A method for obtaining practical flutter-suppression control laws using results of optimal control theory

The results of optimal control theory are used to synthesize a feedback filter. The feedback filter is used to force the output of the filtered frequency response to match that of a desired optimal frequency response over a finite frequency range. This matching is accomplished by employing a nonlinear programing algorithm to search for the coefficients of the feedback filter that minimize the error between the optimal frequency response and the filtered frequency response. The method is applied to the synthesis of an active flutter-suppression control law for an aeroelastic wind-tunnel model. It is shown that the resulting control law suppresses flutter over a wide range of subsonic Mach numbers. This is a promising method for synthesizing practical control laws using the results of optimal control theory

Reframing interventions for optimal child nutrition and childhood obesity: the importance of considering psychological factors

This review aims to emphasise the impact of poor nutrition on children’s health and psychological wellbeing, urging those involved in childhood obesity or nutrition services to broaden their intervention approach. Poor nutrition and childhood obesity affect physical and psychological health. The stress of living with obesity further impacts quality of life, wellbeing and self-esteem. Children living with obesity may experience adverse childhood events and stress, and young people are able to recall the impact of psychosocial issues such as experiencing stigma and discrimination. Food is often a coping mechanism for managing negative emotions, perpetuating cycles of emotional coping and unhealthy eating behaviours. UK guidelines recommend family-based, multi-component weight management interventions for children living with obesity. Interventions mainly target health behaviours and utilise behaviour change techniques attempting to directly improve diet and physical activity as behavioural outcomes. Whilst these interventions may show some improvements in psychological wellbeing, there is limited consideration or understanding of the underlying mechanisms of action which indirectly influence engagement and the sustainability of the behaviour change. Lack of attention and inclusion of psychosocial variables in intervention implementation may help explain the variable effectiveness reported across childhood obesity interventions. In conclusion, enhancing the effectiveness of childhood obesity interventions requires a broader approach that fully incorporates psychosocial factors. Those responsible for commissioning, designing and implementing these interventions should adopt a holistic approach that addresses psychological and emotional needs while incorporating underlying mechanisms of action. This shift in focus could result in more sustainable and comprehensive treatment for childhood obesity

Commentary: Consent and confidentiality in publishing—the view of the BMJ’s ethics committee,

Two years ago four paediatricians and an ethicist submitted to the BMJa case study as an ethical debate which the BMJ decided not to publish because the authors had not obtained the consent of the patient’s parents for publication. The authors submitted it elsewhere, and the article was published last year. Here the authors explain why they think the BMJshould have published despite the lack of consent (doi 10.1136/bmj.a1231); the editor of the journal that did publish the case study explains why he did so (doi: 10.1136/bmj.a1233); and two members of the BMJ’s ethics committee explain why they recommended not to publish it. An accompanying editorial explains why English law would now not allow the BMJto publish it without consent, even if we thought it reasonable to do so. We explain here the response of the BMJ’s ethics committee to the case study submitted by Isaacs and colleagues and make some broader points about the need for patient consent to publish case studies. We conclude that the “public interest” criterion for publication justifiably has a high threshold, which was not met by this paper. Yet we recognise that policy formation in this contested area can be difficult and that further debate is requiredThis article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014

Smarter choices ?changing the way we travel. Case study reports

This report accompanies the following volume:Cairns S, Sloman L, Newson C, Anable J, Kirkbride A and Goodwin P (2004)Smarter Choices ? Changing the Way We Travel. Report published by theDepartment for Transport, London, available via the ?Sustainable Travel? section ofwww.dft.gov.uk, and from http://eprints.ucl.ac.uk/archive/00001224/

Smarter choices - changing the way we travel

Summary: In recent years, there has been growing interest in a range of initiatives, which are now widelydescribed as 'soft' transport policy measures. These seek to give better information and opportunities,aimed at helping people to choose to reduce their car use while enhancing the attractiveness ofalternatives. They are fairly new as part of mainstream transport policy, mostly relativelyuncontroversial, and often popular. They include:. Workplace and school travel plans;. Personalised travel planning, travel awareness campaigns, and public transport information andmarketing;. Car clubs and car sharing schemes;. Teleworking, teleconferencing and home shopping.This report draws on earlier studies of the impact of soft measures, new evidence from the UK andabroad, case study interviews relating to 24 specific initiatives, and the experience of commercial,public and voluntary stakeholders involved in organising such schemes. Each of the soft factors isanalysed separately, followed by an assessment of their combined potential impact.The assessment focuses on two different policy scenarios for the next ten years. The 'high intensity'scenario identifies the potential provided by a significant expansion of activity to a much morewidespread implementation of present good practice, albeit to a realistic level which still recognisesthe constraints of money and other resources, and variation in the suitability and effectiveness of softfactors according to local circumstances. The 'low intensity' scenario is broadly defined as aprojection of the present (2003-4) levels of local and national activity on soft measures.The main features of the high intensity scenario would be. A reduction in peak period urban traffic of about 21% (off-peak 13%);. A reduction of peak period non-urban traffic of about 14% (off-peak 7%);. A nationwide reduction in all traffic of about 11%.These projected changes in traffic levels are quite large (though consistent with other evidence onbehavioural change at the individual level), and would produce substantial reductions in congestion.However, this would tend to attract more car use, by other people, which could offset the impact ofthose who reduce their car use unless there are measures in place to prevent this. Therefore, thoseexperienced in the implementation of soft factors locally usually emphasise that success depends onsome or all of such supportive policies as re-allocation of road capacity and other measures toimprove public transport service levels, parking control, traffic calming, pedestrianisation, cyclenetworks, congestion charging or other traffic restraint, other use of transport prices and fares, speedregulation, or stronger legal enforcement levels. The report also records a number of suggestionsabout local and national policy measures that could facilitate the expansion of soft measures.The effects of the low intensity scenario, in which soft factors are not given increased policy prioritycompared with present practice, are estimated to be considerably less than those of the high intensityscenario, including a reduction in peak period urban traffic of about 5%, and a nationwide reductionin all traffic of 2%-3%. These smaller figures also assume that sufficient other supporting policies areused to prevent induced traffic from eroding the effects, notably at peak periods and in congestedconditions. Without these supportive measures, the effects could be lower, temporary, and perhapsinvisible.Previous advice given by the Department for Transport in relation to multi-modal studies was that softfactors might achieve a nationwide traffic reduction of about 5%. The policy assumptionsunderpinning this advice were similar to those used in our low intensity scenario: our estimate isslightly less, but the difference is probably within the range of error of such projections.The public expenditure cost of achieving reduced car use by soft measures, on average, is estimated atabout 1.5 pence per car kilometre, i.e. £15 for removing each 1000 vehicle kilometres of traffic.Current official practice calculates the benefit of reduced traffic congestion, on average, to be about15p per car kilometre removed, and more than three times this level in congested urban conditions.Thus every £1 spent on well-designed soft measures could bring about £10 of benefit in reducedcongestion alone, more in the most congested conditions, and with further potential gains fromenvironmental improvements and other effects, provided that the tendency of induced traffic to erodesuch benefits is controlled. There are also opportunities for private business expenditure on some softmeasures, which can result in offsetting cost savings.Much of the experience of implementing soft factors is recent, and the evidence is of variable quality.Therefore, there are inevitably uncertainties in the results. With this caveat, the main conclusion isthat, provided they are implemented within a supportive policy context, soft measures can besufficiently effective in facilitating choices to reduce car use, and offer sufficiently good value formoney, that they merit serious consideration for an expanded role in local and national transportstrategy.AcknowledgementsWe gratefully acknowledge the many contributions made by organisations and individuals consultedas part of the research, and by the authors of previous studies and literature reviews which we havecited. Specific acknowledgements are given at the end of each chapter.We have made extensive use of our own previous work including research by Lynn Sloman funded bythe Royal Commission for the Exhibition of 1851 on the traffic impact of soft factors and localtransport schemes (in part previously published as 'Less Traffic Where People Live'); and by SallyCairns and Phil Goodwin as part of the research programme of TSU supported by the Economic andSocial Research Council, and particularly research on school and workplace travel plans funded bythe DfT (and managed by Transport 2000 Trust), on car dependence funded by the RAC Foundation,on travel demand analysis funded by DfT and its predecessors, and on home shopping funded byEUCAR. Case studies to accompany this report are available at: http://eprints.ucl.ac.uk/archive/00001233

Clinical Ethics Case Study 10: For the record: Should our patient’s relatives be able to record her treatment?

A referral to the CEC from the manager of the Accident and Emergency Department F, a 67-year-old woman, was brought in to the Accident and Emergency (A&E) Department by ambulance on a busy Friday night with acute chest pain. Her family (husband and adult daughter) arrived soon afterwards. F was not in good general health: she had diabetes and severe asthma, although these were well managed and F was compliant with ongoing treatment. She was also obese and involved in a weight loss programme through her local health centre. 2 Soon after her arrival in the A&E Department, F went into cardiac arrest and stopped breathing. A resuscitation trolley arrived in good time and a team began to work to try and resuscitate F. At this point, F's adult daughter H entered the treatment area. She retrieved her mobile phone from her bag and began to film the resuscitation attempt. This behaviour alarmed the multidisciplinary team treating F and H was asked to cease recording. The reasons for their request for H to stop were: that the team were becoming distracted and concerned that this intervention could disrupt the care they were providing to F; the effect H's filming may have on other patients and visitors; and how such footage might be interpreted in the future. Nevertheless, H was determined to continue filming. She claimed that: ‘It's our right to film our mother. If she dies, this will help the rest of our family to say goodbye. Plus, if we're worried she hasn't received the best possible treatment, this will help us later on’. H was, however, asked again to stop filming and reluctantly did so. F's resuscitation was successful and she was moved from A&E to the cardiac care ward, where she remains unconscious but slowly improving. Three days later, I (the manager of the A&E Department) received a written complaint from H and F's husband T, saying that they should have been allowed to continue filming the A&E staff resuscitating F. Through some background investigation, H had established that there was no Trust policy on relatives filming patients, or indeed any policy about patients themselves recording consultations and treatment. H claimed that: ‘several of my friends record their medical consultations to help them remember everything, and what we wanted to do is no different from that’. She also stated that ‘this is no different to family members taking photos of their loved ones to remember them by’. On behalf of the A&E Department, I am therefore approaching the CEC for assistance before responding to H's complaint. We are worried that while some people may seek to record or film consultations as an aide memoire in times of stress or for personal reassurance, others may do so for more litigious or unusual purposes (such as making the material available on the Internet). We are also concerned about how such material may be interpreted by an inexpert audience. Further, we worry about patient consent to this filming and the disruptive nature of the practice. On contacting the Trust's communications department, we have established that there seems to be a gap in hospital policy regarding this kind of recording activity, as the only relevant policy is one relating to requests from the press to film on site – with requests for filming or photographs needing to be approved by the Trust's director of communications. The communications department has received requests for clarification as to whether this policy would cover the use of phones or other hand-held devices for recording. From speaking to colleagues in other departments I have also heard anecdotal reports that such attempts at recording are on the increase – from both relatives and patients themselves. Some patients have also apparently attempted to take photographs of other patients with whom they have shared a ward, with claims that this has taken place with verbal consent. We are approaching the ethics committee with the following questions in mind: 1. Should H have been allowed to continue filming? 2. Is H's claim that filming resuscitation is akin to recording other more routine consultations defensible? 3 3. If a patient is unconscious, should a family member be able to record them, or should recording only be possible if a patient consents in advance? What should happen if a patient specifically requested such filming? Or, should recording not be permitted at all? (This is also interesting in relation to giving birth.) 4. Is Trust policy on this issue, to cover and protect both patients and staff, needed? If so, how might such a policy be structured? How could it be implemented in the hospital?This article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014