Minimum fuel horizontal flightpaths in the terminal area

The problem of minimum fuel airplane trajectories from arbitrary initial states to be fixed final state is considered. There are four state variables (two position coordinates, heading, and constrained velocity) and two constrained controls (thrust and bank angle). The fuel optimality of circular and straight line flightpaths is examined. Representative extremals (trajectories satisfying the necessary conditions of the minimum principle) of various types are computed and used to evaluate trajectories generated by an on line algorithm. Attention is paid to the existence of Darboux points (beyond which an extremal ceases to be globally optimal). One fuel flow rate model includes a term quadratic in thrust; hence, the optimal thrust is continuous and nonsingular. The other fuel flow rate model is linear in thrust, and consequently the optimal thrust is discontinuous and singular

Global optimality of extremals: An example

The question of the existence and location of Darboux points is crucial for minimally sufficient conditions for global optimality and for computation of optimal trajectories. A numerical investigation is presented of the Darboux points and their relationship with conjugate points for a problem of minimum fuel, constant velocity, and horizontal aircraft turns to capture a line. This simple second order optimal control problem shows that ignoring the possible existence of Darboux points may play havoc with the computation of optimal trajectories

Minimum-fuel turning climbout and descent guidance of transport jets

The complete flightpath optimization problem for minimum fuel consumption from takeoff to landing including the initial and final turns from and to the runway heading is solved. However, only the initial and final segments which contain the turns are treated, since the straight-line climbout, cruise, and descent problems have already been solved. The paths are derived by generating fields of extremals, using the necessary conditions of optimal control together with singular arcs and state constraints. Results show that the speed profiles for straight flight and turning flight are essentially identical except for the final horizontal accelerating or decelerating turns. The optimal turns require no abrupt maneuvers, and an approximation of the optimal turns could be easily integrated with present straight-line climb-cruise-descent fuel-optimization algorithms. Climbout at the optimal IAS rather than the 250-knot terminal-area speed limit would save 36 lb of fuel for the 727-100 aircraft

Minimum-fuel, 3-dimensional flightpath guidance of transfer jets

Minimum fuel, three dimensional flightpaths for commercial jet aircraft are discussed. The theoretical development is divided into two sections. In both sections, the necessary conditions of optimal control, including singular arcs and state constraints, are used. One section treats the initial and final portions (below 10,000 ft) of long optimal flightpaths. Here all possible paths can be derived by generating fields of extremals. Another section treats the complete intermediate length, three dimensional terminal area flightpaths. Here only representative sample flightpaths can be computed. Sufficient detail is provided to give the student of optimal control a complex example of a useful application of optimal control theory

Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience

Study objective Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying “normal” processes. The study objective is to examine escalation policies in theory and practice. Methods This was a mixed-method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16-month period in a large UK ED (n=30 observations). Results The conceptual analysis of National Health Service escalation policies found that their use requires the ability to dynamically reconfigure resources (staff and equipment), change work flow, and relocate patients. In practice, it was discovered that when the ED is under pressure, these prerequisites cannot always be attained. Instead, escalation processes were adapted to manage pressures informally. This adaptive need (“work as done”) was found to be incompletely specified in policies (“work as imagined”). Conclusion Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload

Language of Lullabies: The Russification and De-Russification of the Baltic States

This article argues that the laws for promotion of the national languages are a legitimate means for the Baltic states to establish their cultural independence from Russia and the former Soviet Union

Improving access for community health and sub-acute outpatient services: protocol for a stepped wedge cluster randomised controlled trial

BACKGROUND: Waiting lists for treatment are common in outpatient and community services, Existing methods for managing access and triage to these services can lead to inequities in service delivery, inefficiencies and divert resources from frontline care. Evidence from two controlled studies indicates that an alternative to the traditional &quot;waitlist and triage&quot; model known as STAT (Specific Timely Appointments for Triage) may be successful in reducing waiting times without adversely affecting other aspects of patient care. This trial aims to test whether the model is cost effective in reducing waiting time across multiple services, and to measure the impact on service provision, health-related quality of life and patient satisfaction. METHODS/DESIGN: A stepped wedge cluster randomised controlled trial has been designed to evaluate the impact of the STAT model in 8 community health and outpatient services. The primary outcome will be waiting time from referral to first appointment. Secondary outcomes will be nature and quantity of service received (collected from all patients attending the service during the study period and health-related quality of life (AQOL-8D), patient satisfaction, health care utilisation and cost data (collected from a subgroup of patients at initial assessment and after 12&nbsp;weeks). Data will be analysed with a multiple multi-level random-effects regression model that allows for cluster effects. An economic evaluation will be undertaken alongside the clinical trial. DISCUSSION: This paper outlines the study protocol for a fully powered prospective stepped wedge cluster randomised controlled trial (SWCRCT) to establish whether the STAT model of access and triage can reduce waiting times applied across multiple settings, without increasing health service costs or adversely impacting on other aspects of patient care. If successful, it will provide evidence for the effectiveness of a practical model of access that can substantially reduce waiting time for outpatient and community services with subsequent benefits for both efficiency of health systems and patient care.<br /

Tobacco Smoke Mediated Induction of Sinonasal Microbial Biofilms

Cigarette smokers and those exposed to second hand smoke are more susceptible to life threatening infection than non-smokers. While much is known about the devastating effect tobacco exposure has on the human body, less is known about the effect of tobacco smoke on the commensal and commonly found pathogenic bacteria of the human respiratory tract, or human respiratory tract microbiome. Chronic rhinosinusitis (CRS) is a common medical complaint, affecting 16% of the US population with an estimated aggregated cost of $6 billion annually. Epidemiologic studies demonstrate a correlation between tobacco smoke exposure and rhinosinusitis. Although a common cause of CRS has not been defined, bacterial presence within the nasal and paranasal sinuses is assumed to be contributory. Here we demonstrate that repetitive tobacco smoke exposure induces biofilm formation in a diverse set of bacteria isolated from the sinonasal cavities of patients with CRS. Additionally, bacteria isolated from patients with tobacco smoke exposure demonstrate robust in vitro biofilm formation when challenged with tobacco smoke compared to those isolated from smoke naïve patients. Lastly, bacteria from smoke exposed patients can revert to a non-biofilm phenotype when grown in the absence of tobacco smoke. These observations support the hypothesis that tobacco exposure induces sinonasal biofilm formation, thereby contributing to the conversion of a transient and medically treatable infection to a persistent and therapeutically recalcitrant condition