Global navigation satellite systems performance analysis and augmentation strategies in aviation

In an era of significant air traffic expansion characterized by a rising congestion of the radiofrequency spectrum and a widespread introduction of Unmanned Aircraft Systems (UAS), Global Navigation Satellite Systems (GNSS) are being exposed to a variety of threats including signal interferences, adverse propagation effects and challenging platform-satellite relative dynamics. Thus, there is a need to characterize GNSS signal degradations and assess the effects of interfering sources on the performance of avionics GNSS receivers and augmentation systems used for an increasing number of mission-essential and safety-critical aviation tasks (e.g., experimental flight testing, flight inspection/certification of ground-based radio navigation aids, wide area navigation and precision approach). GNSS signal deteriorations typically occur due to antenna obscuration caused by natural and man-made obstructions present in the environment (e.g., elevated terrain and tall buildings when flying at low altitude) or by the aircraft itself during manoeuvring (e.g., aircraft wings and empennage masking the on-board GNSS antenna), ionospheric scintillation, Doppler shift, multipath, jamming and spurious satellite transmissions. Anyone of these phenomena can result in partial to total loss of tracking and possible tracking errors, depending on the severity of the effect and the receiver characteristics. After designing GNSS performance threats, the various augmentation strategies adopted in the Communication, Navigation, Surveillance/Air Traffic Management and Avionics (CNS + A) context are addressed in detail. GNSS augmentation can take many forms but all strategies share the same fundamental principle of providing supplementary information whose objective is improving the performance and/or trustworthiness of the system. Hence it is of paramount importance to consider the synergies offered by different augmentation strategies including Space Based Augmentation System (SBAS), Ground Based Augmentation System (GBAS), Aircraft Based Augmentation System (ABAS) and Receiver Autonomous Integrity Monitoring (RAIM). Furthermore, by employing multi-GNSS constellations and multi-sensor data fusion techniques, improvements in availability and continuity can be obtained. SBAS is designed to improve GNSS system integrity and accuracy for aircraft navigation and landing, while an alternative approach to GNSS augmentation is to transmit integrity and differential correction messages from ground-based augmentation systems (GBAS). In addition to existing space and ground based augmentation systems, GNSS augmentation may take the form of additional information being provided by other on-board avionics systems, such as in ABAS. As these on-board systems normally operate via separate principles than GNSS, they are not subject to the same sources of error or interference. Using suitable data link and data processing technologies on the ground, a certified ABAS capability could be a core element of a future GNSS Space-Ground-Aircraft Augmentation Network (SGAAN). Although current augmentation systems can provide significant improvement of GNSS navigation performance, a properly designed and flight-certified SGAAN could play a key role in trusted autonomous system and cyber-physical system applications such as UAS Sense-and-Avoid (SAA)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Frequency, Penetrance, and Variable Expressivity of Dilated Cardiomyopathy-Associated Putative Pathogenic Gene Variants in UK Biobank Participants

BACKGROUND There is a paucity of data regarding the phenotype of dilated cardiomyopathy (DCM) gene variants in the general population. We aimed to determine the frequency and penetrance of DCM-associated putative pathogenic gene variants in a general adult population, with a focus on the expression of clinical and subclinical phenotype, including structural, functional, and arrhythmic disease features. METHODS UK Biobank participants who had undergone whole exome sequencing, ECG, and cardiovascular magnetic resonance imaging were selected for study. Three variant-calling strategies (1 primary and 2 secondary) were used to identify participants with putative pathogenic variants in 44 DCM genes. The observed phenotype was graded DCM (clinical or cardiovascular magnetic resonance diagnosis); early DCM features, including arrhythmia or conduction disease, isolated ventricular dilation, and hypokinetic nondilated cardiomyopathy; or phenotype-negative. RESULTS Among 18 665 individuals included in the study, 1463 (7.8%) possessed ≥1 putative pathogenic variant in 44 DCM genes by the main variant calling strategy. A clinical diagnosis of DCM was present in 0.34% and early DCM features in 5.7% of individuals with putative pathogenic variants. ECG and cardiovascular magnetic resonance analysis revealed evidence of subclinical DCM in an additional 1.6% and early DCM features in an additional 15.9% of individuals with putative pathogenic variants. Arrhythmias or conduction disease (15.2%) were the most common early DCM features, followed by hypokinetic nondilated cardiomyopathy (4%). The combined clinical/subclinical penetrance was ≤30% with all 3 variant filtering strategies. Clinical DCM was slightly more prevalent among participants with putative pathogenic variants in definitive/strong evidence genes as compared with those with variants in moderate/limited evidence genes. CONCLUSIONS In the UK Biobank, ≈1 of 6 of adults with putative pathogenic variants in DCM genes exhibited early DCM features potentially associated with DCM genotype, most commonly manifesting with arrhythmias in the absence of substantial ventricular dilation or dysfunction