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Introduction There is a national target to recruit 100,000 patients with COVID-19 to the PRIEST study Use of a research proforma to collect the required data risked Emergency Department (ED) physicians collecting this dataset at the expense of their more usual clinical history Use of paper admission forms which could not be taken from COVID-19 'dirty' to 'clean' areas either resulted in work duplication to transcribe information written in the 'dirty' zone or potential recall error/omission when staff completed paperwork later in the 'clean' zone Methods The solution (in a hospital which still uses paper notes) was an electronic admissions document, completed in the dirty zone and printed out in the clean zone The use of Visual Basic (VB) allowed insertion of scripts to automate data extraction for research and quality improvement use Microsoft Word was preferred because of staff familiarity, combined with better data governance than cloud solutions such as Google Forms and better legibility/formatting than research data collection tools such as REDCap Results VB enhanced Word documents offer similar benefits for management of patients in COVID-19 treatment areas and for subsequent follow up The electronic forms were received well by staff, as they allowed for clerking and PRIEST to happen simultaneously Clinical staff remarked that the form also acted as a prompt when clerking, which reduced the time taken to carry out subsequent patient encounters Research teams found the form much easier to process, as it negated the need to quarantine notes prior to assessment and allowed for data to be extracted immediately into an Excel spreadsheet Conclusion The use of VB not only increased staff safety, but it also allowed researchers to contemporaneously process data Whilst a mixed paper and electronic notes system is less than perfect, the adjunct of the virtual form was well received during the COVID-19 pandemic Future expansion of VB use as an adjunct to medical clerking will be considered and has already been piloted in the collection of data for COVID-19 patients admitted to our hospital

The Ares I-X trajectory reconstruction produced best-estimated trajectories of the flight-test vehicle ascent through stage separation and of the first- and upper-stage entries after separation. The trajectory-reconstruction process combines onboard, ground-based, and atmospheric measurements to produce the trajectory estimates, using an iterated extended Kalman filter algorithm. The Ares I-X vehicle had a number of onboard and ground-based sensors that were available, including inertial measurement units, radar, air data, and weather balloons. However, due to problems with calibrations and/or data, not all of the sensor data were used. This paper describes the methodology and results of the trajectory-reconstruction process, including flight-data preprocessing and input uncertainties, trajectory-estimation algorithms and dynamic models, output transformations, and comparisons with preflight predictions. The results of the reconstruction indicate nominal vehicle performance that is well within the range o...

Changes in demography and cohort attitudes in the older adult population have meant that substance use amongst older adults is emerging as an immense challenge to mental health services. Although the prevalence of alcohol-related problems decreases with age they remain significant in older adults, whilst the use of prescription and over-the-counter drugs increases in this age group. The interplay between substance use and social, psychological and physiological difficulties associated with ageing further underscores the needs for a greater understanding of this problem. The recent insurgence of clinical and research interest in this field has revealed a discrepancy in the identification of substance use in younger and older age groups, this problem remaining frequently hidden and neglected in older adults. The present article reviews assessment and screening tools developed especially for this age group and indicates the need for systematic multidisciplinary screening in older adult services. Differences ...

A feasibility study was performed to examine the advisability of incorporating a set of Programmed Test Inputs (PTIs) during the Space Launch System (SLS) vehicle flight. The intent of these inputs is to provide validation to the preflight models for control system stability margins, aerodynamics, and structural dynamics. During October 2009, Ares I-X program was successful in carrying out a series of PTI maneuvers which provided a significant amount of valuable data for post-flight analysis. The resulting data comparisons showed excellent agreement with the preflight linear models across the frequency spectrum of interest. However unlike Ares I-X, the structural dynamics associated with the SLS boost phase configuration are far more complex and highly coupled in all three axes. This presents a challenge when implementing this similar system identification technique to SLS. Preliminary simulation results show noticeable mismatches between PTI validation and analytical linear models in the frequency range of the structural dynamics. An alternate approach was examined which demonstrates the potential for better overall characterization of the system frequency response as well as robustness of the control design.

The Ares I-X trajectory reconstruction produced best estimated trajectories of the flight test vehicle ascent through stage separation, and of the first and upper stage entries after separation. The trajectory reconstruction process combines on-board, ground-based, and atmospheric measurements to produce the trajectory estimates. The Ares I-X vehicle had a number of on-board and ground based sensors that were available, including inertial measurement units, radar, air- data, and weather balloons. However, due to problems with calibrations and/or data, not all of the sensor data were used. The trajectory estimate was generated using an Iterative Extended Kalman Filter algorithm, which is an industry standard processing algorithm for filtering and estimation applications. This paper describes the methodology and results of the trajectory reconstruction process, including flight data preprocessing and input uncertainties, trajectory estimation algorithms, output transformations, and comparisons with preflight predictions.

The suite of Inflatable Re-Entry Vehicle Experiments (IRVE) is designed to further our knowledge and understanding of Hypersonic Inflatable Aerodynamic Decelerators (HIADs). Before infusion into a future mission, three challenges need to be addressed: surviving the heat pulse during re-entry, demonstrating system performance at relevant scales, and demonstrating controllability in the atmosphere. IRVE-4 will contribute to a better understanding of controllability by characterizing how a HIAD responds to a set of controlled inputs. The ability to control a HIAD is vital for missions that are g-limited, require precision targeting and guidance for aerocapture or entry, descent, and landing. The IRVE-4 flight test will focus on taking a first look into controlling a HIAD. This paper will give an overview of the IRVE-4 mission including the control response portion of the flight test sequence, and will provide a review of the mission s development.

The flight test of the Ares I-X vehicle provides a unique opportunity to reduce risk of the design of the Ares I vehicle and test out design, math modeling, and analysis methods. One of the key features of the Ares I design is the significant static aerodynamic instability coupled with the relatively flexible vehicle - potentially resulting in a challenging controls problem to provide adequate flight path performance while also providing adequate structural mode damping and preventing adverse control coupling to the flexible structural modes. Another challenge is to obtain enough data from the single flight to be able to conduct analysis showing the effectiveness of the controls solutions and have data to inform design decisions for Ares I. This paper will outline the modeling approaches and control system design to conduct this flight test, and also the system identification techniques developed to extract key information such as control system performance (gain/phase margins, for example), structural dynamics responses, and aerodynamic model estimations.

Aerodynamic parameters were estimated based on flight data from the third flight of the X-43A hypersonic research vehicle, also called Hyper-X. Maneuvers were flown using multiple orthogonal phase-optimized sweep inputs applied as simultaneous control surface perturbations at Mach 8, 7, 6, 5, 4, and 3 during the vehicle descent. Aerodynamic parameters, consisting of non-dimensional longitudinal and lateral stability and control derivatives, were estimated from flight data at each Mach number. Multi-step inputs at nearly the same flight conditions were also flown to assess the prediction capability of the identified models. Prediction errors were found to be comparable in magnitude to the modeling errors, which indicates accurate modeling. Aerodynamic parameter estimates were plotted as a function of Mach number, and compared with estimates from the pre-flight aerodynamic database, which was based on wind-tunnel tests and computational fluid dynamics. Agreement between flight estimates and values computed from the aerodynamic database was excellent overall.

It is claimed that while metrics quantify processes, competing metrics can capture future processes that will control the life-cycle of a designed system. To illustrate the issue, the basic premises of collaborative enabling technology are considered as the system design environment. In this case, capturing competing metrics is done on human functioning spaces. The earned capability of the system design personnel facilitates this capture. This amounts to having a system life-cycle evolving in parallel with human capability earning, while the system is being developed and maintained. Better human capabilities will bring better competing metrics for the system. This will enable the complexity of the system to be handled in a cost-effective way.

Introduction Common variable immunodeficiency (CVID) is a primary immune disorder characterised by impaired B cell differentiation and hypogammaglobulinaemia. It predisposes to encapsulated bacterial infections, commonly affecting the respiratory tract. 8%–20% of CVID patients have a granulomatous form. Granulomatous CVID may share clinical features with sarcoidosis, namely persistent cough, breathlessness, fatigue, fever, and arthralgia. Non caseating granulomata in lymph node biopsies and elevated angiotensin converting enzyme levels occur in both conditions. Differentiation between the two conditions is essential to allow management with immunoglobulin replacement and avoidance of excessive corticosteroids. Method Patients with a diagnosis of “sarcoidosis” recorded in chest clinic letters between April 2009 and September 2010 were identified. Clinic letters, blood tests, histology and imaging were reviewed. Results 175 patients with a diagnosis of sarcoidosis were identified. 80% had lymphadenopathy and 62% pulmonary involvement. Dermatological, ocular, rheumatological and other involvement was found in 19%, 17%, 16% and 9% respectively. 24% had potential features of CVID, such as recurrent chest infections, sinusitis, bronchiectasis or inflammatory bowel disease. Total globulin had been measured in 172/175 (98%) patients. 45/172 (26%) had elevated total globulin; 3/172 (2%)had low total globulin levels. Immunoglobulins had been measured in 106/175 (61%). Immunoglobulins had been measured in: 20/28 (71%) of those with recurrent sinusitis or lower respiratory tract infections; 20/25 (80%) of those with bronchiectasis; and8/8 (100%) of those with both recurrent chest infections and bronchiectasis. Four patients had persistently low IgM, two had persistently low IgA and one had persistently low IgG. No single patient had polyclonal hypogammaglobulinaemia, but levels were not measured in 11/42 (26%) with potential features of CVID. Conclusion Our study identified a cohort of patients with a diagnosis of sarcoidosis and features associated with CVID. We found that immunoglobulins were not being routinely measured during the work-up of patients with sarcoidosis as recommended by the Map of Medicine. Recent review of 28 local CVID patients identified two who were initially misdiagnosed with sarcoidosis. In one case this misdiagnosis persisted for 8 years. Granulomatous CVID is uncommon, but respiratory physicians should ensure that their routine work-up for sarcoidosis excludes this treatable condition.

Objectives: Following deaths of 2 CF patients, relatives returned drugs valued €4,443 and €3,631. 1 had >100 days supply of pulmozyme and stocks of 7 drugs which had date expired. In clinic, CF patients claim non-adherence with drugs because stocks have run out. In 2014, CF centres in England will take over all prescription of high cost nebulised drugs (HCND). Would it be cost efficient to assess home drug stocks to prevent oversupply, wastage and to help assess adherence? Methods:We administered a questionnaire and undertook home visits to 27 patients attending our CF centre to audit their drug stocks. Results: Patients were prescribed 2−23 drugs (median 13), and held stocks of 2−27 drugs. 1% of all drugs were date expired. 15% drugs were no longer prescribed (7.7% by value) of which 82% by value were antibiotics. For 19% drugs, patients held >10 weeks supplies. 37/369 prescriptions were for HCND. For HCND, no patient held >2 months supply. Patients held no home stocks for 15% of prescribed drugs. 18/27 patients lacked stocks of at least 1 prescribed drug. Some held no stocks of 43% of their prescription. Patients held no home stocks for 9/37 (24%) HCND. Lack of home stocks was not correlated with FEV1 or educational level. Many patients had poor awareness of levels of stocks. One patient predicted 7 days, but had median 88 days; another predicted 84 days, but had 7.5 days. 62% patients reported having previously run out of medications; yet 7/10 patients who reported never having run out, held no home stocks of at least 1 prescribed drug. Conclusion: Home drug audits offer no cost savings with HCND. Visits may identify patients who lack stocks and so are non adherent.

The Aircraft System Simulation Environment and Toolkit (ASSET) is a software framework for rapid development and simulation of continuous systems. The central concept of ASSET is a model—analogous to a block in a system block diagram. One important way to simplify the software development process for models is to use encapsulation. Encapsulation is a software development technique that disallows one model from accessing another model's internal state; models can only communicate through their well-defined input/output interface. Unfortunately when building a simulation, the engineer will often require visibility to data values that are not part of the normal interface. The data management system of the ASSET framework attempts to solve this problem. The data management system consists of a large central repository in which all models may write data and a common set of tools to access the data.

The Aircraft System Simulation Environment and Toolkit (ASSET) project is being undertaken as a proof of concept, aimed at demonstrating a rapid model prototyping and modification capability by utilizing modern software technologies and design concepts. Initially, the project is focused on a self-contained batch simulation, but it is designed to ultimately run embedded within other software environments, including realtime. This report focuses on the design and implementation of the model software, which strictly follows a block-diagram design paradigm. The initial implementation, a six-degree-of- freedom simulation of an F-16 airplane, is presented, along with current status and near-term plans.

▴ Li Z, Kosorok MR, Farrell PM, et al . Longitudinal development of mucoid Pseudomonas aeruginosa infection and lung disease progression in children with cystic fibrosis. JAMA2005;293:581–8 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] This longitudinal study correlates acquisition of non-mucoid and mucoid phenotypes of Pseudomonas aeruginosa with respiratory symptoms, quantitative chest radiography, pulmonary function tests, and anti-pseudomonal antibodies in cystic fibrosis (CF). 56 children identified by the Wisconsin CF neonatal screening project between 1985 and 1994 were followed from diagnosis (median age 6.9 weeks) … [1]: {openurl}?query=rft.jtitle%253DJAMA%26rft.stitle%253DJAMA%26rft.issn%253D0002-9955%26rft.aulast%253DLi%26rft.auinit1%253DZ.%26rft.volume%253D293%26rft.issue%253D5%26rft.spage%253D581%26rft.epage%253D588%26rft.atitle%253DLongitudinal%2BDevelopment%2Bof%2BMucoid%2BPseudomonas%2Baeruginosa%2BInfection%2Band%2BLung%2BDisease%2BProgression%2Bin%2BChildren%2BWith%2BCystic%2BFibrosis%26rft_id%253Dinfo%253Adoi%252F10.1001%252Fjama.293.5.581%26rft_id%253Dinfo%253Apmid%252F15687313%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1001/jama.293.5.581&link_type=DOI [3]: /lookup/external-ref?access_num=15687313&link_type=MED&atom=%2Fthoraxjnl%2F60%2F4%2F334.atom [4]: /lookup/external-ref?access_num=000226694200021&link_type=ISI