was reflected by a score of more than 12 on the Edinburgh Postnatal Depression Scale. Questionnaires were mailed six weeks after study entry and at three months post partum to 916 women (92 percent of the total) recruited to the study after funding for this assessment became available. Secondary outcomes among the infants included components of the composite primary outcome, gestational age at birth, birth weight, and other measures of health.

Secondary outcomes among the women included the number of prenatal visits to a health professional, the mode of birth, weight gain during pregnancy, the number of antenatal admissions, and the presence or absence of pregnancy-induced hypertension (defined as a blood pressure of at least 140/90 mm Hg on two occasions four or more hours apart) and other complications. Statistical Analysis Statistical analyses were based on the intention to treat and used SAS software, version 8.2 (SAS Institute). Analyses were adjusted for maternal age, race or ethnic group, and parity.

Binary outcomes are presented as relative risks, with 95 percent confidence intervals; the number needed to treat to benefit (i.e., the number of patients who would need to be treated for a benefit in one patient) and the number needed to treat to harm (i.e., the number of patients who would need to be treated for harm to occur in one patient), with their 95 percent confidence intervals, are presented for primary clinical outcomes. Relative risks were calculated with the use of log binomial regression. Continuous variables were analyzed by means of analysis of variance if they were normally distributed and by means of nonparametric tests if their distribution was not normal. The health state utility was calculated from the SF-36 according to the method of Brazier et al. With no evidence of increased variance owing to the small number of twins in the study, no adjustment was made for clustering of babies with the same mothers. A P value of 0.05 was considered to indicate statistical significance; all P values were two-sided.

A step-down Sidak adjustment was made for analyses involving multiple primary clinical end points. We estimated that we would need to enroll 1000 women for the study to have a statistical power of 80 percent (two-sided alpha value of 0.05) to detect a reduction in the risk of a serious perinatal outcome from 5.2 percent to 2.0 percent, using outcomes reported for all South Australian births and data from Women's and Children's Hospital in Adelaide. Data were reviewed once in January 1999 by our independent data-monitoring committee, whose members were unaware of the treatment assignments, after the enrollment of 460 women. The study protocol included a prespecified stopping rule for a difference in a major end point of at least 3 SD between the groups. Results Of the 1000 women enrolled in the study, 490 were assigned to the intervention group and 510 to the routine-care group ( Figure 1 Enrollment and Outcomes.

Recruitment started in September 1993 and stopped in June 2003, after 1000 women had been enrolled. Clinical outcomes were obtained up to the time of hospital discharge for all women and their 1030 infants. On the whole, the two groups were similar at entry. As compared with the women in the routine-care group, women in the intervention group were older and were less likely to be white or primiparous ( Table 1 Baseline Characteristics of the Women. Rfactor Saloon Stox Download Firefox. Ninety-three percent of the women had been found to be at risk for gestational diabetes on the basis of the oral glucose-challenge test, and the remainder on the basis of risk factors. Primary Outcomes The rate of serious perinatal outcomes among the infants (defined by one or more of the following: death, shoulder dystocia, bone fracture, and nerve palsy) was significantly lower in the intervention group than the routine-care group (1 percent vs.

4 percent; P=0.01, adjusted for maternal age, race or ethnic group, and parity ( Table 2 Primary Clinical Outcomes among the Infants and Their Mothers. Thus, the number needed to treat to prevent a serious outcome in an infant was 34 (95 percent confidence interval, 20 to 103). Change Imei Iphone 4s Download Itunes. A higher percentage of infants born to women in the intervention group than of infants born to women in the routine-care group were admitted to the neonatal nursery (71 percent vs.

61 percent, adjusted P=0.01). The length of stay in the neonatal nursery among the infants who were admitted did not differ significantly between groups (median of 1 day for both groups; interquartile range, 1 to 2 days in the intervention group and 1 to 3 days in the routine-care group; adjusted P=0.81).

There was no significant difference in the percentage of infants who had jaundice requiring phototherapy in the two groups (adjusted P=0.72) ( ). The induction of labor was significantly more common in the intervention group than in the routine-care group (39 percent vs.

29 percent; adjusted P. Secondary Outcomes No perinatal deaths occurred among the infants of mothers in the intervention group, but there were five perinatal deaths (three stillbirths and two neonatal deaths) among infants born to women in the routine-care group ( and ). Two stillbirths were unexplained intrauterine deaths at term of appropriately grown infants, and the other, at 35 weeks' gestation, was associated with preeclampsia and intrauterine growth restriction. One infant had a lethal congenital anomaly, and one infant died after an asphyxial condition during labor without antepartum hemorrhage. There was no significant difference in the rates of shoulder dystocia between the intervention and routine-care groups (1 percent and 3 percent, respectively) ( ). No infant in the intervention group had a bone fracture or nerve palsy, whereas in the routine-care group, one infant had both a fractured humerus that was not related to a difficult birth and a radial-nerve palsy, one infant had Erb's palsy related to shoulder dystocia, and one infant had Erb's palsy alone ( ).

Infants born to women in the intervention group had significantly lower mean birth weights than infants born to women in the routine-care group (P. Discussion In this randomized clinical trial, treatment of women with gestational diabetes — including dietary advice, blood glucose monitoring, and insulin therapy — reduced the rate of serious perinatal outcomes (defined as death, shoulder dystocia, bone fracture, and nerve palsy) from 4 percent to 1 percent. These benefits were associated with an increased use of induction of labor for the mother and an increased rate of admission to the neonatal nursery for the infant, both of which may be related to the knowledge of the diagnosis by the attending physician. The earlier gestational age at birth as a consequence of the induction of labor may have contributed to the reduction in serious perinatal outcomes. Others have reported an increased rate of cesarean delivery associated with the diagnosis and treatment of gestational diabetes.

In our study, the rate of cesarean delivery was similar in the two groups. We chose primary clinical outcomes to assess the effects of treatment for gestational diabetes on both the mothers and the infants. Differences between groups remained significant after adjustment for known confounders (maternal age, race or ethnic group, and parity) and for analyses involving multiple primary end points. Infants born to mothers receiving intensive therapy had lower birth weights than those born to women receiving routine care, an observation that may be explained at least in part by the earlier gestational age at birth in this group, related to the increased use of induction of labor. Infants in this group were no more likely to be small for gestational age, but they were significantly less likely to be large for gestational age and to have macrosomia.

Infants who are large for gestational age are prone to impaired glucose tolerance or diabetes in later life, and girls have an increased risk of gestational diabetes. Long-term follow-up is needed to assess whether the lower birth weights among the infants in the intervention group will translate into reduced rates of these later complications. Despite the increased rate of admission to the neonatal nursery in the intervention group, there were no significant differences between the groups of infants in secondary clinical outcomes, such as hypoglycemia requiring intravenous therapy. As compared with the women in the routine-care group, the women in the intervention group made more visits to the medical clinic and were more likely to see a dietitian and diabetes educator.

However, they made fewer antenatal clinic visits, a difference that was most likely related to their increased likelihood of induction and their infants' earlier gestational age at birth. The reduction in the risk of preeclampsia in the intervention group may be related to the earlier gestational age at birth.

A potentially controversial aspect of our study design from an ethical standpoint was the fact that women were not informed of their diagnosis of “gestational diabetes” during the course of the study, after the change in the WHO criteria. However, despite changes in the nomenclature for gestational diabetes, there continued to be no conclusive evidence regarding the effects of treatment of gestational diabetes and there were wide variations in clinical practice during the time of this study. Women in the study received standard pregnancy care consistent with care in which screening for gestational diabetes is not routine. Our trial also revealed an improved health-related quality of life among women in the intervention group, both during the antenatal period and three months after birth, together with a reduction in the incidence of depression after birth. These findings are contrary to reports suggesting a decline in women's perception of their own health after they receive a diagnosis of gestational diabetes. However, results for these outcomes should be interpreted with caution, since the analysis included only a subgroup of the women. There has been a lack of data from large randomized clinical trials on the effects of screening and treatment of women with gestational diabetes mellitus.

An observational study is currently in progress to assess associations between maternal glucose levels and perinatal outcomes, and an ongoing randomized trial in the United States is addressing the effect of therapy for mild gestational diabetes, as did our study. Our results indicate that treatment of gestational diabetes in the form of dietary advice, blood glucose monitoring, and insulin therapy as required for glycemic control reduces the rate of serious perinatal complications, without increasing the rate of cesarean delivery.

Appendix The following persons and institutions participated in the ACHOIS Trial Group: Coordinating Team: C. Robinson; Steering Group: C. Robinson; Statistical Support: K. Willson; Data-Monitoring Committee: J. Lumley (chair), L. Watson; Writing Group: C.

Robinson; Data Support: S. Bruggemann, P.

Moore; Hospitals (total number of women recruited at each hospital is given in parentheses): Blacktown District Hospital, New South Wales (79): D. Bradford; Bradford Royal Infirmary Maternity Unit, United Kingdom (0): D. West; Caboolture Hospital, Queensland (28): M. Ratnapala, R. Armstrong, A. Heazelwood; Campbelltown Hospital, Sydney, New South Wales (1): H.

Grunstein, S. Marney; Flinders Medical Center, Adelaide, South Australia (43): K. Verco; General Infirmary, Leeds, United Kingdom (3): E.

Lidelle-Johnson, J. Pearce; Hammersmith Hospital, London (2): M. McCarthy; Hervey Bay Hospital, Queensland (24): A. Wickremachandran; Lyell McEwin Hospital, Adelaide, South Australia (125): G. Kennedy-Andrews, N. Kretschmer, H. Mowbray; Modbury Hospital, Adelaide, South Australia (68): C.

Sieben; Nambour General Hospital, Queensland (37): C. Rutherford, C. Smith-Orr; Northern General Hospital, Sheffield, United Kingdom (41): S. Fraser; Queen Elizabeth Hospital, Adelaide, South Australia (29): B. Pridmore (deceased), W. Torr; Royal North Shore Hospital, Sydney (198): G.

George Hospital, Sydney (1): C. Davis; Toowoomba Base Hospital, Queensland (11): P. Ratnapala; Townsville Hospital, Queensland (48): D. Whitehall, S. Lawrence; Women's and Children's Hospital, South Australia (261): C. Wilkinson, V. Coppinger, J.

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According to www.airforce-technology.com: 'In 1995, Embraer was awarded a contract to develop a variant of the Super Tucano, known as the ALX or Light Attack Aircraft, for the Brazilian Air Force (FAB), optimised for the environmental conditions of the Brazilian Amazon. The ALX is capable of operating day and night missions from remote bases and unpaved runways with minimal ground support.' An O-6B Texan is needed The U.S. Military must immediately form squadrons of its new trainers to support combat operations. This aircraft is fully aerobatic and features a pressurized cockpit with an anti-G system, ejection seats, and an advanced avionics package with sunlight-readable liquid crystal displays. Its narrow fuselage and large canopy allow for excellent observation, especially since the rear seat is elevated. Moreover, this modern aircraft has a top speed of 320 mph and is currently for $4.2 million each.The training and parts pipeline is already in place, and every new pilot in the US Air Force, Navy and Marines is already qualified to fly them, although they should attend an observation school to learn how to properly employ them in combat.

The planned T-6 buy should be increased while new T-6s coming off the production line are delivered to newly formed observation squadrons. The T-6 is a single-engine, stepped tandem, two-seat primary trainer aircraft which entered service in 1998. Its Pratt Whitney PT6A-68 engine is flat rated at 1,100 shaft HP. The PT6A-68 engine and the T6-A TEXAN II result in exceptional performance. Its excellent thrust-to-weight ratio provides an initial rate of climb of more than 4,500 fpm and outstanding short field capability. The T-6A combines features typical of a primary trainer with the very low fuel consumption and overall economy of a turboprop, while simultaneously providing 50 percent more overall thrust than its predecessor.

Raytheon developed a kit to optimize the Texan's performance in combat environments, converting them to a for foreign sales, although OV-6B 'Texan' Ranger is a better designation; 'O' for Observation and 'V' for its short take-off and landing ability. The B version has a weapons control computer and six wing hard points for mounting bombs, rocket pods, or machine guns. However, a Ranger should not become an attack aircraft, but a much needed observation and support platform which must include appropriate communications and surveillance equipment like that found on the Army's scout helo.

This inexpensive and nimble two-seat aircraft provides a clear view where a highly trained can ensure safe and effective fires on the enemy below. Airborne fire support today is attempted by partially trained pilots from slow helicopters, F/A-18D fast FACs, or single-seat OA-10s where a pilot is expected to fly the aircraft while coordinating strikes. Despite America's overwhelming technical superiority and air dominance in recent conflicts, dozens of casualties resulted from battlefield confusion. This in Afghanistan, quotes a Washington Postarticle: 'At headquarters, commanders tried to notify the Rangers that the SEALs had retreated from the ridgetop and to direct the helicopters to another landing zone further down the mountain.

Due to intermittently functioning aircraft communications equipment, the Rangers and aircrew never received the instructions, according to the official review. Communication problems also plagued headquarters attempts to determine the true condition of the SEAL team and its exact location.' During the 2003 U.S. Invasion of Iraq, units became intermingled as Iraqi irregulars attacked at random causing confusion. Several US Soldiers were captured and a U.S.

Marine infantry company was forced to retreat after an ill-planned attack, while an American A-10 strafed them. In these cases and dozens of smaller engagements, an OV-6B Ranger overhead could have saved the day. OV-6B Rangers can operate in short take-off environments, like forward airfields, roads, or large amphibious ships. They are also ideal for accommodating senior officer visits to the frontlines, which often ties up much needed helicopters. A Ranger pilot can provide a General with a faster, longer, and safer tour of the frontlines.

Rangers are an economical way to quickly deliver small emergency cargo, like: spare parts, software, battle plans, and specialists. Compared to helicopters and jet attack aircraft, the Ranger is much quieter, one-fifth the cost, and half their length, which makes them harder to see and hit. It is far more practical to risk a $4.2 million Ranger for close reconnaissance than a $200 million F-22 or a slow helicopter without ejection seats. As a result, a Ranger should lead all large helicopter formations hoping to draw fire from enemy gunners. If enemy gunners open fire, it can maneuver and fly onward while trailing attack helicopters attack the threat. Since the retirement of the OV-1 and OV-10s, the Army and marines have used expensive attack helicopters for reconnaissance.

An inexpensive OV-6B Ranger has twice their range, twice their speed, and ejection seats. The Army's primary reconnaissance helicopter, the OH-58 Kiowa [Warrior], is small and quiet, but with a cruise speed of just 80 knots it is far too slow to keep up with transports and attack helos.

The Kiowa's range and endurance is only one-fifth that of a Ranger, which can also fly three times higher to avoid medium-range AAA fires. On rapidly moving battlefields, ground forces can advance beyond the Kiowa's range the first day of an offensive. Even during slow moving operations, the Kiowa lacks the endurance to remain on station for hours to provide continual support for ground forces. OV-6B Ranger missions 1.

Forward Air Control - The U.S. Military had many cases of fratricide during the 2003 Iraq invasion because fast moving jets arrived and pilots assumed they understood the situation on the ground. This was not a problem in Vietnam when OV-1 Mohawks and OV-10 Broncos were employed as spotters. The slower Bronco has been retired leaving a major gap in close air support which the Ranger can fill.

This will free expensive jet 'Fast FACs', like the marine corps F/A-18Ds and USAF OA-10s, to use their speed and payload to deliver munitions. Marine corps lost a couple OV-10s over Iraq during the 1991 war when they were employed in the deep reconnaissance role in a mid-threat environment.

Jet pilot Generals claimed this proved they were too slow and led to their removal from service. Many marines were shocked because OV-10s has twice the speed and range of helicopters. [EDITOR: the USMC OV-10s shot down lacked IRCMs] However, the Ranger has a top speed 320 mph (50 mph faster than the OV-10) and four times more range--up to 900 miles. In high-threat Anti-Aircraft Artillery (AAA) environments, an airborne Ranger crew does not need to actually see targets.

It can remain low over friendly forces as a liaison who knows the location of every ground unit, and sometimes pops up to take a quick look. When jets arrive they see the Ranger right away who can literally point them in the right direction. The problem with ground FACs is that pilots feel uncomfortable because they can't see who they are talking to so they are unsure of their exact position and orientation. An airborne Ranger can turn his aircraft and tell them: 'the bad guys are three kilometers directly to my front.'

He may even pop up to draw fire so the jets can see the enemy guns and attack them. Artillery Spotting - Tiny U.S. Army spotting aircraft were essential for artillery units fighting in Europe during World War II. However, the Army has no spotting aircraft today so an artillery battery is unable to adjust fires unless a forward observer is on the ground near the target and able to communicate with the firing battery. A Kiowa scout helo can spot artillery fire, but that is a very slow platform with little endurance. A Ranger can call in artillery fires on enemy forces miles ahead of friendly ground forces using its speed or high-altitude capability to avoid ground fire.

Frontline Reconnaissance - Rangers are vulnerable in high-threat AAA environments due to their slower speed, although they are much faster than attack helicopters. The solution is for pilots to use their judgment and operate like attack helicopters.

If the AAA threat is high, they will fly low and avoid enemy held areas. They will remain just behind advancing forces and pop up occasionally for a quick look. If enemy heavy machine guns or AAA shoot at them, it exposes their positions to attack by ground forces. Despite the emphasis on high-tech warfare, almost all fighting by US ground troops occurs against enemies with little anti-aircraft weaponry. In those situations, the best surveillance platform is a small, circling two-seat propeller aircraft.

A spotter with high-power binoculars and radios can remain on station for hours, sometimes flying high enough where he cannot be seen or heard. Unlike UAVs, this spotter can see in all directions, and can hear explosions so he knows if someone is shooting at him. Shooting down enemy UAVs is an ideal role for Rangers and unlike UAVs, their guidance cannot be jammed, a rarely mentioned shortfall of UAVs. Search and Rescue - This mission favors long-range slow-moving aircraft. However, it may be risky to employ Rangers in high threat environments. Yet the US military now operates in mostly benign environments in Iraq and Afghanistan where expensive helicopters frequently conduct hours of road and border reconnaissance.

Rangers are better suited for such operations since they are quieter, faster, and much cheaper to operate. The great book 'Killing Pablo' about the hunt for drug lord Pablo Escobar in Colombia mentions another advantage of small propeller aircraft. The US Army employed small RC-12s to locate cell phone transmissions and observe suspect areas. In most Third World nations, small propeller aircraft are common and attract no notice, whereas a jet aircraft or a helicopter flying overhead is odd and attracts immediate attention.

Radio Relay - Small units sometimes lose radio contact because of hills, mountains, buildings, or a lack of batteries. Sophisticated enemies may jam radio or GPS frequencies leaving ground units confused. With a Ranger overhead, they can ask for message relay or directions. In some cases, a Ranger will spot friendly units moving down the wrong road or heading toward an ambush, so the guys in the sky will help. Emergency Close Air Support (CAS) - This mission is listed last in hope of avoiding the inevitable digression into the best platform for CAS. Many soldiers who like the idea of a slow and low flying A-1 SkyHawk used in Vietnam will discover the small Ranger lacks payload capacity and argue for something larger. The jet mafia will use this as an excuse to evaluate and develop alternatives; e.g.

A never-ending study to shelve this idea. This is why promoting an AV-6B Ranger is a bad idea; 'A' is a designation for attack aircraft. Although the T-6B has six hardpoints, adding weaponry will cut speed, range, and endurance. On the other hand, rockets are good for marking targets, and a is nice in case Rangers come across enemy UAVs or helicopters. The best answer is to allow each commander to use his judgment based on the enemy threat and mission at hand.

There may be situations in remote regions where no large airfields exist to operate jet attack aircraft, so OV-6Bs may be the only CAS option. And of course if US ground forces face probable defeat in a major battle, OV-6Bs will be thrown into the fight. While they carry little payload, strafing Rangers will frighten an advancing enemy and force him to redirect his firepower upward. Employ Rangers Now! Despite the obvious value of immediately forming Ranger squadrons, opposition will arise from those who favor a larger platform, or one from their company or district. Others will see the Ranger as a threat to their program, especially those touting expensive and far less capable UAVs.

They will urge 'studies' and 'competition' to kill this idea. No matter what ideas they present, the OV-6Bs research, development, testing, and production timetable is zero; they can be sent to Iraq tomorrow. Various high-tech targeting and surveillance systems may be added, so long as weight and cost increases are moderate. CAS testing a couple of years ago revealed that the best observation and targeting device was a pair of simple high-powered binoculars. Perhaps Rangers can be replaced by a more capable platform in the future, but only the T-6B design is available now.

In addition, if the US military adopts inexpensive OV-6Bs for combat use, this will ensure numerous orders from other nations which will create American jobs. Ranger Ranger Ranger The U.S. Marine corps and U.S. Army need support from OV-6B Ranger squadrons.

Since the marines plan to replace their two-seat F/A-18Ds with single-seat F-35s, they will need a new airborne FAC platform. The Army and Air Force must agree on who will fund and man Ranger squadrons. The Army is prohibited from operating fixed-wing aircraft, although exceptions have been made for VIP aircraft and small signal intelligence aircraft. Unless the Air Force wishes to fund and man Ranger squadrons, they should agree to allow the Army to operate any rotary aircraft; no jets of course. Once the OV-6B squadrons are established, the debate can commence to select and develop a superior replacement aircraft, something that takes the US military at least ten years. If that occurs, the OV-6Bs can revert to T-6s and go to training squadrons.

Meanwhile, OV-6B Rangers can immediately fill a critical gap. Ranger Ranger Ranger Ranger Why not Affordable Russian CAS/MAS Aircraft?