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AEI currently utilizes a RIEGL VZ400 Terrestrial Laser Scanner on various job sites.  This proecss utilizes a high accuracy 3D terrestrial LiDAR unit.  The data collected will be brought into a feature extraction software, TopoDOT.  TopoDOT utilizes a variety of tools to identify adn quickly extrapolate features within pointcloud data.  All features can then be imported into an AutoCAD drawing file.  AEI can provide an accurate 3D pointcloud of terrain plus any existing building or structures.  The pointcloud can also be converted for Building Information Models.

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Allen Engineering is involved with the civil design and surveying for the new park in Palm Bay, Flordia.  This Regional Park will feature 150 full service campsite hookups and is scheduled to break ground in 2018.  We are extremely proud to be involved in this project.

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Allen Engineering is beginning its 21st year associated with the Space Coast Post of the Society of American Military Engineers (SAME).  During our 21 years, we have helped raise over $350,000 in scholarships and endowments.  We are extremely proud to be associated with SAME and its continued commitment to offer opportunities for students pursuing careers in the engineering field.

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Autonomic interventions Know the techniques for use of vagal maneuvers (including indications anxiety symptoms chest pain order buspar 5 mg online, contraindications anxiety head pressure buy cheap buspar 5 mg, risks anxiety natural supplements generic 10mg buspar otc, and limitations) (eg anxiety tattoo discount buspar 5 mg visa, Valsalva, ice to face, carotid sinus massage) Know the effect of vagal maneuvers in treating cardiac arrhythmias C. Temporary pacing Understand the factors associated with temporary pacing (eg, indications, contraindications, risks, and limitations) Understand the basic technical aspects of the different modalities available for temporary pacing D. Cardioversion/defibrillation Understand the factors associated with cardioversion/defibrillation (eg, indications, contraindications, risks, and limitations) Understand the basic technical aspects of cardioversion/defibrillation E. Basis or cause Recognize the association of ectopic atrial tachycardias with surgery for congenital heart disease 3. Management Plan the evaluation and management of a patient with frequent atrial or ventricular ectopy Supraventricular arrhythmias 1. Clinical recognition Recognize the clinical features of sinus tachycardia Differentiate sinus tachycardia by surface electrocardiographic criteria Recognize intracardiac electrophysiologic characteristics of sinus tachycardia 68 b. Basis or cause Understand tachycardia Recognize the association of sinus tachycardia with surgery for congenital heart disease (acute and long-term) c. Management Recognize and medically manage sinus tachycardia in patients of varying ages (eg, fetus, infant, child, adolescent, young adult) Recognize and manage the consequences of long-term sinus tachycardia the mechanisms and natural history of sinus 2. Clinical recognition Recognize the clinical features of ectopic atrial tachycardia Differentiate ectopic atrial tachycardia by surface electrocardiographic criteria Recognize intracardiac electrophysiologic characteristics of ectopic atrial tachycardia b. Basis or cause Understand the mechanisms and natural history of ectopic atrial tachycardia Recognize the association of certain ectopic atrial tachycardias with surgery for congenital heart disease (acute and long-term) c. Management Recognize and medically manage ectopic atrial tachycardia in patients of varying ages (eg, fetus, infant, child, adolescent, young adult) Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for ectopic atrial tachycardia 69 Recognize and manage the consequences of ectopic atrial tachycardia 3. Clinical recognition Recognize the clinical features of multifocal atrial tachycardia Differentiate multifocal atrial tachycardia by surface electrocardiographic criteria Recognize intracardiac electrophysiologic characteristics of multifocal atrial tachycardia b. Basis or cause Understand the mechanisms and natural history of multifocal atrial tachycardia c. Management Recognize and medically manage multifocal atrial tachycardia in patients of varying ages (eg, fetus, infant, child, adolescent, young adult) Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for multifocal atrial tachycardia Recognize and manage the consequences of multifocal atrial tachycardia 4. Clinical recognition Recognize the clinical features of atrial flutter Differentiate atrial flutter by surface electrocardiographic criteria 70 Recognize intracardiac electrophysiologic characteristics of atrial flutter b. Basis or cause Understand the mechanisms and natural history of atrial flutter Recognize the association of atrial flutter with surgery for congenital heart disease (acute and long-term) c. Management Recognize and medically manage atrial flutter in patients of varying ages (eg, fetus, infant, child, adolescent, young adult) Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for atrial flutter Recognize and manage the consequences of atrial flutter 5. Clinical recognition Recognize the clinical features of atrial fibrillation Differentiate atrial fibrillation by surface electrocardiographic criteria Recognize intracardiac electrophysiologic characteristics of atrial fibrillation b. Basis or cause Understand the mechanisms and natural history of atrial fibrillation Recognize the association of atrial fibrillation with surgery for congenital heart disease (acute and long-term) c. Management Recognize and medically manage atrial fibrillation in patients of varying ages (eg, fetus, infant, child, adolescent, young adult) 71 Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for atrial fibrillation Recognize and manage the consequences of atrial fibrillation 6. Clinical recognition Recognize the clinical features of junctional ectopic tachycardia 72 Differentiate junctional ectopic tachycardia by surface electrocardiographic criteria Recognize intracardiac electrophysiologic characteristics of junctional ectopic tachycardia b. Basis or cause Understand the mechanisms and natural history of junctional ectopic tachycardia Recognize the association of junctional ectopic tachycardia with surgery for congenital heart disease (acute and long-term) c. Management Recognize and medically manage junctional ectopic tachycardia in patients of varying ages (eg, fetus, infant, child, adolescent, young adult) Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for the congenital type of junctional ectopic tachycardia Recognize and manage the consequences of tachycardias junctional ectopic 8. Clinical recognition Recognize the clinical features of orthodromic reentry via accessory pathway Differentiate orthodromic reentry via accessory pathway by surface electrocardiographic criteria 73 Recognize intracardiac electrophysiologic characteristics of orthodromic reentry via accessory pathway b. Basis or cause Understand the mechanisms and natural history of orthodromic reentry via accessory pathway c. Management Recognize and medically manage orthodromic reentry via accessory pathway in patients of varying ages (eg, fetus, infant, child, adolescent, young adult) Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for orthodromic reentry via accessory pathway Recognize and manage the consequences of orthodromic reentry via accessory pathway 9. Clinical recognition Recognize the clinical features of the permanent form of junctional reciprocating tachycardia Differentiate the permanent form of junctional reciprocating tachycardia by surface electrocardiographic criteria Recognize intracardiac electrophysiologic characteristics of the permanent form of junctional reciprocating tachycardia b. Basis or cause 74 Understand the mechanisms and natural history of the permanent form of junctional reciprocating tachycardia c. Management Recognize and medically manage the permanent form of junctional reciprocating tachycardia in patients of varying ages (eg, fetus, infant, child, adolescent, young adult) Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for the permanent form of junctional reciprocating tachycardia Recognize and manage the consequences of the permanent form of junctional reciprocating tachycardia 10. Clinical recognition Recognize the clinical features of antidromic reentry via accessory pathway Differentiate antidromic reentry by surface electrocardiographic criteria Recognize intracardiac electrophysiologic characteristics of antidromic reentry b. Basis or cause Understand the mechanisms and natural history of antidromic reentry c. Clinical recognition Recognize clinical features associated with accessory atrioventricular connection or pre-excitation syndromes Recognize associated cardiac defects in a patient with an accessory atrioventricular connection 2. Electrophysiologic diagnosis Recognize characteristics of accessory atrioventricular connections or pre-excitation syndromes based on electrophysiologic studies 4. Basis or cause Know the natural history of accessory atrioventricular connections or pre-excitation syndromes 5. Management Plan the management of patients with accessory atrioventricular connections or pre-excitation syndromes Ventricular arrhythmias 1. Clinical recognition 76 Distinguish the clinical features of benign ventricular ectopy and distinguish from more serious ventricular arrhythmias Know the risk factors, clinical features, and natural history of benign ventricular ectopy associated with a structurally normal heart or congenital heart disease Know the differential diagnosis of benign ventricular ectopy on electrocardiogram Identify the specific electrocardiographic features of diseases associated with benign ventricular ectopy b. Basis or cause Understand the mechanisms and natural history of benign ventricular ectopy c. Management Plan the acute and chronic management of benign ventricular ectopy 2. Clinical recognition Distinguish the clinical features of benign idiopathic outflow tract ventricular ectopy Know the risk factors, clinical features, and natural history of lifethreatening benign idiopathic outflow tract ventricular ectopy associated with a structurally normal heart or congenital heart disease Know the differential diagnosis of idiopathic outflow tract ventricular ectopy on electrocardiogram 77 b.

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First Presbyterian Church - Gridley Food Closet 846-5952 446 Kentucky anxiety symptoms jaw 5mg buspar visa, Gridley Food distribution weekly on Thursdays from 10am-12noon for Gridley/ Biggs residents in need anxiety xyrem discount 10mg buspar with visa. Calfresh (Food Stamps) Emergency Social Services/ Basic Needs Berry Creek Rancheria 534-3859 5 Tyme Way anxiety icd 10 purchase buspar 5 mg fast delivery, Oroville For members of the Concow Maidu tribes in Butte and Plumas counties anxiety 30 minute therapy buy generic buspar 10mg online. Butte County Employment & Social Services Eligibility and application: 1-877-410-8803 Or apply online at Help for People 5533-A Skyway, Paradise 872-4357 Emergency groceries, referrals to social service agencies and vouchers for clothes for Paradise area residents and transients. Butte County Dept of Behavioral Health 24 hour crisis line Adult 1-800-334-6622 24 hour crisis line Youth 1-800-371-4373 Crisis intervention services for mental health. Caring Veterans 228-2412 2859 Carlene Pl, Chico Provides food, clothing, basic needs, benefit information and other emergency services for homeless veterans. Hope Center (The) 538-8398 1950 Kitrick Ave, Bldg A, Oroville Free food, clothing, personal grooming supplies, backpacks, and basic needs to the homeless and those in need. Drop-In Resource Center for computers and social services (by appointment) and quiet room with lending library. Sabbath House 899-9343 1297 Park Ave, Chico Located at the Jesus Center, a secured sleeping area for women and children who are homeless or in crisis. House of Hope 345-2640 Housing for women and women and children transitioning out of homelessness. Sacred Heart Parish 846-2140 1560 Hazel St, Gridley Food distribution Tuesday, Wednesday, and Thursday 10-11am for Biggs and Gridley residents. Torres Community Shelter Safely Surrendered Baby (Safe Haven for Abandoned Newborns) 101 Silver Dollar Way, Chico 891-9048 Temporary shelter and support services for the homeless and those in danger of becoming homeless. Enloe Hospital, Chico 332-7300 Oroville Hospital 533-8500 Feather River Hospital, Paradise 877-9361 Biggs Gridley Memorial Hospital 846-5671 Project Cuddle crisis line 888-628-3353 Spanish Crisis Line 888-483-2323 To protect newborns from abandonment, a parent who is unable or unwilling to care for a newborn can legally, confidentially, and anonymously surrender their baby to the Emergency Room at a local hospital within 3 days of birth. Trinity Bible Church 533-6489 3115 Myers St, Oroville Free lunch on Tu&W 10am-11:30am. Youth for Change Oroville Rescue Mission Salvation Army 533-9120 4250 Lincoln Blvd, Oroville Overnight beds, showers, breakfast/lunch/dinner, food boxes for families with children, Bible classes, church service. Seventh Day Adventist Church Community Services Employment Alliance for Workforce Development One Stop Employment Centers New Life Church (The) 534-6816 10th and Grand, Thermalito Food distributed 2nd Thursday each month, 1011:30am for Thermalito residents. Orchard Church- Church On the Street Serving a free meal and 342-7692 offering support to those in need on Sunday evenings, 6pm, at Chico downtown City Plaza. Chico 345-7777 or 342-7777 Paradise 872-9548 or 877-4454 Magalia 873-2513 or 873-0687 Oroville 533-4461 Yankee Hill clothing only: 533-3594 Provides emergency basic needs for those experiencing hardships. Shalom Free Clinic Pacific Gas and Electric Company Emergency/Customer Help 1-800-743-5000 Programs to assist in bill payment for lowmoderate incomes as well as assistance for gas leaks/hazards. Villa Ave, Palermo Food distributed 3rd Thursday each month, 9-10am for Palermo residents. Health Clinic & Meals - Free food buffet offered each Sunday 1-4pm during health clinic hours. Services offered for those unsure of their employment goals, looking to update their job skills, find a first job, or seek retraining after a business closure or lay off. Butte-Glenn Community College 3536 Butte Campus Dr, Oroville 895-2511 2320 Forest Ave, Chico 895-1352 Career & Employment Services 895-2340 Career planning and counseling, assistance for student Cal-Works recipients, vocational assessments and career exploration tools. Job Placement 895-2334 Job placement services, job development, job postings, and resume critiques. Butte County Dept of Employment and Social Services 1-877-410-8803 78 Table Mountain Blvd, Oroville 538-7301 2445 Carmichael Dr, Chico 895-4364 CalWorks Welfare to Work program; job search & employment-related services. Job listings, job placement assistance, higher education plans, vocational education, on the job training; support for child care, transportation, medical care. Rape Crisis Intervention and Prevention Crisis Line 342-7273 2889 Cohasset #2, Chico 891-1331 Emergency help for sexual assault, ongoing nocost counseling, support groups, and referral to other services. Thomas More Church 877-4501 767 Elliott Rd, Paradise Food distribution Fridays 10:30am-12pm. State Disability Insurance 645 Salem St, Chico 800-480-3287 Spanish 866-658-8846 Wage benefits for eligible workers who are unable to work due to an illness or injury, or a medically disabling condition from pregnancy or childbirth. American Heart Association 2007 O Street, Sacramento 916-446-6505 Education on prevention and risk factors of heart disease and stroke; general info on types of heart attacks and stroke. File unpaid wages or minimum wage claim, working conditions complaint, discrimination claim. Chico Oroville 2445 Carmichael D, Chico 895-4672 2348 Baldwin, Oroville 538-2289 Employment services and training for unemployed seniors (55+) with little/no income. Career workshops, job fairs, job preparation, job search assistance, and work experience. Job Corps Center 916-394-0770 3100 Meadowview Rd, Sacramento Job skills and employment training program for young adults. Biggs-Gridley Memorial Hospital 240 Spruce, Gridley 846-5671 24-hour health care facility, including emergency room, family care center, lab services, physical therapy, acute care. American Cancer Society Chico Branch 1165 East Ave #100, Chico 342-4567 Oroville Branch 533-7746 24 hour help line 1-800-227-2345 Information about cancer and its treatment; referral; support group; transportation to medical appointments; help with grooming. Also a scholarship program for cancer patients who are college-bound or college-enrolled cancer survivors. Birthright Oroville Adult Education ­ Career and Technical Center 2750 Mitchell Ave. Brain Injury Coalition 342-3118 441 Main St #10, Old Municipal Building, Chico Resource information, referrals, and support groups for individuals recovering from brain injuries, disease, or debilitation. Caring for Women Pregnancy Resource Center Hot Line 532-9362 2362 Lincoln St, Oroville 533-8388 Free confidential services. Pregnancy test, information, help with maternity and baby clothes, referrals to local agencies.

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Separate senses with their own receptor organs anxiety symptoms with menopause purchase buspar 5 mg on line, taste and smell are nonetheless intimately entwined anxiety nightmares generic buspar 5mg. As anyone with a head cold Society for NeuroScieNce sensing anxiety 5-htp cheap buspar 5mg with amex, thinking anxiety disorder order 5mg buspar, and behaving BraiN factS 21 and on to a specific area of the cerebral cortex, which makes us conscious of the perception of taste. Airborne odor molecules, called odorants, are detected by specialized sensory neurons located in a small patch of mucus membrane lining the roof of the nose. Axons of these sensory cells pass through perforations in the overlying bone and enter two elongated olfactory bulbs lying against the underside of the frontal lobe of the brain. Odorants stimulate receptor proteins found on hairlike cilia at the tips of the sensory cells, a process that initiates a neural response. Similarly, a single receptor interacts with more than one different odorant, though also to varying degrees. Therefore, each odorant has its own pattern of activity, which is set up in the sensory Taste and smell are separate senses with their own receptor organs, yet they are intimately entwined. This pattern of activity is then Tastants, chemicals in foods, are detected by taste buds, which consist of special sensory cells. When stimulated, these cells send signals to specific areas of the brain, which make us conscious of the sent to the olfactory bulb, where other perception of taste. Similarly, specialized cells in the nose pick up odorants, airborne odor molecules. Actually, what is really being affected is the flavor of information then passes to adjacent parts of the orbital cortex, the food, or the combination of taste and smell. Touch and Pain However, interactions between the senses of taste and smell Touch is the sense by which we determine the enhance our perceptions of the foods we eat. We do this Tastants, chemicals in foods, are detected by taste buds, through touch receptors in the skin. In hairy skin areas, some special structures embedded within small protuberances on the receptors consist of webs of sensory nerve cell endings wrapped tongue called papillae. When the sensory cells are stimulated, the spinal cord, where they synapse, or make contact with, they cause signals to be transferred to the ends of nerve fibers, other nerve cells, which in turn send the information to which send impulses along cranial nerves to taste regions in the the thalamus and sensory cortex. From here, the impulses are relayed to the thalamus information is highly topographic, meaning that the body 22 BraiN factS sensing, thinking, and behaving Society for NeuroScieNce Pain messages are picked up by receptors and transmitted to the spinal cord via small myelinated fibers and very small unmyelinated fibers. From the spinal cord, the impulses are carried to the brainstem, thalamus, and cerebral cortex and ultimately perceived as pain. These messages can be suppressed by a system of neurons that originates in the midbrain. This descending pathway sends messages to the spinal cord where it suppresses the transmission of tissue damage signals to the higher brain centers. Society for NeuroScieNce sensing, thinking, and behaving BraiN factS 23 is represented in an orderly fashion at different levels of the nervous system. Larger areas of the cortex are devoted to sensations from the hands and lips; much smaller cortical regions represent less sensitive parts of the body. Different parts of the body vary in their sensitivity to tactile and painful stimuli. These varying responses are based largely on the number and distribution of receptors. For example, the cornea is several hundred times more sensitive to painful stimuli than are the soles of the feet. Not surprisingly, acuity is greatest in the most densely nerve-packed areas of the body. The sensory fibers that respond to stimuli that damage tissue and can cause pain are called nociceptors. Different nociceptor subsets produce molecules that are responsible for the response to noxious. Interestingly, these same molecules respond to plant-derived chemicals, such as capsaicin, garlic, and wasabi, that can produce pain. Histamine is an example of such a nociceptor, and it can be released in response to certain bug bites or allergies. Tissue injury also causes the release of numerous chemicals at the site of damage and inflammation. Prostaglandins enhance the sensitivity of receptors to tissue damage and ultimately can induce more intense pain sensations. Prostaglandins also contribute to the clinical condition of allodynia, in which innocuous stimuli can produce pain, as when sunburned skin is touched. Persistent injury can lead to changes in the nervous system that amplify and prolong the "pain" signal. The result is a state of hypersensitivity in which pain persists and can even be evoked by normally innocuous stimuli. Persistent pain is in many respects a disease of the nervous system, not merely a symptom of some other disease process. Sending and Receiving Pain and Itch Messages Pain and itch messages are transmitted to the spinal cord via small, myelinated fibers and C fibers, very small, unmyelinated fibers. The myelinated nerve fibers are very painsensitive, and they probably evoke the sharp, fast pain that is produced by, for example, a pinprick. C fiber-induced pain, by contrast, is generally slower in onset, dull, and more diffuse. In the ascending system, impulses are relayed from the spinal cord to several brain structures, including the thalamus and cerebral cortex. These structures are involved in the process by which pain or itch messages become a conscious experience. The experience of pain or itch is not just a function of the magnitude of the injury or even the intensity of the impulse activity generated.

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Dishonest completion may be an issue anxiety symptoms questionnaire discount buspar 5mg mastercard, so review of the responses with the worker is desirable anxiety jokes buy 10 mg buspar fast delivery, as is consideration of the overall clinical picture anxiety gas buspar 5mg with mastercard. Scoring the K10 and managing Safety Critical Workers As previously indicated anxiety symptoms flushing discount buspar 10mg fast delivery, a total score of 50 is possible. Higher scores indicate a greater likelihood of mental disorder and a need for more intensive treatment. Examining health professionals should also consider supporting information such as accident/incident history and sick leave, as well as the clinical examination when selecting the appropriate intervention. They should be assessed as Temporarily Unfit for Duty pending further assessment, and referred to their general practitioner in the first instance. Again, the examining health professional should explore possible reasons and consider the supporting information and clinical picture. Alternatively, the examining health professional may classify the worker as Temporarily Unfit for Duty if there are immediate concerns for safe working. Table 17: K10 risk levels and interventions Risk levels K10 score Intervention No formal intervention. General advice about the importance of mental health for Safety Critical Work, and alert to further information and resources. Brief counselling and reference to self-help materials and support services as applicable to the situation. Review period may be in line with normal periodic review periods, or more frequently if the situation warrants it. May be assessed as Fit for Duty Subject to Review or Temporarily Unfit for Duty, depending on the situation. Should be assessed as Temporarily Unfit for Duty while being evaluated and while treatment is initiated. Scope and interfaces this chapter focuses on sleep disorders, particularly sleep apnoea, as they present a significant risk to safety through increased sleepiness. It is acknowledged that many chronic illnesses can cause fatigue, which may or may not be associated with increased sleepiness. A Safety Critical Worker may therefore be referred for a health assessment (triggered assessment) with symptoms of fatigue in association with poor work performance or incidents. Such workers should be assessed, classified appropriately with regard to fitness for duty as per this standard, and referred to their general practitioner as required. Relevance to Safety Critical Work Effects of sleep disorders on Safety Critical Work A number of sleep disorders may cause excessive daytime sleepiness, which manifests itself as a tendency to doze at inappropriate times when intending to stay awake, and which has obvious implications for rail safety. Relevant disorders include: sleep apnoea (obstructive sleep apnoea, central sleep apnoea and nocturnal hypoventilation); periodic limb movement disorder; circadian rhythm sleep wake disorders. Such disorders may affect the ability to perform Safety Critical Work due to sleepiness and/or due to altered blood gases and hypoxia affecting mental function. These effects are relevant to both Category 1 and Category 2 Safety Critical Workers. Sleep apnoea may also worsen conditions relevant to safety critical work such as hypertension and depression and is associated with type 2 diabetes. Studies have shown an increased rate of motor vehicle accidents of between 2 and 7 times that of control subjects in those with sleep apnoea. Studies have also demonstrated increased objectively measured sleepiness while driving (electroencephalography and eye closure measurements) and impaired driving-simulator performance in sleep apnoea patients. This performance impairment is similar to that seen due to illegal alcohol impairment or sleep deprivation. Drivers with severe sleep disordered breathing may have a much higher rate of accidents than those with a less severe sleep disorder. Those with self-reported episodes of dozing, or frequent sleepiness while driving, are also at a higher crash risk, irrespective of sleep apnoea severity. Patients with narcolepsy present with excessive sleepiness, and can have periods of sleep with little or no warning of sleep onset. Other symptoms include cataplexy, sleep paralysis and vivid hypnagogic hallucinations, which present a significant risk for Safety Critical Work. Those with narcolepsy perform worse than control subjects on simulated driving tasks and are more likely to have (motor vehicle) accidents. General assessment and management guidelines General considerations Sleep apnoea is present on overnight monitoring in 9 per cent of adult women and 24 per cent of adult men. Sleep apnoea syndrome (excessive daytime sleepiness in combination with sleep apnoea on overnight monitoring) is present in 2 per cent of women and 4 per cent of men. Some studies have suggested a higher prevalence in transport vehicle drivers, which may have implications for rail. Obstructive sleep apnoea involves repetitive obstruction to the upper airway during sleep, precipitated by relaxation of the dilator muscles of the pharynx and tongue and/or narrowing of the upper airway, resulting in cessation (apnoea) or reduction (hypopnoea) of breathing. Central sleep apnoea refers to a similar pattern of cyclic apnoea or hypopnoea caused by oscillating instability of respiratory neural drive, and not due to upper airways factors. This condition is less common than obstructive sleep apnoea, and is associated with cardiac or neurological conditions, or may be idiopathic. Increased sleepiness during the daytime may also occur in otherwise normal people and may be due to either: previous sleep deprivation (restricting the time for sleep); or poor sleep hygiene habits; or irregular sleep­wake schedules. These factors may increase the severity of sleep disorders and result in more severe sleepiness in workers with sleep disorders. The approach to the assessment for sleep disorders is summarised in Figure 24 and described below. It involves identifying: whether there is evidence or indicators of excessive daytime sleepiness; whether there is clinical evidence of sleep apnoea (loud snoring, witnessed apnoea events); and whether there are clinical risk factors that warrant further investigation.

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References:

  • https://www.porphyria.com/sites/default/files/2020-06/Acute%20Hepatic%20Porphyria%20%28AHP%29%20Doctor%20Discussion%20Guide.pdf
  • https://dfwhcfoundation.org/wp-content/uploads/2016/06/TQI-Blood-Conservation-Book.pdf
  • http://www.ijcep.com/files/ijcep0001236.pdf