Scientific Approaches to the Study of the "Human Factor" in the Railway Safety Medical System

1. Scientific Approaches to the Study of the "Human Factor" in the Railway Safety Medical System Vice President of JSCo «Russian Railways» Doctor of Medicine, Professor Oleg Atkov CZ-OA@CSS-RZD.RU Moscow,16.10.2012

2. Healthcare Scientific Potential of JSCo «RZD» Non-Governmental Healthcare Institution «Scientific Medical Center of JSCo «RZD» More than245 chairs of Medical Universities and research institutes are functioning on the basis of healthcare facilities of JSCo «RZD» The number of employees of 235 non-governmental healthcare institutions of JSCo «RZD» is 68 thousand persons, including 13 thousand doctors, with more than 800 specialists having an academic degree In order to improve healthcare services provided to employees, the Health Care Advisory Council under the President of JSCo «RZD», consisting of heads of the best medical schools of Russia, successfully functions since 2006

3. Specific Features of the Healthcare System of JSCo «RZD» • The medical component of the Rail Safety Systemincludes medical and psycho-physiological support, rehabilitation after emergency situations on the railway, automated pre-trip medical check-ups, • Comprehensive healthcare solutions include prevention, diagnosis, treatment, rehabilitation, health resort treatment • Scientific developments • New organizational forms of health care include mobile consulting and diagnostic centers • Extensive use of information technologies, including telemedicine • Participation in mitigating health and sanitary consequences of emergencies on the railway

4. Reasons for the Improvement of Health of Transport Workers • The most important task of the medical support in transport is to determine the high-risk group liable to occurrence and development of pathological states, sudden deterioration of health and inadequate response, including detection of fatigue, stress and depression symptoms • Improvement of health of transport workers should ensure the maintenance of mental and physical performance during the work shift, normalization of daily rhythms and sleep disorders, controlled recovery after work shifts, enhancement of stress resistance and tolerance for monotony • Pharmacotherapy is rather specific due to the adverse effect of some drugs on the cognitive function

5. Rail Safety System (GP) About 1500 pre-trip medical check-up rooms are functioning in the healthcare structure of JSCo «RZD». Automated systems (APTMCS) that allow an objective assessment of a worker’s state of health when admitting to a trip have been implemented 5

6. SCIENTIFIC MEDICAL CENTER OF JSCo «RZD» • Main tasks: • Solution of problems of railway medicine (rail safety, • including psychophysiological problems, sudden death, etc.) • and their scientific support • - Enhancement of the effectiveness of diagnosis and treatment • for occupational diseases • - Examination for occupational fitness and occupation-related diseases • Development of measures aimed at reducing the incidence of workers and increasing their • career longevity • - Solution of problems of occupational medicine • - Telemedicine • - Development of principles of safe use of drugs • - Clinical testing of drugs • Interactions with Russian and foreign medical universities • and research institutes • - Clinical work Clinics ofJSCo«RZD» JSCo «RZD»- ZDOROVIE» Medical Universities and Research Institutes 6

7. List of Researches Dedicated to Medical Rail Safety for 2010-2012 • Methods of Psychophysiological Support of Locomotive Crew Workers of JSCo «RZD» • Determination and Assessment of Factors Affecting the Professional Longevity of Locomotive Crew Workers of JSCo «RZD» Development of Prevention Programs... (list of disease risk factors, criteria and programs for their detection) • Development and Justification of Methods for the Calculation of Locomotive Drivers’ Working Time and the Length of Route Depending on Conditions and Type of Train Operation. Development of Methods and Recommendations...(draft guidelines for professional performance improvement, recovery rules) • Influence of Infrasound as a Harmful Occupational Factor on the Health of Locomotive Crew Workers of JSCo «RZD» and Risks for the Development of Occupational Diseases

8. List of Planned Researches Dedicated to Medical Rail Safety for 2013-2014 • Development of Methods and Guidelines for Health Maintenance and High Working Capacity of Railway Employees Working at Night Shifts • Development of Guidelines for Psychological Profiling of Locomotive Crew Workers of JSCo «RZD» • Development of Methods for the Assessment of Influence of Perturbation of the Earth's Magnetic Field on the Cardiovascular System of Railway Workers of JSCo «RZD» in Northern Regions • Development of Guidelines for the Prevention of Fatigue and Maintenance of Job Performance in Locomotive Crew Workers of JSCo «RZD» during Labor Activities

9. SCIENTIFIC MEDICAL CENTER OF JSCo «RZD» New generation simulator “Driver's Cabin of Locomotive EP-1M” 9

10. Possibility to control physiological functions in locomotive drivers Holter monitoring ABP and ECG Pulse oximetry (attached to the ear lobe) EEG recording Electronystamograph EEG ABP, heart rate monitoring and ECG Nystagmogram

11. Telemedicine Technologies in Health Care Delivery, Including in Emergency Situations оn the Railway 2 1 3 4

12. REGULATORY MECHANISMS AND CORRECTION METHODS IN THE CONDITION OF CHANGING CIRCADIAN RHYTHMS IN LOCOMOTIVE CREW WORKERS Purpose of the study: Determination of the specificity of regulatory mechanisms in locomotive crew workers in the condition of changing circadian rhythms Objectives of the study: To identify clinical and neurophysiological features of changes in the functions of the parasympathetic and sympathetic autonomic nervous systems and their regulatory mechanisms associated with altered circadian rhythms due to operational needs To identify the relationship between the vegetative regulatory function and the psycho-emotional state of locomotive crew workers in the condition of changing circadian rhythms To assess the possibility of restoring the functional adaptation mechanisms of the body and methods of their optimization in individuals with altered circadian rhythm of life against low-frequency transcranial magnetic stimulation (TMS) and use of melatonin drugs

13. Early diagnosis of diseases • Possible solutions: • 1. Determination of diagnostically important markers of disease, using an integrated approach that takes into account • - genetic • - traditional clinical and laboratory signs; • 2. Creation of diagnostic and prognostic models based on modern data processing methods: Artificial Neural Networks, Principle Component Analysis (PCA), Support Vector Method (SVM) Accuracy > 90% when genetic and non-genetic traits are included Accuracy< 90% when only non-genetic traits are included A double-layerperceptronwithfourneuronsineachburiedlayer Informativity indexes of prognostic models of coronary atherosclerosis and coronary heart disease

14. CIRCADIAN GENES AND DISEASES RELATED TO PROFESSIONAL LONGEVITY Atherosclerosis Clock rs1801260 Per1 rs2735611 Per2 rs2304672 Bmal1 CRY1 Rev-erb Obesity Diabetes mellitus

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16. Characteristics of the« Arfa» system allow providing a stable level of the magnetic field, which is about 48 µT in the latitude of Moscow ,for a few hours and compensating the geomagnetic field to zero. The Arfa system allows recording the (3) components of the low frequency magnetic field in the working volume of the exposure block in real-time mode. The subject of the study is in the chair inside the exposure block in the screening of the electrostatic and electromagnetic fields up to 1 GHz. The study showed the possibility to measure the impact of hypomagnetic conditions on the performance of the cardiovascular system of examined volunteers. It was possible to estimate individual sensitivity of the subject, as well as indicators liable to the greatest variability in the changing ambient magnetic environment.

17. 24 NON-GOVERNMENTAL HEALTHCARE INSTITUTIONS OF JSCo «RZD» HAVE BEEN ACCREDITED TO CONDACT CLINICAL STADIES • PRINCIPAL ACTIVITIES OF THE SCIENTIFIC CLINICAL CENTER • IN CLINICAL PHARMACOLOGY • Study of adverse effects of pharmacotherapy on professionally relevant functions • of operators for their classification and implementation of common • international standards • Development and introduction of personalized medicine technologies • Coordination of clinical studies conducted by the NGHI of JSCo «RZD» MEDICINAL DRUGS AND RAILROAD TRAFFIC SAFETY MOSCOW - 2011 Saint Petersburg Yaroslavl Ivanovo Nizhny Novgorod Moscow - 5 Voronezh Yekaterinburg Smolensk Samara Chelyabinsk Volgograd Saratov Krasnoyarsk Rostov-on-Don Khabarovsk Kemerovo Novosibirsk Irkutsk Barnaul

18. At present, there is a sign of intensive collaboration in the sphere of railway medicine with the International Union of Railway Medical Services (UIMC), which is a substructure of the International Union of Railways (UIC). The Russian delegation took part in the UIMC Congress (Helsinki, September 2012) and the medical department has become a member of this organization. In addition to the exchange of information on researches, the opportunity to develop common instruments and recommendations based on the railway medical scientific researches in various countries and within international scientific groups may also be very useful.