Technical and economic viability of the implementation of approach systems (radio aids) in regional airfields (Viseu airfield case study)

Despite all the efforts made by various institutions towards aeronautical safety, accidents and incidents are likely to happen at any time and under any circumstance. Around half of these accidents, at a commercial level, tend to occur during the approach and landing phases. Approach systems were developed with the main objective to improve the safety index in these flight phases, reducing the inherent risks of its complexity. This equipment can be categorised as precision providing course guidance and glidepath and non-precision providing course guidance only. When we talk about air transportation, it’s hard not to associate the theme to the big airports in the world. Despite of them representing a crucial part of all the aeronautical industry, regional airports and airfields can’t be ignored, because they also reach unmatchable levels of importance for the people and the regions they represent. The case study utilised was Viseu airfield, and to confirm its importance for the region, the biggest local companies were inquired. After 19 answers, it was possible to confirm the relevance the airfield has or could have, being the preferential choice compared to the international airports of Oporto and Lisbon. The main objective of this work was to demonstrate to what extent the implementation of one of those approach systems in the airfield is viable, and which one would be the better option for this case, from a technical and economic view. The systems analysed for this study were ILS and GBAS, both precision equipment. After a technical and economic analysis, revealing the technical characteristics of the airfield, as well as its revenue from the charged fees, allied with an 80% funded project with a six-year investment recovery forecast, it was concluded that GBAS would be the most suitable option. GLS approach charts were then elaborated, based on already existing GNSS charts in the airfield.Apesar de todos os esforços desenvolvidos pelas várias instituições dedicadas à segurança aeronáutica, acidentes e incidentes continuam a ocorrer, independentemente de qualquer circunstância e momento. Cerca de metade desses acidentes, a nível comercial, verificam-se essencialmente durante as fases de aproximação e aterragem. Os sistemas de aproximação foram projetados com o objetivo principal de aumentar os índices de segurança nessas fases do voo, reduzindo os riscos inerentes à sua complexidade. Esses equipamentos podem ser divididos em sistemas de precisão (orientação lateral e vertical fornecida) e de não precisão (somente orientação lateral fornecida). Quando falamos de transporte aéreo, é difícil não associarmos o tema aos grandes aeroportos distribuídos pelo mundo. Apesar de eles representarem uma parte crucial de toda a indústria aeronáutica, não podemos deixar de relevar os aeroportos e aeródromos regionais, pois estes também alcançam níveis inigualáveis de importância para as pessoas e regiões que representam. O caso de estudo utilizado foi o aeródromo de Viseu, e para confirmar a sua importância para a região, foram inquiridas as maiores empresas locais. Após 19 respostas, foi possível confirmar a relevância que tem ou poderia ter o aeródromo, tendo sido este a escolha preferencial em comparação com os aeroportos internacionais do Porto e Lisboa. O principal objetivo deste trabalho foi demonstrar até que ponto a implementação de um desses sistemas de aproximação no aeródromo é viável, e qual seria a melhor opção para este caso quer do ponto de vista técnico quer económico. Os sistemas analisados para este estudo foram o ILS e GBAS, ambos equipamentos de precisão. Depois de uma análise técnica e económica, relevando as características técnicas do aeródromo, bem como as suas receitas provenientes das taxas cobradas, conciliadas com um projeto financiado em cerca de 80% e com uma previsão de recuperação do investimento em seis anos, concluiu-se que o GBAS seria a opção mais indicada. Posto isto, foram elaboradas cartas de aproximação GLS com base em cartas GNSS já existentes no aeródromo

Património Industrial Ibero-americano: recentes abordagens

Neste livro, que é um contributo importante para o avanço do conhecimento sobre o Património Industrial no mundo ibero-americano,estão reunidos um conjunto de textos de jovens investigadores que abordam os seguintes temas: a importância de incrementar a ligação entre os testemunhos do património industrial e os recursos documentais para o seu estudo; o desenvolvimento da investigação sobre património industrial na universidade de modo a que se produza uma actualização e normalização das metodologias próprias da arqueologia industrial aplicadas, nomeadamente ao conhecimento e registo activo do património industrial; a importância do trabalho de equipas de carácter multidisciplinar; a necessidade de aplicar critérios rigorosos em relação às práticas de reabilitação do património industrial; o reforço do interesse patrimonial de paisagens, edifícios, instalações e infraestrutura pertencentes aos diferentes processos industriais; e destacar o papel fundamental que os grupos e associações de cidadãos desempenham na defesa e disseminação do património industrial

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially