text:
|Publication number
|Publication type
|Publication date
|Aug 26, 1975
|Filing date
|Oct 16, 1973
|Priority date
|Feb 12, 1969
|Publication number
|Harry J. Edenhofer
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (9), Classifications (6), Legal Events (1)
|External Links: USPTO, USPTO Assignment, Espacenet
United States Patent [191 Edenhofer [541 HEARTBEAT MONITOR WITH AUDIO AND VISUAL OUTPUTS [75] Inventor: Harry .I. Edenhofer, Southampton,
[73] Assignee: Survival Technology, Inc., Bethesda,
[22] Filed: Oct. 16, 1973 [21] Appl. No.: 406,890
Related U.S. Patent Documents [58] Field of Search 128/205 R', 2.06 A, 2.06 F, 128/206 R, 2.05 T
[56] References Cited UNITED STATES PATENTS 2,492,617 12/1949 Boland et a1 128/206 11] E Re. 28,529
[ 1 Reissued Aug. 26, 1975 2,927,573 3/1960 Roepke et a1 128/205 T 3.138,151 6/1964 Chapman et a1... 128/205 3,144,018 8/1964 Head 128/206 X 3,144,019 8/1964 Haber 128/206 A 3.316.897 9/1967 Weidinger et a1. 128/206 3 ,426,150 2/1969 Tygart 128/206 R 3,599,628 8/1971 Abbenante et a1 128/206 F OTHER PUBLICATIONS Bastir, German allowed application No. 1,264,680, Mar. 28, 1968, 5 drawings, 5 pages-spec. (128/206) Primary EranzinerWilliam E. Kamm Attorney, Agent, or FirmCushman, Darby & Cushman [57] ABSTRACT A pocket size, self-contained cardiac monitor for onpatient or central station monitoring by visible and/or audible signals related to the beat of a patients heart, the monitor having the features of: using its own circuitry for calibration; having a time delay to mask out spurious signals; and having circuit means to drive a monitor lamp and speaker with a minimum of power.
4 Claims, 4 Drawing Figures Reissuecl Aug. 26, 1975 2 Sheets-Sheet 1 REMOTE JACK INPUT JACK RANGE INVENTOR.
Harry J. Edenhofer Frederick J. Olsson ATTORNEY.
HEARTBEAT MONITOR WITH AUDIO AND VISUAL OUTPUTS Matter enclosed in heavy brackets I: 1 appears in the original patent but forms no part of this reissue specification; matter printed in italics indicates the additions made by reissue.
This is a reissue application based on US. Pat. No. 3,613,670 issued Oct. I9, 1971.
This invention relates to medical equipment and in particular relates to a device serving as a cardiac monitor by producing audible and/or visible signals which are related to the heart rate of a persons heart, the audible signals being in the form of beeps from a speaker and the visual signals being flashes of light from a lamp.
One of the objects of the invention is to provide a design for a cardiac monitor which permits either onpatient or central station type of monitoring, for the latter type the monitor unit being directly connectable to the room call system for activating the alarms or indicators at the nurses central station.
A further object of the invention is .to provide a cardiac monitor having audible and/or visible signals activated in an alarm mode, in the alarm mode the signals being activated in a low range when the heart rate is below a selected rate setting and in a high range when the heart rate exceeds a selected rate setting.
Another object of the invention is to provide a cardiac monitor of the kind in question having circuitry arranged so that spurious signals do not activate the audio visual indicators and thereby prevent false alarms.
Another object of the invention is to provide a cardiac monitor having audible and/or visible signals activated in an alarm mode or in a pulse mode. In the latter mode the signals being activated directly in accordance with the heart rate.
Another object of the invention is to provide in a cardiac monitor of the kind in question circuitry wherein the heart rate set points can be checked for accuracy simply by use of the circuitry itself and thereby obviate the necessity for additional test equipment.
Another object of the invention is to provide in a cardiac monitor of the kind in question an audio-visual signal generator having a minimum number of circuit components and which draws for operation only approximately 2 milliamperes from an 8.4-volt battery.
With the above in mind the invention will be explained below in connection with the following drawings wherein:
FIG. 1 is a diagrammatic view representing various switches and control knobs which. may be on a face panel of an instrument constructed in" accordance with the invention; and I I: FIG. 2 is 1 FIGS. 2-2b are a diagrammatic view partially in block form and partially in circuit form showing various of the electrical components of the invention.
At the outset it is pointed out that the invention contemplates the use of standard conventional electrical components such as transistors, capacitors, resistors, diodes and the like. These various components are arranged and correlated with respect to one another in a unique manner so as to perform certain functions for carrying out the desired monitoring operation.
Referring to FIG. 1 the panel illustrates a monitor adapted for maximum functions as may be required as for example by a patient under intensive care.
The invention contemplates that the device be battery operated and that the battery be contained within the housing of the unit. This is of advantage in that the unit electrically floats so to speak and disturbances created from AC sources or other peripheral equipment are eliminated. The power switch SW-l connects or disconnects the battery with thecircuit.
Below the power switch is the mode switch SW-Z which conditions the unit for operation in either the alarm mode or to the pulse mode. The lamp switch SW-3 provides for use of the lamp either in alarm mode or in pulse mode. The lamp which is indicated at 1 flashes at a period corresponding to the beat of the patients heart. To the right of the alarm light 1, I have indicated several slots 2. These provide openings for a speaker disposed inside of the unit which, of course,
provides the audible signals.
The panel hasa rotatable control knob 3 associated with a scale 4. The knob 3 hasan arrow 5 which indicates the rotational position of the knob on the scale 4. Adjacent the knob 3 there is a similar knob 8 with an arrow 9 which is used in association with the scale 10.
The knob 3 is used for low-range monitoring. When the arrow 5 points, say to the numeral 40 on the scale, the unit will give visible and audible signals as long as the patients heart rate is below 40 beats per minute. After this rate of 40 beats per minute, the audiblevisible signal will cut off and will remain off until the heart rate reaches an upper limit.
The knob 8 is used forthe high range monitoring. When the knob is set so that the arrow 9 corresponds to, say the number 120, the unit will begin to give audible and visible signals when the patients heart rate is greater than 120 beats per minute.
The signals as between the low and high ranges are distinquishable by the difference in rate of occurrence and by that in the low-rate condition each signal is somewhat drawn out.
The switches S W4 and SW-2 are used in the process of checking accuracy of the rate setting in the low and in the high range.
Also, in FIG. 1, l have indicated a remote jack l1 and a scope jack 12. The remote jack is for use in integrating the unit into central station type of monitoring. For example, by a jack from the unit to the call system so that an alarm signal is fed to the central station. The purpose of the scope jack is that the EKG signal from the patient can be put on a oscilloscope for display.
As will be apparent to those skilled in the art as the description proceeds, the theory of operation of the device is in comparing two electrical quantities or signals and then initiating a resultant signal when the comparison indicates that certain conditions are present as between the two quantities. The device develops a quantity in the formof a square wave signal, the total period or interval of which is a function of the time constant of the circuit which develops the signal and also the heart rate of the patient. The circuitry also develops another quantity in the form of a square wave signal, the
is developed which-indicates the condition, ie. that the heart rate is less or greater than the set-in rate limit (by knob 3 or knob 8).
With the above in mind, reference is made to FIG. 2 for a more detailed explanation of the invention.
The first mechanism to be described is the trigger mechanism. This is indicated generally in FIG. 2 by the dotted line 15. The function of this mechanism is to receive the EKG signal from the electrodes attached to the patient and to convert these signals into trigger pulses. While the trigger mechanism may take a variety of forms, the arrangement noted in block form within the dotted lines has special advantages and is therefore prefe rred.
The input jack 16 is of conventional form and is adapted to be connected to the electrodes (not shown) which are placed on the patient in the usual manner. The electrodes are conventional preferably being EKONOTRODE brand. The first component in the trigger mechanism is an input overload safeguard 20 which in essence is a pair of diodes connected back to back, the purpose of which is to short out any high voltages which may be inadvertently or otherwise transferred into the jack. The signal from the overload 20 is fed to an amplifier 21 which amplifies the signal received from the patient. Connected to the output of the amplifier 21 is a low-pass filter 22. The purpose of this filter is to take out high-frequency signals due to patient muscle movement. In connection with the lowpass filter 22 the invention contemplates a 60-cycle notch filter 23 to remove any 60-cycle interference that may be present. The scope jack 12 is on the output of 60-cy'cle filter in order that the heart signal (minus the filtered out components) can be fed directly to an oscilloscope for" observation. The output of the 60-cycle notch filter is then amplified by the amplifier 24 for further processing. The peak detector 25 and the low-pass filter 26 produce rectified and filtered positive pulses. These are then fed into an inverter 27, the output of which produces negatively going trigger pulses when fed through the switch S4 to the input of a one-shot multivibrator indicated within the dotted lines 30.
In the explanation which follows it will be presumed that the switch SW-l is in the on" position and the mode switch SW-2 is in the alarm position and that the light switch SW-3 is also in the alarm position. The battery 29 is connected to the circuit as shown.
The one shot 30 is of conventional form comprising a pair of transistors 31 and 32 which are resistancecapacitanc'e coupled as by the resistance 33 and the capacitor'34.
The function of the one shot 30 is to receive the trigger pulses and to develop an output signal ultimately used in the comparison process. The output of the one shot is a square wave, the total period or interval of which is made up of an on" portion (a pulse) and an off portion. The period is the same as that of the trigger pulses. The on" portion is started by a trigger pulse and is of fixedduration depending upon the time constant or the values of 37 and 34. The off portion remains off until the trigger pulse.
The output of the one shot is connected via the diode 35 and the line 36 to the gate mechanism within the dotted lines 40 and also connected to the input of a low-range delay mechanism within the dotted lines 41. The low delay 41 and the gate 40 will be explained following. i i
The low delay 41 is a conventional construction and comprises a transistor 42 which functions as an inverter and transistor 43 which has an RC circuit comprising the variable resistor 44 and the capacitor45 coupled to the base of the transistor. With the switch SW-2 in the alarm position the output of the time delay mechanism 41 includes the emitter follower 46.
The function of the low mechanism 41 is to receive the signal from the one shot and develop an output signal which is used in the comparing process. The output signal of the low delay 41 is a square wave comprised of an on portion (a pulse) and an off" portion. The total period or interval is the same as between trigger pulses. The low delay 41 is turned on at the time of the termination of the one shot pulse or on portion. The duration of the on portion is controlled by the adjustment of the resistor 44 as noted below, The off portion is a function of theperiod between trigger pulses since the pulse turns on the one shot and when the same finishes operating, the time delay is turned on again.
The RC circuit determines the nonconduction time of the transistor 43 and therefore controls the duration or the on time of the low delay 41. The resistor 44 is coupled to the knob 3 (FIG. 1) and the resistance value is changed by the rotation of the knob. When the knob'3 is rotated so that the arrow 5 is aligned with one of the numbers on the scale 4, the value of the resistor is such that the duration of the on portion corresponds to the heart rate setting on the scale.
From the above it will be apparent that the time relationship of the one-shot signal and the low delay signal is fixed in that the one shot is turned on by a trigger pulse and the low delay is turned on by the one shot. In other words, the one shot is turned on by a trigger pulse, has a fixed on portion and then goes off until the next trigger pulse. The low delay is turned on when the one shot goes off, has a settable on" period and then goes off until turned on again by the one shot.
The gate mechanism 40 comprises a pair of. input diodes 49 and 50 and output resistor 52. Diode 49 is connected to the one shot output. Either diode will conduct when an. anode is positive with respect to the cathode. In the case of the low delay, the diode 49 is active and the output is a square wave, the same as the one shot square wave.
The output of the low delay 41 and the output of the gate 40 are connected to the comparing mechanism 53 which will compare the signals and sense whether the heart rate is below the rate set in by the arrow 5. This is explained by the following.
The comparing mechanism 53 is a silicon-controlled rectifier SCR 54. The SCR will conduct when the gate is positive and the cathode negative. Conduction is stopped by the cathode going positive. The signal from the gate 40 and the signal from the low delay 41 (via emitter follower 46) are respectively applied to the gate and the cathode to effect the conduction modes as noted below.
When the one shot 30 is off or on nonconducting the anode of the gate diode 49 is biased positively through the resistor 51. This causes the diode to conduct through resistor 52 and a positive voltage appears on the gate of the SCR 54. Inasmuch as the one shot is turned off, the time delay has been turned on and the emitter follower 46'does not conduct. This puts a positive voltage on the cathode of the SCR 54 so the SCR does not conduct.
Assuming a trigger pulse has not yet carried at the completion of the on condition of the low time delay, (nonconduction of the emitter follower), the time delay will go into the o'ff"- condition and the emitter follower-will commence conduction. This will make the cathode of the SCR negative and the same will conduct. The SCR will continue to conduct until the low time delay is turned to the on condition by the one shot.
.- The conduction of the SCR 54 of comparing mechanism 53 is adapted to provide for the actuation of the audible and/or visible signals. However, it is believed expedient to defer going into this until after the explanation of the workings of the high delay mechanism which is indicated in FIG. 1 within the dotted lines 60.
Before proceeding, it is pointed out that where the heart rate is over the rate limit setting on the low range, the trigger pulses appear with such rapidity that the low delay cannot complete its on" portion before the next pulse appears. Under this condition the one-shot signal and the low delay signals are duplicates. Therefore, the polarities of the voltages on the SCR will not be correct to cause conduction. There will not be any audible or visible signal (up until the rate exceeds the setting on the high range). Within this rate period the high delay 60 (commented on below) has no effect in turning on the SCR 54.
The high delay mechanism 60 is constructed in the manner similar to the low delay mechanism 41. The high delay includes the transistor 61 which functions as an inverter together with the output transistor 62 to whose base is connected an RC circuit comprising the variable resistor 63 and the capacitor 64.
When the switch SW-2 is in pulse position the fol- .lower 40 is part of the high delay 60.
The output from the low delay is connected to the high delay and will cause the same to develop a square wave output. The duration of the on" portion of the signal is determined by the setting of the resistor 63. The resistor 63 is connected to the knob 8 (FIG. 1) so that the output or conduction time of the transistor 62 is a function of the rate limit set in accordance with the scale 10. In the case of the high delay the diode 50 is active and functions in the same manner as the diode Since an audible or visible indication is desired when the heart rate exceeds the setting on the scale 10 (FIG. 1) the high delay is used to turn on the SCR 54 while the one shot signal is used to turn off the SCR 54. Actually, the low delay signal is used for turn off purposes since this signal is a duplicate of the one shot.
With reference to FIG. 1 it will be observed that when the high delay is on or nonconducting, a positive voltage is applied to the gate of SCR 54. At this time the low delay is on and a positive voltage is also applied to the cathode of the SCR. The SCR cannot conduct. The high and low delays go off together and this causes negative voltages on the gate and cathode of the SCR and the same cannot conduct. Therefore, I have included an additional. delay in the output of the high delay in the form of a capacitor 65 and resistor 66. This had the effect of momentarily holding up the positive voltage on the gate. At this instant, of course, the cathode will bemegative and therefore the SCR will have theproperpolarity for conduction. The SCR will continue to conduct until the low delay stops conducting so that a positive voltage is applied to the cathode.
As mentioned heretofore, the invention is versatile in that it may adapted to fit the particular needs of a patient. For example, in FIG. 1 I have shown circuitry for adapting the unit with both the visible and audible signals to be observed by the patient. This is enclosed within the dotted lines 0-1.
Also, I have shown circuitry particularly useful for central station monitoring. This is shown within the dotted lines 02.
For purposes of explanation, let us assume that the arrangement within the dotted lines 0-1 is to be activated by the comparing mechanism.
When the SCR 54 conducts a negative bias is put on the base of the transistor 67 and since its emitter is positive, the transistor cannot conduct. The effect of this is to complete the circuit including the secondary coil of the isolation transformer T-1 and the primary coil of the speaker transformer T2. The secondary coil of the transformer T2 is connected to the speaker 8-1. When the secondary coil of the transformer T-2 is energized, the speaker responds.
At the same time, conduction of the SCR 54 causes negative bias on the base of the transistor 68 and since its emitter is positive the transistor conducts. Conduction of the transistor 68 puts the positive supply voltage on the emitter of the transistor 69.This causes the emitter-to-base conduction in the transistor 69 down through the resistor 70 up through the primary coil 71 of the transformer Tl, down through the resistor 72, through the base and emitter of the transistor 73 to ground.
The above-described emitter-to-base conduction biases the transistors 69 and 73 so that they have collector conduction through the primary 71 of transformer Tl. The collector conduction increases until there is bias drop off on each transistor. The collector conduction causes a field across the primary coil 71 of the transformer Tl.
With the stopping of the collector conduction the field collapses and induces high voltage in the primary coil 71 of Tl which is rectified by diode 75 and filtered by capacitor 76 to provide a DC potential for neon lamp 1. This also induces a voltage in the secondary coil of Tl. When current flows in the secondary circuit and the speaker 8-1 is activated, audible tone is caused by the rapid energizing and collapsing of the field.
The arrangement comprising the transistor 69 and 73, the transformer Tl, the coupling resistors 70 and 72, together with the diode 75 connected in series with the parallel arranged neon lamp 1 and capacitor 76 is an important part of the invention. I have found that this arrangement is conducive of beingable to drive both the speaker and the lamp with a very minimum of current. For example, in one embodiment with a battery voltage of 8.4 volts, both the lamp and speaker can be activated while drawing about 2.0 milliamperes.
The function of the circuit within the dotted lines 02 for remote central station operation will next be described.
The remote station circuit is connected across the battery conductors and to the SCR 54 as shown in FIG. 1. The speaker 8-1 is out of the circuit and the speaker S2 is connected into the circuit via the connection as shown as A and B. The jack 11 is connected to the remote station (not shown) via a plug to the patients call system.
With the remote station arrangement, it is usually desirable to disable the speaker in the unit so that the noise of the same will not disturb the patient, but to leave the light operative to provide monitoring for a nurse in the patients room. Thus, when the plug is connected to the jack 11, the connection between the terminals 76 and 77 is broken and this disconnects the speaker S-2. The signal produced by circuit is fed to the remote station via the terminals 77 and 78.
For remote station monitoring it is desirable to provide a delay between the time an alarm signal appears (conduction of the SCR 54) and the time a signal is fed to the remote station. The reason for the delay is to try to avoid spurious alarms. For example, if the unit is quiescent because the beat rate is between the low and the high range some spurious signal causing the conduction of SCR 54 will not provide an alarm at the remote station unless the circuit signal is repeated in a manner the same as a heart beat. The circuit provides for this delay as explained following.
When the SCR 54 of the comparing mechanism 53 is in the off condition, the resistor 80 will bias the transistor 81 so that it conducts. This will negatively bias the emitter 84 of the unijunction transistor 82 so that it will not fire.
When the SCR 54 conducts, the transistor 81 stops conducting and positive bias is supplied to the unijunction emitter through the resistor 83. The capacitor 86 however will not permit the bias to be applied immediately to the unijunction emitter 84. The charge time of the capacitor 86 is such that the SCR 54 will conduct several times before the capacitor will be charged enough so that full bias can be applied to the unijunction emitter 84. Preferably, this is made conduction times or heart beats.
Thus, it will be apparent that for a single conduction condition of the SCR 54, this condition will not be translated to the remote station.
When the unijunction fires, this causes a spike voltage to be developed across the coils 90 and 91 of the transformer. The voltage biases the gate-cathode of the SCR 92 so that it can conduct. The SCR 92 continues to conduct until such time as the circuit at the remote station is opened, for example, by a nurse by turning a switch.
Another important feature of the invention is in the provision of means to provide battery fail safe. If the battery voltage drops below a certain level circuitry will be activated to cause the speaker to emit constant audible tone and the light to shine constantly.
The zener diode 93 and the resistors 94 and 95 bias the transistor 96 so that the same conducts. This puts a negative bias on the gate of the SCR 97 so that the same cannot conduct.
The diode 93 and the resistors 94 and 95 are chosen so that if the voltage from the battery (which is normally 8.4 volts) falls below 6.5 volts, the bias on the transistor 96 is removed to the extent that the same stops conducting. With the stopping'of the conduction of transistor 96 the gate of the SCR 97 will be biased positively so that the SCR 97 conducts.
As will be apparent, the conduction of the SCR 97 has the same effect as the conduction of SCR 54. However, the SCR 97 is not cut off and hence the light and transformer will be on constantly. The speaker then gives a steady tone. Another important feature of the invention is that the accuracy of the low-rate delay setting and the high-rate setting can be checked using the circuitry itself. The manner in which this is done is explained following.
For checking, the switch SW4 is moved to the check position and this is a spring-loaded return switch, the knob of the switch is held down. When the switch SW4 is in the check position the trigger pulses from the mechanism 15 are disconnected from the input of one shot and in lieu hereof the switch connects the capacitor 100 with the input of the one shot. Thus, any of the square waves from the cathode follower 46 will be fed to the capacitor 100 which then will develop trigger pulses for each square wave pulse. The trigger pulses are fed to the input of the one shot and the one shot then will operate in the same manner as if it were energized by a patient trigger pulse. The remainder of the circuit will operate as previously described.
For calibration checking in the low range the switch SW2 remains in the alarm position. For calibration checking in the high range the switch SW2 is moved to the pulse position.
It will be observed that if switch SW4 is actuated during the off-portion of the time delay mechanism (as connected by the switch SW-2) the negative signal present on the emitter of the follower 46 will be conducted through the capacitor 100 at the moment of the connection and turn on the one shot. If the moment of the connection of the switch SW4 occurs during the on-portion of the time delay, the negative signal which appears on the follower 46 after completion of the onportion will feed through the capacitor 100 and turn on the one shot. The one shot will continue to recycle upon completion of each delay period until the SW4 switch is released.
The output rate of the emitter follower 46 will reflect the rate of the trigger pulses applied to the input of the one shot. Suppose, for example, that a patient is being monitored on the low range with the low-rate knob set on 40, the switch SW4 is pushed in and a stop watch is used to see that the speaker beeps at the rate of about 40 beats per minute.
Another important feature of the invention is that the unit may be operated in a pulse mode. For this purpose, the switch SW2 is actuated to the pulse position. With reference to FIG. 1 it will be seen that the switch SW2 will connect the emitter follower 46 to the output of the high delay 60. Thus, it will be apparent, therefore, that the gate of the SCR is being fed by both the one shot signal and the delay signal through diode 50. The SCR 54 will simply be made to turn off and on as a function of the heart rate whether that rate is 30, or any other value within the capacity of the instrument.
I claim:
1. For a cardiac monitor, audible-visible alarm means comprising:
first and second transistors, the emitters of which are adapted to receive a supply voltage transformer mechanism including primary coil means and secondary coil means, the ends of primary coil means being respectively connected to the collectors of said transistors;
a speaker connectable to the secondary coil means of said transformer mechanism;
a circuit including a diode in series with parallelconnected capacitor and neon light, the circuit being connected between the collectors of said transistors;
a first resistor connected to the base of the first transistor and to the collector of said second transistor; and
second resistor connected to the base of the second transistor and to the collector of said first transistor.
2. lna cardiac monitor:
trigger mechanism to receive electrical signals developed as a function of the beat of the patients heart and to convert the signals into trigger pulses there being a trigger pulse for each beat;
one shot mechanism connected to receive said trigger pulses and having means to develop pulses of first duration each latter pulse being initiated by a trigger pulse;
low delay mechanism connected to receive said oneshot pulses and having means actuated at the termination of each one-shot pulse to develop low delay pulses and the low delay mechanism including means to adjust the duration of each low delay pulse, said duration corresponding to a selected heart beat rate with a low range;
high delay mechanism connected to receive said oneshot pulses and being actuated at the termination of each one shot pulse to develop high delay pulses and the high delay mechanism including means to adjust the duration of each high delay pulse, said duration corresponding to a selected heart beat rate with a high range;
comparing means connected to operate alternatively as follows:
a. to receive said one shot pulses and said low delay pulses and to compare the interval between the end of the low delay pulse and the start of the next one shot pulse and develop an output signal 7 as a function of said interval; or
b. to receive said one shot pulses and said high delay pulses and develop an output signal which is initiated when the start of a one shot pulse occurs before the termination of a high delay pulse;
monitor mechanism including audio and/or visible means and having connections with said comparing means to receive its output signal and activate the audible and/or visible means when the heart beat rate is within the low range and when the heart beat rate is within the high range; and
switch means to disconnect the trigger mechanism and the input of one shot mechanism and to connect, alternatively, the output of the low delay mechanism or the output of the high delay mechanism with the input of the one shot mechanism, the switches providing for the use of the one shot, the low delay and the high delay to check the calibration of said low delay and said high delay adjusting means.
3. In a cardiac monitor:
trigger mechanism to receive electrical signals developed as a function of the beat of a patients heart and to convert the signals into trigger pulses there being a trigger pulse for each beat;
one-shot mechanism connected to receive said trigger pulses and having means to develop pulses of fixed duration, each latter pulse being initiated by a trigger pulse;
low delay mechanism connected to receive said one shot pulses and having means actuated at the termination of each one shot pulse to develop low delay pulses and the low delay mechanism including means to adjust the duration of each low delay pulse, said duration corresponding to a selected heart beat rate within a low range;
high delay mechanism connected to receive said one shot pulses and being actuated at the termination of each one shot pulse to develop high delay pulses and the high delay mechanism including means to adjust the duration of each high delay pulse, said duration corresponding to a selected heart beat rate within a high range;
comparing means connected to operate alternatively monitor mechanism including audio and/or visible means and having connections with the output of said comparing means to receive its output signal and activate the audible and/or visible means when the heart beat rate is within the low range and when the heart beat rate is within the high range; and
said connections between the comparing means and the monitor mechanism including means operative upon receipt of the initial output signal of the comparing means to prevent the comparing means output signals from reaching the monitor mechanism for a predetermined amount of time whereby to mask out the effects of false trigger signals.
4. In a cardiac monitor: trigger means for receiving electrical signals developed as a function of the beat of a human heart and to convert the signals into trigger pulses, there being a trigger pulse for each detected heartbeat,
liming detection means connected for successive actuation by said trigger pulses and including means for effectively measuring the time interval between successive trigger pulses up to a predetermined time interval and for producing an output signal indicative of the rate of said trigger pulses and hence of said human heartbeat,
output means connected to receive said output signal and to produce a corresponding humanly sensible output indication of said human heartbeat, and
testing means for applying said output signal to the timing means in place of said trigger pulses whereby said timing means produces said output signal at a frequency corresponding to said predetermined period thus permitting the calibration of said predetermined time interval to be checked by observing said humanly sensible output.
|Cited Patent
|Filing date
|Publication date
|Mar 19, 1945
|Dec 27, 1949
|Waters Conley Company
|Instantaneous tachometer method and apparatus
|Nov 30, 1955
|Mar 8, 1960
|American Cyanamid Co
|Recording cardiotachometer
|Jun 11, 1962
|Jun 23, 1964
|Chapman Robert L
|Detector and alarm ventricular impulses
|Mar 23, 1961
|Aug 11, 1964
|Chemetron Corp
|Cardial conitor apparatus
|Aug 8, 1960
|Aug 11, 1964
|Edgar Haber
|Cardiac monitoring device
|Dec 21, 1964
|May 2, 1967
|Teldix Luftfahrt Ausruestung
|Heart monitoring device with filter for suppressing the frequency of an ambient a.c.power source
|Sep 27, 1965
|Feb 4, 1969
|Lockheed Aircraft Corp
|System for fm transmission of cardiological data over telephone lines
|May 3, 1968
|Aug 17, 1971
|Corometrics Medical Systems In
|Fetal heart rate and intra-uterine pressure monitor system
|Aug 7, 1962
|Mar 28, 1968
|Siemens Ag
|Geraet zur UEberwachung der Herztaetigkeit
|U.S. Classification
|600/514, 600/519
|International Classification
|Cooperative Classification
|European Classification
|Oct 5, 1994
Owner name: BRUNSWICK BIOMEDICAL CORPORATION
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:SURVIVAL TECHNOLOGY, INC.;REEL/FRAME:007153/0745
Effective date: 19940926


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3. Even better, if you bundle my Resume Writing Service with crafting a new LinkedIn Profile (which includes a one-to-one tutorial about how to leverage LinkedIn for YOUR particular job search), I'll give you a holiday gift of 15% off the normal rate for those two services combined.
I put a lot of time into individually crafting my clients' marketing documents, and my time is limited! That's why I can't make this an open-ended offer for everyone – just the first ten well-motivated people who understand the value of an accomplishment-based resume that tells your professional story in a compelling fashion.
These days, while a great resume remains critical to an effective job search, so too is an optimized LinkedIn Profile. Did you know that over 92% of recruiters, hiring managers, and HR people use LinkedIn to find the talent they need to drive their business forward? You simply can't afford NOT to have a strong, search engine optimized LinkedIn profile!
Together, a resume and LinkedIn Profile can tell your story, and demonstrate the value that you offer to your next employer. Let's face it: unless you can convince you have what it takes to do the job that needs to be done, you won't get hired by anyone.
I can't guarantee that you'll get hired. But I can tell you that I will help you to put your very best foot forward and avoid so many of the mistakes that trip up even highly-qualified job seekers.
Again, this is a limited-time offer that ends on December 1st, available to new clients only! To take advantage of the offer please complete the form here.
Thanks again for signing up for my email list! You know that I don't write often – I respect that you don't want your inbox full of self-promotional clutter!
Happy hunting!

subset: commoncrawl


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House Sitter in San Marcos
Responsible self employed adult seeking to provide service to folks in the San Marcos and New Braunfels area. I love all pets and own 3 cats and a dog. I know well the importance of managing a household and it's affairs in your absence.
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The word catastrophe comes from Greek tragic drama and refers to the sudden twist of development in the plots. Catastrophe theory is a method for describing the evolution of forms in nature. It is particularly applicable where gradually changing forces produce sudden effects. Its interdisciplinary character was, for people with widely differing agendas, a cultural connector linking mathematics, biology, social sciences and philosophy.
It is represented by using topology. Topology is a generalization of geometry that studies spaces with the degree of generality appropriate to a specific problem. One central concern of topology is to study the properties of spaces that do not change under a continuous transformation, that is, translation, rotation and stretching without tearing.
A new method was needed that would focus on shapes, account for their stability, and explain their creation and destruction. The models are not suited for action or prediction but rather aimed at describing, and intelligibly understanding natural phenomena.
Reflectivity: a=a
Symmetry: a=b then b=a
Transitivity: a=b and b=c then a=c
"Reality presents itself to us as phenomena and shapes." – Rene Thom
The Fold
There was only one kind of singularity that could occur in the catastrophe theory and that is called a fold.
The fold made possible the definition of flux equilibrium by combining a series of different surfaces to define multiple points of equilibrium.
Mathematical Definition
Catastrophe models come in both dynamic and static forms, the static forms being simply the equilibrium (stable and unstable) of the dynamic forms. Multiple stable equilibriums are inherent in catastrophe models.
- Stable Equilibrium
i. A state which depends continuously on the parameters
ii. An equilibrium such that nearby states remain close as the state evolves.
- Catastrophe
A sudden change in state
- Structural Stability
A model is structurally stable if its qualitative behaviour is unchanged by small perturbations of the parameters
- Generic
A technical term meant to suggest what the property usually holds.
Internal Variables = u
Control Variables = a,b
Potential Function = V
The Potential function related the internal and the control variable = V (a,b,u)
Types of Catastrophes
The classification of seven singularities later led to the seven elementary catastrophes.
1.The fold
2.The Cusp
3.The Swallowtail
4.The butterfly
5. The three Umbilics
Chaos: When the present determines the future, but the approximate present does not approximately determine the future.
It is true in a sense, the ambitions of the theory failed, but in practice, the theory has succeeded. This is especially true of chaos theory, with which catastrophe theory had important interactions.
Thom never argued for the intrinsic superiority of his method but rather for its greater capacity to explain the world as it is perceived.
The catastrophe theory will be applied as moments of catastrophe by overlapping two opposing situations:
- A twist in the narrative
- The physical fold on the surface
The different moments will be unrolled and unified on a singular surface to create multiple moments of catastrophes. Both the stable and unstable conditions of the continuous surface will be addressed by negotiating between shifts in unstable narratives on stable physical folds and shifts in the stable narrative on the unstable physical folds.


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karenjerzy... Photographer
JR EdwinModel Female Enfield, Connecticut, US
My MM URL: http://www.modelmayhem.com/glittervomit
Mayhem # 1652044
About MeHey there ModelMayhem!! My name is Jessica Rose. I had a previousMM site that for reasons i don't care to get into i cannot access! So behold!
I'm interested in building my portfolio, Willing to travel (withinlimits of course). Would eventuallylike to make somemoney butnot looking to do this as a career.
Have you worked with JR Edwin? Add Credits for JR Edwin! >>
karenjerzy... Photographer
Jeff Cohn Photographer
Contentiou... Photographer
TAB Photographic Photographer
IamJonatha... Model
Jerry Martin Photographer
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Pictures by Thalep Photographer
Courtney-Jade MareaModel Female Rockhampton, Queensland, Australia
My Website: Facebook | Courtney Jade GriffithsMy MM URL: http://www.modelmayhem.com/courtneyjade28
Mayhem # 2534965
About MeHello everyone :)
My name is Courtney, I am 21 years old, and currently living in Townsville (Mount Louisa).
I currently have red/brown hair just past my shoulders. My hair colour changes regularly, I seem to colour my hair in accordance with hair trends and changes in season. I have big brown eyes which I have always been told is my best feature. I am a size 14 and while I don't have the perfect bikini body, and while there is always room for improvement I am mostly proud of my curves.
I have the ability to do my own natural make up and hair, and have my own transport as I have my own car.
I am a very outgoing person and get along with everyone. I'm fun and easy to work with and take constructive criticism well and learn from it. Outside of my modelling aspirations I am furthering my career in hospitality management.
Modelling to me has been a dream since I was a child, and so far I am really enjoying every aspect of the industry, even though I realise I have had a delayed start compared to most other models. With this lack of experience I currently work on a TFP basis, where ever and whenever I can to get more experience and more exposure whilst in the process of building my portfolio. I am willing to do creative or 'different' kinds of shoots, whether they be in a studio or location environment. I am available to shoot almost all genres and more than happy to shoot with other models.
Please note I am also fairly picky when it comes to male photographers that contact me regarding work, I have been contacted by a lot of men that I classify as a "PWC" (Pervert With Camera), unless I feel the images are NOT cheap or tasteless I will not contact these people back as I have the expectation that a photographer will have the ability to conduct themselves in a professional and respectful manner throughout the shoot. I am a good judge of character and trust the right kinds of people easily.
Some of the many photoshoot concepts I would love to do:-
*Vintage/Retro/Pin-up (Bettie Page/Marilyn Monroe style)
*Role play/Occupations (military, flight attendant, pilot, burlesque dancer, sailor, pirate)
*Abandoned building/industrial site
*Abandoned mental asylum/hospital
*Mock wedding & trash the dress
*Automotive/motorbike inspired shoot (this is a particular favourite as my partner and I both have sports cars we would love to feature in a shoot!)
*Disney princess themed shoot
*Alice in Wonderland-inspired tea party shoot
*Blood/gore shoot
*Sucker Punch inspired shoot
*Lingerie (studio)
*Slightly dominatrix – corset, whip, stockings, high heels, etc.
*Jungle (Waterfall, hiking trail, rainforest etc.
*High Fashion
*Heels + Guys shirt/hoodie + Underwear.
If you would like to book a shoot with me, please do not hesitate to ask.
Feel free to contact me with regards to any projects or work that you would like to collaborate on. I have tons of inspiration boards that I will happily email upon request.
Thank you for taking the time to look at my profile and I hope to be working with you soon!
Have you worked with Courtney-Jade Marea? Add Credits for Courtney-Jade Marea! >>
Credit NotesPHOTOGRAPHY:
Kelly Baltus Photography
HAMA Photography
EnrightOgraphy / nudeXposed
Face Off Photography
Simon Lyell
Bronte Beetson
Lusshh Cosmetics
Pictures by Thalep Photographer
Kirsten McManus Photographer
TransLUCEnt Photography Photographer
Al Deaner Photographer
James Lazzaroni Photographer
Tyronne Fitzgerald Photographer
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What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
At JotForm, we want to make sure that you're getting the online form builder help that you need. Our friendly customer support team is available 24/7.
We believe that if one user has a question, there could be more users who may have the same question. This is why many of our support forum threads are public and available to be searched and viewed. If you'd like help immediately, feel free to search for a similar question, or submit your question or concern.
How can we remove the price from Form Calculation if the user unchecks a product?Asked by kitekidsuk on February 12, 2015 at 09:18 AM
Hope you can help.
I have an order form. The second panel allows you to select various products. If a customer selects two types of products (and a quantity for each), but then changes their mind and unchecks one of the boxes, the total for that product is still in the TOTAL field. How do I remove a value from the TOTAL field, once a customer changes their mind and deselects a product.
Many thanks
I see that you set it all just right Jenny, there is only one more option that we needed to activate to have it working as you want.
I have done this on this clone of your jotform: http://form.jotformpro.com/form/50424910386958
Now, all that you should do is go into Wizard of each Form Calculation that is making the calculation for each product and set it to not count the hidden fields.
Basically every time that you uncheck some product, the dropdown is hidden and the form calculation associated with this product will (because of this setting) just return 0.
This means that the Form Calculation for Total will be adding 0 up to the rest of the options.
If your customers change their mind and select the same option once again, their dropdown will still hold the last selected value and the price will again be added to the total.
To access this option for hidden fields, just click on the Wand like icon in the Quick action bar
After that click on Advanced options and make the same checks as on this screenshot:
* Note the Ignore Hidden fields. option right above the decimal places dropdown.
You can also clone the jotform to your own account by following the steps here: How to Clone an Existing Form from a URL
Do let us know how it goes.
That's fantastic - thanks so much ben! Much appreciated - you've saved me lots of frustration!
JotForm Support
Anytime, Jenny. On behalf of my colleague, you are welcome. We are glad to see that the issue is resolved for you. Please do not hesitate to get in touch with us if you need any further assistance. We will be happy to help.
Thank you for using JotForm!


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This is a private cosy resort on the Kuiburi-Bonok beach surrounded by nature and the sea breeze. The establishment features a lobby, restaurant, wireless Internet access and bicycle hire. The hotel has 89 rooms available for guests.
The hotel and resort is a private place on the Kuiburi-Bonok beach, only 60 minutes away from Hua Hin and 23 km from the city centre. Suvarnabhumi Airport is situated at a distance of approximately 75 km.
There are 3 types of guest rooms including Standard, Deluxe and Junior Suite; as well as 3 types of villas including Villa Garden View, Villa Sea View and Villa Grand View available. The en suite bathrooms are fitted with a shower and hairdryer. All rooms are equipped with a direct dial telephone, satellite/cable TV, Internet access, a safe, a minibar and tea and coffee making facilities.
Guests may take a refreshing dip in the outdoor swimming pool, work out in the gym or relax with a massage.
MasterCard and VISA are accepted as methods of payment.
Room Facilities:
Direct dial telephone
Satellite cable TV
Internet access
Tea Coffee


text:
Have a need to start evaluating internet usage reporting software. Was wondering what everyone is using out there. The major need is reporting what web site users are going to and what time they go there. The owners are not to concerned about where the users go before and after work, want to know where the users are going during work hours. We use a Sonicwall TZ170 firewall but the Viewpoint reporting is crap at best.
Mar 24, 2009 at 8:46 UTC
I've been testing an Untangle opensource firewall just for this purpose and it seems to be working fine. If you purchase the subscription for the AD connector it allows you to track internet usage to the user that is logged on instead of an IP address.
Hope this helps
4 Replies
Mar 24, 2009 at 8:46 UTC
1st Post
I've been testing an Untangle opensource firewall just for this purpose and it seems to be working fine. If you purchase the subscription for the AD connector it allows you to track internet usage to the user that is logged on instead of an IP address.
Hope this helps
Mar 24, 2009 at 9:37 UTC
1st Post
We too have just started using Untangle, and it is working great. I originally set it up with the VM client, and then moved it to an old machine that was getting replaced. The Untangle forum is great for any problems that you might encounter (although I have found very few). Reports can be set to email you every day giving you a clear picture of your users internet surfing tendencies. If you utilize static IPs in your company you can assign each IP with names of users so that the users can be identified (unless of course someone else is logging in to that machine to do the surfing).
Mar 24, 2009 at 1:56 UTC
Thanks just check it out and it looks very interesting. Even the AD add on is priced so nicely that it almost makes it impossible not to try it out.
Mar 25, 2009 at 3:38 UTC
Hi we use a product called webmarshal which is very resonably priced and extremely configurable. you can use it to simply monitor or to set permissions on groups to restrict access to certain sites, ie. adult, gambling etc. You can also set time policies so that users can only browse for say 1hour a day or only during lunch times etc. We use it in this way to allow unrestricted access throughout the day to business related sites, but only allow non business sites (social networking) during lunch hours, or before/after work.
Another nice feature is that you can re-direct all users to a custom web page displaying your web usage policy the first time they access the web each day. They have to click an accept button before they can browse. This is great way of enforcing that everyone knows the rules.
It also comes with a nice suite of reports, with easy to read graphs (great for management) and less hassle for you.
you can download a 30 day free trial from http://www.marshal.com/ its really easy to set up as well. There mail monitoring software is also very good.
This discussion has been inactive for over a year.
You may get a better answer to your question by starting a new discussion.


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The annual costs of cardiovascular diseases and mental disorders attributable to job strain in France
Environmental and occupational health
Work stress has become a major occupational risk factor in industrialized countries and an important economic issue. The objective was to estimate the annual costs of coronary heart diseases (CHD) and mental disorders (MD) attributable to job strain exposure according to Karasek's model in France for the year 2003 from a societal perspective.
We produced attributable fraction estimates which were applied to the number of cases (morbidity and mortality) and the costs of CHD and MD. Relative risk estimates came from a systematic literature review of prospective studies. We conducted meta-analyses based on this selection of studies. Prevalence of exposure to job strain came from the national SUMER survey conducted in France in 2003. Costs included direct medical costs and indirect costs: production losses due to sick leaves and premature deaths.
Between 8.8 and 10.2% of CHD morbidity was attributable to job strain, and between 9.4 and 11.2% of CHD mortality was attributable to this exposure for men. Between 15.2 and 19.8% of MD was attributable to job strain for men, and between 14.3 and 27.1% for women. As a whole, between 450 000 and 590 000 cases of diseases and 910–1130 deaths were attributable to job strain for men. From 730 000 to 1 380 000 cases of diseases and from 150 to 280 deaths were attributable to job strain for women. The total number of sick leave days amounted from 5 to 6.6 million days for men, and from 8.5 to 16 million days for women. The total costs of CHD and MD attributable to job strain exposure ranged from 1.8 to 3 billion euros for the year 2003 (0.12-0.19% GDP). Medical costs accounted for 11% of the total costs, value of life costs accounted for 13-15% and sick leave costs for 74-77%. The cost of CHD was estimated at 113–133 million euros and the cost of MD was between 1.7 - 2.8 billion euros in 2003.
This study on the economic burden of diseases attributable to job strain in France provides relevant insights for policy-makers when defining public health priorities for prevention policies.
Work stress has become a major occupational risk factor in all industrialized countries
A way to evaluate the cost of work stress is to measure claims costs due to stress-related conditions at work. But this type of evaluation depends on national legislative frameworks which vary from one country to another. For example, in Australia, attempts have been made to reduce the costs of stress-related claims by modifying legislative thresholds on such claims
Attributable fractions have been widely used in the literature to estimate the burden of diseases attributable to occupational exposures in terms of morbidity or mortality cases and disability-adjusted life years
A large number of epidemiologic studies have shown that exposure to work stress is a risk factor for various health outcomes, especially cardiovascular diseases
The aim of this article was to estimate the costs of cardiovascular diseases (CVD), and more precisely coronary heart diseases (CHD) and mental disorders (MD), i.e. two highly prevalent common mental disorders, depression and anxiety, attributable to job strain exposure in France in 2003 from a societal perspective, using a cost-of-illness approach
AF data and calculation
As defined by Nurminen and Karjalainen
RR estimates were derived from a systematic literature review of prospective studies published in peer-reviewed journals between 1998 and 2008 (inclusive), i.e. a period centered around the year 2003. Inclusion criteria were a sufficient sample size (over 100 individuals) of a population in industrialized countries, with an explicit use of Karasek's model for exposure assessment and a precise measurement of health outcomes (clinically diagnosed or based on validated instruments). Only studies studying men and women separately and providing unadjusted (or age-adjusted) and multi-adjusted RRs/ORs were retained. This literature review excluded studies based on a job-exposure matrix known to underestimate RRs
In order to summarize the results of this literature review, we conducted meta-analyses based on this selection of studies. We retained 9 studies for CVD
The data used for the estimate of prevalence of exposure Pe to job strain came from the national SUMER survey which was conducted in France in 2003. This survey is a periodical cross-sectional survey conducted by the French Ministry of Labour (DARES) and including a self-administered questionnaire, including Karasek's Job Content Questionnaire (JCQ). In total, 24,486 employees, 12,241 men and 10,245 women, selected on a random basis responded to the JCQ (response rate: 96.5%). The data of the SUMER survey were weighted to provide estimates that were representative of the French working population. As a result, the 2003 SUMER survey provides high quality data for exposure to job strain among the French national working population according to gender
We produced a range of attributable fraction (AF) values. The AF low range value for each disease was calculated using multi-adjusted RR summary estimates in formula (1) and the AF high range value was based on age-adjusted RR summary estimates. In this calculation, we assumed that ORs were satisfactory estimates for RRs, which allowed to use ORs for AFs calculation in formula (1).
We computed confidence intervals at 95%, based on 100 000 simulated distributions of
Data on prevalence of diseases
We considered all national surveys available in France for the number of cases (morbidity and mortality) of CVD and MD. Inclusion criteria were a definition of disease corresponding to health outcomes used in our summary RR estimates, the availability of data for men and women separately, the availability of data for working-age population, and the survey had to be conducted in 2003 or as close as possible to 2003.
CHD morbidity data
Since most of the selected studies for CVD produced RRs for CHD (8 studies out of 9), we retained prevalence and costs data on CHD rather than CVD to ensure consistency between data used in our estimation. We used the prevalence of CHD (CIM 10, codes I20-I25) from the database of the Health and Social Benefits Survey (Enquête Santé et Protection Sociale) conducted in France in 2004 by IRDES (Institut de Recherche et Documentation en Économie de la Santé). Weighted prevalence data were computed and provided by IRDES for men (1.38%) and women (0.37%) from 18 to 64 years. We assumed a stable prevalence of CHD between 2003 and 2004 in France.
CHD mortality data
We used mortality data in 2003 from the database of the Epidemiological Center for the Medical Causes of Death (Centre d'Épidémiologie sur les Causes Médicales de Décès, CEPIDC)
MD morbidity data
We computed the prevalence of MD (depression and anxiety) from a French national survey, the Ten-yearly Health survey 2002–2003 (Enquête Décennale Santé). Data were weighted by age and gender. MD were defined by a score obtained to CES-D equal or higher than 16. The prevalence of MD for the population from 18 to 64 years was 15.5% (95% confidence interval: 14.6%-16.4%) for men and 27.4% (95% confidence interval: 26.4%- 28.4%) for women in France.
MD mortality data
We used data about the prevalence of suicide in 2003 provided by the Epidemiological Center for the Medical Causes of Death (Centre d'Épidémiologie sur les Causes Médicales de Décès, CEPIDC) for men and women from 20 to 64 years
Another sensitivity analysis was conducted using a more restrictive definition of mental disorders based on depression alone. For this analysis, we used depression morbidity data produced by ESEMED study (European Study of the Epidemiology of Mental disorders) which was based on a standardized diagnostic interview (WMH-CIDI: World Mental Health- Composite International Diagnostic Interview). According to this survey, the prevalence of depression was 4.7% (95% confidence interval: 3.6%-5.8%) for men and 8.5% (95% confidence interval: 7.1%-9.9%) for women in France
Cost data and calculation
Indirect costs were calculated on the basis of the human capital hypothesis
A sensitivity analysis was conducted to take account of the two range values for the number of suicides due to depression in the literature (54% or 64%) and the two values of attributable fractions which we computed (from multi or age-adjusted RRs).
CHD medical costs
According to Paris and al
CHD indirect costs
Statistics from the public medical care system provided the number of sick leave days as prescribed by cardiologists in France in 2003
MD medical costs
According to Paris and al
MD indirect costs
A study by Morvan et al.
Meta-analysis results are shown in Figure
Figure 1
For men, 8.8-10.2% of CHD morbidity was attributable to job strain. Attributable fractions (AF) for CHD mortality were 9.4-11.2% for men. AFs for CHD morbidity and mortality for women yielded non significant values (Table
Between 22 071 and 25 743 cases of CHD were attributable to job strain exposure, and between 442 and 524 deaths among men. For MD, between 430 470 and 559 215 cases for men and 727 266–1 378 718 cases for women were attributable to job strain exposure. Between 619 and 894 deaths (suicides associated with depression) for men and women were attributable to this exposure. The number of sick leave days lost because of CHD attributable to job strain went from 55 015 to 64 167 days. For MD, the number of lost working days amounted from 5 016 529 to 6 516 864 days for men and from 8 475 264 to 16 067 034 days for women (Table
The total costs of CHD and MD attributable to job strain exposure ranged from approximately 1.8 to 3 billion euros per year in France. This cost included medical costs, the value of sick leave days lost because of disease, and the value of life years lost because of premature death. The cost of CHD was estimated at 113–133 million euros. The cost of MD was around 1.7 and 2.8 billion euros. Results are shown in Table
We computed a sensitivity analysis based on a less conservative hypothesis for the percentage of suicides associated with depression, according to data available in the literature
We also conducted a more conservative analysis based on a restrictive definition of mental disorders, including depression only. RR estimates for depression were derived from Shields's study
Between 8.8 and 10.2% of CHD morbidity was attributable to job strain, and between 9.4 and 11.2% of CHD mortality was attributable to this exposure for men. Between 15.2 and 19.8% of MD (depression and anxiety) was attributable to job strain for men, between 14.3 and 27.1% for women. As a whole, between 450 000 and 590 000 cases of diseases and 910–1130 deaths were attributable to job strain for men. From 730 000 to 1 380 000 cases of diseases and from 150 to 280 deaths were attributable to job strain for women. The number of deaths attributable to job strain is approximately twice the number of deaths due work fatalities declared in France in 2003. The total number of sick leave days for the year 2003 amounted from 5 to 6.6 million days for men, and from 8.5 to 16 million days for women. The total costs of CHD and MD attributable to job strain exposure ranged from approximately 1.8 to 3 billion euros for the year 2003 in France (0.12-0.19% GDP). Medical costs accounted for 11% of the total costs, value of life costs accounted for 13-15% and sick leave costs for 74-77%. The cost of CHD was estimated at 113–133 million euros and the cost of MD was between 1.7 and 2.8 billion euros. Thus MD accounted for approximately 94-96% of the total costs attributable to job strain exposure. This is due to a higher prevalence of the disease among the population of working age, higher levels of attributable fractions, and also a high amount of sick leave days due to MD. The sensitivity analysis conducted on a more restrictive definition of mental disorders including depression only, produced much lower values in terms of number of cases and costs. This calculation can be considered as very conservative. Indeed, the definition of mental disorders was restricted to clinical depression, and thus excluded anxiety but also symptomatic cases of depression and anxiety. Furthermore, the RR estimates were based on only one available prospective study that produced RR estimates using a standardized diagnostic interview (CIDI)
Some limitations of the study must be pointed out. This estimate of the cost of diseases attributable to job strain exposure may be more under-estimated than over-estimated. We did not produce AF estimates of CHD morbidity and mortality for women since available data were very scarce and the rare included studies yielded non-significant RRs. Therefore the estimation of the cost of CHD attributable to job strain was provided for men only. Another way of interpreting the results may be that our estimates of costs may be null for women, something that may be a bit premature to conclude given the scarcity of the literature. Indeed, recent studies show an increase in CVD prevalence among women in the French population
This study has also several strengths. Our meta-analyses for RR estimates showed a satisfactory homogeneity between studies, except for age-adjusted ORs of MD for women which yielded a significant level of heterogeneity. Overall, the risk of heterogeneity between studies was mitigated by the fact that we included only high quality studies in our systematic review of the literature, with similar exposure and with statistical analyses allowing the estimation of RRs. The data we used are highly consistent: RR, prevalence of exposure, prevalence of disease and cost data are based on the same definition of disease and exposure. To ensure such consistency, we conducted a systematic review of the literature for disease prevalence and costs data in France and we produced data for each gender separately. The only exception may be the use of mental disorders medical costs based on the medical cost of depression only that may underestimate the costs of mental disorders attributable to job strain. We performed a sensibility analysis including depression only to provide a very conservative estimate of mental disorders costs attributable to job strain. The medical costs used in our study included out-of pocket payments by patients along with medical expenses paid by insurances, which is well appropriate for estimations from a societal perspective. We produced two range values of AF estimates with confidence intervals, based on a meta-analysis of RRs. Our calculation method had several strengths: we took account of multi-adjusted and age-adjusted estimates in our calculations, which produced the AF range values. And we combined this approach to meta-analyses to get more precise estimates of AFs based on available data in the literature. This method allowed us to encompass various high-quality RR estimates in our summary RRs, and at the same time to take account of a certain level of uncertainty regarding RRs, since age-adjusted and multi-adjusted estimates yielded different values.
Our summary RRs for CVD are consistent with those from the meta-analysis by Kivimaki et al.
Our results provide an evaluation at one point of time, allowing projections of the cost of job strain according to the evolution of working environments and the trend of prevalence of exposure to job strain. It also allows comparisons with other countries. Our summary estimates of RRs for CHD and MD could be used for AF calculations in other countries where the prevalence of exposure to job strain has been measured in the working population.
This study on the economic burden of diseases attributable to job strain in France provides relevant insights for policy-makers when defining public health priorities for prevention policies. Diseases attributable to job strain and related costs are avoidable since effective intervention strategies to prevent job stress have been identified in several literature reviews
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
HST conceived and conducted the study, directed the literature review of economic data, participated in the literature review of epidemiologic data, performed the statistical analysis of cost estimates, and wrote the manuscript. JFC performed the statistical analysis of summary RRs/ORs and prevalence of diseases, and contributed to the review of successive drafts of the manuscript. MM participated in the literature review of economic data. IN directed the literature review of epidemiologic data, and participated in study conception and manuscript writing. All authors read and approved the final manuscript.
We thank IRDES (Institut de Recherche et Documentation en Économie de la Santé) and Catherine Sermet for providing weighted prevalence data of coronary heart diseases (CHD) for men and women based on the database of the Health and Social Benefits Survey (Enquête Santé et Protection Sociale) conducted in France in 2004.
Agence Nationale de la Recherche, France (ANR).
Job strain and older workers: Can a reduction in job strain help to eliminate the social security drain?
Assessing the economic impact of stress–the modern day hidden epidemic
The role of the workplace in the production and containment of health costs: the case of stress-related disorders
Costs and benefits of stress prevention in organisations
La prévention du stress au travail en Europe : aperçu des activités syndicales - obstacles et stratégies futures
Work-related stress in Australia: The effects of legislative interventions and the cost of treatment
What percentage of workers with work-related illnesses receive workers' compensation benefits?
Occupational disease and workers' compensation: coverage, costs, and consequences
Language preference and non-traumatic low back disorders in Washington State workers' compensation
Cost of work-related injuries in insured workplaces in Lebanon
Contribution of occupational risk factors to the global burden of disease - a summary of findings
The global burden of selected occupational diseases and injury risks: Methodology and summary
Review of estimates of the global burden of injury and illness due to occupational exposures
Dying for work: The magnitude of US mortality from selected causes of death associated with occupation
Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland
Quantitative estimates of work-related death, disease and injury in New Zealand
Occupational injury and illness in the United States. Estimates of costs, morbidity, and mortality
Costs of occupational injuries and illnesses in California
Economic burden of occupational injury and illness in the United States
Modeling the economic burden of diseases imputable to stress at work
Expanding research on the economics of occupational health
Work stress in the etiology of coronary heart disease–a meta-analysis
Is job strain a major source of cardiovascular disease risk?
Psychosocial work environment and mental health–a meta-analytic review
Psychosocial factors at work and risk of depression: a systematic review of the epidemiological evidence
The relation between work-related psychosocial factors and the development of depression
Epidemiology of work related neck and upper limb problems: psychosocial and personal risk factors (part I) and effective interventions from a bio behavioural perspective (part II)
Fractions of cardiovascular diseases, mental disorders, and musculoskeletal disorders attributable to job strain
The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics
Cost-of-illness studies: a major headache?
Perspectives in economic evaluation
Canadian Guidelines for Economic Evaluation of Pharmaceuticals
The occurrence of lung cancer in man
Study of the validity of a job-exposure matrix for psychosocial work factors: results from the national French SUMER survey
Two alternative job stress models and the risk of coronary heart disease
Perceived job stress and incidence of coronary events: 3-year follow-up of the Belgian Job Stress Project cohort
Justice at work and reduced risk of coronary heart disease among employees: the Whitehall 2 Study
Job strain and ischaemic disease: does the inclusion of older employees in the cohort dilute the association? The WOLF Stockholm Study
Job stress and major coronary events: results from the Job Stress, Absenteeism and Coronary Heart Disease in Europe study
A prospective study of job strain and coronary heart disease in US women
Psychological job demands increase the risk of ischaemic heart disease: a 14-year cohort study of employed Danish men
Marital stress worsens prognosis in women with coronary heart disease: The Stockholm Female Coronary Risk Study
Job strain and risk of cardiovascular events in treated hypertensive Japanese workers: hypertension follow-up group study
Gender differences in the effects from working conditions on mental health: a 4-year follow-up
Job strain and evolution of mental health among nurses
Job stress and depression symptoms in middle-aged workers–prospective results from the Belstress study
Psychosocial factors at work and subsequent depressive symptoms in the Gazel cohort
Long working hours and health
Stress and depression in the employed population
Measuring inconsistency in meta-analyses
Propriétés psychométriques de la version française des échelles de la demande psychologique, de la latitude décisionnelle et du soutien social du "Job Content Questionnaire" de Karasek: Résultats de l'enquête nationale SUMER
Importance of psychosocial work factors on general health outcomes in the national French SUMER survey
The contribution of occupational factors to social inequalities in health: findings from the national French SUMER survey
Exposition aux facteurs psychosociaux au travail du modèle de Karasek: étude méthodologique à l'aide de l'enquête nationale SUMER
Mental disorders in young and middle aged men who commit suicide
Suicide and mental disorders: do we know enough?
Suicides: mieux comprendre pour prévenir avec plus d'efficacité
[Prevalence and comorbidity of psychiatric disorders in the French general population]
Estimating the cost of illness
Les dépenses de prévention et les dépenses de soins par pathologie en France
La dépression: prévalence, facteurs associés et consommation de soins
Personnes hospitalisées pour infarctus du myocarde en France: tendances 2002–2008
Taux de patients hospitalisés pour insuffisance cardiaque en 2008 et évolutions en 2002–2008, France
The measurement of effort-reward imbalance at work: European comparisons
Job stress as a preventable upstream determinant of common mental disorders: A review for practitioners and policy-makers
Job strain - attributable depression in a sample of working Australians: assessing the contribution to health inequalities
A systematic review of the job-stress intervention evaluation literature, 1990–2005
The psychosocial and health effects of workplace reorganisation. 1. A systematic review of organisational-level interventions that aim to increase employee control
The psychosocial and health effects of workplace reorganisation. 2. A systematic review of task restructuring interventions
Pre-publication history
The pre-publication history for this paper can be accessed here:


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The BPL48V75ART2U external battery pack houses twelve (12) 12v 9Ah batteries, connected serially in two (2) strings of six (6) batteries. It is designed to match the appearance of the Smart App Online UPS models and can be similarly mounted in 2U rack or tower configurations. A battery data link transmits the unit's diagnostic vitals to the UPS display for real-time monitoring and a heavy gauge power cord, adapted with plug-n-play DC connectors, permits the battery pack to be easily "hot-swapped", ensuring continuous operation of critical systems, during normal UPS maintenance. Rugged, industrial-grade metal construction - meeting the same standards as the UPS models - allows for installation of the unit in demanding environments. A Three-Year Warranty ensures that this battery pack has passed our highest quality standards in design, assembly, material or workmanship.
Telephony, PBX & VoIP > Phone System Accessories > Power Equipment, Surge Protection & UPS > Power Equipment > Power Accessories
CyberPower Smart App Sinewave PR3000LCDRTXL2U UPS


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The gold bond issuing is open now but the price has gone down already.
When next cycle of bonds will be issued? Is it a recurrent process or could it be a one time process?
1 Answers
VS-It will be issued in tranche. The current tranche will be accepted from November 05, 2015 to November 20, 2015. Future tranche will be notified by Govt. However, if you need this old tranche after the last date, then you can buy the same bonds from secondary market.
thank you.


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Best Of :: People & Places
Chris Tingom knows coffee like a veteran barista knows "the shakes." Lucky for us, he's got a steady photo hand, despite all of his caffeine consumption. Tingom brews Arizona's ultimate coffee blog day in and day out: Arizona Coffee. Tingom delicately balances news posts about coffee openings and closings with full-flavored analysis, written with a level of detail and research usually reserved for medical journals. We're especially fond of his "Latte Art Throwdown" coverage. Checking out Tingom's photos is almost like drinking the real thing.
Though nobody knows her real name, "Cake Lady," as downtowners have affectionately dubbed her, continues to contribute to central Phoenix lore. In short, there's a woman about town who occasionally shows up at gatherings (a music performance, an art exhibit) looking for free stuff, especially cake. The consensus is that she reads New Times (a smart woman, indeed) and then calls ahead to inquire about the possibility of free goodies. She's been spotted only a couple of times, including years ago at a birthday party at the now-defunct Paper Heart, where she briefly showed up, then dashed out the door with a bunch of cake to go. Hey, Cake Lady, share some next time!
Yes, you're reading that right. No, we're not heat-addled.
Summer in Phoenix rules.
We first noticed this seeming contraction one day several years ago when all the traffic on Indian School Road dried up. Poof! It was like a scene from I Am Legend or Vanilla Sky. And it made us ponder the other positives of a season in which temps can hit the 120s in the shade and you can get a third-degree burn on your butt just by getting in your car.
The sunsets. The storms. The long light of evenings. The short lines at our favorite hangs. The full-moon hikes. The abundant parking at Piestewa Peak. The pool parties. The misters. The cheap resort rates. The free Sunday-afternoon films at the Phoenix Art Museum.
More than specific pleasures, though, our late-blooming appreciation of Phoenix summer has to do with the sense of inclusion we feel from Memorial Day through late September. For 120-odd days, it's our town — not the fifth-largest city in America. It feels like a community.
It's hot, but it's home.
It was weird, right? This year, summer didn't really start 'til July. Sure, we had a hot day here and there, but any true Phoenician knows to brace for the heat starting in, oh, March. Not so in 2009, and June was particularly balmy. If you don't believe us, check out the stats: We haven't had this many days under 100 in the month of June (only 13!) since 1927. Which only made July the cruelest month — when, as if on cue, the temperature soared.
Here at New Times, we know maps. We've spent countless hours trying to assemble them for our own various purposes. That's why we have such an appreciation for the Small Wonders map, published by Local First Arizona, designed to promote local businesses in both central/downtown Phoenix and Tempe. Consider this our thank you note for the labor of love it took to create these fold-out, easy-to-use, eye-pleasing guides to our favorite stuff in the city. It was surely no small feat to produce them.
Depending on whom you ask, the year-old Metro light rail may or may not be the most over-hyped project in Phoenix history. But no matter what you think of the billion-dollar (and counting!) project, you have to admit the view of the Phoenix skyline from the bridge going over Tempe Town Lake is pretty amazing, especially at dusk. From the confines of the always overpacked or nearly empty train car, you get a glimpse of Phoenix at its best. The downtown towers reach ever higher, their steady ascent seemingly fueled by the mysterious desert waters around you, but they never quite catch their backdrop, South Mountain. As the copper-colored star fades into the purplish haze of an Arizona sunset, even the most curmudgeonly rail-hater has to be impressed by the beautiful scene framed through the windows of this ambitious transportation project.


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Atalanta's Boots are a pair of white boots with a colored trim, an embroidered design and chained anklets. They are available for female characters in Character Creation for Soulcalibur IV.
Soulcalibur IV
This Leg Equipment raises Power and Attack by 20 with HP by 10. It is worn by Cassandra in her 2P Costume, and is made available when she is unlocked for 4,000 Gold at the Fighter Select Screen.


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IPad Pro: How Much Revenue Can It Generate For Apple?
- Investors have lost all faith and confidence in Apple.
- However, there's little reason to substantiate those fears, as outward assumptions on growth seem depressed and upside catalysts to earnings and sales have emerged.
- Furthermore, the various factors sustaining the companies success have remained constant, and that a competitive durable advantage seems sustainable in light of recent innovations.
- I anticipate that the iPad segment will generate substantial year-over-year growth due to the product's characteristics, broader growth trends in 2-in-1s, and the pricing of the product category.
- I also anticipate that the management team may be slow to respond to demand and may not have enough spare capacity to meet demand.
Following the Apple (NASDAQ:AAPL) September 9th event, I started to become a little more optimistic on the company despite the lack of new product category announcements. Needless to say, the expectations for growth seem very muted going into FY 2016. Furthermore, it seems like investors have either given up or have lowered expectations on price momentum going forward.
The market has given investors a much more opportune time to buy Apple stock despite the uncertainty surrounding the long-term growth potential of aging product categories like the iPad and iPhone.
I will explain the potential upside to the iPad throughout the course of this article. Just know that the stock is pretty cheap and opportunities like this don't come around that often.
Addressing the expectations
The average estimate for next year sales growth is 4.8% year-over-year, and given Apple's historic growth rate it seems a bit low. At this point, analysts may be anticipating too much deceleration in terms of sales, as the product categories while mature have not reached full market saturation. Furthermore, there seems to be a lot of demand for Apple branded products, as there's been a lot of upward momentum in premium product categories in both the smartphone and PC/tablet space. As an extension to that argument, I believe that price-sensitive consumers can overcome that sensitivity to pricing assuming the marginal value creation can exceed the pricing dynamics of demand. In other words, it's an economist's way of saying that the current upgrade cycle may result in higher demand due to an improvement in product specification and features, and will result in less price sensitivity.
After looking at the price elasticity of demand for computers, it has extremely high elasticity amongst a variety of products and services. Demand tends to drop by two times as pricing increases, and it's why Apple occupies 5% of the PC market in terms of shipments. In the case of smartphones; saturation seems to be concentrated more heavily in developed markets. The marginal value creation from a high-end to a low-end device is high, and it's why consumers tend to exhibit less price sensitivity assuming the consumer has the means to purchase a high-end smartphone.
Market share trends a red herring
Apple will never win in terms of market share, but will continue to dominate in the higher-priced categories, which also explains why Apple generates 92% of the industry's profits, and has 90% market share for phones above $600 according to the 3rd quarter earnings conference call.
To generate this level of profitability Apple tends to focus more on the consumer experience and works backward based on the needs of consumers in order to determine the type of products they want to design and sell. This is why many within the tech community tend to have a very difficult time predicting what Apple will do next, and often over-estimate the impact of nascent technologies. Furthermore, patent applications don't always indicate that Apple is trying to implement the patents inside of future products, and because Apple is very focused on creating a unique and proprietary user experience you're more likely to see changes in terms of the software more so than hardware going forward.
However in this specific generation, force touch seems to be a game changer, as it impacts both the hardware and software layer and introduces an alternative form of interacting with smartphone devices. Apple has patented this technology and it will be interesting to see how other tech companies will either emulate, copy, or create an alternative form of interaction with devices that will be very similar all while avoiding patent infringement.
Technology a key driver to growth
The transition to iOS 9 and the haptic feedback engine are likely to render older generation devices obsolete relatively quickly as applications continue to optimize around the differences in iOS 9. Therefore, the real theme to this year's product has been user interface, and less so about hardware. Implementing a stronger aluminum body, and creating a rose gold model for Chinese consumers is probably the most noteworthy aspect when it comes to design.
Apple continues to support older devices with software updates that tend to improve security and speed with zero compromises to compatibility with applications and other peripheral devices. As many of you are well aware, compatibility is a huge issue, and ensuring long-term stability in products and services has not been a strong point when it comes to either Windows or Android devices. It's why Apple has a relatively strong resale market and has high resale values. So even if Apple cannot appeal directly to consumers by pricing at retail to match Windows PCs and android devices, the older devices continue to have a life of their own as they transition to new owners who tend to be much more frugal.
I recently made a forecast that the iPad Pro should be able to generate 58.8 million in unit shipments based on the pricing elasticity of computing devices in general. This is because, the iPad Pro seems like a computer replacement, and as such, it is a near full-feature device, which is why consumers will respond similarly to price as if it is a 2-in-1 PC purchase.
The iPad Pro is substantially cheaper and because it's a sub-$1,000 device the demand should be better than what analysts and Apple's management team will realistically anticipate. I'm working off of an $800 ASP at mid-point of the pricing tiers, and as such, I anticipate $47 billion in revenue for the iPad segment. By the end of FY 2015, I anticipate the iPad segment to generate $26.341 billion in revenue, which is approximately a 19.86% year-over-year decline in sales. The reason why I anticipate the segment to generate substantial growth ($27 billion to $47 billion) is driven by rapid growth in the 2-in-1 segment of the PC market, which is based on Intel's recent comments. Also, it helps that Apple has a branding/product advantage when compared to alternative products.
Final thoughts
The incremental revenue from the iPad segment will offset any potential losses from iPhones, however, the issue with my forecast is mostly given by supply-driven factors. Apple has delayed the launch of products on numerous occasions because it was unable to procure enough components for manufacturing to meet market demand. Therefore, while the iPad segment will generate substantial growth in the next fiscal year, the growth rate could be off, as the company will not anticipate a massive uptake in demand as they move down the pricing tiers for PCs.


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|Message view
|« Date » · « Thread »
|« Date » · « Thread »
|Jim Jagielski <...@jaguNET.com>
|Re: commit-then-review
|Fri, 09 Jan 1998 23:29:37 GMT
Dean Gaudet wrote: > > I'm not advocating that we stop communicating with each other... I'll > still babble on about crap I'm working on. I like babbling. > This kind of feedback goes a long way in alleviating people's concern. As things become clearer on how commit-then-review it's getting better as well. For one thing, it's getting all of us talking. All of us are "promising" that committed code will get a serious look through. There's also the note that pre-work communication will go on, which was absent from the original concept (or maybe just not vocalized)... commit-then-review is evolving into a version of LAZY voting, except that the reports in STATUS don't reference actual patches, but concepts and ideas. My whole point, just in case people aren't getting it into their heads, has been the concept of KNOWLEDGE. That the team knows what people are doing, not the details per-se, but just the direction and things like that. -- ==================================================================== Jim Jagielski | jaguNET Access Services email@example.com | http://www.jaguNET.com/ "Look at me! I'm wearing a cardboard belt!"
|View raw message


text: Schedule/Results Template:University of North Carolina Football Schedule/Results UNC more UNC content Player Portal Opinion Archive News Archive Kenan Stadium History/Records most recent game (write a recap) <ListPages> order=new category=University of North Carolina Football Game Recaps count=1 details=hide </ListPages> 2006 football standings Template:Atlantic Coast Conference Football Standings Small random unc fan (see all fans) <ListPages> category=University of North Carolina fans count=1 Details=hide nav=off random=yes </ListPages> random unc blog <ListPages> category=University of North Carolina Blogs count=1 random=yes Details=hide nav=off </ListPages> submit your blog view all unc blogs showdowns (challenge someone) <ListPages> order=new category=University of North Carolina Football Showdowns count=5 details=hide </ListPages> Retrieved from "http://armchairgm.wikia.com/wiki/University_of_North_Carolina_Football?oldid=165771" Ad blocker interference detected! Wikia is a free-to-use site that makes money from advertising. We have a modified experience for viewers using ad blockers Wikia is not accessible if you've made further modifications. Remove the custom ad blocker rule(s) and the page will load as expected. Categories: College Football Teams Atlantic Coast Conference Football Teams


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...according to the listening test.
Just took it again and got Elementary (low).
I think it might be better if you had 3 options to select:
Didn't understand at all
Partially understand
Fully understand
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