Identification of high-level functional/system requirements for future civil transports

In order to accommodate the rapid growth in commercial aviation throughout the remainder of this century, the Federal Aviation Administration (FAA) is faced with a formidable challenge to upgrade and/or modernize the National Airspace System (NAS) without compromising safety or efficiency. A recurring theme in both the Aviation System Capital Investment Plan (CIP), which has replaced the NAS Plan, and the new FAA Plan for Research, Engineering, and Development (RE&D) rely on the application of new technologies and a greater use of automation. Identifying the high-level functional and system impacts of such modernization efforts on future civil transport operational requirements, particularly in terms of cockpit functionality and information transfer, was the primary objective of this project. The FAA planning documents for the NAS of the 2005 era and beyond were surveyed; major aircraft functional capabilities and system components required for such an operating environment were identified. A hierarchical structured analysis of the information processing and flows emanating from such functional/system components were conducted and the results documented in graphical form depicting the relationships between functions and systems

High speed research system study. Advanced flight deck configuration effects

In mid-1991 NASA contracted with industry to study the high-speed civil transport (HSCT) flight deck challenges and assess the benefits, prior to initiating their High Speed Research Program (HSRP) Phase 2 efforts, then scheduled for FY-93. The results of this nine-month effort are presented, and a number of the most significant findings for the specified advanced concepts are highlighted: (1) a no nose-droop configuration; (2) a far forward cockpit location; and (3) advanced crew monitoring and control of complex systems. The results indicate that the no nose-droop configuration is critically dependent upon the design and development of a safe, reliable, and certifiable Synthetic Vision System (SVS). The droop-nose configuration would cause significant weight, performance, and cost penalties. The far forward cockpit location, with the conventional side-by-side seating provides little economic advantage; however, a configuration with a tandem seating arrangement provides a substantial increase in either additional payload (i.e., passengers) or potential downsizing of the vehicle with resulting increases in performance efficiencies and associated reductions in emissions. Without a droop nose, forward external visibility is negated and takeoff/landing guidance and control must rely on the use of the SVS. The technologies enabling such capabilities, which de facto provides for Category 3 all-weather operations on every flight independent of weather, represent a dramatic benefits multiplier in a 2005 global ATM network: both in terms of enhanced economic viability and environmental acceptability

An exploration of function analysis and function allocation in the commercial flight domain

The applicability is explored of functional analysis methods to support cockpit design. Specifically, alternative techniques are studied for ensuring an effective division of responsibility between the flight crew and automation. A functional decomposition is performed of the commercial flight domain to provide the information necessary to support allocation decisions and demonstrate methodology for allocating functions to flight crew or to automation. The function analysis employed 'bottom up' and 'top down' analyses and demonstrated the comparability of identified functions, using the 'lift off' segment of the 'take off' phase as a test case. The normal flight mission and selected contingencies were addressed. Two alternative methods for using the functional description in the allocation of functions between man and machine were investigated. The two methods were compared in order to ascertain their relative strengths and weaknesses. Finally, conclusions were drawn regarding the practical utility of function analysis methods

Early Detection and Monitoring of Cancer with the Anti-Malignin Antibody Test "

ABSTRACT: The serum anti-malignin antibody (AMA) test determines the antibody to malignin. a IO,OOO-Da peptide present in patients with a wide variety of cancers.l~ A total of 3315 double-blind tests demonstrated that AMA is a general transformation antibody, elevated in active no.nterminal cancer, regardless of the site or tissue type, with sensitivity and specificity of95% on the flTst determination and >99% on repeat determinations. - 9 Data have not however been published yet that indicate whether, in daily clinical practice, the AMA test provides accurate prospective and predictive information. Fony-two physicians from II states, who ordered the AMA test, performed blind, report here on their results on 208 determinations in the first consecutive 181 patients and controls. Used in monitoring treatment in 56 patients, the test predicted or agreed 94.1 % overall with the clinical status. Used in early detection in 125 patients and controls, of which 118 now have confirmed diagnoses. AMA was elevated in 21, all of whom were proven to have cancer; AMA was normal in 97, none of whom had cancer. Transient elevated AMA occurred in 3%, followed by normal values. Seven patients with still uncertain diagnosis who have had elevated AMA on repeated tests for I year or longer include six who are symptomatic, and three whose families have a high frequency of cancer. The conditions of these 7 may include undetected cancer because of the 118 with now certain diagnosis the AMA test predicted all correctly. From our experience, the AMA test should be used together with other routine procedures whenever signs and symptoms suggest cancer to facilitate early detection

Medication Adherence and Cardiometabolic Control Indicators Among American Indian Adults Receiving Tribal Health Services: Protocol for a Longitudinal Electronic Health Records Study

BackgroundAmerican Indian adults have the highest prevalence of type 2 diabetes (T2D) in any racial or ethnic group and experience high rates of comorbidities. Uncontrolled cardiometabolic risk factors—insulin resistance, resulting in impaired glucose tolerance, dyslipidemia, and hypertension—increase the risk of mortality. Mortality is significantly reduced by glucose- and lipid-lowering and antihypertensive medication adherence. Medication adherence is low among American Indian adults living in non–Indian Health Service health care settings. Virtually nothing is known about the nature and extent of medication adherence among reservation-dwelling American Indian adults who primarily receive their medications without cost from Indian Health Service or tribal facilities. Electronic health records (EHRs) offer a rich but underused data source regarding medication adherence and its potential to predict cardiometabolic control indicators (C-MCIs). With the support of the Choctaw Nation of Oklahoma (CNO), we address this oversight by using EHR data generated by this large, state-of-the-art tribal health care system to investigate C-MCIs. ObjectiveOur specific aims are to determine, using 2018 EHR data, the bivariate relationships between medication adherence and C-MCIs, demographics, and comorbidities and each C-MCI and demographics and comorbidities; develop machine learning models for predicting future C-MCIs from the previous year’s medication adherence, demographics, comorbidities, and common laboratory tests; and identify facilitators of and barriers to medication adherence within the context of social determinants of health (SDOH), EHR-derived medication adherence, and C-MCIs. MethodsDrawing on the tribe’s EHR (2018-2021) data for CNO patients with T2D, we will characterize the relationships among medication adherence (to glucose- and lipid-lowering and antihypertensive drugs) and C-MCIs (hemoglobin A1c ≤7%, low-density lipoprotein cholesterol <100 mg/dL, and systolic blood pressure <130 mm Hg); patient demographics (eg, age, sex, SDOH, and residence location); and comorbidities (eg, BMI ≥30, cardiovascular disease, and chronic kidney disease). We will also characterize the association of each C-MCI with demographics and comorbidities. Prescription and pharmacy refill data will be used to calculate the proportion of days covered with medications, a typical measure of medication adherence. Using machine learning techniques, we will develop prediction models for future (2019-2021) C-MCIs based on medication adherence, patient demographics, comorbidities, and common laboratory tests (eg, lipid panel) from the previous year. Finally, key informant interviews (N=90) will explore facilitators of and barriers to medication adherence within the context of local SDOH. ResultsFunding was obtained in early 2022. The University of Florida and CNO approved the institutional review board protocols and executed the data use agreements. Data extraction is in process. We expect to obtain results from aims 1 and 2 in 2024. ConclusionsOur findings will yield insights into improving medication adherence and C-MCIs among American Indian adults, consistent with CNO’s State of the Nation’s Health Report 2017 goal of reducing T2D and its complications. International Registered Report Identifier (IRRID)PRR1-10.2196/3919

Association of Medication Adherence with HbA1c Control among American Indian Adults with Type 2 Diabetes Using Tribal Health Services

   OBJECTIVE To examine HbA1c levels and adherence to oral glucose-lowering medication and their association with future HbA1c levels among American Indian adults with type 2 diabetes (T2D) receiving medication at no-cost from a tribal healthcare system.  RESEARCH DESIGN AND METHODS Tribal citizens with T2D and who used Choctaw Nation Health Services Authority (CNHSA) and Pharmacies and had HbA1c data during 2017-2018 were included in this study. Medication adherence (proportion of days covered [PDC] ≥ 0.80) was calculated using 2017 CNHSA electronic health record data.  RESULTS Of the 74,000 tribal citizens living on tribal lands, 4,560 were eligible. 32% had HbA1c at or below target (≤ 7%); 36% were above target (> 7% to ≤ 9%); 32% were uncontrolled (> 9%) in 2017. Percentage of patients with PDC ≥.80 was 66% for Biguanides, 72% for Sulfonylureas, 75% for DPP-4 inhibitors, and 83% for SGLT-2 inhibitors. The proportion of patients with HbA1c at or below target increased slightly from 32% in 2017 to 42% in 2018. Higher average PDC in 2017 was associated with lower HbA1c levels in 2018 (β=-1.143, p CONCLUSION Medication adherence was higher than found in previous studies that used self-report methods in American Indian populations, though a smaller proportion of patients had an HbA1c at or below target relative to US adults with T2D. Mediation adherence was associated with improved HbA1c level for most oral glucose-lowering medication classes. Future studies of American Indians should use both longitudinal prescription data from both electronic health record and pharmacy refill data. </p