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The Association between Shift Work and the Metabolic Syndrome in Female Workers
This study aimed to determine identify any association between shift work and the metabolic syndrome by comparing the prevalence rates of the metabolic syndrome in shift work groups and daytime work groups for female workers.
Based on data from health examinations carried out from April to December of 2012, we selected as our subjects 254 female workers from the Daegu area Dyeing Industrial Complex. We diagnosed the metabolic syndrome using the examination results, and information about age, whether or not they did shift work, job type, smoking habits, drinking habits, exercise habits, and past medical history was collected through self-administered questionnaire surveys and face-to-face interviews. The variables found in a univariate analysis to be significant in the occurrence of the metabolic syndrome - age, drinking habits, exercise habits, and shift work - were included in a logistic regression analysis of the risk of the metabolic syndrome for female workers.
The prevalence rates of the metabolic syndrome for the total group of study subjects was 11.8%, for daytime workers was 2.8%, and for shift workers was 15.3%. A logistic regression analysis of the odds of the metabolic syndrome for female workers was conducted that included factors associated with the occurrence of the metabolic syndrome: age, drinking habits, exercise habits, and shift work. The results revealed that the odds ratio of the metabolic syndrome in the shift work group, 6.30 (95% CI 1.24-32.15), was significantly higher when compared with the daytime work group.
Shift work appears to have an association with the metabolic syndrome in female workers. Accordingly, we believe that the attention of government agencies and business owners is needed together with the individual practice of health behaviors to manage the metabolic syndrome for the prevention of cardiovascular disease in female shift workers.
The metabolic syndrome, a state of insulin resistance, is a syndrome that is accompanied by abdominal obesity, lipoidosis, impaired glucose tolerance, and high blood pressure [1]. After being named "syndrome X" by Reaven [2] the cluster of cardiovascular disease risk factors was named the metabolic syndrome and diagnosis criteria was first proposed by the World Health Organization (WHO) [3]. Later, in 2001, the United States National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III emphasized the importance of the metabolic syndrome for managing cardiovascular problems and proposed standards for diagnosing the metabolic syndrome that required three or more of the following criteria to be met: abdominal obesity, hypertriglyceridemia, low high-density lipoprotein cholesterolemia, high-blood pressure, and impaired glucose tolerance [4]. In 2005, the International Diabetes Federation (IDF) proposed new diagnosis criteria that modified the NCEP-ATP III, noting the high relation to insulin resistance, and proposed abdominal obesity, an easy clinical measurement, as a diagnostic prerequisite [5]. In addition, in 2005, the American Heart Association/National Heart Lung and Blood Institute (AHA/NGLBI) modified the diagnostic criterion for impaired fasting glucose and the use of medication as a risk factor, based on NCEP-ATP III [6].
The metabolic syndrome increases the risk of diabetes and cardiovascular disease, as well as the death rate from these diseases [7]. In the United States, 34% of adults over 20 have the metabolic syndrome, and the rate continues to increase [8]. The results of an analysis of data gathered from the Korean National Health and Nutrition Examination Surveys (KNHANES) from 2007–2010 showed the prevalence rate of the metabolic syndrome in South Korea for adults over 30 to be 31.9% for men and 25.6% for women, with a total prevalence of 28.8% [9]. This is important, not only from a clinical perspective, but from a public health perspective as well [10].
While shift work is being adopted by companies for economic, technical, and social reasons, it means dividing workers into two or more groups so that they work in shifts at separate times. This definition excludes temporary or occasional night work, night duty done by daytime workers, and fixed-time work cycles in which workers do not change shifts. The method of shift work can be divided into shifts that include night work and shifts that do not, as well as 24-hour periods divided into two 12-hour or three 8-hour shifts that rotate every 4–5 days [11]. 20-25% of manufacturing workers in Europe and the United States perform shift work [12]. In South Korea, the results of a study by the Ministry of Employment and Labor in 2011 on companies with 10 or more employees (3,414 samples) revealed the proportion of shift workers to be 15.2% [13].
Human physiology has a circadian rhythm of about 24 hours, which is maintained by the interaction of environmental conditions and the biological clock [14]. The disruption of the circadian rhythm that results from shift work has been reported to lead not only to problems such as sleep disorders and exhaustion, but also to domestic life and social activity problems [15], as well as various health problems [16].
Shift work-related health problems include an increase in digestive system problems, drowsiness, exhaustion, and sleep disorders [17]. They also include a metabolic syndrome-related increase in body fat, as well as a rise in blood pressure, which, through an increase in ischemic heart disease and cardiovascular problems, has led to an increase in mortality rates [18]. In women, there are also reports of an association with breast cancer, menstrual irregularity, and infertility [19].
Research on the factors that influence the development and prevalence of the metabolic syndrome in Korean workers, as well as on the physical harm caused by shift work, has mainly focused on male workers in dockyards, electronics manufacturing, and steel-mills [20, 21]. While there has been one study on female workers that examined the association of shift work duration and cardiovascular disease risk factors in university hospital nurses [22], there is still an insufficient number of studies on the association of shift work and the metabolic syndrome in female manufacturing workers.
Accordingly, this study was carried out to provide baseline data about the health management and prevention of metabolic syndrome-linked disease in female shift workers and to investigate the association between shift work and the metabolic syndrome in female workers in dye-related jobs.
Out of the 343 female workers from the 19 fabric processing businesses located in the Dyeing Industrial Complex near the city of Daegu, 257 participated in the medical examination (74.9% participation rate) in the Department of Occupational and Environmental Medicine at 'Y' University Hospital from April until December of 2012. Among those, excluding 3 individuals with a medical history of thyroid disease, 254 individuals were included as subjects in this study. This study was conducted in compliance with the international "Declaration of Helsinki". The Institutional Review Board of our university hospital approved the study protocol.
In the process of conducting regular and special medical examinations on workers, we inquired about their past medical history, habits of exercise, smoking, drinking, type of work, and whether or not they did shift work through interview-based medical examinations. Height and weight were measured using automated height and weight measuring devices with the subjects lightly clothed and their shoes removed. For the waist circumference, we measured midway between the pelvic iliac crest and the lower hypochondrium in an upright posture, in accordance with the WHO's diagnostic criteria for abdominal obesity [23]. Blood pressure was measured with a mercury blood pressure monitor after the subject had rested for at least 4 minutes while sitting. Blood samples were collected from the study subjects between 8–10 a.m. after fasting for a minimum of 8 hours under the guidance of the company health administrator, and blood glucose, triglycerides, and high-density lipoprotein cholesterol were measured using an automated chemistry analyzer (Olympus AU5400). Shift workers were not examined on a day in which they worked a late night/early morning shift. Instead, they were examined on a day when they worked a morning or day shift.
Diagnostic criteria for the metabolic syndrome
For the diagnostic criteria for the metabolic syndrome, we used the modified ATP III definition proposed by the American Heart Association/National Heart, Lung and Blood Institute (AHA/NGLBI) in 2005 [5] based on the standards set in the 2001 NCEP-ATP III [4]. For the abdominal obesity criterion, we used Korean-specific waist circumference values (90 cm for men, 85 cm for women) proposed in 2005 by the Korean Society for the Study of Obesity [24]. Thus, the metabolic syndrome can be diagnosed by meeting 3 or more of the 5 criteria: a waist circumference of 85 cm and above; triglyceride levels of 150 mg/dL or greater, or taking medication to lower triglyceride levels; a high-density lipoprotein (HDL) cholesterol level under 50 mg/dL, or taking medication to raise HDL levels; systolic blood pressure at or above 130 mmHg, or diastolic blood pressure at or above 85 mmHg, or taking antihypertensive medication; fasting blood glucose of 100 mg/dL or higher, or taking medication to blood glucose.
Daytime workers and shift workers
Daytime workers were defined as those individuals who worked from 7–8 am to 5–6 pm, while the rest - those who worked 2 shifts of 8 hours, 2 shifts of 12 hours, or 3 shifts of 8 hours - were considered shift workers.
The collected data was analyzed using the statistical program SPSS version 18.0 (SPSS, Inc., Chicago, IL, USA). The research subjects were divided into a daytime work group and a shift work group, after which the general characteristics, physical measurements, and examination findings, as well the frequency of abnormalities for each metabolic syndrome component, were analyzed for both groups, using the chi-squared test, Fisher's exact test, and t test. In addition, in order to analyze the factors that influence the prevalence of the metabolic syndrome in female workers, we conducted a logistic regression analysis using the prevalence of the metabolic syndrome as a dependent variable, selecting only those factors that yielded a p-value of 0.25 or lower in a univariate analysis, and calculated the odds ratio and its 95% confidence interval. The level of statistical significance was set at a p-value of less than 0.05.
General characteristics of the research subjects
Among the research subjects, there were 71 individuals in the day work group (28.0%) and 183 in the shift work group (72.0%). The average age for the day work group was 36.4 ± 12.5 years (18–76). The shift work group, with an average age of 49.7 ± 8.6 years (21–70), was significantly older (p < 0.001). A majority of the day work group, 46 individuals (64.8%), were under 40 years old, whereas a majority of the shift work group, 102 individuals (55.7%), were 40–49 years old.
Subjects that currently smoked included 1 from the daytime group (1.4%) and 2 from the shiftwork group (1.1%). Among the individuals who consumed alcohol at least once a week, 36 (50.7%) were daytime workers. This was a higher rate of alcohol consumption (p = 0.040) compared to the 67 shift workers (36.6%) who drank at least once a week. Among the individuals who exercised regularly at least once a week, the daytime work group exercised at a higher rate (p = 0.011), with 61 individuals (85.9%), compared to the shift work group with 129 individuals (70.5%).
Concerning past disease history, 3 individuals from the daytime work group (4.2%) had a history of high blood pressure, while the number from shift work group was significantly higher, with 23 individuals (12.6%) (p = 0.049). One individual from the daytime work group (1.4%) and 2 from the shift work group (1.1%) had diabetes. None of the daytime workers had dyslipidemia, while 1 of the shift workers (0.5%) did (Table 1).
Table 1 General characteristics of the subjects (No(%))
Among the businesses where the research subjects worked, 8 had under 50 employees, and 9 had between 50 and 99 employees, while 2 of the businesses had 100 employees or more, and shift work was organized in 2 or 3 shifts. Among the daytime work group, 20 people (28.2%) did office work, 16 people (22.5%) worked in research, 14 (19.7%) in administration, and 6 (8.5%) in sales. All of the subjects from the shift work group worked in manufacturing: 74 people (40.4%) worked in inspection, 36 people (19.7%) worked in processing and pre-processing, 25 (13.7%) as cutting, and 13 (7.1%) as winders.
Physical measurements and examination findings of the research subjects
The average and standard deviation of the waist circumference for the daytime work group and the shift work group was 71.5 ± 6.0 cm and 75.0 ± 5.5 cm, respectively, showing no significant difference. For body mass index, however the shift work group had a higher BMI at 23.9 ± 2.9 kg/m [2] versus the 22.4 ± 3.7 kg/m [2] for the daytime worker group (p = 0.043). The systolic blood pressure of each group was 117.3 ± 13.0 mmHg and 125.1 ± 17.1 mmHg, the shift work group having a significantly higher rate (p = 0.008). The diastolic blood pressure was 74.7 ± 7.5 mmHg and 77.5 ± 9.3 mmHg, showing no difference between the two groups. Fasting blood glucose levels were 85.5 ± 12.7 mg/dL and 98.4 ± 37.0 mg/dL, with the shift work group having significantly higher levels (p = 0.003). The total cholesterol for the daytime work group and the shift work group was 180.6 ± 30.8 mg/dL and 193.0 ± 35.2 mg/dL, low-density lipoprotein cholesterol was 103.2 ± 26.6 mg/dL and 112.2 ± 31.6 mg/dL, and high-density lipoprotein cholesterol was 60.9 ± 15.7 mg/dL and 59.1 ± 15.1 mg/dL, respectively, with no significant difference between the two groups. Triglyceride levels, however, were 87.8 ± 58.4 mg/dL and 105.5 ± 66.2 mg/dL, respectively, revealing significantly higher levels among shift workers (p = 0.025)(Table 2).
Frequency of abnormalities in the metabolic syndrome components
Table 2 Results of the physical examination and laboratory tests of the subjects
Among each of the components of the diagnostic criteria, there was no significant difference between the 2 groups' waist circumference, triglyceride levels, and high-density lipoprotein cholesterol, whereas in the case of systolic and diastolic blood pressure and fasting blood glucose, there was a significantly higher percentage of abnormal levels within the shift work group (p < 0.001). The prevalence of the metabolic syndrome among the daytime work group was 2.8%, while the shift work group had a significantly higher prevalence of 15.3% (p = 0.006) (Table 3).
Logistic regression analysis results according to general characteristics and shift work
Table 3 Prevalence of each criterion for the metabolic syndrome of the subjects
In the univariate analysis, the greater the age, the greater the alcohol consumption, the less a worker exercised, the greater the likelihood of a worker having the metabolic syndrome. Those who did shift work were also more likely to have the metabolic syndrome (p < 0.05). Therefore, we used age, alcohol consumption, exercise habits, and whether or not subjects did shift work, factors which had yielded p-values of 0.25 or lower in univariate analysis, as variables in a logistic regression analysis and calculated the odds ratio and its 95% confidence interval (CI) for the metabolic syndrome. In the logistic regression analysis results, in comparison with the daytime work group, the shift work group had an odds ratio of 6.30 (95% CI 1.24-32.15), while the other variables were not significant (Table 4).
Table 4 Logistic regression analysis for the metabolic syndrome of female workers by general characteristics and shift work (N = 254)
The clinical importance of the metabolic syndrome has been revealed through many prospective studies. Ford et al. [25] analyzed prospective studies published from 1998 to 2004 and reported that the estimated relative risk of cardiovascular disease for the metabolic syndrome, as defined by NCEP-ATP III, was 1.65 (95% CI 1.38-1.99), and the estimated relative risk for diabetes was 2.99 (95% CI 1.96-4.57). This showed that the metabolic syndrome was an important risk factor for developing cardiovascular disease and diabetes. Lakka et al. [26] reported their results from monitoring middle-aged men with the metabolic syndrome for 11.4 years, finding that the relative risk of coronary artery disease was 2.9 (95% CI 1.2-7.2), while the relative risk of mortality from coronary artery disease, cardiovascular disease, and other causes was 3.6 (95% CI 1.7-7.9), 3.2 (95% CI 1.7-5.8), and 2.3 (95% CI 1.5-3.4), respectively. Boden-Albala et al. [27] conducted a follow-up study on 3,298 people for an average of 6.4 years, looking at the association of the metabolic syndrome and cerebrovascular disease. They reported an association of the metabolic syndrome with the risk of cerebral infarction, the odds in men being 1.1 (95% CI 0.6-1.9), while women had greater odds of 2.0 (95% CI 1.3-3.1). Thus, the prevention and treatment of the metabolic syndrome before the development of cardiovascular disease and diabetes is very important. Also, the metabolic syndrome increases the risk of left ventricular hypertrophy unrelated to high blood pressure, it is associated with subclinical cardiovascular disease, arteriopathy, renal disease, and atrial fibrillation [28], and it is also associated with health problems such as fatty liver disease, polycystic ovary syndrome, cholesterol gallstone, asthma, sleep disorder, and malignant tumors [29].
The prevalence rate of the metabolic syndrome in South Korean adults increases with age [30]. In this study, we looked at the prevalence of the metabolic syndrome as well as abnormal values of each component criterion for different age groups. For the age brackets of under 40, 40–49 years old, and 50 and above, blood pressure was 26.5%, 44.5%, and 61.2%, respectively; fasting blood glucose was 7.4%, 16.0%, and 35.8%; waist circumference was 7.4%, 5.0%, and 9.0%; triglyceride levels were 10.3%, 13.4%, and 29.9%; low high-density lipoprotein cholesterolemia was 22.1%, 21.0%, and 40.3%; and the prevalence of the metabolic syndrome was 7.4%, 7.6%, and 23.9%, respectively. These results showed signs of an increase in the prevalence of the metabolic syndrome and abnormalities of each metabolic syndrome component as the age brackets increased. These results were similar to those of a study on the factors related to the metabolic syndrome in dockyard and electronics manufacturing workers [21, 23]. The subjects in our study aged 30 or over comprised 223 individuals (87.8%), of which 13.5% had the metabolic syndrome. This was lower than the 25.6% metabolic syndrome prevalence in women aged 30 and over reported in the Korean National Health and Nutrition Examination Surveys of 2007–2010. One reason for this discrepancy might be found in the KNHANES, which reported that odds ratio of the metabolic syndrome for full-time homemakers was 1.85 times greater than for non-homemakers. According to research by Waggoner et al. [31], the lower prevalence of the metabolic syndrome for women with jobs can be attributed to the healthy worker effect.
Smoking is an example of another factor related to the development of the metabolic syndrome. Smoking, a risk factor in coronary artery disease, increases total cholesterol and triglyceride levels, induces insulin resistance, hyperinsulinemia, and low high-density lipoprotein cholesterol, and appears to raise the risk of the metabolic syndrome [32]. In addition, smoking shows a strong correlation with the five diagnostic criteria for the metabolic syndrome proposed by ATP III. David et al. [33] reported that smoking itself is associated with a high-fat and low-fiber diet, which increases total cholesterol and triglyceride levels. As only three out of the 254 subjects in this study were smokers, the small number of subjects made the confirmation of an association between smoking and the metabolic syndrome difficult.
Through a number of studies, it has become clear that a moderate amount of alcohol consumption lowers the risk of heart disease. A moderate amount of alcohol consumption inhibits blood coagulation and platelet aggregation and also increases high-density lipoprotein cholesterol, by which it is believed to have cardioprotective effects. On the other hand, the overconsumption of alcohol is known to increase triglyceride levels and raise blood pressure [34]. Meanwhile, there are reports that, compared with men, women are more susceptible to health hazards from alcohol consumption [35]. In the United States Recommended Dietary Allowance proposed in 2005, the recommended alcohol consumption is no more than two glasses per day for men, and half of that amount for women, no more than 1 glass a day [36]. In this study as well, while the prevalence of the metabolic syndrome was higher in those who drank alcohol than in those who did not, it was not statistically significant.
Exercise is known to reduce overall metabolic risk factors, improving lipid metabolism and lowering blood pressure in patients with high blood pressure, reducing insulin resistance, and improving hyperglycemia [37, 38]. In this study, while those who exercised regularly at least once a week for 30 min or more tended to have lower triglyceride and fasting blood glucose levels, higher levels of high-density lipoprotein cholesterol, and a lower prevalence of the metabolic syndrome compared with those who did not exercise, the differences were not statistically significant.
In this study, shift work was confirmed to be a risk factor for the metabolic syndrome in female workers. This relationship was also found in a study by Li et al. [39], which found that the odds ratio for the metabolic syndrome in both male and female shift workers was 1.87 (95% CI 1.13-3.08), and in the three-year follow-up study by Kawada et al. [40], the odds ratio for male double-shift workers was 1.43 (95% CI 1.05-1.95). However, a study by Puttonen et al. [41] found the odds ratio of the metabolic syndrome in men to be 1.83 (95% CI 1.13-2.96), with no meaningful difference from the prevalence in women. These findings differ from the results of our study. That shift work has a direct association with the development of cardiovascular disease can be inferred from the following studies: Research by Esquirol et al. [42, 43] found through a meta-analysis of 17 studies on shift work-related health hazards that shift workers, both male and female, had 1.4 times greater odds of developing cardiovascular disease than did daytime workers. Vyas et al. [44], through a systematic review and meta-analysis of 34 experiments conducted at Canada's Western University comprising 2,011,935 subjects, found the odds ratios for myocardial infarction, cerebral infarction, and coronary artery disease in shift workers compared to daytime workers were 1.23 (95% CI 1.15-1.32), 1.05 (95% CI 1.01-1.09), and 1.24 (95% CI 1.10-1.39), respectively.
Factors such as stress, lack of sleep, and changes in health behavior are involved in the mechanism of the metabolic syndrome [45]. The association of the metabolic syndrome and stress has been confirmed by many studies [46, 47]. When stress is continuously undergone, an increase in adrenocortical hormones caused by hypothalamus-pituitary-adrenal axis dysregulation leads to metabolic dysfunctions such as high blood pressure, hardening of the arteries, insulin resistance, and dyslipidemia. It also produces an anti-insulin effect, causing a rise in blood glucose levels, and can cause visceral obesity by accumulating abdominal fat [48, 49]. In addition, studies have found that partial sleep restriction causes a change in the hormones that regulate the ingestion of food, ghrelin (increases after sleep restriction) and leptin (decreases after sleep restriction), which increases appetite [50], while a lack of sleep reduces glucose tolerance and insulin-sensitivity, and increases blood pressure [45]. According to research by Lee et al. [51], the stress received by shift workers is significantly high compared with that of daytime workers, the same of which is true for sleep disorders [52]. Ordinarily in humans, during the day, glycometabolism is accelerated and fat storage occurs. While sleeping at night, glucose-use lowers and lipometabolism occurs. Therefore, having to ingest food at night due to shift work, when insulin-sensitivity is at its lowest, can lead to metabolic dysfunction [45].
For reasons such as these, stress management and the management of appropriate eating habits and lifestyle habits by shift workers appears necessary in order to reduce the prevalence of the metabolic syndrome. Likewise, employers must work to prevent illness by taking actions such as giving shift workers sufficient rest time, checking the state of their health on a frequent basis, managing the working environment, and providing anti-smoking/drinking education, daily physical activities, and healthy meals. On a national level, there appears to be a need for oversight to ensure compliance with working hour requirements, night work restrictions, and vacation provision, as well as the establishment of policies to reduce the number of night-shift workers.
Among the limitations of this study were the difficulty in determining causal relationships as a cross-sectional study, and the exclusion of the investigation of the influence of socioeconomic factors on the metabolic syndrome. For example, at the time of selecting the research subjects, in order to minimize employment-related biases, we selected subjects who were working in the fabric industry. However, when we divided the subjects by office work and manufacturing work, the manufacturing jobs were mainly categorized as shift work, and office work became mostly day work. Because of this, the effect of shift work became conflated with the type of work, and our being unable to separate this was a limitation. An additional drawback was that we could not take the qualitative aspects of each variable, such as the shift work hours or the intensity of the work, into consideration.
Our confirmation that shift labor can influence the prevalence of the metabolic syndrome in female workers doing such work is of value. What is needed from this point on are large-scale prospective studies on the management and prevention of the metabolic syndrome that involve more female worker subjects and that take into account socioeconomic factors as well as the other factors investigated in our study.
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Puttonen S, Viitasalo K, Harma M: The relationship between current and former shift work and the metabolic syndrome. Scand J Work Environ Health 2012,38(4):343–348. 10.5271/sjweh.3267
Esquirol Y, Bongard V, Mabile L, Jonnier B, Soulat JM, Perret B: Shift work and metabolic syndrome: respective impacts of job strain, physical activity, and dietary rhythms. Chronobiol Int 2009,26(3):544–559. 10.1080/07420520902821176
Esquirol Y, Perret B, Ruidavets JB, Marquie JC, Dienne E, Niezborala M, Ferrieres J: Shift work and cardiovascular risk factors: new knowledge from the past decade. Arch Cardiovasc Dis 2011,104(12):636–668. 10.1016/j.acvd.2011.09.004
Vyas MV, Garg AX, Iansavichus AV, Costella J, Donner A, Laugsand LE, Janszky I, Mrkobrada M, Parraga G, Hackam DG: Shift work and vascular events: systematic review and meta-analysis. BMJ 2012, 345: e4800. 10.1136/bmj.e4800
Tucker P, Marquié JC, Folkard S, Ansiau D, Esquirol Y: Shiftwork and metabolic dysfunction. Chronobiol Int 2012,29(5):549–555. 10.3109/07420528.2012.675259
Bara AC, Arber S: Working shifts and mental health–findings from the British household panel survey (1995–2005). Scand J Work Environ Health 2009,35(5):361–367. 10.5271/sjweh.1344
Driesen K, Jansen NW, Kant I, Mohren DC, van Amelsvoort LG: Depressed mood in the working population: associations with work schedules and working hours. Chronobiol Int 2010,27(5):1062–1079. 10.3109/07420528.2010.489877
Vanitallie TB: Stress: a risk factor for serious illness. Metabolism 2002, 51: 40–45. 10.1053/meta.2002.33191
Jung JW, Shin HC, Park YW, Kim CH, Cheong SY, Sung EJ: The relationship between metabolic syndrome, stress and depression. Korean J Health Promot Dis Prev 2004,4(1):10–17. Korean
Spiegel K, Tasali E, Penev P, Van Cauter E: Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 2004,141(11):846–850. 10.7326/0003-4819-141-11-200412070-00008
Lee KJ, Kim JJ, Lee NS: Impact of shift work and work stress on job satisfaction in manufacture working women. Journal of Soonchunhyang Medical Science 2009,15(1):89–98. Korean
Lee JT, Lee KJ, Park JB, Lee KW, Jang KY: The relations between shiftwork and sleep disturbance in a university hospital nurses. Korean J Occup Environ Med 2007,19(3):223–230. Korean
Han Hui Ye, Jae Uk Jeong, Man Joong Jeon & Joon Sakong
HHY: Study concept and design, Drafting of the manuscript. JUJ: Analysis of data. JS: Technical support. JMJ: Critical revision of the manuscript. All authors read and approve the final manuscript.
Ye, H.H., Jeong, J.U., Jeon, M.J. et al. The Association between Shift Work and the Metabolic Syndrome in Female Workers. Ann of Occup and Environ Med 25, 33 (2013). https://doi.org/10.1186/2052-4374-25-33
Female workers


The celebration of the Man of Steel's 80th anniversary continues with the ACTION COMICS: 80 YEARS OF SUPERMAN POSTER! Originally slated to run in the ACTION COMICS: 80 YEARS OF SUPERMAN HC, this poster is now offered as a stand-alone item. This spectacular poster features every ACTION COMICS cover ever, from the series' 1938 debut to issue #1000, coming in April! The poster measures 27" x 40"..


Bling Bling Packaging produces all types of custom boxes for retail packaging. Our custom retail packaging solutions can be constructed from corrugated, chip board, fiberboard, and/or clear acetate, as your needs dictate. All materials can be printed with up to six colors (cyan/blue, magenta, yellow, black, orange, and green).
Contact Bling Bling Packaging and we'll help turn your vision into reality!
Our talented team of designers can create custom embossing dies to match your logo, slogan, product name, or complete contact imprint. Embossed retail packaging can give any product a high-class, elegant look.
Foil stamping can enhance logos, lettering in product names or slogans, or any part of your packaging to which you want to draw a customer's attention. Traditional silver and gold foil stamping are available, as well as a variety of new foil stamp colors, from mild to wild.
Your custom retail packaging can be printed with up to six colors, with inline printing on SBS or CCNB paper, from 10pt to 24pt, plus AQ, satin, or UV coatings. Foil stamping and embossing can also be added for an eye-catching look.
Also see: Chipboard Boxes and Chipboard Counter Displays.
Quotes: Get your custom packaging quote within 24-48 hours.* Quotes are good for 30 days.
In House Design: We have both structural design and graphic design teams in house to create the perfect retail packaging for your products.
Direct to Plate & Conventional Film/Platemaking: Our onsite services provide reliability and guaranteed quality, with no third-service providers to drop the ball.
Quick Turnaround: Our turnaround times are among the best in the retail packaging industry.
Warehouse-to-Store Floor Efficiency: Our custom retail packaging is designed for high efficiency production and superior marketability. This minimizes the labor labor required for setup, allowing your products to arrive in stores in safe condition, undamaged, and ready to be displayed and sold.
Prototypes: We can often produce a prototype of your custom packaging design same-day; 48 hours is the maximum, including challenging designs or intricate die cuts. See the style, material, and size of your retail packaging project before the print run begins.
In House Die Shop: We have onsite capabilities to cut special dies for YOUR logo, slogan, or promotional wording.
* Quote time is dependent upon our receiving the full and complete information about your job. This is why; if possible, we prefer to meet the client one-on-one to ensure that we understand your exact wishes.
We can create thermoform trays, clamshell packages, or custom packing inserts, as needed, for your retail packaging project. This also includes blister cards and header cards.
Our chipboard folding cartons include printing up to 6 colors in line on SBS or CCNB paper from 10pt to 24pt, plus AQ, satin, or UV coatings. In-house silver or gold foil stamping and embossing are available.


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blood clotting
Strength tests for platelets
Bleeding disorders could one day be diagnosed by putting platelets through strength tests, researchers have proposed.
Biomedical engineers from Emory and Georgia Tech have devised a microfluidic testing ground where platelets can demonstrate their strength by squeezing two protein dots together. Imagine rows and rows of strength testing machines from a carnival, but very tiny. Platelets are capable of exerting forces that are several times larger, in relation to their size, in comparison with muscle cells.
After a blood clot forms, it contracts, promoting wound closure and restoration of normal blood flow. This process can be deficient in a variety of blood clotting disorders. Previously, it was difficult to measure individual platelet's contributions to contraction, because clots' various components got in the way.
The prototype diagnostic tools are described in Nature Materials.
Top: platelets exert their strength. Bottom left: red = platelets, green = fibrinogen dots. Bottom right: size of actual device.
"We discovered that platelets from some patients with bleeding disorders are 'wimpier' than platelets from healthy people," says Wilbur Lam, MD, PhD, assistant professor in the Department of Pediatrics at Emory University School of Medicine and in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University. "Our device may function as a new physics-based method to test for bleeding disorders, complementary to current methods."
The first author of the paper is instructor David Myers, PhD. Lam is also a physician in the Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta. Collaborators at North Carolina State University led by Ashley Brown, PhD, contributed to testing the device.
The scientists infer how strong or wimpy someone's platelets are by measuring how far the protein dots move, taking a picture of the rows of dots, and then analyzing the picture on a computer. The dots are made of fibrinogen, a sticky protein that is the precursor for fibrin, which forms a mesh of insoluble strands in a blood clot.
In addition to detecting problems with platelet contraction in patients with known inherited disorders such as Wiskott Aldrich syndrome, Myers, Lam and colleagues could also see differences in some patients who had bleeding symptoms, but who performed normally on standard diagnostic tests. Read more
Posted on October 11, 2016 by Quinn Eastman in Heart, Uncategorized Leave a comment
Aflac Cancer and Blood Disorders Center
Children's Healthcare of Atlanta
Wilbur Lam
Wiskott Aldrich syndrome
Tapping evolution to improve biotech products
Scientists can improve protein-based drugs by reaching into the evolutionary past, a paper published this week in Nature Biotechnology proposes.
As a proof of concept for this approach, the research team from Emory, Children's Healthcare of Atlanta and Georgia Tech showed how "ancestral sequence reconstruction" or ASR can guide engineering of the blood clotting protein known as factor VIII, which is deficient in the inherited disorder hemophilia A.
Structure of Factor VIII
Other common protein-based drugs include monoclonal antibodies, insulin, human growth hormone and white blood cell stimulating factors given to cancer patients. The authors say that ASR-based engineering could be applied to other recombinant proteins produced outside the human body, as well as gene therapy.
It has been possible to produce human factor VIII in recombinant form since the early 1990s. However, current factor VIII products still have problems: they don't last long in the blood, they frequently stimulate immune responses in the recipient, and they are difficult and costly to manufacture.
Experimental hematologist and gene therapist Chris Doering, PhD and his colleagues already had some success in addressing these challenges by filling in some of the sequence of human factor VIII with the same protein from pigs.
"We hypothesized that human factor VIII has evolved to be short lived in the blood to reduce the risk of thrombosis," Doering says. "And we reasoned that by going even farther back in evolutionary history, it should be possible to find more stable, potent relatives."
Doering is associate professor of pediatrics at Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta. The first author of the paper is former Molecular and Systems Pharmacology graduate student Philip Zakas, PhD.
Doering's lab teamed up with Trent Spencer, PhD, director of cell and gene therapy for the Aflac Cancer and Blood Disorders Center, and Eric Gaucher, PhD, associate professor of biological sciences at Georgia Tech, who specializes in ASR. (Gaucher has also worked with Emory biochemist Eric Ortlund – related item on ASR from Gaucher)
ASR involves reaping the recent harvest of genome sequences from animals as varied as mice, cows, goats, whales, dogs, cats, horses, bats and elephants. Using this information, scientists reconstruct a plausible ancestral sequence for a protein in early mammals. They then tweak the human protein, one amino acid building block at a time, toward the ancestral sequence to see what kinds of effects the changes could have. Read more
Posted on September 29, 2016 by Quinn Eastman in Immunology, Uncategorized Leave a comment
ancestral sequence reconstruction
Chris Doering
Eric Gaucher
Expression Therapeutics
factor VIII
Trent Spencer
FDA approves treatment for acquired hemophilia
On Oct. 24, the Food and Drug Administration approved Obizur, a treatment for acquired hemophilia A. Obizur was originally developed by a research team led by Emory hematologist Pete Lollar. The Obizur technology was licensed by Emory in 1998 to startup company Octagen (more about Octagen from Philadelphia Business Journal) and eventually brought to commercial availability by the pharmaceutical firm Baxter International.
Lollar is Hemophilia of Georgia Professor of Pediatrics in the Aflac Cancer and Blood Disorders Center at Emory University School of Medicine and Children's Healthcare of Atlanta. The team that developed the drug included Ernest Parker, John Healey and Rachel Barrow, and followed a research collaboration between Lollar and Emory cardiologist Marschall Runge (now at UNC).
Hemophilia is a group of blood clotting disorders leading to excessive bleeding that can occur spontaneously or following injury or surgery. Hemophilia A is caused by a deficiency of clotting factor VIII, and can be either inherited or acquired.
In acquired hemophilia A, the immune system is somehow provoked into making antibodies against factor VIII that inactivate it. Acquired hemophilia is a challenge for doctors to deal with because patients frequently present with severe, life threatening bleeding and also because it's a surprise: patients do not have a previous personal or family history of bleeding episodes. Antibodies to factor VIII also can be a problem for approximately 30 percent of patients with inherited hemophilia.
Lollar's team developed a modified form of factor VIII, derived from the protein sequence of pigs, which is less of a red flag to the immune system. Read more
Posted on November 4, 2014 by Quinn Eastman in Immunology Leave a comment
acquired hemophilia
Pete Lollar
Clot dissolver tPA's tardy twin could aid in stroke recovery
Emory researchers led by neurologist Manuel Yepes, MD have identified a protein released by neurons while the brain is recovering from a stroke. The results were published online today in Journal of Neuroscience.
The protein, called urokinase-type plasminogen activator or uPA, has been approved by the FDA to dissolve blood clots in the lungs. It has been tested in clinical trials in some countries as a treatment for acute stroke.
The Emory team's findings suggest that in stroke, uPA's benefits may extend beyond the time when doctors' principal goal is dissolving the blood clot that is depriving the brain of blood.
Instead, uPA appears to help brain cells recover from the injuries induced by loss of blood flow. Treating mice with uPA after an experimental stroke can improve their recovery of motor function, the researchers found.
Posted on October 22, 2014 by Quinn Eastman in Neuro Leave a comment
Center for Neurodegenerative Disease
Manuel Yepes
tissue-type plasminogen activator
urokinase-type plasminogen activator
Possible diabetes drug/stent interaction
Diabetes and heart disease often intersect. Emory cardiologist Aloke Finn and his colleagues recently had two papers in the Journal of the American College of Cardiology and in Atherosclerosis describing a possible interaction between the widely used diabetes drug metformin and drug-eluting stents, which are used to to treat coronary artery disease. Anwer Habib, MD is the first author of both papers.
The stent props the once-blocked artery open while the drugs in the stents are supposed to prevent the artery from becoming blocked again. The drugs — usually mTOR inhibitors such as http://www.magliettedacalcioit.com everolimus or the newer zotarolimus — slow down cell growth, but this cuts both ways. The drugs slow down the recovery of the lining of the blood vessel and this may contribute to blood clot formation after stent placement.
In cultured human cells and in rabbits with implanted stents, Finn and colleagues showed that metformin augmented the effect of mTOR inhibitors on regrowth of the blood vessel lining. (However — the authors acknowledge that their animal model was not diabetic or atherosclerotic.)
The findings could mean that people taking metformin would need to take medications to prevent blood clotting medications for a longer time after stent placement. The authors say that clinical studies following patients who receive drug-eluting stents should look at metformin's effects on blood clotting events. A study examining drug eluting stents in diabetic patients is in the works at Emory.
Posted on July 10, 2013 by Quinn Eastman in Heart Leave a comment
Aloke Finn
coronary artery
drug-eluting stent
mTOR inhibitors

redpajama_set_name: RedPajamaCommonCrawl


Go wherever you want with an UTV. Unlike an ATV that only carries one rider and has no cargo space, a UTV can cart around several people and your gear. Here are just a few ways that a UTV will come in handy when you're ready for an adventure.
UTVs are the vehicle of choice for farmers and ranchers because they are so versatile. When you need to go to the far reaches of your ranch to repair fencing or address another problem, you may need to take supplies and a partner with you. Rather than driving your good truck over the rough terrain, you can load what you need in the UTV and head out.
Campgrounds are great if you want the convenience of plumbing and electricity, but some people want the full experience of camping without modern conveniences. With the UTV, you can load up your gear and then head off into the great unknown with your family.
Just as ATVs are fun, UTVs are also a blast. You can load up a few friends and go hit the track where you can all enjoy the action. The biggest challenge you'll face then is deciding who drives next. With the availability of great UTV accessories like special doors and tires, you can also customize your UTV and make it even more amazing.
There are several ways to use your UTV, and you will never grow tired of having one. Versatile enough to be used for work and play, it's a smart investment that can be used in countless applications.


Stunning, spacious 3 bedroom quad villa with communal pool for sale in Aguas Nuevas close to Torrevieja.
This beautiful quad style villa is in a quiet location only a short walk to the beach and the town centre of Torrevieja.
Entering the property onto the lovely patio garden with off road parking. Up some steps and through the front door takes you into the spacious lounge diner and has an American style kitchen which is fitted with quality wall mounted and floor standing units. From the lounge is a bright bedroom and also w/c. On the first floor is the master bedroom which has patio doors onto a sun-drenched balcony, second double bedroom and the family bathroom.
This fantastic property also benefits from hot and cold air conditioning and the use of a fantastic communal swimming pool.
Our La Siesta office are proud to offer for sale this beautiful, spacious, bargain quad villa which is conveniently situated close to shops, bars, restaurants, supermarkets, etc. the golden sandy beaches of the Costa Blanca, Costa Calida & the Mar Menor are only 5 minutes away, and is close to all main transport links, with just a 30 minute drive to Murcia (San Javier) or 40 minute drive Alicante airports and only minutes from any of a dozen world class golf courses.
This quad is for sale part furnished and it has been priced to sell so an early viewing is highly recommended!


Mine Doors, Track Cleaners, Cable Vulcanizers | American Mine Door Co.
Finally! ...a safer, better designed alternative to traditional "machine" doors... that fits into my budget!
Improving Safety is Priority #1!
Safety is priority one in the mines. And we also know miners are at risk in high (water gauge) pressure work areas.
Too many accidents and "near misses" have occurred in high pressure mines where doors are opening in the same direction causing abrupt dangerous slamming of doors that could lead to accidents and injuries.
Underground mines continue to be challenged to improve mine safety and the new EcoVent door provides a safer solution to underground machine doors.
American Mine Door's patented opposing wing design uses the mines own ventilation air pressure to assist opening and closing of the doors regardless of what direction the air is flowing. No more worries. One wing opens with the air flow while the other wing opens against the airflow; cancelling the other out. With this equalized air pressure, doors will not slam closed, reducing the potential for injuries to hands or feet that can get caught between the door wings.
See the EcoVent Door in Action!
Interested in learning more about our new EcoVent Mine Door? Download our Press Release and EcoVent Mine Door Flier.


In efforts to better help you—the gamer—find better games and help game designers and publishers get the word out about their games EverythingBoardGames.com has teamed up with number of talented reviewers to form the Everything Board Games Network. The EBG Network will bring you more great game reviews and updates from around the board gaming universe. Joining us is George Jaros from GJJ Games, Jeremy Davis from GameGeek.Ninja, Derek Maggs from the Australian Tabletop Gaming Network, and Dave Merrell.
Dane Trimble is an Advertising Manager for a national magazine by day and a husband, father of four, and board gamer by night (and mornings). He has a passion for board games and believes board games help bring families closer together while providing kids a unique way to learn many diverse skills. And he thinks they are down right fun!!!


Voice is mostly amplify and reflect the voice of public. Not only the journal try to collect true news happened weekly, but also it include articles, foreign affairs, entertainment etc,.
Please click above page number to view enlarged News!


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Louise Tolliver Payne
July 8, 1939 - March 17, 2021
Louise Tolliver Payne, age 81, of Greeneville, died Wednesday at the home of her sister, Judy, in the Ducktown Community of Limestone on the farm where they were raised. Louise was born July 8, 1939 in Sullivan County, the oldest of four daughters born to the late Hayes and Blanche Quillen Tolliver. At a young age she began working on the family farm alongside her father and was the Valedictorian of her 1957 graduating class at Chuckey High School. In her early years, she worked at Hurd Lock and Magnavox and then in the early 1970's, she returned to the farm with her husband, Ralph. Louise's father taught her the value of hard work, a trait she passed on to her children and her grandchildren. She was the model of a strong woman, a hard worker, one who never gave up, and completing a task. Louise struggled with numerous health issues over the years, was a two-time cancer survivor, and still she kept going, until she hurt herself on December 12th while working at her home. Louise supported her family and their activities and endeavors in school. She loved sports and attended as many of her children and grandchildren's games as possible, sometimes loudly, depending on the referee's call. She loved all animals. She had attended New Ebenezer Church and the former First Free Methodist Church. Survivors include two sons and daughters-in-law: Billy and Jeannie McCrary, Jackie and Teresa McCrary; one daughter: Katrina Payne Seaton; former daughter-in-law: Kathy Ottinger McCrary; one granddaughter: Laura McCrary Harville and husband, Neal; seven grandsons: Boone McCrary and wife, Christie, Ethan McCrary, Christopher Seaton and wife, Kristen, Ben Seaton and wife, Dana, Matthew Seaton, Braden Seaton and Jaelyn Collins, and Bradley Seaton; two great-grandsons: Hayes and Thaddeus Harville; six great-granddaughters: AnnaBelle, Eleanore, Penelope, and Lorelei Harville, Reagan and Delaney Seaton; three sisters and a brother-in-law: Judy and Richard Harrison, Jane Luster, and Helen Turnmire; brothers-in-law and their wives: Alfred and Judy Payne, Clyde and Phyllis Payne; three special nieces: Carrie Hall, Sabrina Tarlton, and Melissa Scott; special friends: Sandra Weller, Emma Frances Susong, Mike Davis, and Ken Baughman; several nieces, nephews, great-nieces, and great-nephews; and her dog: Sally. In addition to her parents, she was preceded in death by her husband, Ralph H. Payne; father-in-law: Howard A. Payne; mother-in-law: Bell Shipley Payne; brothers-in-law: Joe Luster, Sherman Turnmire, and Bill Scott; and sister-in-law: Charlotte Payne Scott. The family will receive friends from 4 – 7 p.m. Sunday at Doughty-Stevens Funeral Home. The funeral service will follow at 7 o'clock Sunday evening in the funeral home chapel. The Rev. Jim Fillers will officiate. Family and friends are asked to meet at Doughty-Stevens at 10:15 a.m. Monday to go in procession to GreeneLawn Memory Gardens for the 11 a.m. committal service. Active pallbearers will be grandsons. Honorary pallbearers will be Mike Davis, Ken Baughman, David Hensley, Chris Hall, Mickey Tarlton, Richard Harrison, Hayden Anderson, Austin Anderson, Connor Hall, and Reid Tarlton. The family extends special thanks to the staff of Smoky Mountain Hospice, especially Allie Long.
Louise Tolliver Payne, age 81, of Greeneville, died Wednesday at the home of her sister, Judy, in the Ducktown Community of Limestone on the farm where they were raised. Louise was born July 8, 1939 in Sullivan County, the oldest of four daughters... View Obituary & Service Information
The family of Louise Tolliver Payne created this Life Tributes page to make it easy to share your memories.
Louise Tolliver Payne, age 81, of Greeneville, died Wednesday...
Send flowers to the Payne family.


This is Week 5 of our Crafty.js series.
How do you win the game Frogger?
Last time we learned 3 different Control Structures, Ifs, If-elses, and Whiles. Which of these could we use to trigger a You Win! message?
A sprite is a graphic that is used in a video game. It could be a character; it could be an item.
Our Entities will have Sprites applied to them.
Sprites are often contained in a single image called a Sprite Sheet.
Now, let's get back to our game of Frogger and add Sprites! Use this pen to get started.
You should see the Sprite applied to the Frog!
These 4 Numbers represent the Sprite's X, Y, Width, and Height.
Each car Sprite has its own coordinates on the Sprite Sheet. For example the coordinate for the second car is about 30, 7.
Use the following guide to change the Sprite for the car entity.
The XY coordinates for each vehicle.
In the line of code that creates the Sprite, What is the URL?
How important are X-Y coordinates for making video games?


Elite: Dangerous will release on December 16th but players can already test the final pre-release update: Gamma 2.00. Hitting yesterday, progress will now be secure with no more incoming wipes. Players can thus prepare for the official launch and then kick it off with the story on the 16th. Until then, check out the Cinematic Launch Trailer.


My bill was due on the 6th but unfortunately an unexpected expense came up and I just wanted to let you all know I will make my payment on the 13th. Is that okay?
This is a Customer to Customer forum. Usually you will not be assessed a late charge, until the next bill if you wait until then to make the payment. 7 days after pay on date, is not going to cause you to be charged a late charge.


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NELSON MANDELA'S POST 100 YEARS BIRTHDAY: Beyonce', JAY Z, Femi Kuti, Whizkid, Tiwa Savage, others headline Global Citizen Festival in South Africa…Streaming LIVE to over 100 millions viewers today * Home town converges crowd, fans and lover of freedom from world over * Pharrell Williams steals show with hit tune 'I am Happy' *Beyonce recalled how she met Madiba BY QUINNET YVONNE, Jo'Burg & GEORGE ELIJAH OTUMU/FOREIGN BUREAU CHIEF
Written by EDITOR-IN-CHIEF	| December 2, 2018 | 0
NELSON MANDELA'S POST 100 YEARS BIRTHDAY:
Beyonce', JAY Z, Femi Kuti, Whizkid, Tiwa Savage, others headline Global Citizen Festival in South Africa…Streaming LIVE to over 100 millions viewers today
* Home town converges crowd, fans and lover of freedom from world over
* Pharrell Williams steals show with hit tune 'I am Happy'
*Beyonce recalled how she met Madiba
BY QUINNET YVONNE, Jo'Burg & GEORGE ELIJAH OTUMU/FOREIGN BUREAU CHIEF
ONE OF AFRICA'S GREATEST ICONS, NELSON MANDELA , a former South African President,even in death is being cherished and appreciated by his exemplary leadership lifestyle. To celebrate his unique humility, accomplishments in life, an open air concert titled 'The Global Citizen Festival', with the intention of wiping away poverty out of Nigeria.
The Global Citizen Festival: Mandela 100, marking a century since South African president and anti-apartheid leader Nelson Mandela was born, takes place Sunday, December 2, in his home country with Beyoncé, Jay-Z and Ed Sheeran headlining in the name of ending extreme poverty.
Other performers in the festival at the FNB Stadium in Johannesburg include Pharrell Williams, Chris Martin, Usher, Wizkid, Cassper Nyovest, D'Banj, Eddie Vedder, Femi Kuti, Kacey Musgraves, Sho Madjozi and Tiwa Savage.
The festival, free for fans who take anti-poverty actions, begins at 2 p.m. local time, which is 7 a.m. EST. It will be livestreamed on YouTube below:
Ahead of the event, Beyoncé penned a letter to Mandela, who was born on July 18, 1918, and died in 2013. The letter reads:"I first met you in 2004 at the 46664 AIDS Benefit Concert in Cape Town, and the impact you have had on my life resonates with me today and every day," the American singer wrote in the letter she posted on her website. "Your kindness and gratitude for every experience, and your ability to forgive are lessons I have learned and will pass on to my three children. My entire family holds you in high regard."
Beyoncé continued: "It is an honor for me to travel to South Africa this week in celebration of you and your efforts to right so many wrongs. You were a strategic warrior, a bold activist, and charismatic and well-loved leader. Your vision for dignity, for human rights, for peace and a South Africa free of racism and apartheid, allows us all to turn dreams into reality."
Her involvement in the Global Citizen Festival this year follows up her support for Mandela in previous years. In 2003, Beyoncé performed at a concert that Mandela hosted to bring awareness about HIV and AIDS. Two years afterward, Mandela called for efforts to "make poverty history" during a speech in Trafalgar Square in London.
Ahead of the event, Beyoncé penned a letter to Mandela, who was born on July 18, 1918, and died in 2013.
"I first met you in 2004 at the 46664 AIDS Benefit Concert in Cape Town, and the impact you have had on my life resonates with me today and every day," the American singer wrote in the letter she posted on her website. "Your kindness and gratitude for every experience, and your ability to forgive are lessons I have learned and will pass on to my three children. My entire family holds you in high regard."
Hugh Evans, who launched the Global Citizen Festival in 2012, said this year's edition is the biggest yet.
"On every way that we measure outcomes—the number of citizens engaged, the number of policy outcomes that are achieved, the number of lives that are affected as a result of those policy outcomes—we believe it has the potential to be the most significant campaign we've ever been part of," Evans told AFP earlier this year.
The goal was to raise $1 billion leading up to the festival to help the poorest people in the world, and half of the amount is intended for girls and women. Beyoncé, Jay-Z and the other performers will share the stage with world and private sector leaders who have committed to fighting extreme poverty.


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Tsjerven Brjag (Bulgaars: Червен бряг) is een stad in de oblast Pleven, in het noorden van Bulgarije. Het is de hoofdplaats van de gelijknamige gemeente Tsjerven Brjag. De gemeente Tsjerven Brjag grenst aan de volgende gemeenten: Loekovit,  Roman, Dolni Dabnik, Iskar, Knezja en Bjala Slatina.

Gemeente in Bulgarije
Stad in Bulgarije
Pleven (oblast)

redpajama_set_name: RedPajamaWikipedia


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(COALESCE(salesdata_Month08Amount,0) / IF(salesdata_ExchangeRate<>'',salesdata_ExchangeRate,1) ) +
(COALESCE(salesdata_Month09Amount,0) / IF(salesdata_ExchangeRate<>'',salesdata_ExchangeRate,1) ) +
(COALESCE(salesdata_Month10Amount,0) / IF(salesdata_ExchangeRate<>'',salesdata_ExchangeRate,1) ) +
(COALESCE(salesdata_Month11Amount,0) / IF(salesdata_ExchangeRate<>'',salesdata_ExchangeRate,1) ) +
(COALESCE(salesdata_Month12Amount,0) / IF(salesdata_ExchangeRate<>'',salesdata_ExchangeRate,1) ) +
0) FROM SalesData
WHERE salesdata_SalesDataTypeID = 3
AND salesdata_CompanyID = company_ID
AND salesdata_SalesYearID = 6
AND NOT salesdata_IsBeingProcessed
),0)

Output:
0 row(s) affected, 5 warning(s):
 1265 Data truncated for column 'company_CurrentYearValueGBP' at row 127
 1265 Data truncated for column 'company_CurrentYearValueGBP' at row 127
 1265 Data truncated for column 'company_CurrentYearValueGBP' at row 127
 1265 Data truncated for column 'company_CurrentYearValueGBP' at row 127
 1265 Data truncated for column 'company_CurrentYearValueGBP' at row 127
 Rows matched: 1470  Changed: 0  Warnings: 5

In MySQL 5.7.14 with SQL mode "STRICT_TRANS_TABLES", the same query is creating the following error:
Error Code: 1292. Truncated incorrect DECIMAL value: ''

I understand why the error is happening (because of the comparison salesdata_ExchangeRate<>'') but can anyone explain why in MySQL 5.6 even though strict mode is enabled, that the query is only producing warnings and not aborting with an error? The behaviour seems different between the two versions.
Update 1
Created a simple table with the following structure on both MySQL 5.6.13 and MySQL 5.7.14:

Added the following records:

Running the following query reproduces the same error in MySQL 5.7.14:
UPDATE testtable
SET testtable_CalculatedValue = IF(testtable_DecimalValue<>'',testtable_DecimalValue,0)
WHERE testtable_ID > 0

Error Code: 1292. Truncated incorrect DECIMAL value: ''

In MySQL 5.6.13, testtable_CalculatedValue is set to 1.35 as expected.

A: Setup:
mysql> CREATE TABLE so53868586 (
         id INT AUTO_INCREMENT,
         deci  DECIMAL(12,2) DEFAULT NULL,
         calc DECIMAL(12,2) DEFAULT NULL,
         PRIMARY KEY(id)
     ) ENGINE=InnoDB;
Query OK, 0 rows affected (0.02 sec)

mysql> SET @@sql_mode = "STRICT_TRANS_TABLES";
Query OK, 0 rows affected (0.00 sec)

mysql> INSERT INTO so53868586 (deci)
         VALUES (1.35), (NULL), (0), (12345);
Query OK, 4 rows affected (0.00 sec)
Records: 4  Duplicates: 0  Warnings: 0

Test
mysql> SELECT * FROM so53868586;
+----+----------+------+
| id | deci     | calc |
+----+----------+------+
|  1 |     1.35 | NULL |
|  2 |     NULL | NULL |
|  3 |     0.00 | NULL |
|  4 | 12345.00 | NULL |
+----+----------+------+
4 rows in set (0.00 sec)

mysql>
mysql> UPDATE so53868586 SET calc = IF(deci <> 0, deci, 0)
         WHERE id > 0;
Query OK, 4 rows affected (0.00 sec)
Rows matched: 4  Changed: 4  Warnings: 0

mysql>
mysql> SELECT * FROM so53868586;
+----+----------+----------+
| id | deci     | calc     |
+----+----------+----------+
|  1 |     1.35 |     1.35 |
|  2 |     NULL |     0.00 |
|  3 |     0.00 |     0.00 |
|  4 | 12345.00 | 12345.00 |
+----+----------+----------+
4 rows in set (0.01 sec)

(That was using 5.6.22.)
5.7.15 got the same results, but complained about SET @sql_mode with
mysql> show warnings;
+---------+------+-------------------------------------------------------------------------------------------------------------------------------------------------------------------------+
| Level   | Code | Message                                                                                |
+---------+------+-------------------------------------------------------------------------------------------------------------------------------------------------------------------------+
| Warning | 3135 | 'NO_ZERO_DATE', 'NO_ZERO_IN_DATE' and 'ERROR_FOR_DIVISION_BY_ZERO' sql modes should be used with strict mode. They will be merged with strict mode in a future release. |
| Warning | 3090 | Changing sql mode 'NO_AUTO_CREATE_USER' is deprecated. It will be removed in a future release.                                                                          |
+---------+------+-------------------------------------------------------------------------------------------------------------------------------------------------------------------------+

Have I failed to reproduce your test case?
I see nothing relevant in the Changelog for 5.7.15 (or anywhere around there), but you could consider updating.  (5.7.14 was issued over 2 years ago.)

redpajama_set_name: RedPajamaStackExchange


The Vorago RH-OBC-1 is an On Board Computer (OBC) / Command & Data Handling (C&DH) avionics board using radiation-hardened components and radiation effects fault-tolerant design methodology. The board is based on a VORAGO Technologies VA10820 ARM® Cortex®-M0 microcontroller (MCU) and includes rad-hard Cypress FRAM, rad-hard Intersil power management devices and a rad-hard Cobham 14-bit Analog-to-digital convertor. Radiation-mitigating protection circuits are incorporated to protect commercial grade CAN and USB-to-UART devices.
The RH-OBC is designed to be compatible with the Pumpkin 104-pin CubeSat Bus. The RH-OBC is a rad-hard replacement for Pumpkin's non-rad-hard Motherboard (MB) + Pluggable Processor Modules (PPM); it implements a rad-hard subset of the subsystems typically found on an MB+PPM.
The VA10820 MCU is supported by Keil® MDK-ARM microcontroller software kit, IAR Systems® Embedded Workbench®, and iSYSTEM winIDEA (not included).
Example firmware is built using the FreeRTOS operating system for simple incorporation of tasks.
The RH-OBC-1 is supported by/in Bright Ascension's FDK.
This module is compatible with all CubeSats that conform to the 104-pin CubeSat bus connector. A 5Vdc supply voltage on +5V_SYS is required to power the board.


A catheter sheath introducer comprises a hub and a tubular sheath having an inner lining with one or more dampers to improve retention of medical devices received or passed through the sheath without significantly increasing the force required to advance the medical device through the sheath. The dampers are made of a friction inducing material, for example, rubber-based materials, and configured as fingers, bumps or flaps that are unidirectional by means of an asymmetrical shape relative to a longitudinal axis of the sheath.
The present invention is directed to a novel catheter sheath introducer.
Catheter sheath introducers are well known in the health care industry as a means of providing access to the circulatory system for a number of applications. In a now well know process, the catheter sheath introducer is placed in a desired blood vessel to facilitate various procedures. Among these medical procedures, for example, are mapping, ablation and balloon angioplasty which require the manipulation of catheters through the circulatory system.
Catheter introducers typically include a tubular sheath and a hub attached to a proximal end of the sheath. Throughout a medical procedure, a number of medical devices may be received or fed through the hub and sheath, including a dilator, a guide wire and/or one or more catheters. Catheters especially may have long shafts that require much manipulation to pass through the hub and sheath in order to reach the desired position in the body to effect the medical procedure. However, catheter shafts can slip rotationally and/or longitudinally in the sheath, increasing the effort needed to correctly position the diagnostic or therapeutic distal portion of the catheter within the body.
Accordingly, a need exists for a catheter sheath introducer with improved hold and retention of catheters and other medical devices extending there through without significantly increasing the force required to advance the catheter or medical device through the sheath.
In accordance with the present invention, a catheter sheath introducer comprising a hub and a tubular sheath having an inner lining with one or more dampers is provided. The dampers are unidirectional so as to improve retention of medical devices received or passed through the sheath without significantly increasing the force required to advance the medical device through the sheath.
In one embodiment, the dampers extend from an inner circumferential lining of the sheath and project inwardly in a lumen of the sheath so as to contact a medical device received in or passed through the lumen of the sheath. The dampers are made of a friction inducing material, for example, rubber-based materials, and configured as fingers, bumps or flaps that are unidirectional by means of an asymmetrical shape relative to a longitudinal axis of the sheath so that the medical device encounters less frictional impedance when being advanced distally relative to the sheath and more frictional impedance with being withdrawn proximally relative to the sheath.
FIG. 1 is a perspective view of a catheter sheath introducer of the present invention in accordance with one embodiment.
FIG. 2 is an elevational view, with portions broken away, of the catheter sheath introducer of FIG. 1.
FIG. 3 is an enlarged side cross-sectional view of dampers within a sheath of FIG. 2.
FIG. 3A is an end cross-sectional view of the dampers of FIG. 3, taken along line A-A.
FIG. 4 is an enlarged side cross-sectional view of the dampers of FIG. 2, engaged with a medical device being advanced distally through the sheath.
FIG. 4A is an end cross-sectional view of the dampers and medical device of FIG. 4, taken along line A-A.
FIG. 5 is an enlarged side cross-sectional view of the dampers of FIG. 2 applying a retention force on the medical device.
FIG. 5A is an end cross-sectional view of the dampers and medical device of FIG. 5, taken along line A-A.
FIG. 6 is an enlarged side cross-sectional view of dampers in accordance with another embodiment, engaged with a medical device being advanced distally through a sheath.
FIG. 6A is an end cross-sectional view of the dampers and medical device of FIG. 6, taken along line A-A.
FIG. 7 is an enlarged side cross-sectional view of the dampers of FIG. 6, engaged with a medical device being advanced distally through the sheath.
FIG. 7A is an end cross-sectional view of the dampers and medical device of FIG. 7, taken along line A-A.
FIG. 8 is an enlarged side cross-sectional view of the dampers of FIG. 6 applying a retention force on the medical device.
FIG. 8A is an end cross-sectional view of the dampers and medical device of FIG. 8, taken along line A-A.
FIG. 9 is an enlarged side cross-sectional view of dampers in accordance with yet another embodiment, engaged with a medical device being advanced distally through a sheath.
FIG. 9A is an end cross-sectional view of the dampers and medical device of FIG. 9, taken along line A-A.
FIG. 10 is an enlarged side cross-sectional view of the dampers of FIG. 9, engaged with a medical device being advanced distally through the sheath.
FIG. 10A is an end cross-sectional view of the dampers and medical device of FIG. 10, taken along line A-A.
FIG. 11 is an enlarged side cross-sectional view of the dampers of FIG. 9 applying a retention force on the medical device.
FIG. 11A is an end cross-sectional view of the dampers and medical device of FIG. 11, taken along line A-A.
Referring to the drawings, FIGS. 1 and 2 show a catheter sheath introducer 10 having a tubular sheath 12 and a hub 14. The sheath 12 has a distal end 12D and a proximal end 12P, and the hub 14 is attached to the proximal end 12D. The catheter sheath introducer 10 also includes a hemostasis valve 16 to provide sealing of the sheath around a medical device 18, e.g., a dilator unit. A branch conduit 20 and a locking sleeve 21 off of hub 14 are provided to allow for, among other things, connections to saline solution or medicines and access to other medical procedures. An end cap 24 is provided at the proximal end of hub 14. A guide wire 22 is also shown as it is often used with such devices as balloon angioplasty catheters.
FIG. 2 shows the catheter sheath introducer 10 cut away to expose some of the internal structure. The sheath 12 is joined to the internal body of hub 14. The sheath 12 is a tubular structure with at least one layer 26 providing an inner circumferential surface or lining 28 surrounding a lumen 30. The layer 26 be constructed of any suitable material that is sufficiently pliant, elastic, flexible and friction-inducing with medical devices extending through the sheath 12. Suitable materials include rubber-based materials, e.g., silicon rubber, or a thermoplastic elastomer, or extrudable tacky plastic, e.g., polyethylene, polypropylene.
In accordance with a feature of the present invention, one or more dampers 32 are formed on in inner surface 28 of the sheath 12. The dampers 32 include raised formations that project inwardly from into lumen 30 to at least partially occlude the lumen 30. In the embodiment of FIGS. 2, 3 and 3A, the dampers 32 are configured like "fingers", each with a base 34, two generally parallel side edges 36 and an unattached outer edge 38. In the illustrated embodiment, the dampers 32 are arranged in diametrical pairs that oppose each other in the lumen 30 and equally spaced from each other around the circumference and each damper has a generally uniform thickness. When the lumen 30 is empty, each pair of dampers 32 are in their neutral configuration with the outer edges 38 of one or more pairs of dampers being in contact with each other, although it is understood that equal spacing and contact are not necessary in every embodiment of the present invention. In the neutral configuration, the dampers 32 point toward the distal end 12D of the sheath where each side edge 36 defines an inner angle θ ranging between about 0 and less than 90 degrees, preferably between about 20 and 60 degrees and more preferably about 45 degrees, relative to the inner surface 28 of the sheath 12. Each damper 32 has a length such that at least a distal portion of each damper is distal of the base 34 of the respective damper. The plurality of dampers may vary as needed or desired. In one embodiment, the plurality ranges between about two and six, and more preferably about three or four.
When a user advances a medical device 18 through the lumen (FIGS. 4 and 4A), the medical device comes into contact with one or more dampers 32. Angled distally, the dampers deform, e.g., elongating and/or becoming further distally angled, under the advancing force of the device 18 and allow further distal advancement of the device 18 through the lumen 30.
When the medical device 18 is released by the user, elasticity of the dampers 32 aided by their friction-inducing property causes the dampers to at least initially shorten and thicken before stabilizing in a compressed state thereby providing a retention force acting on the device 18 to hold it in place. The retention force prevents slippage of the medical device in terms of rotational and/or longitudinal movement that may be caused by other forces acting on the device, including the body's circulatory system and/or deformation/elasticity of the device itself due to kinks or bends along its length. The retention force is sufficient to hold the device 18 in place but a relatively low static coefficient of friction provided by the dampers against the device 18 allows the device to be withdrawn proximally when actively pulled by the user. The unidirectional geometry of the dampers 32 by means of their shape and configuration allows the sheath introducer 10 to provide "hands-free" utility so that the user need not maintain a hand on the device at all times while the device is inside the sheath introducer.
In an alternate embodiment as illustrated in FIGS. 6 and 6A, the dampers 32 are configured as "bumps" with greater radial and circumferential thicknesses compared to the above-described "finger" dampers. The thickness may be uniform and/or nonuniform in the radial and/or circumferential direction. In the illustrated embodiment, the thickness in the radial direction is tapered, that is, thicker at the base 34 and thinner at an outer edge 38. Compared to the "finger" dampers, the "bump" dampers may have a more curved profile. However, the bump dampers are also unidirectional in that the curved profile is angled distally, where the outer edge has a more linear proximal portion 38P and a more curved distal portion 38D.
In another alternate embodiment as illustrated in FIGS. 7 and 7A, the dampers 32 are configured as "flaps" with a lesser radial thickness but a thicker base 34. The dampers are also unidirectional and thus are angled toward the distal end 12D of the sheath. Both side edges 36 form an angle θ, as defined above.
The preceding description has been presented with reference to presently preferred embodiments of the invention. Workers skilled in the art and technology to which this invention pertains will appreciate that alterations and changes in the described structure may be practiced without meaningfully departing from the principal, spirit and scope of this invention. As understood by one of ordinary skill in the art, the drawings are not necessarily to scale. Some features are exaggerated for purposes of discussion. Accordingly, the foregoing description should not be read as pertaining only to the precise structures described and illustrated in the accompanying drawings, but rather should be read consistent with and as support to the following claims which are to have their fullest and fair scope.
wherein the plurality of damper sets is configured to contact and apply a retention force on the medical device received in the lumen of the elongated sheath, the retention force being applied to hold the medical device in a selected position relative to the sheath and to resist unintentional rotational and longitudinal movement from the selected position, the circumferentially aligned dampers being configured to deform upon contacting the medical device, and the circumferentially aligned dampers defining an open passage when the circumferentially aligned dampers are in the neutral position.
2. The catheter sheath introducer of claim 1, wherein the circumferentially aligned dampers are constructed of a rubber-based material.
3. The catheter sheath introducer of claim 2, wherein the circumferentially aligned dampers are formed from the at least one layer of the tubular structure.
4. The catheter sheath introducer of claim 1, wherein the circumferentially aligned dampers are angled distally.
5. The catheter sheath introducer of claim 1, wherein the circumferentially aligned dampers are configured as fingers.
6. The catheter sheath introducer of claim 1, wherein the circumferentially aligned dampers are configured as bumps.
7. The catheter sheath introducer of claim 1, wherein the distal end of at least one of the circumferentially aligned dampers of one of the diametrically opposing pairs is in contact with the distal end of at least one of the circumferentially aligned dampers of another of the diametrically opposing pairs when the circumferentially aligned dampers are in the neutral position.
8. The catheter sheath introducer of claim 1, wherein each circumferentially aligned damper has at least one edge that forms an inner angle with the inner circumferential surface of the elongated sheath toward the distal end of the tubular structure, the inner angle being less than about 90 degrees.
wherein the plurality of damper sets is configured to contact and apply a retention force on the medical device received in the lumen of the elongated sheath, the retention force being applied to hold the medical device in a selected position relative to the sheath and to resist unintentional rotational and longitudinal movement from the selected position, the circumferentially aligned dampers being configured to deform upon contacting the medical and the circumferentially aligned dampers defining an open passage when the circumferentially aligned dampers are in the neutral position.
10. The catheter sheath introducer of claim 9, wherein each circumferentially aligned damper has at least one edge that forms an inner angle with the inner circumferential surface of the elongated sheath toward the distal end of the tubular structure, the inner angle being less than about 90 degrees.
12. The catheter sheath introducer of claim 11, wherein each circumferentially aligned damper has at least one edge that forms an inner angle with the inner circumferential surface of the elongated sheath toward the distal end of the tubular structure, the inner angle being less than about 90 degrees.
English translation of JP Office action dated Sep. 5, 2017, issued in corresponding JP 2014-000790, 6 pages.
English translation of SIPO Search Report dated Aug. 9, 2017, issued in corresponding CN 201410007830.7, 3 pages.
Extended European Search Report, dated Mar. 28, 2014, for Application No. 14150354.0, 8 pages.


text:
Q: Why the C++ standard explicitly says that for built-in assignment operators, no temporaries for left operand are introduced? C++ standard explicitly says that for built-in assignment operators, no temporaries for left operand are introduced. However I do not think it is necessary. Citing from N4296 §13.3.1.2/4:

For the built-in assignment operators, conversions of the left operand
  are restricted as follows:
(4.1) — no temporaries are introduced to hold the left operand, and
(4.2) — no user-defined conversions are applied to the left operand to achieve a type match with the left-most
  parameter of a built-in candidate.

I understand the second rule (see for example https://stackoverflow.com/a/39937432/6209703), but the first seems rendundant to me. All built-in operators are described in §13.6, and there are only three assignment operators (paragraphs 18, 19, 20). Their first argument is always a reference to a non-const type, and such references cannot be bound to temporaries.


text:
class Exchequer::Subscription
  def self.update(id, options)
    new(id).update_card options[:card]
  end

  def initialize(id)
    @chargify = Chargify::Subscription.find id
  end

  def update_card(card)
    if @chargify.update_attributes :credit_card_attributes => card.to_hash
      true
    else
      Exchequer::ErrorMapper.map @chargify, :to => card
      false
    end
  end
end

redpajama_set_name: RedPajamaGithub


Many insurance policy holders operate under the assumption that the coverage they have is sufficient for every possible event. In most cases, however, this is not true. An insurance agent near Boston can set you up with an umbrella policy that provides extra liability when you need it.
Your homeowners or general liability policy has certain limits, and those limits can leave you vulnerable. If, for example, the limit on bodily injury payouts in your homeowners policy is $100,000, and the injured visitor's medical bills exceed that amount, who is going to pay the excess cost? That's where your personal umbrella policy kicks in. It covers what other policies don't so that you aren't stuck with an enormous bill.
You can't be too careful when it comes to protecting yourself, your family and your property. Consider talking to an insurance agent near Boston about adding an umbrella policy to your insurance package.