Jeppensen

BACKGROUND: Smoking is an important cardiovascular disease risk factor, but the mechanisms linking smoking to blood pressure are poorly understood. METHODS AND RESULTS: Data on 141 317 participants (62 666 never, 40 669 former, 37 982 current smokers) from 23 population-based studies were included in observational and Mendelian randomization meta-analyses of the associations of smoking status and smoking heaviness with systolic and diastolic blood pressure, hypertension, and resting heart rate. For the Mendelian randomization analyses, a genetic variant rs16969968/rs1051730 was used as a proxy for smoking heaviness in current smokers. In observational analyses, current as compared with never smoking was associated with lower systolic blood pressure and diastolic blood pressure and lower hypertension risk, but with higher resting heart rate. In observational analyses among current smokers, 1 cigarette/day higher level of smoking heaviness was associated with higher (0.21 bpm; 95% confidence interval 0.19; 0.24) resting heart rate and slightly higher diastolic blood pressure (0.05 mm Hg; 95% confidence interval 0.02; 0.08) and systolic blood pressure (0.08 mm Hg; 95% confidence interval 0.03; 0.13). However, in Mendelian randomization analyses among current smokers, although each smoking increasing allele of rs16969968/rs1051730 was associated with higher resting heart rate (0.36 bpm/allele; 95% confidence interval 0.18; 0.54), there was no strong association with diastolic blood pressure, systolic blood pressure, or hypertension. This would suggest a 7 bpm higher heart rate in those who smoke 20 cigarettes/day. CONCLUSIONS: This Mendelian randomization meta-analysis supports a causal association of smoking heaviness with higher level of resting heart rate, but not with blood pressure. These findings suggest that part of the cardiovascular risk of smoking may operate through increasing resting heart rate.

INTRODUCTION: Emergency laparotomy is a high-risk procedure associated with severe post-operative morbidity and high mortality. The aim was to conduct a nationwide cohort consisting of all patients undergoing emergency laparotomy during an 11-year period and to examine both short- and long-term outcomes. METHODS: Adult patients treated with emergency laparotomy due to gastrointestinal conditions from 2003 through 2013 were identified in the Danish National Patient Register. Demographic data and surgical outcomes were identified in nationwide registers. RESULTS: A total of 47,300 patients were included in the study. Hereof, 15,015 patients underwent minor laparotomy (open appendectomy or cholecystectomy) and the rest underwent major laparotomy (n = 32,285). In all, 8,193 patients (17.3%) were readmitted within 30 days from surgery, whereas 7,521 patients (15.9%) underwent gastrointestinal reoperation. A total of 10,944 patients (23.1%) experienced a post-operative complication. The post-operative mortality at 7, 30, 90 and 365 days was 8.5%, 13.3%, 16.9% and 21.9%, respectively. When excluding minor laparotomies (open appendectomy and cholecystectomy), the 7-, 30-, 90- and 365-day mortality was 12.1%, 18.7%, 23.6% and 30.5%, respectively. CONCLUSIONS: More than one in every five patients died within one year after undergoing emergency laparotomy, and mortality rates were even higher when excluding minor laparotomies as almost one in every three patients died within one year. FUNDING: This study received support from the Frimodt-Heinecke Foundation and from the foundation Manufacturer Frands Køhler Nielsens and wife memorial fund. TRIAL REGISTRATION: The study was registered with Researchregistry.com (Id no: researchregistry2930).

The purpose of the paper is to carry out experimental and numerical investigations on a 1:45 scaled model of a non-ship-shaped FPSO vessel that could work in clear water open-sea and in ice-covered arctic environments with least ice-management requirement. The FPSO vessel is designed with a turret mooring system which is disconnectable during emergency and inclement weather conditions. As a first phase of the study experiments were conducted on a 1:45 scale model with three different mooring arrangements viz. 100% turret mooring, 50% vessel and 50% turret mooring, and 100% vessel mooring. Experiments are performed on the model with different sizes of damping plates attached at the keel to study its influence on the responses of the vessel. A numerical study has been carried out in WAMIT on the scaled model and the results are compared with those obtained from model tests in the wave basin.

No abstract available.

New cockpit systems such as an electronic flight bag (EFB) are enablers to provide flight crews with real-time strategic weather information. Strategic weather information will enhance pilot situational awareness along the route to optimize flight-tracks and reduce flight time. In addition, strategic weather information reduces the flight crewpsilas workload and consequently human errors. This paper describes a study concerning the depiction of strategic real-time weather data on electronic displays. The first step of this study was to analyze the current weather information and its source as provided to pilots. Next, several human factors aspects and their relative impact to the development of a weather display were analyzed and evaluated. This included weather schemas, color coding, and symbol design. The resultant design study identifies the issues inherent in the overlay of multiple weather phenomena for a single composite display of the information. Based on the results of this design study, five weather display concepts, ranging from a static application to weather overlays on an electronic chart display (ECD), were identified. The final stage of this study conducted an evaluation of these display concepts with both visual flight rules (VFR) and instrument flight rules (IFR) operations taken into account. Pilot participation was used to rank the different concepts in terms of usability, understandability, functionality and workload and evaluate aspects of color-coding and symbology.

In the past Jeppesen has built and distributed worldwide terrain models for several Terrain Awareness and Warning Systems (TAWS) avionics clients. The basis for this model is a 30 arc-second NOAA Globe dataset with higher resolution data used where available (primarily in the US). On a large scale however these terrain models have a 900m (3000ft) resolution with errors that can often add up to 650m (1800ft) vertically. This limits the use of these databases to current TAWS systems and is deemed unusable for other aviation applications like SVS displays that require a more resolute and accurate terrain model. To overcome this deficiency, the target of this project was to develop a new worldwide terrain database providing a consistent terrain model that can be used by current (TAWS) and future applications (e.g. 2D moving maps, vertical situation displays, SVS). The basis for this project is the recently released SRTM data from NGA that provides a more resolute, accurate and consistent worldwide terrain model. The dataset however has holes in the peak and valley regions, desert, and very flat areas due to irrecoverable data capture issues. These voids have been filled using new topography algorithms developed in this project. The error distribution of this dataset has been analyzed in relation to topography, acquisition method and other factors. Based on this analysis, it is now possible to raise the terrain a certain amount, such that it can be guaranteed that only a certain number of real terrain points are higher than the data stored in the terrain database. Using this method, databases for designated confidence levels of 10-3, 10-5 and 10-8 – called TerrainScape level 1- 3 – have been generated. The final result of the project is a worldwide terrain database with quality factors sufficient for use in a broader range of civil aviation applications.

Air transportation system authorities throughout the world are becoming increasingly focused on improving the efficiency of air operations to enhance the safety and capacity of their systems and also respond to environmental concerns, all while meeting the demands of the increasingly large traveling public. A critical component to improving efficiencies within air transportation systems is the implementation of a performance-based navigation (PBN) concept. That concept leverages the navigation and performance capabilities of the aircraft by structuring the airspace such that the aircraft can maneuver efficiently with minimal fuel expenditure from takeoff to landing. The US Next Generation Air Transportation System (NextGen) and Europe's Single European Sky Air Traffic Management (ATM) Research Initiative (SESAR) are focused on a PBN design for future airspace operations. One key element of those future airspace designs is a specific aircraft navigation capability that allows the aircraft to traverse over the ground on a fixed ground path consistently, predictably, and reliably while turning. That capability is referred to as a "Constant Radius ARC to a Fix (RF) navigation leg. When incorporated into an instrument procedure design, the RF leg is used by the aircraft's flight management computer system (FMS) to consistently fly the turn over the same ground track. This accommodates avoidance of environmentally sensitive areas or other restricted airspace and also provides for the flexibility to shorten the time and miles traveled by the aircraft thus reducing fuel burn and emissions. Over the past few years, the RF leg has been available only to specially qualified operators and aircraft. However, recent innovative action by the FAA and its aviation industry partners are promoting the RF leg for incorporation into public instrument procedure designs so that all segments of the industry can take advantage of the operational enhancements realized by instrument procedures containing the flexible RF leg. This paper describes the RF leg, how it can be implemented into instrument procedure designs for use by the aircraft navigation systems and the benefits to current and future air transportation systems when it is made available to all aviation segments.

Since the introduction of the electronic flight bag (EFB) in the Boeing 777 in 2003, airport moving maps (AMM) are making their way into modern flight decks in order to provide improved situation awareness to the pilot during ground operations. The Airbus A380 and the Boeing 787 will be equipped with AMM displays as standard, while retrofits are available for older airliners. The new ARINC specification 816 is based on RTCA DO-272A and DO-291 and defines an "Embedded Interchange Format for Airport Mapping Database". The goals are to simplify data handling but also to provide additional features to further increase the benefit of AMM displays. ARINC 816 addresses the requirements of embedded avionics systems by moving complex processing steps like coordinate projections or triangulations to the data provider. According data are pre-computed and loaded into the system. Thus, less powerful avionics hardware is needed and its certification is less complex. Both contribute to a more cost effective design. A particular difficult task is the labeling of the airport map. ARINC 816 splits this process into two components: the identification and aggregation of objects to be labeled is done offline and the results are stored as containers and anchor points in the dataset. The avionics system can focus on the placement and deconfliction of the previously identified labels. Some issues have been identified in the implementation of this concept. Some have already been addressed in Supplement 1 to the specification; others are discussed in this paper. All data are encoded in binary-XML. While this format is convenient to handle, it has the disadvantage of significantly larger file sizes than comparable binary formats. Using an open and standardized format allows end users to choose between different database suppliers independently from the selected avionics system, and it enables database suppliers to convert airport data directly into the end-system specification and deliver the data directly to the airline. Data delivery can be accomplished by products such as data distribution and management (DDM) for subsequent loading onto the airplane by CD-ROM, portable data loaders, wireless gatelink or other "last mile" solution. The AMDB data is provided in accordance with a data packaging standards such as ARINC-665. This paper discusses joint industry activities which led to this new standard, new airport data and their benefits for airport moving maps, and the benefits for end users.

This study is concerned with solving real-life sized APS problems practically. Specifically, the problem of Multilevel Capacitated Lot Sizing Problem with linked lot sizes (MLCLSP-L) is considered. The problem is a classical, practical and notoriously hard problem. We propose a new modeling technique for MLCLSP-L based on a GA-driven hyperheuristic, which enables modeling of some issues previously not modeled. Proposed model uses an indirect representation by allowing GA search through a space of low level heuristics. Each one of the low level heuristics is simple and determines the detailed production plan of a machine in a period. The solution is constructed through combination of these low level heuristics. New model is demonstrated by solving moderate size test problem along with software developed.

Extracorporeal shockwave therapy (ESWT) is a novel treatment modality to stimulate tissue regeneration and anti-fibrosis. In this review, we summarise the use of ESWT for erectile dysfunction (ED), diabetic foot ulcers (DFU), Peyronie's disease (PD), chronic kidney disease (CKD), and scleroderma. Several randomised clinical trials demonstrate the efficacy of ESWT for vasculogenic ED and DFU, and ESWT may also relieve pain in patients with PD. ESWT is still experimental for CKD and scleroderma. In general, ESWT is associated with few and mild adverse effects.

We propose a two-phase combination of two optimization techniques, Lagrangian relaxation and column generation, with the aim of overcoming their respective drawbacks.In a prediction phase, subgradient optimization is used and the Lagrangian relaxed solutions found are used to initialize a master problem.In a solution phase, column generation is performed.We provide a validation of this two-phase method through an asymptotic result for the prediction phase and give guidelines for its truncated usage.The two-phase method is assessed on a multicommodity network flow problem, for which it performs significantly better than a pure column generation method.We conclude that the subgradient optimization prediction phase can accelerate a column generation method considerably.

International audience

Helicopters are widely used for operations close to terrain such as rescue missions; therefore all-weather capabilities are highly desired. To minimize or even avoid the risk of collision with terrain and obstacles, Synthetic Vision Systems (SVS) could be used to increase situational awareness. In order to demonstrate this, helicopter flights have been performed in the area of Zurich, Switzerland A major component of an SVS is the three-dimensional (3D) depiction of terrain data, usually presented on the primary flight display (PFD). The degree of usability in low level flight applications is a function of the terrain data quality. Today's most precise, large scale terrain data are derived from airborne laser scanning technologies such as LIDAR (light detection and ranging). A LIDAR dataset provided by Swissphoto AG, Zurich with a resolution of 1m was used. The depiction of high resolution terrain data consisting of 1 million elevation posts per square kilometer on a laptop in an appropriate area around the helicopter is challenging. To facilitate the depiction of the high resolution terrain data, it was triangulated applying a 1.5m error margin making it possible to depict an area of 5x5 square kilometer around the helicopter. To position the camera correctly in the virtual scene the SVS had to be supplied with accurate navigation data. Highly flexible and portable measurement equipment which easily could be used in most aircrafts was designed. Demonstration flights were successfully executed in September, October 2005 in the Swiss Alps departing from Zurich.

ABSTRACT Introduction Physical activity (PA) interventions in schools can improve children’s overall PA levels and positively affect academic performance. However, implementing PA during the school day can be challenging in the complex school setting. Many school-based PA studies do not present their interventions’ design processes, although this knowledge is important to replicate the intervention. Purpose This article aims to provide insights into the collaborative design process of the two PA interventions for third-grade pupils of the ACTIVE SCHOOL project. The evidence-based interventions focus on PA integrated into academic content (Move & Learn intervention) as embodied learning or PA as moderate to vigorous activity performed during the school day (Run, Jump & Fun intervention). The study’s objective was to engage teachers and pedagogues early in the design process to ensure the design was tailored to practice. Methods A team consisting of researchers, school staff, and experts were involved in the design process. The process lasted one school year and comprised three phases: exploration and analysis, construction and design, and reflection and evaluation. Multiple methods were used, including focus group interviews, a design workshop, and observations of iterative in-school testing. Results The result of the analysis and exploration phase was a set of learning points based on information about school culture, school staff competences, and needs. The design and construction phase produced a set of intervention skeletons, which were the actual elements of the interventions. The evaluation and reflection phase created the main results, which are specific principles and multifaceted implementation strategies for Move & Learn and Run, Jump & Fun, respectively. Finally, dose and timing of the interventions were specified. Conclusion Collaboration with schools and an iterative approach were determinants for designing interventions appropriate to the Danish school context and school staff practice.

In this paper a novel approach for aircraft trajectory generation is presented. Based on a pathfinding algorithm in conjunction with a cost function, a concept for a cost-optimized trajectory generator is introduced. The trajectory generator is able to incorporate time constraints along the aircraft’s route, as they will be an integral part of future airspace concepts to overcome the challenges of growing air-traffic. The target value, which is sought to be inimized by the pathfinding algorithm, is the result of the herein described cost function. Contrary to already existing approaches on aircraft trajectory optimization in this conceptual cost function an airline-wide, network centric, cost optimization can be performed, rather than focusing solely on a single aircraft. Evaluation of the cost-sensitive trajectory generator is performed in a fast-time simulation, results are compared to a non-optimizing trajectory generation. Results indicate average cost savings of 0.12% for arrival time variations of �30s at time constrained waypoints and proof general viability of the proposed concept. Further development of the herein presented method is recommended, especially in respect to Overall airline network optimization and disruption management use cases across the various entities of an airline.

During the last years there has been a wide reduction in institution places in psychiatric health care. The purpose of this study was to present how psychiatric patients experience their situation at home, and in what situations they need help from the psychiatric community nurses. Data were gathered from eleven qualitative interviews with eight patients. A hermeneutical approach and method was used in the study. The main focus was on the quality of life of the patients. The patients expressed a need of having an informal contact with the nurses and that the nurses focused on motivation and practical action. Three main factors showed out to be the causes related to the need of help. The first factor was the experience of psychological pain. The second factor was the experience of loneliness, and the third factor was related to the tendency of passivity. The patients need for help and guidance was therefore often related to emotional support, social contact and activities.

Jeppesen Sanderson, Inc. maintains, manufactures, and distributes flight manuals containing safety information for over 300,000 pilots and 400 airlines worldwide. Its service deteriorated when a growing line of over 100,000 aviation charts overwhelmed its production system. We developed optimization-based decision support tools that improved production planning. Concurrently, we developed a method for evaluating investments in production technology. Our work reduced lateness and improved production processes, which led to a decrease in customer complaints, a reduction in costs of nearly 10 percent, an increase in profit of 24 percent, and the creation of a new OR group. Today, OR-based decision support systems are spreading to all areas of the company.

This case report presents an incident of rectal carcinoma in a 24-year-old man with Hirschsprung's disease, for which he was operated in his early childhood, with a Soave pull-through procedure. No direct association between Hirschsprung's disease and rectal cancer was found in our review of the literature. However, several case reports of rectal cancers following pull-through procedures exist. A low threshold for further clinical investigations is recommended, if these patients are presenting with gastrointestinal symptoms.

Goal is to improve runway safety by reducing runway and taxiway incursions and excursions. We propose achieving this by introducing three new flight deck-centric data link applications that offer operational safety enhancements on the aerodrome surface. We also propose updating onboard AMDBs via data link, using an authoritative data source, and integrated flight deck displays. Remaining challenges: - Flight Deck Integration (Human Factors) - Coordination/Harmonization of Standards - Shared Situational Awareness.

An airport qualification may be required for a pilot to receive qualification for the execution of an approach or departure from a terrain, weather, or procedure challenging airport. The FAA identified these challenging airports and calls them ldquospecial pilot qualification airportsrdquo. This qualification may be accomplished through a familiarization using airport images or through a familiarization flight with an authorized person. Currently, Jeppesen offers airport familiarization charts. These charts depict approach procedure photos to a runway from the pilotpsilas perspective and aerial views of the airport. Before the approach, Pilots make use of these photos to get familiarized with the airport, the runway layout, the approach and terrain. This paper describes a new possibility to generate airport familiarization images using remote sensing data, terrain data, airport vector data, obstacles and approach procedure data through GIS. The objective is to replace analogues photos with synthetic pictures. Finally, an overview of the potential feature extensibility of the synthetic airport familiarization system is presented.