text:
|Detection of abnormal and induction of normal heart rate variability
|Methodology for automated QT variability measurement
This application is a Division of U.S. application Ser. No. 09/005,194 filed Jan. 9, 1998, now issued as U.S. Pat. No. 6,035,233, which is a Divsion of U.S. application Ser. No. 08/570,727 filed Dec. 11, 1995, now issued as U.S. Pat. No. 5,749,900.
receiving a plurality of heart beat signals from said heart for each of a plurality of epochs;
computing a measurement of heart rate variability for each of said epochs;
defining an abnormal heart rate variability zone to include a first measurement of heart rate variability from a corresponding first epoch if said heart exhibits a cardiac anomaly during said first epoch; and
comparing said abnormal heart rate variability zone with said measurements of heart rate variability occurring after said first epoch.
creating a pathway along said series of successive measurements;
modifying said abnormal heart rate variability zone to include said pathway; and
comparing said modified abnormal heart rate variability zone with said measurements of heart rate variability occurring after said first epoch.
Traditionally, human heartbeat was thought to be regulated according to classical principles of homeostasis. Under this theory, the human physiological system operates in a manner which adjusts heart rate variability to achieve a state of equilibrium. Clinicians, in fact, traditionally described the normal beat activity of the heart as a "regular or normal sinus rhythm."
Modern views now depart from these traditional ideologies. More recent studies and research show that, even with healthy individuals, the heart does not beat with metronomic regularity. Rather, the heart exhibits beat-to-beat fluctuations which are far from equilibrium. See C. K. Peng, et al, "Fractal Landscapes in Physiology & Medicine: Long-Range Correlations in DNA Sequences and Heart Rate Intervals" pp. 55-65, appearing in Fractals in Biology and Medicine, by T. F. Nonnenmacher, et al (Ed.) (1994). Electrocardiograms, for example, show that an individual will exhibit a fluctuating or erratic heart rate variability during both rest and sleep periods.
Beat-to-beat fluctuations which occur around a person's mean heart rate are known as heart rate variability. The fluctuations from beat-to-beat are attributed, in part, to the nonlinear interaction between the sympathetic and parasympathetic branches of the involuntary nervous system. The sympathetic autonomic and parasympathetic autonomic nervous systems regulate, to some extent, the sinoatrial (SA) node and atrioventricular (AV) node of the heart and, thus, largely influence the control of the heart rate. These two nervous systems operate somewhat reciprocally to effect changes in the heart rate. In this regard, parasympathetic stimulation decreases the firing rate of the pacing cells located in the sinus node of the heart. Sympathetic stimulation, on the other hand, increases this firing rate.
Most clinicians agree that the parasympathetic and sympathetic inputs to the SA node mediate low frequency heart rate fluctuations (i.e., generally below 0.15 Hz), whereas modulation of parasympathetic outflow mediates higher frequency fluctuations. Studies have further shown that a decrease in heart rate variability correlates with a decrease in parasympathetic nervous activity and an accompanied increase in sympathetic nervous activity. See J. Thomas Bigger, et. al, "Components of Heart Rate Variability Measured During Healing of Acute Myocardial Infarction" American Journal of Cardiology, Vol. 61 (1988), pp.208-215. In a healthy, resting heart, for instance, the parasympathetic activity dominates to maintain the heart rate. However, in an unhealthy heart, for example one having heart disease, sympathetic activity may more influence and control the heart rate.
Over the past several years, heart rate variability was increasingly recognized as a diagnostic and a prognostic indication of the cardiac health risks to which a person is susceptible. As a result, much research has been directed toward heart rate variability. In particular, clinicians have been investigating the possibility that heart rate variability may provide important information to forecast impending cardiac anomalies. One study, for example, verified that a low standard deviation of heart rate variability is a powerful prognostic indicator of sudden coronary death in patients recovering from acute myocardial infarction. See Alberto Malliani, et. al, "Power Spectral Analysis of Cardiovascular Variability in Patients at Risk for Sudden Cardiac Death" Journal of Cardiovascular Electrophysiology, Vol. 5 (1994), pp. 274-286.
Today, cardiologists generally are in accord that heart rate variability does have a correlation to the present condition of a person's heart rate or the future occurrence of an abnormal cardiac event. In fact, numerous studies have been performed which demonstrate this correlation. For example, if the heart rate of a healthy individual is compared to the rate of a patient having congestive heart failure, distinct differences in the beat intervals will be observed. In this regard, the healthy individual will exhibit more complex patterns of fluctuation than the non-healthy individual.
Furthermore, studies specifically relate heart rate variability to death in cardiac patients. Diminished heart rate variability now is associated with an increased risk for ventricular fibrillation and sudden cardiac death. One study concluded:
Heart rate variability is an independent predictor of death when other known postinfarction risk variables (for example, prolonged left ventricular ejection fraction, ventricular arrhythmias, and clinical variables) are considered. Heart rate variability has a higher association with risk for death than other variables obtained by Holter monitoring, (for example, mean heart rate and ventricular arrhythmias). Heart rate variability also appears to be a better predictor of arrhythmia complications than prolongation of the ejection fraction.
See Conny M. A. van Ravenswaaij-Arts, et. al, Annals of Internal Medicine, Vol. 118 (1993), pp. 436-447.
As noted, clinicians use heart rate variability to predict the onset of sudden cardiac death. Although the exact cause of cardiac death is not completely understood, most victims suffer from ventricular tachycardia that degenerates into ventricular fibrillation. Investigators have exhausted significant effort to predict the onset and triggers for such ventricular tachyarrhythmias. Heart rate variability is one available predictive value. Recent studies in this field verify that a decrease or increase in heart rate variability during the first several weeks after an acute myocardial infarction may be used to predict subsequent mortality or ventricular rhythmic disorders. One study examined approximately 800 patients who had survived an acute myocardial infarction and concluded that patients with a heart rate variability of less than 50 milliseconds had a 5.3 times higher mortality rate than those patients with a heart rate variability of more than 100 milliseconds. See Robert E. Kleiger, et. al, "Decreased Heart Rate Variability and Its Association with Increased Mortality After Acute Myocardial Infarction" American Journal of Cardiology, Vol. 59 (1987), pp. 256-262. Patients experiencing congestive heart failure and coronary artery disease also exhibit a decrease in heart rate variability. See Casolo G. et al, "Decreased Spontaneous Heart Rate Variability in Congestive Heart Failure," American Journal of Cardiology, Vol. 64 (1989), pp. 1162-1167.
Even in healthy individuals having normal heart rate variability, the heart rate intervals generally have a circadian variation. This circadian variation, however, may begin to become less pronounced and more irregular several minutes to several hours before the onset of an abnormal cardiac event. Researchers, for example, have found that heart rate variability progressively decreases in the hours preceding the onset of arrhythmia. Monitoring heart rate variability in such instances thus provides clinicians with a tool to forecast impending cardiac events.
As one advantage, measurements of heart rate variability are generally non-invasive and may be reliably performed. A Holter monitor or electrodes affixed to the patient measure heart rate very accurately. The electrodes detect the heartbeat, usually the R-R interval, for a series of beats. Thereafter, statistical data, such as mean, median, and standard deviation, are computed and then used to forecast the onset of a cardiac event. One known method for using heart rate variability is to compare heart rate intervals recorded under normal heart rate conditions to subsequent heart rate intervals. Deviations between the two recordings then may be used as an indication of heart rate variability fluctuation. In one embodiment, a Holter monitor records R-R intervals while the patient exhibits normal or healthy heart rate variability. An algorithm based on mean and standard deviation then computes a single user value which is stored in permanent memory. This user value represents the patient's stress state during normal heart rate variability conditions. Thereafter, the patient wears a wrist detector which monitors the R-R intervals for discrete beat periods, for example 100 beats. Once a beat period is complete, the wrist detector uses the algorithm to compute the patient's present user value or present stress state. This present user value is then compared to the permanently stored user value which was previously recorded under normal heart rate conditions. Theoretically, this comparison reveals deviations from normal heart rate variability which, in turn, are a measure of the patient's cardiac stress state. Large deviations between the two user values reflect large deviations in the autonomic nervous system balance between the sympathetic and parasympathetic activities. For example, if the presently recorded user value deviates from the permanently stored user value more than 25%, the patient may be subject to an elevated stress level with an accompanying abnormal heart rate variability.
One important disadvantage associated with methods and apparatus for utilizing heart rate variability concerns the failure to provide a more intelligent algorithmic structure. Heart rate variability algorithms typically first compute a present user value based on the R-R intervals. Thereafter, this present user value is compared with a previously stored user value and a deviation between the two is computed. The algorithmic structure itself, however, remains unchanged. Thus, when subsequent R-R intervals are received and new user values calculated, these values are again compared with the same permanently stored user value. As such, the algorithm repeatedly uses the same threshold parameters defining normal and abnormal heart rate variability.
Another disadvantage associated with methods and apparatus for utilizing heart rate variability concerns the treatment of heart rate variability data leading up to an abnormal cardiac event. Devices measuring heart rate variability often have memories which operate on a first-in-first-out basis. These types of memories hold the heart rate data in sequence and discard the oldest data and save the newest, incoming data. The older data, however, may provide important information regarding the onset of subsequent cardiac events.
The present invention is addressed to a method and apparatus for evaluating heart rate variability of a person in order to recognize or forecast a cardiac event. Heart rate variability zones initially are established to define normal and abnormal cardiac sinus rhythm of the person. Thereafter, these zones are automatically modified after the occurrence or non-occurrence of a cardiac event. As such, the bounds defining normal and abnormal heart rate variability specifically adapt to a person's physiological and cardiological conditions. Once a cardiac event occurs, a pathway leading up to that event is stored. Patient heart rate variability is then compared to this pathway to determine the re-occurrence of a cardiac event.
In the present invention, a microprocessor-based cardiac stimulator receives heart-beat signals from the heart. The cardiac stimulator computes time intervals occurring between successive heart beats and then derives a measurement of heart rate variability from epoch data for predetermined time periods. This epoch data may include both statistical data derived from the time intervals and sensing data derived from patient sensors. The cardiac stimulator then compares measurement of heart rate variability with previously stored heart rate variability zones which define normal and abnormal heart rate variability. If the measurement of heart rate variability is within the limits of an abnormal heart rate variability zone then an appropriate therapy regime is initiated. On the other hand, if the measurement of heart rate variability is within a normal heart rate variability zone, a therapy regime is not initiated. However, when the measurement of heart rate variability is within a normal heart rate variability zone and the person is nevertheless experiencing a cardiac event, then the abnormal heart rate variability zone is modified to include the measurement of heart rate variability. As such, the definition of normal and abnormal heart rate variability changes to meet the cardiac requirements of a particular individual.
Once a cardiac event occurs, a memory permanently stores the present epoch data and, additionally, a series of epoch data leading up to the event. Together, this series of epoch data forms a pathway from a generally normal heart rate variability condition to an abnormal heart rate variability condition. This pathway aids in predicting the occurrence of future cardiac events and in identifying the occurrence of present cardiac events. In this regard, all measurements of heart rate variability occurring after the cardiac event are compared with the pathway. This comparison reveals whether the person is again experiencing conditions similar to those leading to the prior cardiac event.
As another advantage, the abnormal heart rate variability zone may be divided into a plurality of abnormal subzones. Each of these subzones corresponds to a therapy regime for initiating further sensing or therapeutic vigilance. Further, the therapy regimes may have a structure with progressively higher degrees of aggressiveness and vigilance.
Additionally, selective activation of therapy regimes minimizes non-essential energy consumptive and diagnostic activities and, thus, conserves power supply longevity.
The invention, accordingly, comprises the apparatus and method possessing the construction, combination of elements, and arrangement of parts which are exemplified in the following detailed description. For a fuller understanding of the nature and objects of the invention, reference should be made to the following detailed description taken in connection with the accompanying drawings.
FIG. 1 is a block diagram of an implantable cardiac pulse stimulator;
FIG. 2 is a flow diagram for specifying heart rate variability parameters;
FIG. 3 is a perspective view of heart rate variability zones;
FIG. 4 is a block diagram of a therapy regime;
FIG. 5 is a flow diagram for calculating epoch statistical data;
FIG. 6 is a flow diagram for calculating epoch sensing data;
FIG. 7 is a flow diagram for comparing epoch data with stored heart rate variability parameters;
FIG. 8 is a perspective view of modified heart rate variability zones;
FIG. 9 is a flow diagram for comparing current epoch data with stored epoch data; and
FIG. 10 is a perspective view of a series of epoch data locations leading to a cardiac event.
FIG. 1 is a block diagram illustrating an implantable cardiac stimulator 10 for carrying out the teachings of the present invention. Stimulator 10 may be a pacemaker, defibrillator, or other implantable pulse generator. A microprocessor 12 provides control and computational facilities for stimulator 10. Microprocessor 12 has input/output ports connected in a conventional manner via bidirectional bus 14 to memory 16, an A-V interval timer 18, and a pacing interval timer 20. A-V interval timer 18 and pacing interval timer 20 have an output connected individually via lines 22 and 24, respectively, to a corresponding input port of microprocessor 12.
A-V and pacing interval timers 18 and 20 may be external to microprocessor 12, as illustrated, or internal thereto. Additionally, these timers may be conventional up/down counters of the type that are initially loaded with a count value and count up to or down from the value and output a roll-over bit upon completing the programmed count. The initial count value is loaded into A-V and pacing interval timers 18 and 20 on bus 14. Respective roll-over bits are output to microprocessor 12 on lines 22 and 24. Memory 16 preferably includes both ROM and RAM. Generally, ROM stores operating routines, and RAM stores programmable parameters and variables.
Microprocessor 12 preferably also has an input/output port connected to a telemetry interface 26 via line 28. Stimulator 10, when implanted, is thus able to receive variable and control parameters from an external programmer and to send data to an external receiver if desired. As such, operating parameters stored within microprocessor 12 may be selectively altered non-invasively. Many suitable telemetry systems are known to those skilled in the art. U.S. Pat. No. 4,539,992 by Calfee, et al., issued Sep. 10, 1985 and entitled "Method and Apparatus for Communicating with Implanted Body Function Stimulator" describes an example of a telemetry system and encoding arrangement.
Control lines 30 and 32 connect microprocessor output ports to inputs of an atrial stimulus pulse generator 34 and a ventricular stimulus pulse generator 36, respectively. Pulse parameter data, such as amplitude, width, enable/disable, and pulse initiation codes transmit to generators 34 and 36 via lines 30 and 32, respectively. In addition, control lines 38 and 40 connect microprocessor input ports to outputs of an atrial sense amplifier 42 and a ventricular sense amplifier 44, respectively. Atrial sense amplifier 42 detects the occurrences of P-waves, and ventricular sense amplifier 44 detects the occurrences of R-waves.
The input of atrial sense amplifier 42 and the output of atrial stimulus pulse generator 34 connect to a first conductor 46 which connects to a first conventional type lead 48. An electrically conductive pacing/sensing tip 52 is located at a distal end of lead 48. This pacing/sensing tip electrically connects to conductor 46 and connects, for example, to heart 50 in right atrium 54.
The input of ventricular sense amplifier 44 and the output of ventricular stimulus pulse generator 36 connects to a second conductor 56 which connects to a second conventional type lead 58. An electrically conductive pacing/sensing tip 62 is located at a distal end of lead 58. This pacing/sensing tip electrically connects to conductor 56 and connects, for example, to heart 50 in right ventricle 60. Leads 48 and 58 may be inserted into heart 50 transvenously or in any other suitable manner.
Conductors 46 and 56 conduct the stimulus pulses generated in atrial and ventricular stimulus pulse generators 34 and 36, respectively, to pacing/sensing tips 52 and 62. Pacing/sensing tips 52 and 62 and corresponding conductors 46 and 56 also conduct sensed cardiac electrical signals in the heart to atrial and ventricular sense amplifiers 42 and 44.
Cardiac stimulator 10 also may serve as a defibrillator. In this regard, microprocessor 12 controls a high voltage defibrillator circuit 64. Two high voltage leads 66 and 68 connect to the heart with two electrodes 70 and 72. In the illustrated embodiment, epicardial patch electrodes are diagrammatically represented; although, other electrode configurations, such as endocardial electrodes or others known to those skilled in the art, may be used.
The input and output ports of microprocessor 12 also connect to various sensors 74 via a bidirectional control bus 76. Implantable cardiac stimulators often employ sensors or sensing capabilities. Sensors 74 may be a variety of different sensing devices which gather information about the patient. These sensors, for example, may sense ventilation, acceleration, activity, oxygen level, blood pressure, temperature, blood oxygenation, blood pH, impedance, adrenaline levels, or the like.
Those skilled in the art will recognize that the present invention may be used with various implantable devices, with stimulator 10 in FIG. 1 illustrating an example of one such device. Other possible implantable devices, for example, may be directed solely or jointly to tachycardias, bradycardias, or fibrillation, and, in this regard, comprise a defibrillator, a single or dual chamber pacer, or combinations thereof. In addition, the method of the invention may be used in devices which do not stimulate the heart at all or devices which are not implantable. Such devices, however, must be able to sense or record the cardiac wave-form in order to measure the beat-to-beat intervals of the heart. Measurement of this interval may be done remotely from the heart, for example with electrodes placed on the patient, or within the heart itself, for example, from either the atrium, ventricle, or both.
In order to obtain the beat-to-beat interval between successive heart beats, signals from the heart communicate from electrodes to the cardiac stimulator or other such monitoring device. In FIG. 1, either sensing tip 52 or sensing tip 62 detects the heart's signals. Once these signals are detected, they may be processed in various ways to acquire the beat-to-beat intervals. U.S. Pat. No. 5,201,321 by Fulton, issued Apr. 13, 1993, and entitled "Method and Apparatus for Diagnosing Vulnerability to Lethal Cardiac Arrhythmias" teaches a method and apparatus for receiving heart beat signals and then calculating the beat-to-beat intervals. As an example, the signal received from the heart is digitized, and the output is provided to a peak detector which is connected to a memory. The peak detector measures the timing of the peak amplitude, such as the A-A, P-P, V-V, or R-R interval of the heart signal (A-A interval is the time between successive atrial depolarizations as measured from within the atrium; P-P interval is the time between successive atrial depolarizations as measured on the body of the patient; V-V interval is the time between successive ventricular depolarizations as measured from within the ventricle; and R-R interval is the time between successive ventricular depolarizations as measured on the body of the patient). The memory or recording device then stores the timing of the successive intervals. The timing intervals usually are measured in units of time or in terms of the number of samples between beats. The particular method or apparatus used to record the beat-to-beat intervals is less critical, as long as these intervals are accurately obtained.
Preferably, the beat-to-beat intervals are recorded during predetermined lengths of time or epochs. The epoch period typically will endure for several minutes, for example five minutes, or for a given number of heart beats, for example 100 to 1000 beats. The length of the epoch is programmable and may vary. Preferably, beat-to-beat intervals are continuously recorded for successive epochs.
The overall operating method and algorithm of the present invention is illustrated in a discussion of the flow diagrams which follow. The flow diagrams represent the program structure under which microprocessor 12 preferably operates. The program structure may be written in a low level computer language, such as assembly, and retained in a memory within the microprocessor.
Looking first to FIG. 2, a program structure commences at begin 100. As represented at block 102, conventional initialization procedures are performed. These procedures may include setting all pointers, registers, and counters, and clearing specified memory locations. Epoch statistical data then is selected, as depicted in block 104. This statistical data generally includes computational and statistical algorithms, variables, equations, and the like known to those of ordinary skill in the art. Typically, this statistical data will include any combination of at least one of a measure of central tendency or a measure of dispersion. Additional examples of statistical variables and equations which may be calculated for an epoch period include: mean, MAD (mean absolute deviation), median, mode (most commonly occurring heart rate variability interval), amplitude of mode (percentage that mode occurs), variation range (difference between highest and lowest heart rate variability interval), PNN50 (percentage of heart rate intervals having a duration longer than 50 ms), standard deviation, range, power spectral density, and variance.
In order to evaluate the heart rate variability of the patient and, in turn, forecast the patient's heart condition, sensing data may be used in addition to statistical data. Looking now to block 106, epoch sensor data is selected. Sensing data is derived from sensors or electrodes which measure physiological conditions of the patient. Such sensors may be directed toward sensing, for example: evoked QT intervals, respiration, stroke volume, central venous oxygen saturation, right ventricular pressure, blood pressure, muscle noise, acceleration, impedance, activity or motion, temperature, blood pH, and adrenaline. An activity sensor, for example, is capable of measuring the movement and motion of the patient.
Any combination of statistical equations/algorithms and sensing data may be utilized to evaluate heart rate variability. Statistical equations, for example, may be used singly or incorporated into a statistical algorithm to produce statistical data for a given epoch. This statistical data, in turn, may be combined with sensing data. Together, the statistical and sensing data form the epoch data for a given epoch.
Block 108 shows that heart rate variability zones and corresponding therapy regimes are designated and then stored into memory. The heart rate variability zones define normal and abnormal heart rate variability for the patient. FIG. 3 illustrates an exemplary heart rate variability zone configuration generally at 120. Three separate axes define configuration 120. Mean value of AA intervals defines the x-axis; PNN50 defines the y-axis; and patient activity defines the z-axis. Within configuration 120, an abnormal heart rate variability zone is shown generally at 122. A normal heart rate variability zone 124 occurs outside the boundaries of abnormal zone 122.
A set of parameters defines the boundaries or limits of abnormal zone 122 and normal zone 124. These parameters include values or ranges of values for each of the three axes. Preferably, the parameters divide abnormal zone 122 into a plurality of heart rate variability sub zones. FIG. 3 shows abnormal zone 122 subdivided into six different subzones 126-131, respectively. Separate and independent sets of parameters define each subzone 126-131. Each of the subzones corresponds to a different heart rate variability state, and the subzones may have a hierarchical format with respect to the level of abnormality of heart rate variability or with respect to the corresponding cardiac condition of the patient. For example, subzone 126 may represent heart rate variability conditions with a more heightened degree of alert than subzone 129.
In FIG. 3, a somewhat rectangular configuration illustrates each subzone. It will be appreciated that these configurations are for illustrative purposes and will vary depending on the parameters which define the bounds of the subzones. In addition, the configurations generally will depend not only on the statistical and sensor data selected to define the subzones but also on particular physiological conditions and requirements of an individual patient. In this regard, each patient undergoing heart rate variability analysis may require a different set of parameters defining each subzone 126-131. Further yet, the subzones may have a plurality of different parameters. In FIG. 3, three different parameters define abnormal zone 122. The number of parameters may vary from one to more than four or five. A fourth parameter, for example, could be time of day. Configuration 120 depicts three parameters and six subzones for illustration.
The parameter's bounds or limits for each subzone may be established before heart rate variability analysis commences. For example, a doctor or clinician may assign specific numerical values for each of the subzones based on the medical history of a patient. Alternatively, the patient may undergo monitoring to determine limits for abnormal and normal heart rate variability. A Holter monitor or other device used to record and store heart rate variability data may monitor the heart rate variability of the patient. Thereafter, limits for each of the subzones may be calculated based on this data. As another alternative, the boundaries defining the subzones may be based on an initial estimation and pre-programmed into memory.
Each subzone also has an associated therapy regime. The therapy regimes preferably have a hierarchical format with respect to the level of abnormality of heart rate variability or with respect to the corresponding cardiac condition of the patient. In this regard, a lesser degree of aggressiveness may be associated with a subzone having a more acceptable heart rate variability and a more aggressive therapy assigned to a subzone having more abnormal heart rate variability.
FIG. 4 illustrates an exemplary therapy regime generally at 150. In this figure, therapy regime 150 has eight different therapy levels 152-159. Commencing then with the least aggressive regime, therapy level 152 calls for the initiation of more energy expensive tests or data acquiring procedures to better or more accurately assess the heart condition of the patient. These procedures may include various forms of added vigilance, such as activating a sensor which senses ventilation, acceleration, impedance, activity or motion, oxygen, blood pressure, temperature, blood oxygenation, blood pH, or adrenaline. Further, the procedures may include increasing the level of diagnostic data collection, for example, waveform storage with increased sampling rate, increasing diagnostic biopotential channel bandwidth, increasing parameter recordings, and increasing signal processing. Further yet, additional statistical data may be calculated or additional statistical algorithms employed. This statistical data may be based on heart rate intervals stored during current or previous epochs. Additionally, the initiation of completely non-invasive procedures are possible. For example, a warning or alarm may communicate to the patient, health provider, clinician, or a designated location. Such a warning, for example, could communicate the patient's pending heart condition or, alternatively, alert a clinician of the patient's condition or need for added attentiveness. Next, therapy level 153 calls for bradycardia pacing or antibradycardia pacing. If the heart rate variability were more abnormal, a higher rate overdrive pacing would be implemented, as shown in therapy level 154. Level 155 illustrates antitachycardia pacing and would occur, for example, if the patient were experiencing atrial flutter or ventricular tachycardia. The next higher level 156 calls for a form of neural stimulation to stimulate vagal activity of the patient. Level 157 illustrates activation of a counteractive drug dose. A drug infusion pump could infuse drugs to the patient to counteract any increased adrenalin and act as a tranquilizer. As such, the drug would effectively normalize heart rate variability. If the patient experiences yet a more extreme cardiac condition, a cardioversion shock may be initiated, as shown at level 158. An extreme level 159 calls for administering a defibrillation shock if the patient exhibits even more extreme cardiac conditions or exhibits extreme abnormal heart rate variability.
Selective activation of therapy regime 150 saves energy and thus conserves power supply longevity. In this regard, a heightened degree of vigilance generally is not initiated until the patient exhibits an abnormal heart rate variability. Once abnormal variability is detected, a therapy regime, such as shown in levels 152-159, is initiated. Possible regimes, as noted, include additional sensing, computing, or the like. Since these regimes require power to initiate, selective activation saves energy. Further, during periods of abnormal heart rate variability, non-essential computational and diagnostic activity occurring within the stimulator may be suspended, halted, or not commenced in order to reduce potential sources of interference and devote computational resources to monitoring and diagnosing heart rate variability or a cardiac event. For example, if an abnormal heart rate variability is detected, unnecessary reforming of a defibrillator capacitor may be stopped.
Each therapy level 152-159 may correspond to a different heart rate variability subzone. For example, looking also to FIG. 3, subzone 126 may correspond with therapy level 152, while subzone 131 corresponds with therapy level 159. It will be appreciated that FIG. 4 illustrates an example of one therapy regime. However, alternative therapy regimes may differ for individual patients and be tailored to meet specific cardiac requirements.
Additionally, other types of heart rate measurement and evaluation schemes also are available. For example, time domain analysis or a frequency domain analysis are two common ways researchers use to examine heart rate variability. In the time domain analysis, a graph typically displays the R-R intervals as the number of beats occurring during a specified time. As an example, ECG monitors may record and calculate heart rate variability. In the frequency domain analysis, a Fourier transform algorithm decomposes sequential R-R intervals into a sum of sinusoidal functions. A graph typically displays the result of this algorithm and shows the amplitude of the patient's heart rate fluctuations at different oscillation frequencies. The frequency domain analysis is particularly advantageous in some instances because certain frequency bands within the spectral analysis are associated with autonomic nervous system control of sinus node period. See J. Thomas Bigger, et. al, "Frequency Domain Measures of Heart Period Variability and Mortality After Myocardial Infarction" Circulation, Vol. 85 (1992), pp. 164-171.
Looking now to FIG. 5, a program structure is shown for calculating selected epoch statistical data. The program structure begins at 170 and commences conventional initialization procedures at 172. Next, as shown in block 174, measurement of successive heart beat signals occurs. Then, as represented at 176, the beat-to-beat intervals between heart beats of the patient is calculated. These intervals represent the time period between successive beats. A memory stores the intervals, as shown in block 178. Next, a query is made at block 180 to determine whether the beat-to-beat interval has a length of time greater or less than 50 ms. If the beat-to-beat interval is greater than or equal to 50 ms, then a counter is incremented at 182. If the interval is less than 50 ms, a counter is incremented at 184. The counters may be in the microprocessor or control circuitry and count the number of times during a single epoch the beat-to-beat intervals are greater or less than 50 ms. At block 186, a query determines if the epoch period ended. If the epoch period has not ended, then the program structure returns to block 174 and continues to measure intervals between successive heart beats. If the epoch has ended, statistical data is calculated for the epoch, as shown at 188. The statistical data calculated at 188 is calculated for the data collected during the epoch. As illustrated in FIG. 3, the statistical data may also include, for example, PNN50 and Mean. Once the statistical data is calculated, it is stored into memory, as shown in block 190. In addition to storing the statistical data for the current epoch, counts one and two, the timing of the intervals, and the time of day also are stored. The program structure of FIG. 5 repeats, as shown along line 192, and again begins to measure heart beat intervals and calculate statistical data for succeeding epoch periods.
Turning now to FIG. 6, a program structure commences selected sensing of the patient and calculation of sensing data. The program structure begins at 200 and initiates conventional initialization procedures at 202. Next, as shown in block 204, selected sensors are initiated and begin to collect information for the current epoch period. As noted, a variety of different sensing devices may sense and collect data from the patient. FIG. 3 illustrates initiation of an acceleration, activity, or motion sensor. Next, a query is made at block 206 to determine whether the epoch period has ended. If the epoch period has not ended, then the program structure returns to block 204 and continues to collect information. If the epoch has ended, the program structure proceeds to block 208, and the sensors selected in block 204 calculate sensing data for the epoch. For example, activity signals received during the epoch may be averaged to indicate a mean activity rate As shown in block 210, memory stores the sensing data and the time of day. At the end of the epoch, the program structure of FIG. 6 repeats, as shown along line 212, and again begins to sense using the selected sensors.
Looking now to FIG. 7, a program structure is shown for modifying stored heart rate variability zones which were previously stored into memory. The heart rate variability zones are automatically customized to adapt to an individual person's physiological and cardiological conditions. The program structure begins at 216 and then proceeds to block 218 which specifies collecting epoch data and deriving a measurement of heart rate variability. Epoch data, including sensing and statistical data, is collected and calculated as described in connection with FIGS. 2, 5, and 6. The measurement of heart rate variability is derived from the epoch data. This measurement of variability represents a measure of the person's or subject's heart rate variability for a given epoch period and includes all of the epoch data or selected portions. Next, a query in block 220 is made as to whether the end of the epoch period is reached. If the answer is negative, then epoch data is continued to be collected. If the answer is affirmative, the program structure continues to block 222 and a query is made whether present measurement of heart rate variability is within an abnormal heart rate variability zone. FIG. 3 illustrates this occurrence. As shown, three different axes (mean AA, PNN50, and activity) define abnormal heart rate variability zone 122 and normal heart rate variability zone 124. The measurement of heart rate variability is compared with zones 122 and 124 to determine the present cardiac condition and heart rate variability of the patient for the present epoch.
If the present measurement of heart rate variability is within abnormal heart rate variability zone 122, then, as shown in block 224, corresponding therapy is initiated. For example, FIG. 3 shows a possible location 226 within subzone 128. If, on the other hand, the present measurement of heart rate variability is not within abnormal heart rate variability zone 122, then the query of block 228 is presented. FIG. 3 shows a possible location 230 within normal zone 124 and outside the bounds of abnormal zone 122.
Block 228 queries whether the stimulator or measuring device is detecting any form of abnormal cardiac condition. For example the stimulator may be initiating a therapy, detecting a cardiac event, or within a heightened alarm, warning, or sensing condition. For example, the patient may be experiencing a degree of tachycardia, bradycardia, fibrillation, dysrhythmia, arrhythmia, or the like. If the answer to block 228 is negative, then the program structure proceeds to block 232 and the epoch data, including the measurement of heart rate variability, is temporarily saved into memory. If, however, the answer to block 228 is an affirmative, then heart rate variability zone configuration 120 of FIG. 3 is modified to include the measurement of heart rate variability corresponding to the present epoch sensor and statistical data. Modification, for example, may include enlarging or shortening the boundaries of one or more of subzones 129-131. Memory then stores the epoch data and measurement of heart rate variability as shown in block 236.
FIG. 3 illustrates a possible location 238 which is not initially within abnormal zone 122. Thus, no therapy would be initiated due to heart rate variability data of the patient. However, if the stimulator or measuring device concurrently detects an abnormal cardiac condition, the stimulator itself may initiate a therapy or heightened level of vigilance. In this instance, the parameters of abnormal zone 122 change to include the parameters of location 238. FIG. 8 illustrates this occurrence wherein the parameters of subzone 129 enlarge to include location 238. The modified heart rate variability zone configuration 120', including modified subzone 129', is permanently stored into memory. Subsequent measurements of heart rate variability are then compared to modified configuration 120'.
Looking now to FIG. 9, a program structure is shown for comparing present epoch data with previously stored epoch data to determine the heart condition of the patient. The previously stored epoch data represents instances in which the patient experienced a cardiac event or some form of abnormal cardiac condition. A comparison between the present epoch data and the stored epoch data then aids in predicting a re-occurrence of the event.
The occurrence of a cardiac event signifies that the patient's heart is experiencing a cardiac anomaly. Such an anomaly, for instance, may be recognized as an abnormal cardiac rhythm, as a cardiac complication, or as an indication of a possible impending abnormal cardiac condition. Examples of an anomaly would include arrhythmia, dysrhythmia, fibrillation, tachycardia, bradycardia, flutter, myocardial infarction, heart disease or sickness, or the like.
The program structure begins at 250 and then proceeds to block 252 which specifies collecting epoch data and deriving a measurement of heart rate variability. FIGS. 2, 5, and 6 describe the collection and calculation of epoch data. Next, a query in block 254 is made as to whether the end of the epoch period is reached. If the answer is negative, then the program structure loops to block 252, and epoch data is continued to be collected. If the answer is affirmative, the program structure continues to block 256 and a query is made as to whether a cardiac event has occurred. If a cardiac event occurs, memory stores the epoch data as shown in block 258. FIG. 10 illustrates storage of this epoch data.
FIG. 10 shows an exemplary heart rate variability zone configuration 270 having mean AA value as the x-axis, MAD as the y-axis, and patient respiration as the z-axis. Two hypothetical epoch series are shown at 274 and 276, respectively. Epoch series 274 includes a plurality of measurements of heart rate variability shown at 278-282. Measurements 278-282 represent epoch data locations leading to a cardiac event shown at measurement 282. Epoch series 276 illustrates a plurality of measurements of heart rate variability 284-288 leading up to a cardiac event represented at location 288. Each of the measurements includes all or part of the epoch data and other information collected and stored during a corresponding epoch. Epoch series 274, for example, may have ended in a bradycardia event at location 282. Pathway 290 represents an abnormal heart rate variability path or zone and is shown as a line leading to measurement 282. Epoch series 276 may have ended in a tachycardia event at measurement 288. A pathway 292 is shown as a line leading to this measurement.
Each heart rate variability pathway 290 and 292 may be expanded to include an abnormal heart rate tolerance zone, shown at 294 and 296, respectively. Tolerance zones 294 and 296 serve to enlarge pathways 290 and 292 and provide broader limits or boundaries defining the epoch series leading to the cardiac event. Preferably, the tolerance zone would expand pathways 290 and 292 from about 10% to 20%.
Epoch series 274 and 276 may provide a predictable avenue through which subsequent cardiac events occur. In this regard, individual patients may experience numerous cardiac events over a given period of time. Two or more of these events may have a preferred or common pathway leading to a particular event. For example, two separate cardiac events may start at different measurement locations but progress to or through a zone of commonality. The pathways, in fact, may partially or fully overlap. As such, the stored pathways may be compared with present pathways to aid in forecasting future cardiac events or to aid in recognizing the onset of a current event.
Additionally, cardiac events occur suddenly or develop over a more extended period of time. Once an event occurs, the present epoch data exhibiting that event is stored in permanent memory. In addition, prior epoch data also is permanently stored into memory. Thus, memory stores a series of epoch data once a cardiac event occurs. The amount and number of prior epoch data stored may depend on memory allocation availability, on the length of epoch time, or on the compressibility of the data, for example. Preferably, about several hours of prior epoch data are stored after the occurrence of a cardiac event.
The time of day in which the epoch occurs also may be a factor when comparing a current epoch with a stored epoch series. Epoch data may exhibit a circadian variation over a given time period. For example, when a person is sleeping, the mean heart rate, mean minute ventilation (i.e., an indication of the metabolic demand), and mean activity will be lower, and PNN50 and mean absolute deviation will be relatively higher. When the person is awake and active, such as exercising, the mean heart rate, mean minute ventilation, and mean activity will be relatively higher, and the PNN50 and mean absolute deviation will be relatively lower.
As another factor, a smaller amount of variability exists at higher heart rates. For example, a person with a heart rate of 100 bpm typically will have more sympathetic nerve activity inhibiting vagal action. In this situation, the heart rate variability of the patient expectedly is extremely low. If the heart rate were maintained at 100 bpm and pacing used to effectuate heart rate variability, little effect may result.
Turning back now to FIG. 9, as noted, if the answer to the query in block 256 is positive, then the epoch data is permanently stored into memory, as shown in block 258 and described in connection with FIG. 10. If the answer is negative, then a comparison is made between the current measurement of heart rate variability and stored epoch series, as shown in block 300. Block 302 then queries whether the current measurement of heart rate variability matches the stored epoch series. If no match exists, then the epoch data is temporarily stored, as shown in block 304. If a match does exist, then block 306 indicates an appropriate therapy is initiated.
FIG. 10 illustrates the comparison between current measurement of heart rate variability and stored epoch series. Epoch series 307 has three measurements of heart rate variability 308, 310, and 312. Two measurements or locations 308 and 310 are shown outside the boundaries or limits of either pathway 290 and tolerance zone 294 or pathway 292 and tolerance zone 296. Thus, neither of these two measurements match the stored epoch series. However, measurement 312 is within the boundaries of tolerance zone 294. Thus, a match exists between measurement 312 and epoch series 274.
Any of a variety of therapy regimes may be initiated if the current measurement of heart rate variability matches the stored epoch series. FIG. 4 shows alternate therapies. As one possibility, the same therapy regime originally initiated during the occurrence of the stored epoch series also could be initiated. For example, since measurement 304 in FIG. 10 is within the boundaries of tolerance zone 294, the same therapy initiated with measurement 279 or 278 could be initiated. Therapy regimes with a conservative and less aggressive approach also are possible. In this instance, more energy expensive vigilance may suffice. For example, additional sensors may be activated or a warning or alarm may be communicated. Alternatively, the aggressiveness of a therapy regime may depend on the potentially ensuing event. For example, pathway 274 may have led to a slow ventricular tachycardia which was otherwise not fatal to the patient. Antitachycardia pacing may have sufficed to correct the arrhythmic event. A similar therapy regime could be employed.
Since certain changes may be made in the above-described apparatus and method without departing from the scope of the invention herein involved, all matter contained in the description or shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.


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subset: commoncrawl


text:
Club Type supports up to 50 different languages such as Spanish, English, Portuguese, German, French, Italian, Dutch, Swedish, Finnish, Danish, Irish, Basque, Luxembourgian, and Icelandic in Latin and other scripts.
Please note that not all languages are available for all formats.
Perhaps the greatest tragedy in all English history began in 1642 when, for five years, families and friends were divided by violent struggle. Respect for the monarchy was as great then as it is today; but it was squandered by Charles I and Civil War ensued. Out of Cromwell's eventual victory came a period of absolute rule just as arbitrary. In communicating the affaires of Court, Mercurius Aulicus can claim to be Englands first regular newspaper, printed at Oxford and reprinted in London almost throughout the entire war.


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This is The Morning Shift, our one-stop daily roundup of all the auto news that's actually important — all in one place at 9:00 AM. Or, you could spend all day waiting for other sites to parse it out to you one story at a time. Isn't your time more important?
Hey, the site looks a little different. In response to some of the feedback we've gotten over the past few weeks our designers tightened up the front page so it requires less scrolling. We've also moved the masthead up into that top bar.
Heart-clicks are now stars, and when you heart something you "save" it. Other than that, the functionality should remain the same.
1st Gear: A $2.1 Million Raise, Please
Remember how we said the U.S. Treasury's auditor found excessive pay for GM executives? That's still a thing.
Documents obtained by the Detroit Free Press from the House Oversight committee show GM wants to give CEO Dan Akerson a raise to $11.1 million for 2013, compared to the $9 million he got in 2012.
On the one hand, Ford's Alan Mulally was raking in $29.5 million way back in 2011 to spend on red sweater vests and Sergio Marchionne gets about $22.2 million to buy fancy black turtleneck sweaters. Poor Akerson doesn't seem to own any sweaters.
On the other hand, so long as GM is partially owned by the government they're going to be subjected to this kind of oversight.
Update: GM just put out this pissy response to the report:
Reports that General Motors has requested an increase in Dan Akerson's 2013 compensation are false. In fact, Dan specifically asked to keep his compensation at the same level for 2013 as it was in 2012 and 2011. That amount of $9 million is what the company submitted to the Office of the Special Master for TARP Executive Compensation.
Unfortunately, someone who obviously did not understand the compensation request leaked the information in a way that misrepresented the truth in order to score political points on the eve of a congressional hearing.
We ask that media outlets that reported the false story to correct the record.
2nd Gear: Government Starts To Sell The Rest Of GM Stake
Hey, what a coincidence, The Detroit News' David Shepardson reports that the U.S. Treasury is in the process of offloading its remaining 19% stake in GM.
The plan is to drop all of their stock, discreetly, until all 300.1 million shares are no longer owned by the government as of March 2014. At the current price of the stock, the government will lose more than $12 billion on the bailout, which isn't that bad when you think about the impact of GM going f'real bankrupt and not fake bankrupt like they did.
I mean, we get a new Corvette and a diesel compact car. Bring back the El Camino and we'll be totally square.
3rd Gear: Ferrari Dealer Wants To Buy The Boston Globe?
Ernie Boch, Jr. is a car dealer in the New England area who owns Toyota, Scion, Honda, Ferrari, and Maserati dealerships. The Boston Globe is the troubled newspaper currently owned by The New York Times. Boch, Jr. thinks it would be fun to own a newspaper and is hooking up with a marketing agency CEO and Subaru of New England to buy the Globe reports Automotive News.
This is all very preliminary and Boch, Jr. is merely in the investigative/due-diligence portion of the process, but it would be intriguing to see what a car dealer would do with a newspaper. Car reviews on the front page? Why not!
4th Gear: Geely To Pour $152 Million In London Cab Maker
Bloomberg is reporting this morning that Manganese Bronze, maker of the iconic London black cab, will take $152 million and dump it into the company over the next five years to make it profitable. You'll remember they bought the cab maker for about $17 million.
The weird Chinese affection for the Coventry-built cabs has always amused me, but apparently there's enough demand overseas to convince them it could be a nice side business. There are already reportedly 500 of those cabs operating in China.
More of the black cabs have also started operating in Australia and Saudi Arabia.
5th Gear: The Rolls-Royce Wraith
Rolls-Royce's seemingly endless teasers are now, finally, coming closer to an end with the admission that the Rolls-Royce Wraith will be a "fastback."
Here's what RR's Giles Talyor had to say about it:
"The purposeful fastback profile is Wraith's defining element.
Inherent in the graceful line that sweeps from the top of the screen to the very rear edge is the promise of fast, yet effortless touring. Yet, perhaps my favourite aspect is the expressive gesture that comes from the side window graphic, gliding through Wraith's glamorous coach door."
Ok, enough teasing, just show us.


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Danimal24 necesitaba un nuevo diseño de otro y lanzó un concurso de diseño en 99designs.
Un ganador ha sido elegido entre 8 diseños de 3 diseñadores freelance.
Panorak is building a website for outdoor enthusiasts to find, track, and share all of their adventures.
The piece will be seen by small business owners. Bike shops, raft guides, rock climbing gyms, etc.
Here are two examples of what we're looking for:
I have attached a spreadsheet with our pricing scheme. Your job is to make it artistic so we can sell our advertising services to small business owners. The piece will be used in print and as an image on the website.
I am also including a screen shot from the website, which is still in design. Please stay consistent with our overall design- rounded corners, same colors, etc.
Feel free to contact me with any questions. Good Luck!


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In its last meeting of the calendar year, the Palo Alto school board appointed new leaders Tuesday night.
The board unanimously named Vice President Dana Tom as president and Barb Mitchell as the new vice president.
Tom joined his colleagues in praising outgoing board president Camille Townsend for her thoughtful leadership.
"We did have a wonderfully productive year and you really fostered our success," Tom said. "You were a key part of that."
Townsend, who was recently re-elected to a third term, kept her response characteristically focused.
"It's been a really productive year with a hugely involved community," she said. "I think the team has been very engaged and we welcomed it, but we got through our meeting agendas."
Email Jason Green at firstname.lastname@example.com; follow him at twitter.com/jgreendailynews.


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- Red Bull news
Infiniti to become Red Bull's title sponsor in 2013
- Drivers:
- Christian Horner
- Teams:
- Red Bull
Infiniti has signed a four-year deal to become the title sponsor of Red Bull from 2013, meaning the team will officially be known as Infiniti Red Bull Racing.
The new deal is a step up from Infiniti's existing relationship with Red Bull and the car brand, which is part of the Renault-Nissan Alliance, will increase its involvement from purely commercial to a technical partnership going forward.
"Red Bull Racing and Infiniti have been working on a number of initiatives since the start of our relationship in 2011," Christian Horner said. "During that time, Infiniti has demonstrated significant technical prowess and I've been impressed by the depth of the wider engineering capabilities of the Nissan Motor Company.
"In terms of marketing, Infiniti has leveraged their involvement with Red Bull Racing and Formula One extremely effectively to become much better known in a short space of time. These two attributes make Infiniti the ideal title and technical partner for Red Bull Racing."
President of the Renault-Nissan Alliance, Carlos Ghosn, made clear that the Red Bull's engines would continue to branded as Renaults in order to avoid any confusion with between the two brands' separate responsibilities.
"I don't think we want any confusion within the Alliance as to who does what," he said in the Interlagos paddock on Sunday. "Renault changed and adapted its strategy in 2008 when most of the [manufacturer] teams went out of F1 and Renault stayed. We just changed our strategy and instead of being just a one-team player we wanted to be a multi-team player by bringing the heart of the competition, which is the engine. By having Renault supplying today one third of all the cars running and being for the third year in a row [constructors']champions with Red Bull is a validation of the strategy we have taken."
Ghosn added: "Infiniti as a premium car producer and marketer associating its name to Red Bull, particularly through a very thorough and sophisticated marketing effort. It has at the first result, brought the awareness of the Infiniti brand higher than the level we were targeting and now we are going to go for an even higher level of awareness of Infiniti in many markets and particularly in emerging markets. And then the sky is the limit and we are going to continue work together to find new ways of collaboration both on a technical level and also in marketing."


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Kafka Developer
Job Description
Kafka Developer
Eclaro is looking for Kafka Developer for an opportunity for our client in SAN ANTONIO, TX.
Eclaro is looking for Kafka Developer for an opportunity for our client in SAN ANTONIO, TX.
Required Skills:
- Develops code using Kafka, Spark Streaming tool
- Experience in change data capture (CDC) in DB
- Experience in Attunity Replication
- Strong technical abilities to understand, design, write and debug complex code
- Familiarity with Big Data architecture and data integration concepts on Message Queuing (MQ), ETL, DW, Hadoop, Non SQL, basic DB technologies, software development tools and SQL
Contact Jameese Halcon at email@example.com
Contact Jameese Halcon at firstname.lastname@example.com
ECLARO is a company that delivers talent. We provide fully customizable, comprehensive talent acquisition and management of seasoned professionals through a number of business models, including: Consulting, Professional Hire, Global Integrated DeliveryTM and Managed Services. ECLARO recruits and manages a staff of highly skilled individuals in an array of specialized disciplines. This approach enables our clients to leverage new opportunities, respond to increased and changing demands and increase their profitability. Please visit www.eclaroIT.com to see why the Right People are The AnswerTM.
Specialties: Customized solutions for Human Capital and Talent Acquisition, Permanent placement and retained search, Recruiting, Staff Augmentation, Contract Labor, Managed Services, RPO, MSP, VMS, IT solutions, management and support, offshore business process outsourcing.
Equal Opportunity Employer: Eclaro values diversity and does not discriminate based on Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
Website: http://www.eclaro.com
Industry: Staffing and Recruiting
Type: Privately Held
Company Size: 501-1000 employees
Founded: 1999
Application Instructions
Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!Apply Online
Posted: 10/11/2019
Job Status: Contract/Temporary


text:
Journal of Chemical Technology and Biotechnology
Journal of Chemical Technology and Biotechnology
Vol 93(12 Issues in 2018 ) Print ISSN: 0268-2575 Online ISSN: 1097-4660 Impact Factor: 2.659
Download Product Flyer
Journal of Chemical Technology and Biotechnology(JCTB) is an international, inter-disciplinary peer-reviewed journal concerned with the application of scientific discoveries and advancements in chemical and biological technology that aim towards economically and environmentally sustainable industrial processes.
Published for SCI by John Wiley & Sons Ltd.
SCI (Society of Chemical Industry) is a unique international forum where science meets business on independent, impartial ground. Anyone can join and current Members include consumers, business people, environmentalists, industrialists, farmers, and researchers. The Society offers a chance to share information between sectors as diverse as food and agriculture, pharmaceuticals, biotechnology, materials, chemicals, environmental science and safety. As well as organising educational events, SCI awards a number of prestigious honours and scholarships each year, publishes peer-reviewed journals, and provides Members with news from their sectors in the respected magazine, Chemistry & Industry .
Originally established in London in 1881 and in New York in 1894, SCI is a registered charity with Members in over 70 countries.


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The Presidential Commission for the Study of Bioethical Issues recently issued a request for public comment on a variety of issues raised by large-scale human genome sequencing, and just last week The New York Times ran an article on Washington University's effort to save the life of Dr. Lukas Wartman, who was diagnosed with leukemia, by fully sequencing the genes of his cancer cells and his healthy cells for comparison. After finding that Dr. Wartman had a normal gene that worked in overdrive, spurring growth of his cancer, researchers were able to identify and use a new drug—which had been tested and approved only for advanced kidney cancer—to shut down his malfunctioning gene. Researchers say that Dr. Wartman's case is an illustration of the importance of genes in driving a cancer, as opposed to the organ or tissues where the cancer originates.
Whole genome sequencing, along with greatly improved DNA sequencing techniques, has the potential to improve our understanding of the pathogenesis of disease and enhance drug design.
Many predict that within a decade or so whole genome sequencing will be widely available at a price of $1,000 or less and perhaps paid for by insurance. Industry and venture capitalists are increasingly interested in initiatives to identify specific disease-causing genes and to test drugs that target those genes.
A number of ethical and legal issues present challenges to this approach. One issue relates to ownership of and control over the tissue sample that contains the DNA and derivative information. The court in Moore v. Regents of the University of California, a leading case on the topic, rejected the notion that Moore had a property right to his spleen cells that were removed during a splenectomy and then commercially exploited. Rather, the court held that Moore had an informed consent right to be told by his physician about the planned removal and use of his cells and then to decide whether to provide them.
A few states, however, have enacted or are considering laws that would explicitly establish individuals' ownership rights to their genetic samples. For example, in Alaska, a DNA sample and the results of DNA analysis performed on the sample are the exclusive property of the person sampled or analyzed. The difference in approach to this legal ownership question can be explained, in part, by the fact that today, unlike 20 years ago when Moore was decided, DNA sequence variants can readily serve as a source of personal identification, and that it is even possible to re-identify individuals in pooled mixtures of DNA. If tissue samples that contain DNA are not de-identifiable, legitimate concerns arise about previous practices that accommodated research use of discarded tissue without the consent or even knowledge of the individuals from whom the samples were extracted.
Laws that explicitly establish individuals' ownership rights in their tissue in order to guard against these concerns, however, have important implications for research involving large-scale human genome sequencing. Some fear that such laws could have a chilling effect on the development of biorepositories for research purposes, due to fear of private claims for violation of individuals' property rights in their DNA samples. Some worry that procedures for transfer of an individual's property right in his samples to a research entity will run afoul of legal and ethical concerns about selling human tissue. And some hypothesize that individuals will have a greater ability to place limitations on the research use of their samples.
Rapid technological advances complicate not only tissue sample ownership but also the use of genetic information obtained via genome sequencing performed with consent of the tissue donor. In order to protect autonomy and privacy interests, it is critical to obtain fully informed consent from the tissue donor for whole or partial genome sequencing, subsequent testing and use and disclosure of test results. The informed consent discussion must address:
• Risks, which depend on what information the genome sequencing reveals
• The personal and social significance of that information
• Security protections for the DNA and genotypic information
• The types of data misuse that could occur
For instance, one risk of whole genome sequencing is that the individual might learn more information about himself and his family than he prefers to know or have known by others, especially if such information could lead to embarrassment, stigmatization or discrimination. In addition, adequate legal protection of the privacy of genetic information is increasingly important as genetic technology progresses. The 2008 Genetic Information Nondiscrimination Act, which prohibits use of genetic information in health insurance and employment matters, provides an important starting point. Unless legal protections keep pace with evolving technologies, however, public confidence in the promise of genomics to improve health will be at risk.
Source: Inside CounselLeave Drinker Biddle to Learn More


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Skip to Main Content
Doing Business
How Do I...
Public Safety Services
Prosecuting Attorney
Court Cases
Sexual Assault
Sexual Assault
The Grand Traverse County Prosecutor's Office prosecutes all forms of sexual assault that occur within the county, whether the case involves family members, acquaintances, strangers, or intimate partners. The office works closely with law enforcement and child protective services, as well as medical and mental health professionals to be sure that a complete investigation is conducted and that the victim is supported throughout the process.
Child Advocacy Center
In sexual abuse cases involving children, the Prosecutor's Office works closely with the
Traverse Bay Child Advocacy Center (CAC)
. The center provides a child and family friendly setting where young children and teens are interviewed by qualified forensic interviewers. While at the CAC, parents and guardians are supported and provided information regarding the investigation and court process. A family advocate shares the resources available in the community to help the victim and his or her family through this difficult time.
Alleged Mentally Ill
Drug Enforcement
Felony Non-Support
OWI / Traffic Safety
Recovery Court
Sexual Assault
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text:
U.S. Equal Employment
Opportunity Commission
The EEOC works with the Fair Employment Practice Agencies (FEPAs) and the Tribal Employment Rights Offices (TEROs) to manage charges of discrimination and the protection of the employment rights of Native Americans. The EEOC contracts with approximately 90 FEPAs nationwide to process more than 48,000 discrimination charges annually. These charges raise claims under state and local laws prohibiting employment discrimination as well as the federal laws enforced by the EEOC. FEPA and TERO offices for the area covered by this office are listed below.
South Carolina Human Affairs Commission (FEPA)
1026 Sumter Street, Suite 101
Columbia, SC 29201
Mailing Address
P.O. Box 4490
Columbia, SC 29240
Phone: 803-737-7800
Fax: 803-253-4191
Website: http://www.schac.sc.gov
E-mail: email@example.com


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The Art of Clean Up: Life Made Neat and Tidy by Ursus Wehrli demonstrates just how few words are truly needed to make a statement.
The book's main premise is the need for organization. Wehrli organizes a seemingly disorganized world by straightening, rearranging, substituting, and replacing people and objects, documenting each reorganization effort through photography. The presentation really amused me, using the page spread to depict before and after scenes for various daily situations. The "before" photograph will present a perceived disorderly scenario, such as a bowl of alphabet soup, people walking across a quad, or the cosmos, and the "after" scene will depict Wehrli's way of organizing it.
The bowl of alphabet soup and the cosmos compete for my #1 favorite scene; the soup is organized alphabetically in the bowl, and the cosmos have been sorted and arranged graphically by size. The people walking across the quad are arranged similarly to the cosmos, with people sorted by shirt color.
In instances that the photo subject is deemed "too messy" to properly rearrange, humorous substitutions are made. Twisty pretzels are replaced with straight pretzel sticks; a pond of Koi fish is substituted with a pan of breaded fish sticks. Corn on the cob substitutes popcorn; Chiclets gum replaces chewed gum, and a dollar bill is replaces all the pesky loose change.
The viewer must spend some time looking at each image to find all the substitutions, as a grown-up version of I Spy. I thoroughly enjoyed browsing through the images, and I hope that you will too!


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A Saucy Wench
I have become Death, the destroyer of electronic gadgets
"When I got too tired to run anymore I just pretended I wasnt tired and kept running anyway" - dd, age 7
Lazy idiot
Tick tock
Skooter 2.5
Unfortunate Miles
Me 38.
I'm running somewhere tomorrow. It's going to be beautiful. I can't wait.
Poor baby
Have the Shmoopies registered yet? Onionbag?
What are you talking about. Registration does not open until August 1. What is today's date?
The King of Beasts
"As a dreamer of dreams and a travelin' man I have chalked up many a mile. Read dozens of books about heroes and crooks, And I've learned much from both of their styles." ~ Jimmy Buffett
"I don't see much sense in that," said Rabbit. "No," said Pooh humbly, "there isn't. But there was going to be when I began it. It's just that something happened to it along the way.""
Poor Cheryl.
for having to put up with you, or did she register this year?


text:
Free Giveaway from HIC Harold Import Company
Fante's Cousin Sandro's Meat Grinder
Enter to win Fante's Cousin Sandro's Meat Grinder. This cast iron grinder clamps on the counter top (1/2" to 2 ¾") just like the classic grinder Bubbie used. It is equipped with a stainless steel blade, and an attachment for sausage making. Wash it all in hot soapy water.
• Control the quality, freshness and flavor of your meats
• Create custom meat combinations and control the fat content
• Grinder is made of cast iron
• Stainless steel knife blade
• Cutting plate is stainless steel with 4 1/2 mm holes
• Clamp will fit a counter top from 1/2" up to 2 3/4"
For more information, see the Koshereye article about Fante's Cousin Sandro's Meat Grinder.
Giveaway limited to continental U.S. only. If not living in continental U.S, you can still enter and, if selected, "gift" your prize to a continental U.S. friend or relative. The winner will be notified by email. Once notified, the winner must respond within 48 hours or the prize will be awarded to the runner-up.
This fabulous giveaway ended midnight, October 9, 2013. The lucky winner will be announced shortly.


text:
Makes 4 servings
- 2 cups chopped fresh pineapple
- 1 cup frozen raspberries, thawed
- 1 cup low-fat vanilla yogurt
- 1 firm, medium banana, peeled and sliced 1/3 cup chopped dates
- 1/4 cup sliced almonds, toasted
In glasses, layer pineapple, raspberries, yogurt, banana, and dates. Sprinkle the top with almonds.
Nutritional Analysis Per Serving: 258 calories, 6 g protein, 5 g fat (1 g saturated fat), 47 g carbohydrate, 43 mg sodium, 3 mg cholesterol.
Courtesy of www.5aday.com
*DISCLAIMER*: The information contained in or provided through this site section is intended for general consumer understanding and education only and is not intended to be and is not a substitute for professional advice. Use of this site section and any information contained on or provided through this site section is at your own risk and any information contained on or provided through this site section is provided on an "as is" basis without any representations or warranties.


text:
Teacher resources and professional development across the curriculum
Teacher professional development and classroom resources across the curriculum
View Debate
In this section, you will watch the workshop participants debate over explicit instruction. The questions that follow will help frame your own response of the issue.
The workshop participants analyzed a word study lesson, and responded to it, based on their own teaching experiences and the principles from the research. In the ensuing discussion, the controversies surrounding phonics instruction emerge, especially with respect to planned, explicit instruction versus "opportunistic" instruction. Use the video image below to locate where to begin viewing.
In response to the formal lesson plan, second-grade teacher, Meynardo Gutierrez initiates this discussion by stating, "Actually, the beauty of Language Experience... is that you don't have to set up anything particular for them to learn at a particular time. You just do it, right then and there."
Dr. Paratore replies, "An opportunistic approach to phonics instruction privileges some children and leaves others behind. And the ones it leaves behind are the ones who depend on teachers to learn."
© 2003 WGBH Educational Foundation. All rights reserved.
© Annenberg Foundation 2017. All rights reserved. Legal Policy


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Prime Minister David Cameron has defended plans to give the taxman new powers to seize money directly from the bank accounts of people who owe more than £1,000 in tax or tax credits.
An influential House of Commons committee has said it has "considerable concern" over the plans, and urged further scrutiny of the debt collection proposal, which was unveiled by Chancellor George Osborne in his March Budget.
Mr Cameron insisted that it was right to pursue tax debtors by every means possible, warning that the alternative would be to put up tax rates.
Under the scheme, HM Revenue and Customs (HMRC) will be allowed to gain access to money held in a debtor's bank or building society account - including joint accounts and Isas - without needing to apply to a court.
The cross-party Treasury Committee said in a report: "The proposal to grant HMRC the power to recover money directly from taxpayers' bank accounts is of considerable concern to the committee. Giving HMRC this power without some form of prior independent oversight - for example by a new ombudsman or tribunal, or through the courts - would be wholly unacceptable."
The committee also highlighted the potential for fraud and error if the taxman was given direct access to millions of accounts, warning: "This policy is highly dependent on HMRC's ability accurately to determine which taxpayers owe money and what amounts they owe, an ability not always demonstrated in the past.
"Incorrectly collecting money will result in serious detriment to taxpayers. The Government must consider safeguards, in addition to those set out in the consultation document, to ensure that HMRC cannot act erroneously with impunity. These might include the award of damages in addition to compensation, and disciplinary action in cases of abuse of the power."
HMRC said the new powers would affect a "small core" of around 17,000 people a year who typically owe £5,800 in tax and tax credit debts. The cash will not be taken under the plans unless it still leaves the debtor with at least £5,000 across their accounts.
The revenue body argues that joint accounts must be included in the plans, otherwise they would give debtors an opportunity to wriggle out of paying what they owe.
In cases where someone who owes nothing to the taxman shares a joint account with a debtor, the taxman would only recover debt from half of the funds in the account.
Anyone whose name is on the account would be notified when a hold has been placed on the funds and both the account holder who owes tax and the one who does not would have the right to appeal
Eamonn Butler, director of free-market think-tank the Adam Smith Institute, condemned the plans as a "fundamental assault on the rule of law" and "dangerous".
He said the proposed new power "is contrary to the fundamental principle that people are innocent until proven guilty".
UK Independence Party (Ukip) leader Nigel Farage told LBC 97.3 radio: "It's appalling. What the taxman now does is he sends you a demand and says 'You owe me this money, you're guilty. Prove to me your innocence'. Now we are going to give them the power not just to send us the demand and threaten us, but to take it straight out of our bank accounts. It mustn't be allowed to happen."
Mr Cameron told Sky News: "I think we have a choice here. If we don't collect taxes properly and make sure people pay their taxes properly, we look at the problem of having to raise tax rates. I don't want to do that, so I support the changes that the Chancellor set out in the Budget, which is to really say that not paying your taxes is not acceptable.
"I'm sure the Treasury will look very carefully at the detail, but it's very clear that they can only do this if it's a debt of over £1,000, they can only do it if there's £5,000 or more in the account after this has been completed. There's a set of rules and regulations.
"But on the general principle, do we want to pursue every avenue of making people pay their taxes that they are meant to pay before we put up taxes - because that's the alternative - absolutely, yes we do."
A spokesman for HMRC said: "Most people pay their taxes on time, but a minority do not, and some refuse to engage with us at all.
"This will only affect a tiny number of debtors, whom we have contacted a minimum of four times to ask for payment."
A Treasury spokesman said: "The Government's long-term economic plan is to reduce the deficit so that we deal with our debts.
"It is therefore important that people pay the tax they owe on time. Although the vast majority do this, there is still a minority that chooses not to pay, despite being able.
"The proposed powers will give HMRC another tool to collect tax debt owed. The current consultation includes a range of safeguards to ensure the power is tightly targeted."


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PLEASANT HILL — BART train service between Walnut Creek and Concord on the Pittsburg-Bay Point line was temporarily suspended in both directions because of a problem with the tracks, stranding thousands of people during the evening commute, officials said.
A train was taken out of service at 5:10 p.m. Tuesday near the Pleasant Hill station after damage to the track and third rail was spotted. The damage was at an "interlocking," which impacts both sides of the tracks.
Trost described the damage as "extensive."
Shortly after 6 p.m., officials said they were running about two out of every three trains through the area in the eastbound direction, toward Pittsburg/Bay Point. Some passengers would be asked to change trains to get through the area, according to BART spokeswoman Alicia Trost.
Around 8:15 p.m., trains began moving through the area in both directions using a single track, though there were still delays of 15 to 20 minutes. BART officials also set up at least seven buses to transport riders from the Walnut Creek station to the Concord station, Trost said.
Trost said at 9 p.m. that officials expected to have BART service running Wednesday morning, but that she was not certain if trains would still have to be single-tracked around the problem area.
At the Walnut Creek station on Tuesday evening, dozens of commuters were trying to figure out how they could get home. Many said that BART officials were not clearly communicating what they should do.
"There are just too many confusing messages," said Concord resident Ron McClean, 53, who was trying to get the San Francisco Giants game. He said he had already been traveling for an hour; he was put on a bus at the Pleasant Hill station, but had to wait with others before entering the Walnut Creek station once service resumed to prevent overcrowding on the platform.
"I've never experienced anything like this," said Jared Didhian, 24, who was trying to get to class at SF State. "Public transportation has always worked for me. I'm not too sure what's going on."
Staff writer Karina Ioffee contributed to this report. Follow Kristin J. Bender at Twitter.com/kjbender.


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Release details
People, Planet and Profit - a winning mix! Fourteenth edition of the TBLI CONFERENCE(TM) ends today.
Zürich, November 9, 2012
People, Planet and Profit - a winning mix! Fourteenth edition of the TBLI CONFERENCETM ends today.
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Award for Best Research House/ Consultant in ESG
Sponsored by Chipsol
WINNER: oekom research AG
Award for Best IMPACT Investing Product
Sponsored by Credit Suisse
WINNER: SJF Ventures
Award for Outstanding Contribution to Development of ESG & IMPACT Investing
Sponsored by Thomson Reuters
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Editorial information:
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About Chris Brand
The Liberals are in the pockets of big business, same as ever. They tabled the bill for CETA with no explanatory memorandum the day after signing the treaty, despite their own policies for treaties of waiting 21 sitting days and always having an explanatory memorandum.
If they lost them, they presumably can't prove in court that any evidence they find on them hasn't been corrupted in some way.
Personally, I'm partial to the Hitchiker's Guide to the Galaxy version - "To summarize: it is a well known fact that those people who most want to rule people are, ipso facto, those least suited to do it."
Having followed a number of court cases where there are lots of arguments about the exact meaning of specific words used in the legislation, I'm waiting to see lawyers arguing about this phrasing.
"The legislation included the word "unwanted". That word must have been put there for a reason. The reason must be to distinguish it from "wanted harassment". Clearly to the person receiving the harassment, it's always unwanted, so this must refer to the person doing the harassing, to distinguish it from "accidental harassment". So as long as the person doing the harassing does so intentionally, it's not covered by this statute".
Census data does get released. In the UK, at least, it becomes public 100 years after it was collected. Many countries seem to do something similar.
More than 50% more petitions about civil rights than about the economy ? And how much time do they spend debating those two issues ? Even more telling, how much time was devoted to campaigning on those two issues ?
So if it's not the average voter who's mostly concerned about the economy, who is it ? Perhaps the politicians themselves and their backers ?
Of course any ToS like that is completely unreasonable. As long as I keep paying for the service, it's none of your damn business how I use it.
I'd think that the reference to "permanently forgetting" was probably to the second half of that sentence: "and scraped the Urban Dictionary from its memory".
I think respect goes both ways. As the gift-giver, it shows a huge lack of respect to think that you should have any say over what happens to the gift after it's been given. It's a gift. It's theirs. They can give it away, sell it, burn it, whatever. If you didn't want them to have full control over it, you shouldn't have given it to them.
The attitude you espouse seems very similar to the companies who say "I'm selling you this, but after you've bought it, I'm still going to impose the following rules..."
That is interesting, not least because (a) it's not the purchaser doing the ripping, and (b) there is apparently some sort of license between Amazon and the record companies.
In Canada, C-11 made it so that your "private copies" were only legal if you continued to own the originals, but these don't sound like "private copies", they sound like freebies given to you by Amazon, in accordance with their license with the record companies.
I guess it would come down to what conditions they impose on you when they give you (access to) the MP3s.
Well personally, I'm quite happy to see these arguments from the MPAA and friends about fair use, because I fully intend to tell my government "As the MPAA have told the Australian government [citation], changing any law creates too much legal uncertainty due to the lack of precedent and case history. Therefore, it's too dangerous to ratify CETA/TPP".
The key point being that it wasn't a media executive that he murdered.
From the article - "Allowing government agencies to reject FOIA requests because they don't like how the information is being used or are worried about public response is a big step in a very wrong direction".
Of course that was towards the end. Perhaps you didn't get all the way down there before writing this comment ?
"Show me your id"
"Actually, I heard there was a high crime rate around here, so I left my wallet at home"
If they were to admit to it, the game probably wouldn't last much longer. Unfortunately, it's in their best interest to keep on obfuscating.
If we banned them from using the word "patent", they'd have to say something like "More people in China paid for 20-year monopolies", which might not sound quite so rosy.
I can't wait to see how they factor "skin color" into the decisions about what ads to show people...
I read that block quote all the way through twice. It's fascinating that you don't need to change a single word to read it as a condemnation of the action against megaupload. It's all in your underlying assumptions. If you believe that all the various things mentioned as impacted were bad, then the quote says what a great thing the shutdown was. If you think of the things affected as legitimate, then the quote works just as well to say how terrible the shutdown of megaupload was.
If 3% of the population is caught breaking a law in a 5-month period, that might be a good indication that the law is out of line with people's expectations.
In general, I can do what I like with things I buy (not entirely true, but very close)...
Unless the thing embodies a copyrighted work...
Unless what I want to do is fair use...
Unless that fair use is prevented by a DRM...
Unless there's an exception to the "you can't break DRM" rule for this use.
The fact that it gets this complicated to decide what is legal is a great indication that copyright itself hurts the free market (the free market operates right at the top, where I can certainly buy and sell things I own). The concept of "fair use" (and the "limited times" part of copyright) only exists because otherwise copyright would interfere way too much with everyday life. The fact that the introduction of laws protecting DRM introduce exceptions to the exceptions to the exceptions to the exception to the rule that I can generally do what I like with things I own should have been a huge red flag to the people drafting the DMCA.


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