Controller team possibilities for sectorless air traffic management

Sectorless air traffic management is an en-route concept, which eliminates the need for control sectors. Instead of assigning a geographic area (sector), air traffic controllers are assigned certain aircraft. Controllers are responsible for their assigned aircraft all the way from entry to exit. In previous simulations, one controller was responsible for six aircraft at the same time. As these aircraft can be located anywhere in the sectorless airspace, controllers were provided with one traffic display for each assigned aircraft. This discussion paper suggests other possibili-ties for providing traffic information to sectorless air traffic controllers. Instead of having one traffic display for each aircraft under control (tiled display), controllers could work with a general map, a zoom display to magnify certain traffic situations, or a combination of such displays. We revisit the concept of controller teams and explore alternatives. In addition to working alone or in pairs of executive and controller, the sectorless air traffic management concept opens possibilities for innovative teamwork. For example, there could be a team of one coordinator and several executives, or even a control-room team. This paper gives examples of new display and team ideas and discusses their respective advantages and disadvantages. We argue that the way traffic information is displayed to controllers affects their mental models and working methods. In addition, we provide results on the tiled display from previous simulations and introduce ideas for future research

Color schemes for a sectorless ATM controller working position

In sectorless air traffic management (ATM) concept, air traffic controllers are no longer in charge of a certain sector. Instead, the sectorless airspace is considered as a single unit and controllers are assigned certain aircraft, which might be located anywhere in the sectorless airspace. The air traffic controllers are responsible for these geographically independent aircraft all the way from their entry into the airspace to the exit. In order to support the controllers with this task, they are provided with one radar display for each assigned aircraft. This means, only one aircraft on each of these radar displays is under their control as the surrounding traffic is under control of other controllers. Each air traffic controller has to keep track of several traffic situa-tions at the same time. In order to optimally support controllers with this task, a color-coding of the information is necessary. For example, the aircraft under control can be distinguished from the surrounding traffic by displaying them in a certain color. Furthermore, conflict detection and resolution information can be color-coded, such that it is straightforward which controller is in charge of solving a conflict. We conducted a human-in-the-loop simulation in order to compare different color schemes for a sectorless ATM controller working position. Three different color schemes were tested: a positive contrast polarity scheme that follows the current look of the P1/VAFORIT (P1/very advanced flight-data pro-cessing operational requirement implementation) display used by the German air navigation service provider DFS in the Karlsruhe upper airspace control center, a newly designed negative contrast polarity color scheme and a modified positive contrast polarity scheme. An analysis of the collected data showed no significant evidence for an impact of the color schemes on controller task performance. However, results suggest that a positive contrast polarity should be preferred and that the newly designed positive contrast polarity color scheme has advantages over the P1/VAFORIT color scheme when used for sectorless ATM

First results on flight rules and conflict avoidance maneuvers for a sectorless ATM concept

The idea of sectorless ATM (Air Traffic Management) envisages the airspace as a whole instead of dividing it into sectors. The dismissal of sectors, however, necessitates the definition of a complete and unambiguous set of flight rules in order to regulate which aircraft has to introduce an avoidance maneuver in case of a conflict. This paper describes the research on flight rules conducted within DLR’s research project on sectorless ATM and describes the developed rule set in detail. Since in a sectorless concept only one specified aircraft amongst the ones in conflict is responsible for the conflict resolution different kinds of avoidance maneuvers than nowadays are necessary. This paper specifies the avoidance maneuvers that have been developed for automatic conflict resolution by DLR’s traffic simulator. In particular, vertical conflict resolution often combines horizontal and vertical avoidance to allow for inaccuracies of the vertical movement and trajectory prediction. The conflict resolutions are also offered as suggestions to the controller, who can either choose one of them or develop his or her own solution. It is debated why for short and medium-term conflict resolutions the automatically generated solutions might seem more sensible or efficient than for long-term conflict resolutions. It is explained that in long-term situations the system can be able to analyze situations more thoroughly than the controller. The discussion elaborates on possibilities to implement and apply these findings in a sectorless ATM concept

Estimated Glomerular Filtration Rates Calculated by New and Old Equations in Children and Adolescents With Type 1 Diabetes-What to Do With the Results?

Background: To apply and evaluate various equations for estimated glomerular filtration rates (eGFR) in a large paediatric type 1 diabetes population and compare the eGFR values with urinary creatinine clearances (UCC) in a subset of patients. Methods: Six eGFR formulae applicable for children and adolescents were used for calculation of eGFR values in 36,782 children/adolescents with type 1 diabetes. Via regression models, factors influencing eGFR values were identified. eGFR values were compared with measured UCC in 549 patients. Spearman correlation coefficients were given to assess the relation of eGFR and UCC values. Bland-Altman-Plots with corresponding linear regression were drawn to evaluate the agreement between eGFR and UCC. Results: eGFR values differed widely depending on the formula used, resulting in a percentage of pathological values <60 mL/min/1.73 m2 up to 8%. Regression models showed age, sex, and duration of diabetes as influencing factors. Microalbuminuria was associated with significantly higher eGFR values for all formulae. In comparison of eGFR with UCC, the highest correlation coefficient was 0.33, the lowest 0.01. Bland-Altman-Plots demonstrated graphically a poor agreement between eGFR and UCC, regardless of the formula used. Conclusions: The broad range of eGFR values indicate that an ideal eGFR formula for children and adolescence with T1D is yet missing. The minimal agreement between measured UCC and eGFR values urges us to be careful in application and interpretation of eGFR values regardless of the formula used

Operational Feasibility of Sectorless ATM

The current practice to organize the airspace and to balance demand and capacity is the partitioning of airspace into sectors. With the increase in air traffic a common practice has been to decrease the size of the sectors in order to limit the workload of the ATCos. However, this approach has its limits. With the increasing number of sectors the number of coordination activities will increase. In addition, a smaller sector size reduces the possibilities for controllers for tactical and strategic control. This contribution reports about a different approach: the entire en-route airspace (of Germany) as one large sectorless airspace. An aircraft that enters this airspace will be controlled by only one ATCo during its entire flight in this airspace. Furthermore, “instead of having two controllers controlling one sector containing n aircraft, one controller will be responsible for a limited number of m>2 aircraft, from departure to arrival terminal areas (TMA)”. An average feasible number of three a/c per ATCo was tentatively identified in the DLR / DFS project “Airspace Management 2020 (LRM2020)”. The new concept offers advantages over the traditional air traffic control: The traffic load can be easily distributed in a very balanced way over the controllers on duty. SESAR concept elements like business trajectories can be easily incorporated in this concept since the controller will have in mind the entire flight of his aircraft. He is only supposed to interfere in case of conflicts. A two weeks simulation campaign with eight experienced DFS upper area control ATCos has been carried out in 2010 to check the operational feasibility of the new concept

Long-Term Outcomes, Genetics, and Pituitary Morphology in Patients with Isolated Growth Hormone Deficiency and Multiple Pituitary Hormone Deficiencies: A Single-Centre Experience of Four Decades of Growth Hormone Replacement

Background: Growth hormone (GH) has been used to treat children with GH deficiency (GHD) since 1966. Aims: Using a combined retrospective and cross-sectional approach, we explored the long-term outcomes of patients with GHD, analysed factors influencing therapeutic response, determined persistence into adulthood, investigated pituitary morphology, and screened for mutations in causative genes. Methods: The files of 96 GH-deficient children were reviewed. In a subset of 50 patients, re-assessment in adulthood was performed, including GHRH-arginine testing, pituitary magnetic resonance imaging (MRI), and mutational screening for the growth hormone-1 gene (GH1) and the GHRH receptor gene (GHRHR) in isolated GHD (IGHD), and HESX1 , PROP1 , POU1F1 , LHX3 , LHX4 , and GLI2 in multiple pituitary hormone deficiency (MPHD) patients. Results: GH was started at a height SDS of –3.2 ± 1.4 in IGHD patients and of –4.1 ± 2.1 in MPHD patients. Relative height gain was 0.3 SDS/year, absolute gain 1.6 SDS, and 1.2/2.6 SDS in IGHD/MPHD, respectively. Mid-parental target height was reached in 77%. Initial height SDS, bone age retardation and duration of GH replacement were correlated with height SDS gain. GHD persisted into adulthood in 19 and 89% of subjects with IGHD and MPHD, respectively. In 1/42 IGHD patients a GH1 mutation was detected; PROP1 mutations were found in 3/7 MPHD subjects. Anterior pituitary hypoplasia, combined with posterior pituitary ectopy and pituitary stalk invisibility on MRI, was an exclusive finding in MPHD patients. Conclusions: GH replacement successfully corrects the growth deficit in children with GHD. While the genetic aetiology remains undefined in most cases of IGHD, PROP1 mutations constitute a major cause for MPHD. Persistence of GHD into adulthood is related to abnormal pituitary morphology

Sex differences over time for glycemic control, pump use and insulin dose in patients aged 10-40 years with type 1 diabetes: a diabetes registry study.

INTRODUCTION To evaluate sex differences in people with type 1 diabetes concerning changes in glycemic control and trends in insulin pump use and insulin dose over two decades in adolescents and one-and-a-half decades in adults. RESEARCH DESIGN AND METHODS People aged 10-20 years (data years 1999-2018) and 21-40 years (data years 2004-2018) with type 1 diabetes were identified in the Diabetes Prospective Follow-up Registry (DPV). All available patients' data sets of the respective period were used for linear regression analyses to investigate trends in HbA1c, pump use, insulin doses and body mass index SD scores (BMI-SDS) in females and males. In addition, stratification by migrant background was made for the adolescent group. RESULTS In the youth group (n=68 662), both boys and girls showed an HbA1c decrease over the period examined. After stratification for migrant background, an HbA1c convergence between boys and girls was seen in those without migrant background as of 2016. Usage of insulin pumps increased continuously from 3% (boys and girls) to 47% (boys) and 54% (girls), respectively. The daily insulin dose in units per kilogram body weight and day increased continuously from 1999 to 2018. An insulin dose leveling between boys and girls occurred. BMI-SDS consistently increased in girls whereas only slight variations were observed in boys.The adult group (n=15 380) showed constant HbA1c sex differences from 2004 to 2018 with lower HbA1c level in females. The use of insulin pump therapy rose from 18% to 35% (males) and 30% to 50% (females). CONCLUSIONS The gap in metabolic control between boys and girls with type 1 diabetes seems to close, but predominantly in adolescents without a migrant background. Improved HbA1c was associated with increased insulin pump use, especially in girls.In adult patients, sex differences in metabolic control and insulin pump use persist: women show constantly lower HbA1c values and higher insulin pump use

Outpatient screening for anxiety and depression symptoms in adolescents with type 1 diabetes - a cross-sectional survey

Abstract Background The daily demands of type 1 diabetes management may jeopardize adolescents’ mental health. We aimed to assess anxiety and depression symptoms by broad-scale, tablet-based outpatient screening in adolescents with type 1 diabetes in Germany. Methods Adolescent patients with type 1 diabetes mellitus (n = 2,394; mean age 15.4 y [SD 2.0]; 50.7% male) were screened for anxiety (GAD-7) and depression symptoms (PHQ-9) by self-report questionnaires and linked to clinical data from the DPV patient registry. Logistic regression was used to estimate the contribution of clinical parameters to positive screening results. Results Altogether, 30.2% showed a positive screening (score ≥ 7 in either test), and 11.3% reported suicidal ideations or self-harm. Patients with anxiety and depression symptoms were older (15.7 y [CI 15.5–15.8] vs. 15.3 y [CI 15.2–15.4]; p  15 years (aOR 1.40 [1.16–1.68]; p  9% (> 75 mmol/mol; aOR 2.58 [1.83–3.64]; each p < 0.0001), with a migration background (aOR 1.46 [CI 1.17–1.81]; p < 0.001), or smoking (aOR 2.72 [CI 1.41–5.23]; p = 0.003) had a higher risk. Regular exercise was a significant protective factor (aOR 0.65 [CI 0.51–0.82]; p < 0.001). Advanced diabetes technologies did not influence screening outcomes. Conclusions Electronic mental health screening was implemented in 42 centers in parallel, and outcomes showed an association with clinical parameters from sociodemographic, lifestyle, and diabetes-related data. It should be integrated into holistic patient counseling, enabling early recognition of mild mental health symptoms for preventive measures. Females were disproportionally adversely affected. The use of advanced diabetes technologies did not yet reduce the odds of anxiety and depression symptoms in this cross-sectional assessment