Background: Adults with congenital heart disease (ACHD) are at risk for stroke and dementia. We report baseline and Year 1 results from an ongoing study assessing brain health in people with moderate- and great-complexity ACHD. Methods: Participants aged ≥18 undergo baseline and Year-3 brain MRI/MRA and annual cognitive assessment (MoCA, NIH Toolbox-Cognitive Battery (NIH-TB)). Results: Of 93 participants to date, 79 (85%) have completed Year 1 follow-up. At baseline, the great-complexity group had lower MoCA (26.32 vs. 27.38; p=0.04) and NIH-TB scores (total composite 45.63 vs. 52.80; p=0.002) than the moderate-complexity group. Year-1 testing showed numerical improvements across cognitive batteries in both groups. More participants with great-complexity ACHD had white matter hyperintensities (WMH; 72% vs. 55%; p=0.21) and cerebral microbleeds (CMBs; 72% vs. 54%; p=0.17) on baseline neuroimaging, but differences were not significant. Conclusions: Baseline neuroimaging shows a greater-than-expected burden for age of CMB and WMH in the context of previous cardiac surgery. Baseline cognitive performance was worse with great-complexity ACHD. Improved cognitive battery performance across both subgroups at Year-1 suggests a practice effect. Repeat neuroimaging will be performed in Year-3 and cognitive performance is reassessed annually.

We evaluated a digital learning programme for non-specialists to develop knowledge-based competencies in a problem-solving intervention for adolescents to examine the overall impact of training on knowledge-based competencies among learners; and to compare the effects of two training conditions (self-guided digital training with or without coaching) in a nested parallel, two-arm, individually randomised controlled trial. Eligible participants were 18 or older; fluent in Hindi or English; able to access digital training; and had no prior experience of delivering structured psychotherapies. 277 participants were enrolled from 31 March 2022 to 19 June 2022 of which 230 (83%) completed the study. There was a significant increase in competency score from pre-training (Mean = 7.01, SD = 3.29) to post-training (Mean = 8.88, SD = 3.80), 6 weeks after the pre-training assessment. Knowledge competency scores showed larger increase among participants randomised to the coaching arm (AMD = 1.09, 95% CI 0.26–1.92, p = 0.01) with an effect size (d) of 0.33 (95% CI 0.08–0.58). More participants completed training in the coaching arm (n = 96, 69.6%) compared to the self-guided training arm (n = 56, 40.3%). In conclusion, a coach-supported remote digital training intervention is associated with enhanced participation by learners and increased psychotherapeutic knowledge competencies.

Early psychosocial adversities exist at many levels, including caregiving-related, extrafamilial, and sociodemographic, which despite their high interrelatedness may have unique impacts on development. In this paper, we focus on caregiving-related early adversities (crEAs) and parse the heterogeneity of crEAs via data reduction techniques that identify experiential cooccurrences. Using network science, we characterized crEA cooccurrences to represent the comorbidity of crEA experiences across a sample of school-age children (n = 258; 6–12 years old) with a history of crEAs. crEA dimensions (variable level) and crEA subtypes (subject level) were identified using parallel factor analysis/principal component analysis and graph-based Louvain community detection. Bagging enhancement with cross-validation provided estimates of robustness. These data-driven dimensions/subtypes showed evidence of stability, transcended traditional sociolegally defined groups, were more homogenous than sociolegally defined groups, and reduced statistical correlations with sociodemographic factors. Finally, random forests showed both unique and common predictive importance of the crEA dimensions/subtypes for childhood mental health symptoms and academic skills. These data-driven outcomes provide additional tools and recommendations for crEA data reduction to inform precision medicine efforts in this area.

Background: Since January 1, 2016 2358 people have died from opioid poisoning in Alberta. Buprenorphine/naloxone (bup/nal) is the recommended first line treatment for opioid use disorder (OUD) and this treatment can be initiated in emergency departments and urgent care centres (EDs). Aim Statement: This project aims to spread a quality improvement intervention to all 107 adult EDs in Alberta by March 31, 2020. The intervention supports clinicians to initiate bup/nal for eligible individuals and provide rapid referrals to OUD treatment clinics. Measures & Design: Local ED teams were identified (administrators, clinical nurse educators, physicians and, where available, pharmacists and social workers). Local teams were supported by a provincial project team (project manager, consultant, and five physician leads) through a multi-faceted implementation process using provincial order sets, clinician education products, and patient-facing information. We used administrative ED and pharmacy data to track the number of visits where bup/nal was given in ED, and whether discharged patients continued to fill any opioid agonist treatment (OAT) prescription 30 days after their index ED visit. OUD clinics reported the number of referrals received from EDs and the number attending their first appointment. Patient safety event reports were tracked to identify any unintended negative impacts. Evaluation/Results: We report data from May 15, 2018 (program start) to September 31, 2019. Forty-nine EDs (46% of 107) implemented the program and 22 (45% of 49) reported evaluation data. There were 5385 opioid-related visits to reporting ED sites after program adoption. Bup/nal was given during 832 ED visits (663 unique patients): 7 visits in the 1st quarter the program operated, 55 in the 2nd, 74 in the 3rd, 143 in the 4th, 294 in the 5th, and 255 in the 6th. Among 505 unique discharged patients with 30 day follow up data available 319 (63%) continued to fill any OAT prescription after receiving bup/nal in ED. 16 (70%) of 23 community clinics provided data. EDs referred patients to these clinics 440 times, and 236 referrals (54%) attended their first follow-up appointment. Available data may under-report program impact. 5 patient safety events have been reported, with no harm or minimal harm to the patient. Discussion/Impact: Results demonstrate effective spread and uptake of a standardized provincial ED based early medical intervention program for patients who live with OUD.

Background: Buprenorphine/naloxone (bup/nal) is a partial opioid agonist/antagonist and recommended first line treatment for opioid use disorder (OUD). Emergency departments (EDs) are a key point of contact with the healthcare system for patients living with OUD. Aim Statement: We implemented a multi-disciplinary quality improvement project to screen patients for OUD, initiate bup/nal for eligible individuals, and provide rapid next business day walk-in referrals to addiction clinics in the community. Measures & Design: From May to September 2018, our team worked with three ED sites and three addiction clinics to pilot the program. Implementation involved alignment with regulatory requirements, physician education, coordination with pharmacy to ensure in-ED medication access, and nurse education. The project is supported by a full-time project manager, data analyst, operations leaders, physician champions, provincial pharmacy, and the Emergency Strategic Clinical Network leadership team. For our pilot, our evaluation objective was to determine the degree to which our initiation and referral pathway was being utilized. We used administrative data to track the number of patients given bup/nal in ED, their demographics and whether they continued to fill bup/nal prescriptions 30 days after their ED visit. Addiction clinics reported both the number of patients referred to them and the number of patients attending their referral. Evaluation/Results: Administrative data shows 568 opioid-related visits to ED pilot sites during the pilot phase. Bup/nal was given to 60 unique patients in the ED during 66 unique visits. There were 32 (53%) male patients and 28 (47%) female patients. Median patient age was 34 (range: 21 to 79). ED visits where bup/nal was given had a median length of stay of 6 hours 57 minutes (IQR: 6 hours 20 minutes) and Canadian Triage Acuity Scores as follows: Level 1 – 1 (2%), Level 2 – 21 (32%), Level 3 – 32 (48%), Level 4 – 11 (17%), Level 5 – 1 (2%). 51 (77%) of these visits led to discharge. 24 (47%) discharged patients given bup/nal in ED continued to fill bup/nal prescriptions 30 days after their index ED visit. EDs also referred 37 patients with OUD to the 3 community clinics, and 16 of those individuals (43%) attended their first follow-up appointment. Discussion/Impact: Our pilot project demonstrates that with dedicated resources and broad institutional support, ED patients with OUD can be appropriately initiated on bup/nal and referred to community care.

Zonal Safety Analysis (ZSA) is a major part of the civil aircraft safety assessment process described in Aerospace Recommended Practice 4761 (ARP4761). It considers safety effects that systems/items installed in the same zone (i.e. a defined area within the aircraft body) may have on each other. Although the ZSA may be conducted at any design stage, it would be most cost-effective to do it during preliminary design, due to the greater opportunity for influence on system and structural designs and architecture. The existing ZSA methodology of ARP4761 was analysed, but it was found to be more suitable for detail design rather than preliminary design. The authors therefore developed a methodology that would be more suitable for preliminary design and named it the Preliminary Zonal Safety Analysis (PZSA). This new methodology was verified by means of the use of a case study, based on the NASA N3-X project. Several lessons were learnt from the case study, leading to refinement of the proposed method. These lessons included focusing on the positional layout of major components for the zonal safety inspection, and using the Functional Hazard Analysis (FHA)/Fault Tree Analysis (FTA) to identify system external failure modes. The resulting PZSA needs further refinement, but should prove to be a useful design tool for the preliminary design process.

Unusual speleothems, associated with hyperalkaline (pH > 12) groundwaters have formed within a shallow, abandoned railway tunnel at Peak Dale, Derbyshire, UK. The hyperalkaline groundwaters are produced by the leaching of a thin layer (<2 m) of old lime-kiln waste on the soil-bedrock surface above the tunnel by rainwater. This results in a different reaction and chemical process to that more commonly associated with the formation of calcium carbonate speleothems from Ca-HCO3-type groundwaters and degassing of CO2. Stalagmites within the Peak Daletunnel have grown rapidly (averaging 33 mm y–1), following the closure of the tunnel 70 years ago. They have an unusual morphology comprising a central sub-horizontally-laminated column of micro- to nano-crystalline calcium carbonate encompassed by an outer sub-vertical assymetricripple-laminated layer. The stalagmites are composed largely of secondary calcite forming pseudomorphs (<1 mm) that we believe to be predominantly after the 'cold climate' calcium carbonate polymorph, ikaite (calcium carbonate hexahydrate: CaCO3·6H2O), withminor volumes of small (<5 μm) pseudomorphs after vaterite. The tunnel has a near constant temperature of 8–9°C, which is slightly above the previously published crystallization temperatures for ikaite (<6°C). Analysis of a stalagmite actively growing at the time ofsampling, and preserved immediately within a dry nitrogen cryogenic vessel, indicates that following crystallization of ikaite, decomposition to calcite occurs rapidly, if not instantaneously. We believe this is the first occurrence of this calcium carbonate polymorph observed within speleothems.

The College of Aeronautics performs an annual group project as a major part of its Aircraft Design MSc programme. Projects are chosen to be representative of current areas of interest and the programme carried out in a manner which is as close as possible to that of aircraft manufacturers.

The chosen projects alternate annually between civil and military types to give breadth to the course. It was decided that an executive jet would be a suitable subject for examination and a market study was performed. The small capacity end of the market was served by such aircraft as Learjets and medium capacity by BAe 125s and Citations. The top end of the market was of more interest because suitable aircraft could also perform other roles. The main reason for this was that market pressure for unrestricted headroom pointed towards larger diameter fuselages which could also be used for commuter aircraft.

The College of Aeronautics performs an annual group design project as a major part of its Aircraft Design MSc programme. Projects are chosen to be representative of current areas of interest and the programme is carried out in a manner which is as close as possible.to that of aircraft manufacturers.

Vice Admiral Forrest S. Peterson, Commander Naval Air Systems Command, said at the AIAA/NASA-Ames V/STOL Conference in 1977 that:

V/STOL appeared to be the most effective, most economical means of addressing many of our major military needs: dispersal of air assets over a broad geographic range, reducing the present reliance on relatively few ships and large permanent bases and reducing the cost of maintaining an adequate, efficient air arm.

A methodology has been developed to integrate the vulnerability discipline into the conceptual/preliminary design process of combat aircraft. An interactive and programmable solid modelling Computer Aided Design (CAD) system is used to generate a CAD solid model of the aircraft’s critical components. The aircraft’s components’ sizes and shapes are pre-defined by a conceptual/preliminary design synthesis computer model. A systematic Child-Parent assembly process is used to model the aircraft vulnerability, by defining the criticality degree of each component in the aircraft assembly. Solid Modelling CAD techniques have been modified to develop techniques to perform the two main standard vulnerability assessments, namely the shotline and vulnerable area methods.

It has always been important for military commanders to be able to rely on their equipment being available to them during a conflict. Some recent published figures, however, showed that two modern fighter aircraft were only available for missions for 47% or 56% of the time.

A simple operation simulation model was derived to show an aircraft's sensitivity to the main availability parameters. This model can be applied to any aircraft type provided that the necessary inputs can be calculated. The simulated operations were as realistic as possible, although many assumptions had to be made.

For reasons of national security it was not possible to relate this study directly to any current service aircraft, so a design project study has been used as the baseline aircraft in the simulation model. This aircraft was the 1980 Mini-CAS, developed at Cranfield Institute of Technology. This was used because all the necessary data were available or could be estimated with reasonable confidence and also the operating conditions are comparable to a number of current service types employed in the Close-Air-Support role. Thus the simulation was kept realistic and the results and conclusions are directly applicable to real and projected designs. Subsequent work checked the validity of the model by simulating an A-10 exercise and Sea Harrier operations in the Falklands conflict.

The Operations Simulation Model proved to be a satisfactory means of assessing the effectiveness of a force of aircraft under war-time conditions. It was far more flexible than the Availability and Mission Readiness equations commonly used to compare the in-service performance of aircraft and highlighted areas where resources could best be concentrated to improve availability. Further improvements are necessary however, to take account of spares shortages and the effect of adverse weather.

Hybrid laminar flow control (HLFC) is an active drag reduction technique that permits extended laminar flow on an aircraft surface and thus offers the potential for significant fuel savings. This is at the expense of an increase in system weight and specific fuel consumption. An overview of HLFC system failure types and consequences is presented as an introduction to this study, which investigated the impact of a potential loss of laminar flow due to flight in cirrus clouds. At typical cruising altitudes, the ice crystals are of a sufficient size and may result in sufficient particle flux to cause a temporary transition of the boundary layer. A computer performance model of a twin engine aircraft in the class of the Boeing 757 has been used to study the impact of alternative fuel planning scenarios on the fuel consumed by a HLFC aircraft, taking into account a model of probable cloud encounter. Based on the models, the study showed that if the fuel planning assumed 25% time-in-cloud (TIC) during the cruise, then in the extreme case of 55% TIC during the cruise, the contingency fuel (taken as 3% of the trip fuel), would be sufficient for the aircraft to complete the mission (including the alternate leg and hold).

A computer assisted conceptual aircraft designmethodology (CACAD) has been developed to sizeturbofan powered transport aircraft. New modules forpredicting the maintenance costs of each airframesystem and subsection of structure, were developedand incorporated into CACAD.

Many aspects of variable camber wing technology (VCW)were modelled. These included different types ofdrag saving due to chordwise, as well as spanwisecamber variation. Models were also derived for mass,maintenance cost, and extra development costincrements for wing trailing edge devices, flightcontrol, and hydraulic systems. These wereincorporated into CACAD, and then amultidisciplinary trade-off study resulted inpredicted savings of up to 3·5% in direct operatingcost (DOC). The technology was evaluated for DOCimprovement against a number of existing, future,and derivative aircraft, under different sensitivityconditions. Reliability, maintainability, anddevelopment (R, M&D) predictions were shown tobe decisive in determining the feasibility of VCWtechnology. The study showed that long range, low tomedium capacity, derivative aircraft are the mostsuitable applications for VCW technology.

Data were pooled from three Australian sentinel general practice influenza surveillance networks to estimate Australia-wide influenza vaccine coverage and effectiveness against community presentations for laboratory-confirmed influenza for the 2012, 2013 and 2014 seasons. Patients presenting with influenza-like illness at participating GP practices were swabbed and tested for influenza. The vaccination odds of patients testing positive were compared with patients testing negative to estimate influenza vaccine effectiveness (VE) by logistic regression, adjusting for age group, week of presentation and network. Pooling of data across Australia increased the sample size for estimation from a minimum of 684 to 3,683 in 2012, from 314 to 2,042 in 2013 and from 497 to 3,074 in 2014. Overall VE was 38% [95% confidence interval (CI) 24–49] in 2012, 60% (95% CI 45–70) in 2013 and 44% (95% CI 31–55) in 2014. For A(H1N1)pdm09 VE was 54% (95% CI–28 to 83) in 2012, 59% (95% CI 33–74) in 2013 and 55% (95% CI 39–67) in 2014. For A(H3N2), VE was 30% (95% CI 14–44) in 2012, 67% (95% CI 39–82) in 2013 and 26% (95% CI 1–45) in 2014. For influenza B, VE was stable across years at 56% (95% CI 37–70) in 2012, 57% (95% CI 30–73) in 2013 and 54% (95% CI 21–73) in 2014. Overall VE against influenza was low in 2012 and 2014 when A(H3N2) was the dominant strain and the vaccine was poorly matched. In contrast, overall VE was higher in 2013 when A(H1N1)pdm09 dominated and the vaccine was a better match. Pooling data can increase the sample available and enable more precise subtype- and age group-specific estimates, but limitations remain.

This paper describes the development of a generic aircraft systems dispatch reliability design methodology (ASDRDM) that has been developed for use during early phases of the aircraft systems design process.

The methodology incorporates prediction of both reliability and maintainability through the aircraft design hierarchy, down to component level. It can be applied at the early design stage, but can also be used for advanced design phases and can use generic or actual failure rate and mean time to repair data. It allows designers to modify system architectures and component reliability and maintainability characteristics. The paper shows the validation that has been performed, and its use is demonstrated by a case-study.

A computational study was performed to compare the stress distributions in finite element torsion box models of a box wing structure that result from employing four different wing/end fin joint fixities. All considered wings were trimmed in pitch. The joint fixities refer to the type of attachment that connects the tip of the fore and aft wings to the end fin. Using loads from a vortex lattice tool, the analysis determined the best wing-joint fixity of a statically loaded idealised box wing configuration by comparing the stress distributions resulting from the different wing joints in addition to other essential aerodynamic requirements. Analysis of the wing joint fixity indicates that the rigid joint is the most suitable.