The International Civil Aviation Organization (ICAO) specifies that in the design phase of instrument flight procedures, an additional clearance may be added to an obstacle when flights are over ...mountainous terrain. This clearance increase can be up to 100 per cent of the minimum obstacle clearance (MOC). Airspace and instrument flight procedure designers usually face the problem of determining what value should be applied, since setting the maximum value of 100% often implies operational penalties, but there are no standardized criteria to determine lower values. The ICAO PANS-OPS indicates that the additional clearance over obstacles in mountainous areas is caused by two effects, both related to orography and wind speed. The first effect is due to the altimeter indication error. The second one is related to the loss of altitude when an aircraft is exposed to turbulence produced by mountain waves. This paper presents a methodology for determining the additional clearance to be applied over obstacles when, in the flight procedure design phase, the overflight of mountainous terrain is expected. Through this methodology, results have been achieved for the proposal of an appropriate additional clearance. The development of graphs and tables allows us to identify which additional value should be considered in each case.
Este trabajo examina discusiones de aula de un grupo de escolares de segundo curso de Educación Primaria implicados en una actividad de indagación experimental. Se han analizado de manera simultánea ...las preguntas de la docente y las operaciones epistémicas realizadas por las y los estudiantes. Nuestros resultados muestran que las preguntas productivas y las estrategias dialógicas utilizadas por la maestra son determinantes para promover las operaciones epistémicas vinculadas a la indagación. Además, la comparación con un grupo control que no participó en el diseño del experimento ni en las discusiones durante la indagación demuestra que el hecho de involucrar al alumnado en dichos procesos promueve que emerjan algunos aspectos de la naturaleza de la ciencia en el discurso de los niños y las niñas.
Background
The impact of glucagon-like peptide-1 receptor agonists on patients with heart failure has not been fully described. Our main objective was to evaluate the safety and clinical and glycemic ...efficacy of once-weekly semaglutide in obese patients with type 2 diabetes and heart failure.
Methods
In this observational, retrospective, real-world study, we enrolled outpatients with type 2 diabetes, obesity, and heart failure who started semaglutide and were followed-up on at 3, 6, and 12 months.
Results
A total of 136 patients were included. From baseline to 12 months, there was a significant improvement on the Kansas City Cardiomyopathy Questionnaire total symptom score (59.0 ± 24.1 vs 79.9 ± 28.4 points, p<0.01), a reduction in the proportion of patients with New York Heart Association functional class III (40.4% to 16.2%, p<0.01), and a reduction in N-terminal pro-brain natriuretic peptide levels (969.5 ± 653.5 vs 577.4 ± 322.1 pg/mL, p<0.01). Emergency department visits due to heart failure, hospitalizations due to heart failure, and all-cause hospitalizations also declined. Additionally, significant reductions in glycated hemoglobin (-1.4%) and body weight (-12.7 kilograms) were observed as well as a de-intensification of antidiabetic therapy. Moreover, semaglutide was safe and well-tolerated.
Conclusion
In obese patients with type 2 diabetes and heart failure, the use of once-weekly semaglutide was safe and clinically efficacious, improving health and functional status. Nevertheless, more strong evidence on glucagon-like peptide-1 receptor agonists in heart failure is required.
In a trial involving asymptomatic contacts of patients with PCR–confirmed Covid-19 in Spain, the authors compared the use of hydroxychloroquine with usual care. Postexposure therapy with ...hydroxychloroquine did not prevent SARS-CoV-2 infection or symptomatic Covid-19 in healthy persons.
Meniere disease (MD) is a heterogeneous clinical condition characterized by sensorineural hearing loss, episodic vestibular symptoms, and tinnitus associated with several comorbidities, such as ...migraine or autoimmune disorders (AD). The frequency of bilateral involvement may range from 5 to 50%, and it depends on the duration of the disease. We have performed a two-step cluster analysis in 398 patients with bilateral MD (BMD) to identify the best predictors to define clinical subgroups with a potential different etiology to improve the phenotyping of BMD and to develop new treatments. We have defined five clinical variants in BMD. Group 1 is the most frequently found, includes 46% of patients, and is defined by metachronic hearing loss without migraine and without AD. Group 2 is found in 17% of patients, and it is defined by synchronic hearing loss without migraine or AD. Group 3, with 13% of patients, is characterized by familial MD, while group 4, that includes 12% of patients, is associated by the presence of migraine in all cases. Group 5 is found in 11% of patients and is defined by AD. This approach can be helpful in selecting patients for genetic and clinical research. However, further studies will be required to improve the phenotyping in these clinical variants for a better understanding of the diverse etiological factors contributing to BMD.
In performance-based navigation (PBN) procedures with barometric vertical guidance, the effective vertical path angle (VPA) depends on the actual air temperature at the time of approach execution. A ...very low design temperature could result in an obstacle clearance height (OCH) higher than needed; hence, the airport throughput could be reduced when the cloud ceiling is below the OCH. Conversely, the design of a low temperature higher than is practical could lead to long periods in which the procedure cannot be used. The results of this research show that there is not much difference between the effective VPA for the different low temperatures studied. However, this slight difference, when obstacles penetrating the final approach surface (FAS) exist, usually leads to the approach minima being significantly different from each other. The objective of this study was to analyse the impact of the selected designed low temperatures in PBN procedures with barometric vertical guidance on the OCH/runway throughput and approach periods of use balance. Finally, guidelines on the selection of the minimum designed low temperature are proposed.
Vestibular Migraine (VM) and Meniere's Disease (MD) are episodic vestibular syndromes defined by a set of associated symptoms such as tinnitus, hearing loss or migraine features during the attacks. ...Both conditions may show symptom overlap and there is no biological marker to distinguish them. Two subgroups of MD patients have been reported, according to their IL-1β profile. Therefore, considering the clinical similarity between VM and MD, we aimed to investigate the cytokine profile of MD and VM as a means to distinguish these patients. We have also carried out gene expression microarrays and measured the levels of 14 cytokines and 11 chemokines in 129 MD patients, 82 VM patients, and 66 healthy controls. Gene expression profile in peripheral blood mononuclear cells (PBMC) showed significant differences in MD patients with high and low basal levels of IL- 1β and VM patients. MD patients with high basal levels of IL- 1β (MDH) had overall higher levels of cytokines/chemokines when compared to the other subsets. CCL4 levels were significantly different between MDH, MD with low basal levels of IL- 1β (MDL), VM and controls. Logistic regression identified IL- 1β, CCL3, CCL22, and CXCL1 levels as capable of differentiating VM patients from MD patients (area under the curve = 0.995), suggesting a high diagnostic value in patients with symptoms overlap.
The required minimum separation distance between aircraft is believed to be one of the limiting factors on airspace capacity. In recent decades, aircraft separation rules have been modified by ...progressively shortening the required minimum separation distance. Following this trend in the coming years, a further reduction in the minimum separation distance would be expected. Still, a thorough assessment of the impact of this action on air traffic management performance should be carried out before investing in a reduction of separation minima. A Monte Carlo analysis of the en-route Spanish airspace shows that it is worth reducing the en-route minimum separation distance from 5 NM to 3 NM. This paper shows that a separation minima reduction will bring significant fuel savings, flight delay reduction, air traffic controller workload drop, and overall improvement of safety.
Hepatitis C virus (HCV) and HIV are major causes of worldwide disease. We aimed to evaluate the effect of a combined screening programme, which included a risk‐assessment questionnaire and rapid ...tests for point‐of‐care diagnosis, on screening and new diagnosis rates. This prospective, cluster randomized study was carried out in primary care. The intervention arm included a 4‐hour educational programme, the use of a risk‐assessment questionnaire and rapid tests. In the control centres, only the educational intervention was provided. The main variables compared were the screening coverage and the number and rate of new HCV and HIV diagnoses. Of a total of 7991 participants, 4670 (58.5%) and 2894 (36.2%) presented a risk questionnaire for HIV or HCV, respectively. The younger participants, men and those from Latin America and Eastern Europe, showed the greatest risk of presenting with a positive questionnaire. The overall screening coverage was higher within the intervention arm (OR 17.7; 95% CI 16.2‐19.5; P < .001). Only two HIV‐positives were identified compared to one in control centres. The rate of HCV diagnoses was higher among intervention centres, with 37 versus seven positive tests (OR 5.2; 95% CI 2.3‐11.6; P < .001). Of them, 10 were new diagnoses and 27 had been previously diagnosed, although not linked to care. In conclusion, a simple operational programme can lead to an increase in HCV and HIV screening rates, compared to an exclusively educational programme. The selection of at‐risk patients with a self‐questionnaire and the use of rapid tests significantly increased the diagnostic rate of HCV infection.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
The expected growth of air traffic in the coming decades demands an increase in airspace capacity, which is already close to saturation in many scenarios. One of the limiting factors of this capacity ...is the separation minima. At present, the separation standards that apply in a given volume of airspace are fixed, and their values were determined decades ago. Therefore, in order to increase airspace capacity, this is an area in which improvement is sought, namely through the implementation of new operational concepts, which include the redefinition of separation minima and the way they are applied. A key issue in this redefinition of separation minima is the question of the possibility of reducing the current standards. However, a reduction in the separation to a fixed value may not be a valid solution, as not all aircraft and ways of operation are the same. In this paper, the authors propose a new operational concept, the Ad Hoc or Variable separation minima. Ad Hoc separation refers to the application of different separation minima values in the same volume of airspace, depending on a set of factors, e.g., aircraft model and encounter geometry, among others. In this research, the factors that define these Ad Hoc separation minima and their relationships are discussed. A model for their determination is presented. Simulations are performed to analyze the operational feasibility of the Ad Hoc separation minima. The results show that the application of this concept is operationally feasible.
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