This article is the second to be published on the Internet from our Air France Flight 447 Project. Target date to have all chapters online is February 1, 2012. Photos and technical graphs are presented in a larger size than is usual for a web page so that details and small font text may be read as easily as is possible. This web page was coded for 1280 x 800 which is a wide screen (landscape) format. Printout will be 25 pages in 11 x 8.5 inch format. Please bookmark this page and occasionally check back to remain current with the publication schedule for the AF 447 Project.
Comments and opinions in this article are the sole responsibility of Bennett Blumenberg and do not reflect the views of any organization, government or private, that are mentioned in this article. The author does not have any relationship, public or private, with the organizations referenced in this article.
The Air Data and Inertial Reference System (ADIRS) supplies temperature, anemometric barometric and inertial parameters to the Primary Flight Display and cockpit displays that are critical to the pilots. “An ADIRS consists of up to three fault tolerant ADIRUs located in the aircraft electronic rack, an associated Control and Display Unit (CDU) in the cockpit and remotely mounted Air Data Modules (ADMs).[6] The No 3 ADIRU is a redundant unit . . Reference (IR) fault in ADIRU No 1 or 2 will cause a loss of attitude and navigation information on their associated Primary Flight Display (PFD) and Navigation Display (ND) screens. An ADR (Air Data Reference)
fault will cause the loss of airspeed and altitude information on the affected display. In either case the information can only be restored by selecting the No 3 ADIRU.
“At 2 h 10 min 51, when the aircraft was at about 37,500 ft and still climbing, the stall warning was activated (refer to 1.6.3). A change in the recorded normal acceleration behavior was revealed from 2 h 10 min 53, at an angle of attack about 1 to 2 degrees greater than the warning activation threshold.”(BEA 3rd Interim Report, p.43)
“This modification of the behavior in the load factor at the centre of gravity results in the appearance of a high frequency component of an amplitude increasing to until about 0.1 g peak-to-peak, and with a signature that is very different from a turbulence signature of meteorological origin”. According to the simulation, the turbulence observed in the first seconds of climbing had stopped.(p. 43) “The airspeed displayed on the right-hand side may be partially deduced from the recording logic and from the fact that the associated angle of attack value from the ADR becomes invalid if the airspeed is less than 60 kt (the systems consider that the airspeed is insufficient for the angle of attack sensor to provide reliable information).”(BEA 3rd Interim Report, p.44).
The simulation also allowed for the recreation of the ECAM messages as they were displayed to the crew. Simulation work continues to: a) recalculate air speed from ADR 2; b) determine what instructions were displayed by flight directors' crossbars; and c) understand aircraft movement in three axes to further quantify the turbulence.
“It should be noted that, at the time of the accident, the presence of ice crystals at high altitude was not considered to be an objective danger and that crews were not made aware of this.” (p.52) “A scale of 160 NM enables the change in the weather situation to be assessed and anticipate route changes. A scale of 80 NM is used for avoidance. Short scales must be periodically discontinued in order to observe distant weather conditions and to avoid an impasse amid the disturbances. The shape of the echoes may alert the crew to the possible presence of hail. Zones of turbulence may be presented above a detected zone of precipitation. Red or magenta zones as well as fringe-shape echoes must in this way be by-passed from windward by regularly adjusting the tilt and the range. The avoidance decision must be taken before the echoes are at 40 NM.” (BEA 3rd Interim Report, p.52).
. . . “there may be strong turbulence 5,000 feet above the detected echo and that storms with peaks above 35,000 feet are dangerous.” (p. 54). “One Pilot's Personal Reflection” noted that turbulence within active cells of as strong storm can be strong enough to cause “structural failure”. He also observed that large hailstone almost always exist within such cells and can be “be thrown out of the top and sides of such storms, and it is best to avoid such cells by at least 20nms”. Granted that hailstones have not been confirmed in the storm that Air France 447 flew into.
“Supercooled [liquid] water (SLW) is common at normal altitude in and around thunderstorms, because in the absence of minute dust specks upon which ice crystals will form, water can remain liquid down to -40ºC. “ . . in young updrafts, or slowly rising layered clouds with cloud tops that are not too cold (above about -20ºC), SLW is often observed when such supercooled water touches anything, it will instantly turn to ice. If GZCP flew into super cooled water, the leading edges of the airframe become immediately covered with ice reducing lift and enhancing drag of the airfoil. Engines and pitot tubes are also severely affected very quickly.”
"Air Speed is THE critical data for the central computer system, and it is measured by pitot tubes by comparing the ram air pressure coming into the front of the tube with the static air pressure as measured by a static port on the side of the fuselage. The A330 has three independent pitot-static systems and it is very important they do not become blocked by dust, insects, ice, paint etc. One of the most important pre-flight checks is to check that the protective covers of the pitot-static sensors have been removed, and that they are not blocked. If the comparative check between air speed indicators during takeoff does not reveal proper function, then the pilot has the option to abort takeoff. “
When any flight deck crew notices a 'failure', there is a required Air France protocol for the processing of that anomaly. This procedure is believed by Air France to enhance as much as is possible: a) precise identification of the event; b) review of possible actions; c) implementation of most effective actions; and d) communication to all crew members and passengers. The necessity for “an immediate action performed from memory when the safety of the flight is directly compromised” is recognized. The entire protocol is explained on pp 54-55 of the August 4, 2011 BEA Interim Report No 3. In June 2004, Airbus published an “Unreliable Speed procedure (including a list of possible symptoms linked to erroneous speed or altitude information, among which [is recognized] the possible existence of undue stall warning.” The Airbus Procedure that has been in force since November 1997 (as described in the Airbus Flight Crew Operating Manual, Vol. 3) is reproduced on p.60 of the BEA Interim Report No 3. This protocol describes actions that were available to the pilots of Air France 447, Rio de Janeiro to Paris on May 31 to June 1, 2009, flying an Airbus 300 registration FGZCP. (This registration ID can be considered the 'name' of the aircraft and thus serves for precise identification of the plane that flew Flight 447.
Brightness Temperature (top) and False Color Images of AF 447 Impact Site
Largest Mesoscale Convection System (MCS) indicated by colored circle - NASA Goddard Space Flight Center
ON-BOARD RADAR: DRAGON AIRLINES - FLIGHT KA-609 Back to Top
On board weather radar systems have limitations in the detection of turbulence within developing weather systems. These limitations should be mentioned because the size and strength of the turbulence encountered by Air France 447 with the ITCZ is important and still a subject of some controversy. One of the best insights into
these limitations is provided by the Accident Report by the Hong Kong Transportation Safety Board (HTSB); about Dragon Airlines, Flight KA-609 from Kota Kinabalu, Malaysia to Hong Kong which flew an Airbus A330-300, registration B-HYA.
14 crew and 216 passengers encountered severe turbulence while in cruise at FL 410 and deviating from the airway due to information provided by the airborne weather radar system. When this incident had ended, all 12 cabin crew and 3 passengers were injured. Flight KA-609 had accidentally flown into a zone of severe turbulence that was created by strong convective activity associated with a tropical depression. Review of the cabin Flight Displays revealed that the crew was not able to view the developing weather pattern accurately,and therefore could not understand the severity of the developing weather. When a deviation from the flight plan and flyway was finally initiated, it was not sufficient to avoid the severe turbulence. To quote paragraph 2.2.2 from the HTSB Accident Report:
“Weather radar detects droplets of precipitation. The strength of the return depends on the size, composition and amount of droplets. Water particles are almost five times more radar reflective than ice particles of the same size. Weather radar is therefore effective in detecting rainfall and wet hail but not effective in detecting the upper level of a storm cell where most moisture exists in a dry, frozen state, i.e. in the forms of snow, ice crystals and hail. To determine the positions of storm cells, the antenna tilt angle should be adjusted to scan the icing level, where reflective water-covered ice/hail would be abundant. Above the icing level, ice crystals have minimal radar reflectivity. Although convective activities and turbulence exist at these levels, they do not show up readily on radar. To keep track of weather in the vicinity of the flight path, the antenna tilt angle should be frequently adjusted to scan the most reflective area in the icing level band. As altitude changes or as the aircraft gets closer to the storm cell, the tilt angle has to be changed so that the radar beam keeps scanning the most radar reflective area.”
One result of working with a deficient portrayal of rapidly developing severe weather is that crew responses will unavoidably cannot be optimized. American Airlines, Flight 587 crashed shortly after takeoff from Kennedy Airport (NYC) on November 12, 2001. The United States NTSB Report about this incident revealed that unnecessary and excessive rudder pedal inputs caused the tail and fin to detach from the fuselage and cause the crash. Frequent and unnecessary rudder pedal inputs were also a feature of the PF response and near arguments between crew members in the cockpit of Air France Flight 447 as CVR data revealed. However, there are important differences to keep in mind. With AA Flight 587 in 2001, “the entire rudder separated from the vertical stabilizer except for portions of the rudder spar structure that remained attached to hinge arm assembly numbers . . . “ As regards Air France, Flight 447, the rudder remained attached to the vertical stabilizer (fin).
Via radio or satellite, the Aircraft Communications Addressing and Reporting System (ACARS) transmits short, technical messages about the state of the aircraft. This message base is intended to outline a maintenance protocol protocol that should be attended to asap after landing. In a crisis situation where many of the usual communications from the cockpit are not possible, ACARS provides an invaluable record of problems with essential aircraft functions.
At the beginning of the CVR recording, just after midnight, the airplane was in cruise at flight level 350. Autopilot 2 and autothrust were engaged. The automatic fuel transfer to the “trim tank” was carried out during climb, and the airplane’s balance 27.5%, for a weight of 218 tonnes. The flight was calm. The crew, made up of the Captain and a copilot, was in VHF contact with the Recife control centre. . . They were concerned about the closing of one of the ETOPS alternate airfields, Sal-Amilcar in Heading Verde. They asked the OCC for a change who answered that the airfield was open in case of emergency.
. .. At around 1 h 35, the airplane arrived at the INTOL point and the crew left the Recife frequency to pass over to HF communication with the Atlantic oceanic control centre. A SELCAL test was carried out successfully, but the attempts to make the ADS connection with Dakar Oceanic failed.
Just afterward, the copilot modified the scale of his ND from 320 NM to160 NM and noted that “there’s something straight ahead”, which was doubtless a reference to some direct radar echoes detected by the weather radar. The Captain confirmed and the crew again discussed the fact that the high temperature meant that they were not’t able to climb to FL370.
AT 1h 45, the airplane entered a slightly turbulent area, just before the SALPU point. Note: at around 0 h 30 the crew had received some information from the OCC on the presence of a convective zone linked to the ITCZ between SALPU and TASIL. The crew dimmed the cockpit lighting and turned on the lights “to see outside”. The copilot noted that they were going to “go into the layer” and that it would have been good to be able to climb. A few minutes later, the turbulence became a little stronger and the copilot proposed requesting a climb to level 360 non standard because he thought he was “really at the edge” of the cloud layer. The Captain answered that they would wait a little. He reduced the scale on his ND to 40 NM; the weather radar then changed to weather + turbulence mode. A little later he mentioned the appearance of Saint-Elmo’s fire and said that “it’s going to be turbulent” when he went to take a rest.
A little after 1h 52, the turbulence stopped. The copilot drew the Captain’s attention to the value of REC MAX, which then reached FL 375. The Captain made no comment.
A 1h 45, the airplane entered a slightly turbulent area, just before the SALPU point. Note: at around 0 h 30 the crew had received some information from the OCC on the presence of a convective zone linked to the ITCZ between SALPU and TASIL. The crew dimmed the cockpit lighting and turned on the lights “to see outside”. The copilot noted that they were going to “go into the layer” and that it would have been good to be able to climb. A few minutes later, the turbulence became a little stronger and the copilot proposed requesting a climb to level 360 non standard because he thought he was “really at the edge” of the cloud layer. The Captain answered that they would wait a little. He reduced the scale on his ND to 40 NM; the weather radar then changed to weather + turbulence mode. A little later he mentioned the appearance of Saint-Elmo’s fire and said that “it’s going to be turbulent” when he went to take a rest.
At 1h 55, the captain left his seat to take a rest without leaving instructions or assigning tasks for the two First Officers. The BEA believes that because of the captain's lack of guidance, there was an absence of formal framework and a breakdown of communication between the two First Officers. This charge is serious and the basis for criticisms of pilot communication, non-optimal task-sharing and subsequent flying decisions. Likely, the captain did not know what do beyond what he said. Greater experience aside, the captain had not received any specific training that would have prepared him for this situation. It was also possible, that each crew member was beginning to sense that the cockpit displays were not an accurate representation of the weather situation and its rapidly changing interaction with the flight envelope.
The second first office took the captain's seat. The First 1st Officer in the right hand seat became the Pilot Flying (PF), and the Second 1st Officer in the left seat was now the Pilot Monitoring (PNF). The First 1st Officer (PN) then pointed out to the PNF that “the little bit of turbulence that you just saw […] we should find the same ahead […] we’re in the cloud layer unfortunately we can’t climb much for the moment because the temperature is falling more slowly than forecast”. . . .
. . . The copilot in the right seat said that they were “apparently on the edge of the layer”, before adding that he would have preferred to climb to FL 360. Climbing to a higher level was a preoccupation for the crew. The pilots clearly wanted to fly outside of the cloud layer, probably to limit turbulence.
The conversations in the cockpit did not reveal any malfunction of the weather radar nor worries that the display might not be a usable image. The background noise changed rapidly at ~ 2 h 09 min 46 and was identified as possibly indicating ice crystals but the crew did not comment. The weather phenomenon now surrounding FGZCP were of a type little known to pilots at the time. The PNF then took the initiative to reduce the Mach towards 0.8 and the engine anti-ice devices were triggered. The PNF appears to act with confidence and demonstrated an ability to make decisions that accommodate to a rapidly changing situation. Unfortunately, because it was not possible to quickly understand the degradation of the PFD, decisions made were doomed to be less than optimal.
Now Click Here to view the same graph in a vertical orientation which makes reading before 2h 11h 55sec easier. Click the + magnifier to display the graph at maximum size, then CTL ++ to enlarge the image further. Scroll slowly and read carefully.
Phase 2
At 2 h 10 min 05, the sudden drop in the measured airspeeds, likely due to the obstruction of the Pitot probes by ice crystals, caused autopilot and autothrust disconnection (the thrust was then locked) and the change in flight control from Normal Law to Alternate Law. Airspeed decreased from ~275 knots to 60 knots, indicated air speed was displayed in the left side PFD. Significant turbulence is revealed by Autopilots inputs and the aircraft rolled about 8 to the right. The nose pitched up to 11º within ten seconds. “The PF announced "I have control" and made a quick left nose up input almost to the mechanical stops of the side stick. The nose pitched further up and at 02:10:10Z the stall warning activates.” The Flight Directors were not disengaged by the crew, but the crossbars disappeared.
Click Here to view an exceptional, large, and detailed graph about the events the beset Air France 447 from 2h 04min to 2h 14min 7sec at which time the last ACARS message noted extreme vertical speed at a altitude of less than 4,000'. Click the + magnifier to display the graph at maximum size, then scroll slowly and read carefully. This graph is a superb data presentation, please do not pass over this link.
Author's note: It is impossible not to notice that the pitot tube system receives only very brief mention in the BEA 3rd Report. “One Pilot's Personal Reflection” elaborates. “The pitot tube captures ram air, which is sensed by an Air Data Module in the A330, and converted to airspeed. The drain tube allows water to pass without clogging the pitot. To do that, it passes air all the time. The pitot opening is a specific size, say 5mm diameter, and the drain is maybe 2mm. That makes the pitot about 20 sq. mm area, and the drain about 3 sq. mm area, for a ratio of about 7:1. This means the ram air pressure at the sensor is about 14% less than actual ram air pressure.”
“When it comes to clogging at high altitude, there are three possibilities:-
1. Pitot clogged, drain clogged at same time:- Indicated Air Speed (IAS) will not change with change of aircraft speed, but IAS will increase with increase of altitude.
2. Pitot open, drain clogged:- IAS will increase 14%. 14% excess IAS will remain regardless of actual airspeed or altitude.
3. Pitot clogged, drain open:- IAS will decrease toward zero as the drain bleeds off the ram air pressure to ambient. Increased altitude will not affect IAS.”
“Stalling occurs when the wing reaches an Angle of Attack (AoA), the angle at which the air hits the leading edge of the wing, when the airflow over the top of the wing breaks down completely and becomes turbulent. When the break point is reached, lift is lost until the AoA is reduced to a point where normal airflow over the wing is re-established. During certification test flying. a lot of very brave flying is done to ensure that the aircraft exhibits sufficient warning (increasing airframe buffet) before the break point, and that at the break point the aircraft pitches nose down so that it re-establishes a normal AoA. . . . “Stalling occurs when the Angle of Attack (AoA) exceeds the critical point, usually around 15 degrees nose up. Once the AoA goes beyond this point the air flow separates, causing buffeting and loss of lift. . . . The only way to uninstall the wing is to pitch the nose down so as to reduce the AoA to less than 15 degrees However, the critical AoA at higher Mach numbers can be considerably less than this and there are several problems that pilots do not always adequately understand. The first is the deep stall which can happen on T-tailed aircraft . . The deep stall occurs when the turbulent air flow from the wings blanks the elevators such that they lose all effectiveness.”
When autopilot and auto-thrust were no longer available and the aircraft reverted to Alternate Law - “Hello PF, FGZCP systems needs your direct input from this point forward!”, the pilots had to fly the aircraft using power and attitude table data displays IF those were available.
“The only way to uninstall the wing is to pitch the nose down so as to reduce the AoA to less than 15 degrees
However, the critical AoA at higher Mach numbers can be considerably less than this. But there are several problems that pilots do not always adequately understand. The first is the deep stall which can happen on T-tailed aircraft . . The deep stall occurs when the turbulent air flow from the wings blanks the elevators such that they lose all effectiveness.”
At 2 h 10 min 10, the PF’s nose-up inputs increased the angle of attack and the stall warning triggered twice transitory. Probably in reaction to this warning, the PNF exclaimed “what is that?”. The PF then said “We haven’t got good … We haven’t got a good display … of speed” and the PNF says “We’ve lost the speeds” which the first clear indication on the CVR that the crew recognizes serious trouble has arrived. The angle of attack recorded was around 5°, for a theoretical stall warning threshold trigger value of slightly over 4°.
At 2:10 min 16, a cockpit display informs that an ACARS message AUTO FLT REAC W/S DET FAULT was sent because wind shear detection had become unavailable.
Between 02:10:18 and 02:10:25 the PNF reads various ECAM messages in a disordered manner, noted the loss of speed (autothrust) and change-over to Alternate Law to the PF. Both left hand and ISIS air speeds were now below 100 knots, AoA had increased to more than 10º. (The Integrated Standby Instrument System (ISIS) is a backup, independent source data for attitude, airspeed, Mach, altitude and vertical speed.) The aircraft was climbing 700 feet/min and then rolled left and right. The bank angle remained between -10 (left) and +13 (right) degrees of bank, as result of PF inputs. The thrust lock function was de-activated. Both first officers recognized the loss of airspeed indications, however none called for the unreliable airspeed procedures. Comparing the three airspeed indications the PNF urges the PF several times to lower the nose and descend. The aircraft was climbing through FL370 and continued to climb.
Between 2:12:27 and 2:12:33, the CVR records the confusion of the PF that the aircraft was climbing when it should be descending.
Click Here for the Air France, Flight 447, Preliminary Weather Analysis for June 1, 2009 that was released by BEA on June 9, 2009. This document provides a slide show for the Life Cycle of the two Cumulonimbus cloud Formations that formations that developed to a height of 16,000 km in the early hours of June 1. 2009 and were devastating to Air France, Flight 447. Excellent!
The crew identified the loss of the speed displays but neither of the two copilots called out the associated procedure. The “Unreliable IAS” emergency maneuver requires as a first step to disconnect the automatic flight controls and disengage the Flight Directors. The two copilots had only been trained for the emergency maneuver at lower levels, in the course of which the pitch attitude to adopt is 10° or 15°. However, an OSV note described the problems of the loss of speed indications up to then on the A330/A340 fleet in cruise and recalled the procedures to apply. This note had been distributed to all the flight crew in the A330/A340 division.
The latter then made several nose-down inputs that resulted in a reduction in the pitch attitude and the vertical speed, whose values nevertheless still remained excessive; the airplane then being near 37,000 ft and continuing to climb, without any intervention from the PNF. Although the REC MAX had been a permanent preoccupation before the AP disconnection, neither of the two copilots made any reference to it.
At around 2 h 10 min 34, the speed displayed on the left side rose rapidly to 215kt and became valid again; the speed on the ISIS was still incorrect. FGZCP had lost ~60 kt since the autopilot disconnection and the beginning of the climb, which is consistent with the increase in altitude of ~2,000 ft.
At 12:10:45, there is a slight argument between the PNF and PF about putting the wings level.
At 2 h 10 min 47, the thrust levers were slightly retarded to 2/3 of the IDLE/CLB (85% of N1) range. Two seconds later, the pitch attitude went down a little to 6°, the roll was controlled, the angle of attack was slightly below 5° and the THS was 3° nose-up. The vertical speed was reduced from a high at +1,100 ft/min to 100 ft/min .The angle of attack was reduced to ~3 degrees and the roll was controlled and the flight of FGCP likely appeared 'normal' at this time. In the following seconds, the PNF tried to call back the Captain
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During this phase, at no time did either of the two copilots make any callouts on speed, pitch attitude, vertical speed or altitude. The Flight Directors not having been disengaged, the cross bars disappeared and reappeared several times. It is not possible at this stage pf the investigation to know what orders may have been given, nor to establish if these orders influenced the actions of the PF.
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After a rapid increase in pitch attitude and altitude, resulting from the PF’s inputs, the airplane’s flight path seemed to have been mastered. The increase in initial pitch attitude and magnitude of vertical speed were excessive for this flight altitude and should have led to immediate call outs of the discrepancies by the PNF. The absence of specific training in manual aircraft handling at high altitude likely contributed to the inappropriate piloting inputs and surveillance. The low level of synergy observed between the two copilots may have resulted from the absence of a clear attribution of roles by the Captain, as well as from the absence of any CRM training between two copilots, in a situation with a relief Captain. However, there are no regulations that require such training nor guidelines for taking decisions when designating the relief Captain during flights made by reinforced crews.
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All commentators agree that the each crew member was very experienced for their specific assignment in the crew of FGZCP, Air France Flight 447. Intuition, however irrational and unprofessional, intuition should not be dismissed as irrelevant in a situation such as this. Each pilot brings their previous flying experience to each flight, and intuition is automatically in play when there is no immediate explanation for a situation. Because intuition is not rational, is not a linear deductive process, hesitation in revealing intuitive thoughts to colleagues and a superior is understandable. Pilots are human beings and a deep technical training does not eliminate, the irrational components of the human mind. Furthermore, everyone can recall situations where an intuitive assessment proved accurate and valuable.
This web page is an appendix from the eBook that derives from our Air France Flight 447 project. Chapters and appendices from this ebook are released out of sequence so as to make them available at the earliest possible date.
The first chapter in the Air France, Flight 447 eBook introduces the flight of Airbus F-GCZP from Rio de Janeiro to Paris, May 31/June 1, 2009 and the serious problems that soon became apparent to the crew. The second chapter in this eBook discusses the search for the wreckage of Air France, Flight 447, and the recovery of the Flight Deck Recorder and Cockpit Voice Recorder. The third chapter reviews the last five minutes of Air France, Flight 447. The fourth chapter examines the design and function of the pitot-static and angle of attack sensors whose data is essential to the Fly-By-Wire computer system interaction with flight control surfaces. There is a consensus that iced over pitot tubes rendered the Airbus 330 computer system unable to properly instruct flight control surfaces because the data stream the conveyed essential parameters about the flight envelope was either absent or corrupted from a critical time point forward. The fifth chapter will look at the vertical stabilizer of Airbus 330 aircraft, review the problems inherent with carbon-resin components in aircraft design, review aviation incidents in which tail components detached from the aircraft fuselage, and attempt to assess the contribution to the Air France FLight 447 tragedy that was made by the loss of the vertical stabilizer.
The sixth chapter will look at 'hypercomplexity' as inherently problematic in aircraft design. The seventh and last chapter will attempt an integrative scenario - synthetic analysis - to explain the AF 447 tragedy. Several suggestions for changes to aircraft design and pilot training will be offered. Target date to have all chapters and appendices online is February 1, 2012, at which point this ebook can be read in a coordinated sequence. Photos and technical graphs are presented in a larger size than is usual so that details and small font text may be read as easily as is possible. The design of these web pages is optimized for a monitor
resolution of 1440 x 900. If your monitor is set to display smaller dimensions, horizontal scrolling of these web pages will be necessary. Please bookmark this page and occasionally check back to remain current with this publication schedule.