Body Mass Index (BMI) as a first-line screening criterion for detection of excessive daytime sleepiness among professional drivers

OBJECTIVES: Obstructive sleep apnea (OSA) is the main predisposing factor of excessive daytime sleepiness (EDS), and, therefore, increases the risk of road crashes. However, it is difficult to rely on medical intake for OSA or fatigue since drivers' symptoms reports are not reliable. On the other hand, direct measurement of EDS among large numbers of drivers carries serious practical drawbacks. Obstructive sleep apnea, in turn, is strongly related to obesity, and elevated body mass index (BMI) is considered one of the major risk factors for OSA. Thus, it could be postulated that BMI may carry predictive value for EDS proneness. METHODS: The present study examined the interrelation between BMI, degree of OSA, as measured with Respiratory Distress Index (RDI), and the degree of EDS, as measured with the mean sleep onset latency in the Multiple Sleep Latency Test (MSLT) among obese (BMI = 32) professional drivers. The drivers went through polysomnography followed by the five sessions of MSLT in the next day. RESULTS: In accordance with prior studies, we have found strong correlation between BMI and the degree of OSA on the one hand, and between the degree of OSA and EDS on the other hand. OSA was detected among 77.7% of the drivers, 47.1% were sleepy, 19% had severe sleepiness [mean sleep latency [MSL < or = 5 min.], 28.1% had moderate sleepiness [MSL < or = 10 min.]. None of the drivers complained about any sleep problem, including snoring, and all reported that they do not experience excessive daytime sleepiness. Thus, there was no correlation between their subjective report and objective findings. CONCLUSIONS: Obese drivers with BMI above 32 are highly prone to be sleepy during the day. Their subjective reports of OSA or fatigue symptoms are not reliable. Therefore it is highly recommended to screen them easily by weight and height measure for further sleep study and decision about their driving abilities.     

Evaluation of Vehicle-Based Crash Severity Metrics

Objective: Vehicle change in velocity (delta-v) is a widely used crash severity metric used to estimate occupant injury risk. Despite its widespread use, delta-v has several limitations. Of most concern, delta-v is a vehicle-based metric which does not consider the crash pulse or the performance of occupant restraints, e.g. seatbelts and airbags. Such criticisms have prompted the search for alternative impact severity metrics based upon vehicle kinematics. The purpose of this study was to assess the ability of the occupant impact velocity (OIV), acceleration severity index (ASI), vehicle pulse index (VPI), and maximum delta-v (delta-v) to predict serious injury in real world crashes.

Methods: The study was based on the analysis of event data recorders (EDRs) downloaded from the National Automotive Sampling System / Crashworthiness Data System (NASS-CDS) 2000–2013 cases. All vehicles in the sample were GM passenger cars and light trucks involved in a frontal collision. Rollover crashes were excluded. Vehicles were restricted to single-event crashes that caused an airbag deployment. All EDR data were checked for a successful, completed recording of the event and that the crash pulse was complete. The maximum abbreviated injury scale (MAIS) was used to describe occupant injury outcome. Drivers were categorized into either non-seriously injured group (MAIS2?) or seriously injured group (MAIS3+), based on the severity of any injuries to the thorax, abdomen, and spine. ASI and OIV were calculated according to the Manual for Assessing Safety Hardware. VPI was calculated according to ISO/TR 12353-3, with vehicle-specific parameters determined from U.S. New Car Assessment Program crash tests. Using binary logistic regression, the cumulative probability of injury risk was determined for each metric and assessed for statistical significance, goodness-of-fit, and prediction accuracy.

Results: The dataset included 102,744 vehicles. A Wald chi-square test showed each vehicle-based crash severity metric estimate to be a significant predictor in the model (p < 0.05). For the belted drivers, both OIV and VPI were significantly better predictors of serious injury than delta-v (p < 0.05). For the unbelted drivers, there was no statistically significant difference between delta-v, OIV, VPI, and ASI.

Conclusions: The broad findings of this study suggest it is feasible to improve injury prediction if we consider adding restraint performance to classic measures, e.g. delta-v. Applications, such as advanced automatic crash notification, should consider the use of different metrics for belted versus unbelted occupants.     

Emergency drills for agricultural drought response: a case study in Guatemala

Drills are an important element of disaster management, helping to increase preparedness and reduce the risk of real‐time failure. Yet, they are not applied systematically to slow‐onset disasters such as a drought, which causes damage that is not instantly apparent and thus does not solicit immediate action. This case study evaluates how drills inform institutional responses to slow‐onset disasters. It spotlights Guatemala, a country where drought has severe impacts on livelihoods and the food security of small farmers. By implementing part of the Ministry of Agriculture, Livestock and Food's institutional response plan for drought, it explores how drills can help to detect issues in emergency response and to foster an institutional focus on improvements in preparedness. The results reveal that drills alone do not trigger institutional improvements if unsupported by a wider strategy that seeks to enhance capacities and protocols. These findings are valuable, however, in making problems transparent and in creating the space for discussion.     

Surrounded by Chemical Valley and ‘living in a bubble’: the case of the Aamjiwnaang First Nation,Ontario

This study examines the perceptions and coping strategies of the Aamjiwnaang First Nation, which is surrounded by ‘Chemical Valley’, the largest complex of petrochemical plants in Canada. Analysis of in-depth interviews showed that residents perceive ‘Mother Earth to be sick’; however, a strong level of community cohesion prevails, with ‘place’ as a significant anchor to the culture and history of the community. Residents articulated a collective sense of responsibility for the well-being of members both within and surrounding the community, whereby some residents would never leave, regardless of the toxic environment and concern for high rates of cancer and respiratory diseases among both adults and children. Residents employed action-focused coping strategies such as ‘indoor evacuation’ and the ‘Cop-sniff test’, and emotional coping strategies including blocking out the effects of ‘Chemical Valley’ by frequently ignoring warning sirens from industry. The results call on the need for a collaborative environmental planning intervention involving clear community participation. Findings suggest the need for an indoor recreational facility for both children and adults, and a graded warning system.     

Stress and strain among union lay officials and rank-and-file members

This study explored the effects of fulfilling, on a voluntary basis, the role of lay officials in a local union of teachers on stress, strain, and the relationship between stress and strain. Levels of typical teachers' stress, and their effects on strain, were systematically compared for lay officials and rank-and-file members. Data were gathered from 1045 teachers who constituted 60 per cent of the staff in a representative sample of 30 high schools in Israel. Respondents completed a questionnaire that included measures of several types of occupation-specific stresses and two psychological strains: Somatic complaints and burnout. Relative to the rank-and-file members, union officials reported higher levels of overload and parent–teacher conflict, but the same levels of strain. The results of the regression analyses indicated, as expected, that union officials' strain was predicted by stresses associated with their representational duties. For the two groups of teachers, the measures of stress exerted the same detrimental effect on each of the strains. Thus, it was concluded that lay union officials were not at greater risk of psychological strain relative to their fellow teachers.     

Textiles for health: a review of textile fabrics treated with chitosan microcapsules

Environmental Chemistry Letters - The&nbsp;textile industry has recently&nbsp;been developing innovative products that integrate functional properties within commodity textiles. In...     

Balkan endemic nephropathy and aristolochic acid I: an investigation into the role of soil and soil organic matter contamination,as a potential natural exposure pathway

Aristolochic acids (AAs) are carcinogenic and nephrotoxic plant alkaloids present in Aristolochia species, used in traditional medicine. Recent biomolecular and environmental studies have incriminated these toxins as an etiological agent in Balkan endemic nephropathy (BEN), a severe kidney disease occurring in the Balkan Peninsula. The questions on how the susceptible populations are exposed to these toxins have not yet been clearly answered. Exposure to AAs through the food chain, and environmental pollution (soil/dust), could provide an explanation for the presence of BEN in the countries where no folkloric use of the plant has been documented (Bulgaria, Croatia). Additional exposure pathways are likely to occur, and we have shown previously that AAs can contaminate crop plants through absorption from soil, under controlled laboratory environment. Here, we attempt to provide additional support to this potential exposure pathway, by revealing the presence of AAI in soil and soil organic matter samples collected from BEN and non-BEN areas. The samples were processed in order to be analyzed by high-pressure liquid chromatography, and ion trap mass spectrometry. Our results showed the presence of AAI in small concentrations, both in BEN and non-BEN soils, especially where Aristolochia plants and seeds were present.