Driving With Cardiovascular Disease: The Impact of Implantable Cardioverter Defibrillators on Driver Safety

Cardiovascular disease (CVD) is the leading cause of death in the United States. With America’s workforce rapidly aging, more attention is being placed on CVD and its treatment among employees in safety sensitive occupations, such as the transportation industry. Implantable cardioverter defibrillators (ICDs) are increasingly being used to treat certain cardiovascular conditions, but despite the fact that they are effective in preventing sudden death from cardiac arrhythmia, there is concern about allowing individuals with an ICD to drive. A systematic review and meta-analysis was conducted to examine the health and safety impacts ICDs on driving. We considered data pertaining to four outcomes among individuals with an ICD: crash rate, the occurrence of sudden death while driving, the occurrence of syncope while driving, and the occurrence of at least one shock from their ICD while driving. Currently, the impact of an ICD on driver safety cannot be determined. Our assessments of the evidence pertaining to crash rates and sudden incapacitation while driving were inconclusive. Our results do indicate, however, that some individuals with an ICD will experience an inappropriate ICD discharge while driving (Strength of Evidence Rating: Strong). Experiencing such a discharge while driving is a potential hazard to driver safety. Quantitative assessment of the available data suggests that approximately 6.3% (95% CI: 4.7%-8.4%) of all individuals with an ICD who drive will experience a discharge while driving. These findings have potential implications for regulatory agencies with responsibility for road safety; particularly those agencies that regulate safety sensitive industries

Seizure and the Risk for Seizure Recurrence Among Individuals Who Have Undergone Surgery for Epilepsy

Epilepsy is a central nervous system disorder for which recurrent seizures are the main symptom. Seizures resulting from epilepsy may culminate in unpredictable and sudden incapacitation, and thus are of significant concern to those interested in driver safety. Surgical therapy is one of the main treatment options for patients who do not respond to pharmacotherapy. Although approximately two thirds of individuals who undergo the most common types of surgery for epilepsy become seizure free, a significant proportion of these individuals will experience seizure recurrence. A systematic review and metaanalysis was conducted to examine the likelihood of seizure recurrence among individuals who have undergone surgery for epilepsy. Specifically, we were interested in quantifying the relationship between time since last seizure and the likelihood that a seizure will occur within the following year. Our results indicate that the longer the time that has elapsed since the occurrence of the last seizure, the lower the risk for seizure recurrence in the following year. The average annual risk for experiencing seizure recurrence among individuals who have remained seizure free for ≥8 years is less than 2% and less than 1% for those who have remained seizure free for ≥10 years. These findings have important implications for regulatory agencies with responsibility for road safety; particularly those agencies that regulate safety sensitive industries

One dimensional chain of quantum molecule motors as a mathematical physics model for muscle fibre

A quantum chain model of many molecule motors is proposed as a mathematical physics theory on the microscopic modeling of classical force-velocity relation and tension transients of muscle fibre. We proposed quantum many-particle Hamiltonian to predict the force-velocity relation for the slow release of muscle fibre which has no empirical relation yet, it is much more complicate than hyperbolic relation. Using the same Hamiltonian, we predicted the mathematical force-velocity relation when the muscle is stimulated by alternative electric current. The discrepancy between input electric frequency and the muscle oscillation frequency has a physical understanding by Doppler effect in this quantum chain model. Further more, we apply quantum physics phenomena to explore the tension time course of cardiac muscle and insect flight muscle. Most of the experimental tension transients curves found their correspondence in the theoretical output of quantum two-level and three-level model. Mathematically modeling electric stimulus as photons exciting a quantum three-level particle reproduced most tension transient curves of water bug Lethocerus Maximus.Comment: 16 pages, 12 figures, Arguments are adde

Conservatoires in society: institutional challenges and possibilities for change

Educational sociologists and philosophers have long recognised that educational institutions play a significant role in shaping as well as supporting societal norms. In the face of growing global social, political, and environmental challenges, should conservatoires be more overt in expressing a mission to sustain and improve the societies in which they are located? In times of ever-increasing scepticism emanating from governments and the broader populace alike about the efficacy of public spending, if not the public sphere itself, this essay suggests it is both timely and necessary for conservatoires to reconsider, reinvigorate and re-articulate their capacity to contribute to broader social goods. Drawing on the authors’ professional experience as well as current literature and debates, the essay is both deliberately provocative and open-ended, articulating a number of points of departure that institutions might consider in addressing the challenge of maintaining and exercising their relevance to broader society

A system for rating the stability and strength of medical evidence

BACKGROUND: Methods for describing one's confidence in the available evidence are useful for end-users of evidence reviews. Analysts inevitably make judgments about the quality, quantity consistency, robustness, and magnitude of effects observed in the studies identified. The subjectivity of these judgments in several areas underscores the need for transparency in judgments. DISCUSSION: This paper introduces a new system for rating medical evidence. The system requires explicit judgments and provides explicit rules for balancing these judgments. Unlike other systems for rating the strength of evidence, our system draws a distinction between two types of conclusions: quantitative and qualitative. A quantitative conclusion addresses the question, "How well does it work?", whereas a qualitative conclusion addresses the question, "Does it work?" In our system, quantitative conclusions are tied to stability ratings, and qualitative conclusions are tied to strength ratings. Our system emphasizes extensive a priori criteria for judgments to reduce the potential for bias. Further, the system makes explicit the impact of heterogeneity testing, meta-analysis, and sensitivity analyses on evidence ratings. This article provides details of our system, including graphical depictions of how the numerous judgments that an analyst makes can be combined. We also describe two worked examples of how the system can be applied to both interventional and diagnostic technologies. SUMMARY: Although explicit judgments and formal combination rules are two important steps on the path to a comprehensive system for rating medical evidence, many additional steps must also be taken. Foremost among these are the distinction between quantitative and qualitative conclusions, an extensive set of a priori criteria for making judgments, and the direct impact of analytic results on evidence ratings. These attributes form the basis for a logically consistent system that can improve the usefulness of evidence reviews

Routes to sustainability in public food procurement: An investigation of different models in primary school catering

Increasingly, policymakers are setting ambitious goals for sustainability in public procurement, integrated across different pillars. Such ambitions are apparent in public catering services, where procurement models have been shifting towards greater localisation of supply chains and purchasing of more organically grown food. To date however, few studies have examined empirically what the impacts of different procurement models are across these multiple pillars of sustainability. This research aimed to fill the gap, by measuring and comparing the environmental, economic and nutritional outcomes of different models of school meals procurement. Case studies were undertaken of ten primary school meals services in five European countries, capturing different procurement model types. Results showed carbon emissions ranged from 0.95 kgs CO2e per meal in the lowest case to 2.41 kgs CO2e in the highest case, with adoption of low carbon food waste disposal methods and reduction of the amount of ruminant meat in the menus being the most important actions for lowering emissions. In terms of economic impact, local economic multiplier ratios ranged from 1.59 to 2.46, and although the level of local food sourcing contributed to these ratios, the effect was eclipsed, in some cases, by investment in local catering staff. Meanwhile, implementation of a robust standards regime and improving canteen environment and supervision were the most important actions for nutritional quality and intake. The paper discusses the implications of the findings for integrated, sustainable models of food procurement

Solution structure and novel insights into the determinants of the receptor specificity of human relaxin-3

Relaxin- 3 is the most recently discovered member of the relaxin family of peptide hormones. In contrast to relaxin- 1 and - 2, whose main functions are associated with pregnancy, relaxin- 3 is involved in neuropeptide signaling in the brain. Here, we report the solution structure of human relaxin- 3, the first structure of a relaxin family member to be solved by NMR methods. Overall, relaxin- 3 adopts an insulin- like fold, but the structure differs crucially from the crystal structure of human relaxin- 2 near the B- chain terminus. In particular, the B- chain C terminus folds back, allowing Trp(B27) to interact with the hydrophobic-core. This interaction partly blocks the conserved RXXXRXXI motif identified as a determinant for the interaction with the relaxin receptor LGR7 and may account for the lower affinity of relaxin- 3 relative to relaxin for this receptor. This structural feature is likely important for the activation of its endogenous receptor, GPCR135