Flight Crew Alertness and Sleep Relative to Timing of In-Flight Rest Periods in Long-Haul Flights

BACKGROUND: In-flight breaks are used during augmented long-haul flight operations, allowing pilots a sleep opportunity. The U.S. Federal Aviation Administration duty and rest regulations restrict the pilot flying the landing to using the third rest break. It is unclear how effective these restrictions are on pilots’ ability to obtain sleep. We hypothesized there would be no difference in self-reported sleep, alertness, and fatigue between pilots taking the second vs. third rest breaks. METHODS: Pilots flying augmented operations in two U.S.-based commercial airlines were eligible for the study. Volunteers completed a survey at top-of-descent (TOD), including self-reported in-flight sleep duration, and Samn-Perelli fatigue and Karolinska Sleepiness Scale ratings. We compared the second to third rest break using noninferiority analysis. The influence of time of day (home-base time; HBT) was evaluated in 4-h blocks using repeated measures ANOVA. RESULTS: From 787 flights 500 pilots provided complete data. The second rest break was noninferior to the third break for self-reported sleep duration (1.5 6 0.7 h vs. 1.4 6 0.7 h), fatigue (2.0 6 1.0 vs. 2.9 6 1.3), and sleepiness (2.6 6 1.4 vs. 3.8 6 1.8) at TOD for landing pilots. Measures of sleep duration, fatigue, and sleepiness were influenced by HBT circadian time of day. DISCUSSION: We conclude that self-reported in-flight sleep, fatigue, and sleepiness from landing pilots taking the second in-flight rest break are equivalent to or better than pilots taking the third break. Our findings support providing pilots with choice in taking the second or third in-flight rest break during augmented operations

Varespladib and cardiovascular events in patients with an acute coronary syndrome: the VISTA-16 randomized clinical trial

IMPORTANCE: Secretory phospholipase A2(sPLA2) generates bioactive phospholipid products implicated in atherosclerosis. The sPLA2inhibitor varespladib has favorable effects on lipid and inflammatory markers; however, its effect on cardiovascular outcomes is unknown. OBJECTIVE: To determine the effects of sPLA2inhibition with varespladib on cardiovascular outcomes. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized, multicenter trial at 362 academic and community hospitals in Europe, Australia, New Zealand, India, and North America of 5145 patients randomized within 96 hours of presentation of an acute coronary syndrome (ACS) to either varespladib (n = 2572) or placebo (n = 2573) with enrollment between June 1, 2010, and March 7, 2012 (study termination on March 9, 2012). INTERVENTIONS: Participants were randomized to receive varespladib (500 mg) or placebo daily for 16 weeks, in addition to atorvastatin and other established therapies. MAIN OUTCOMES AND MEASURES: The primary efficacy measurewas a composite of cardiovascular mortality, nonfatal myocardial infarction (MI), nonfatal stroke, or unstable angina with evidence of ischemia requiring hospitalization at 16 weeks. Six-month survival status was also evaluated. RESULTS: At a prespecified interim analysis, including 212 primary end point events, the independent data and safety monitoring board recommended termination of the trial for futility and possible harm. The primary end point occurred in 136 patients (6.1%) treated with varespladib compared with 109 patients (5.1%) treated with placebo (hazard ratio [HR], 1.25; 95%CI, 0.97-1.61; log-rank P = .08). Varespladib was associated with a greater risk of MI (78 [3.4%] vs 47 [2.2%]; HR, 1.66; 95%CI, 1.16-2.39; log-rank P = .005). The composite secondary end point of cardiovascular mortality, MI, and stroke was observed in 107 patients (4.6%) in the varespladib group and 79 patients (3.8%) in the placebo group (HR, 1.36; 95% CI, 1.02-1.82; P = .04). CONCLUSIONS AND RELEVANCE: In patients with recent ACS, varespladib did not reduce the risk of recurrent cardiovascular events and significantly increased the risk of MI. The sPLA2inhibition with varespladib may be harmful and is not a useful strategy to reduce adverse cardiovascular outcomes after ACS. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01130246. Copyright 2014 American Medical Association. All rights reserved

Investigation of the effectiveness of a split sleep schedule in sustaining sleep and maintaining performance

Shift work is common in today's society, and is associated with negative health outcomes, and accidents and incidents. These detrimental effects can be primarily attributed to sleeping and working at an adverse circadian time. The aim of this study was to examine whether a split sleep schedule is as effective as a consolidated day shift or night shift schedule for maintaining performance and sustaining sleep. Fifty-three healthy male volunteers (mean ± SD age = 26.51 ± 4.07 years) underwent a randomized three condition study design. A split sleep condition involving two 5-h sleeping opportunities in 24 h [time in bed (TIB) 0300 h-0800 h and 1500 h-2000 h] was compared to a 10-h consolidated nighttime sleep (TIB 2200 h-0800 h) and 10-h consolidated daytime sleep (TIB 1000 h-2000 h). All participants underwent a baseline period of 10 h of nocturnal time in bed (TIB) followed by a 5-d simulated workweek spent in one of the three conditions. Polysomnography, psychomotor vigilance task, digit-symbol substitution task and subjective state were assessed. During the 5-d simulated workweek, participants in the nighttime sleep condition slept the most (total sleep time per day (TST) 8.4 h ± 13.4 min), followed by the split sleep condition (TST 7.16 h ± 14.2 min) and the daytime sleep condition (TST 6.4 h ± 15.3 min). Subjective sleepiness was highest in the daytime sleep condition and lowest in the nighttime sleep condition. No significant differences in performance were observed between the conditions. Compared to a nighttime consolidated sleep opportunity or split sleep, placement of a consolidated sleep opportunity during the day yielded truncated sleep and increased sleepiness. Further research in real-world situations is warranted to fully assess the efficacy of alternative split sleep schedules for improving safety and productivity

Photonic Crystal Surface Emitting Diode Lasers with λ near 2 µm

Epitaxially regrown electrically pumped photonic crystal surface emitting lasers (PCSELs) operating near 2 µm were designed and fabricated within a III-V-Sb material system. A high-index-contrast photonic crystal layer was incorporated into the laser heterostructures by air-pocket-retaining epitaxial regrowth. Transmission electron microscopy studies confirmed uniform and continuous AlGaAsSb initial growth over the nano-patterned GaSb surface, followed by the development of the air-pockets. The PCSEL threshold current density had a minimal value of ~170 A/cm2 in the 160–180 K temperature range when the QW gain spectrum aligned with the Γ2 band edge of the photonic crystal. The devices operated in a continuous wave regime at 160 K. The divergence and polarization of the multimode laser beam emitted from the 200 µm × 200 µm PCSEL aperture were controlled by filamentation

Photonic Crystal Surface Emitting Diode Lasers with λ near 2 µm

Epitaxially regrown electrically pumped photonic crystal surface emitting lasers (PCSELs) operating near 2 µm were designed and fabricated within a III-V-Sb material system. A high-index-contrast photonic crystal layer was incorporated into the laser heterostructures by air-pocket-retaining epitaxial regrowth. Transmission electron microscopy studies confirmed uniform and continuous AlGaAsSb initial growth over the nano-patterned GaSb surface, followed by the development of the air-pockets. The PCSEL threshold current density had a minimal value of ~170 A/cm2 in the 160–180 K temperature range when the QW gain spectrum aligned with the Γ2 band edge of the photonic crystal. The devices operated in a continuous wave regime at 160 K. The divergence and polarization of the multimode laser beam emitted from the 200 µm × 200 µm PCSEL aperture were controlled by filamentation