A break from pain! Interruption management in the context of pain

Activity interruptions, namely temporary suspensions of an ongoing task with the intention to resume it later, are common in pain. First, pain is a threat signal that urges us to interrupt ongoing activities in order to manage the pain and its cause. Second, activity interruptions are used in chronic pain management. However, activity interruptions by pain may carry costs for activity performance. These costs have recently started to be systematically investigated. We review the evidence on the consequences of activity interruptions by pain for the performance of the interrupted activity. Further, inspired by literature on interruptions from other research fields, we suggest ways to improve interruption management in the field of pain, and provide a future research agenda

Evaluating Usage, Preferences, and Perceived Restorative Qualities of Staff Break Areas in Healthcare Facilities

Nurses are extremely important to the healthcare industry, and maintaining the quality of nursing care is one of the central concerns of today’s healthcare managers. Unfortunately, the nursing profession in the U.S. is on the precipice of a crisis. Healthcare facilities are suffering from high rates of staff burnout and turnover, and interest in the profession among younger students is on the decline. Healthcare leaders are concerned for improving nurses’ satisfaction, performance, and job retention, but they often overlook the importance of respite for nurses, and underestimate the value of well-furnished staff break areas. A healthy break area can improve nurses’ mood, attitude, and alertness, factors that have been associated with a higher quality of patient care and better facility outcomes. In this study, the researcher gathered empirical evidence regarding nurses’ desires and responses to different environmental features of staff break areas. The design interventions that were tested included (a) the proximity of break areas to work areas, (b) levels of socializing vs. privacy, (c) visual and physical access to the outdoors, (d) the presence of artworks, plants, and natural light, and (e) amenities for indoor and outdoor break spaces. These break-room features were examined in regard to their perceived restorative qualities and their potential to affect staff usage and satisfaction. A multi-method approach was used in the research, employing both qualitative explorations (focused interviews and narrative survey questions) and quantitative measurements (discrete survey questions and a visual ranking of break-room spaces). Important findings include the result that staff break areas are more likely to be used if they are in close proximity to nurses’ work areas, that these spaces need complete privacy from patients and families, and that it is most effective to provide a mixture of opportunities for individual privacy and socialization with co-workers. Having physical access to private outdoor spaces (e.g., balconies or porches) was shown to have a significantly greater restorative effect in comparison with window views, artwork, or indoor plants. The study outcomes were incorporated into a set of design and policy suggestions to encourage effective improvements in the quality of nurses’ rest breaks

Multi-centre parallel arm randomised controlled trial to assess the effectiveness and cost-effectiveness of a group-based cognitive behavioural approach to managing fatigue in people with multiple sclerosis

Abstract (provisional) Background Fatigue is one of the most commonly reported and debilitating symptoms of multiple sclerosis (MS); approximately two-thirds of people with MS consider it to be one of their three most troubling symptoms. It may limit or prevent participation in everyday activities, work, leisure, and social pursuits, reduce psychological well-being and is one of the key precipitants of early retirement. Energy effectiveness approaches have been shown to be effective in reducing MS-fatigue, increasing self-efficacy and improving quality of life. Cognitive behavioural approaches have been found to be effective for managing fatigue in other conditions, such as chronic fatigue syndrome, and more recently, in MS. The aim of this pragmatic trial is to evaluate the clinical and cost-effectiveness of a recently developed group-based fatigue management intervention (that blends cognitive behavioural and energy effectiveness approaches) compared with current local practice. Methods This is a multi-centre parallel arm block-randomised controlled trial (RCT) of a six session group-based fatigue management intervention, delivered by health professionals, compared with current local practice. 180 consenting adults with a confirmed diagnosis of MS and significant fatigue levels, recruited via secondary/primary care or newsletters/websites, will be randomised to receive the fatigue management intervention or current local practice. An economic evaluation will be undertaken alongside the trial. Primary outcomes are fatigue severity, self-efficacy and disease-specific quality of life. Secondary outcomes include fatigue impact, general quality of life, mood, activity patterns, and cost-effectiveness. Outcomes in those receiving the fatigue management intervention will be measured 1 week prior to, and 1, 4, and 12 months after the intervention (and at equivalent times in those receiving current local practice). A qualitative component will examine what aspects of the fatigue management intervention participants found helpful/unhelpful and barriers to change. Discussion This trial is the fourth stage of a research programme that has followed the Medical Research Council guidance for developing and evaluating complex interventions. What makes the intervention unique is that it blends cognitive behavioural and energy effectiveness approaches. A potential strength of the intervention is that it could be integrated into existing service delivery models as it has been designed to be delivered by staff already working with people with MS. Service users will be involved throughout this research. Trial registration: Current Controlled Trials ISRCTN7651747

Effects of driver work-rest patterns, lifestyle and payment incentives on long-haul truck driver sleepiness

The aim of the study is to identify and model the role of payment incentives, driver work-rest patterns and other lifestyle habits influencing the drowsy driving behavior among long-haul truck drivers. To achieve this aim, this study targeted two main objectives: (1) to examine the significant differences between the groups of drowsy and non-drowsy drivers based on the opportunities of monetary incentives and (2) to examine the role of different factors: driver demographics, work-rest patterns, lifestyle and occupational characteristics particularly incentives associated with driving in causing driver sleepiness among Indian truck drivers. The study is based on interview responses from 453 long-haul truck drivers approached in three Indian cities- Mumbai, Indore and Nagpur. Initial principal component analysis of the responses related to financial incentives (occupational characteristics) resulted into two correlated factors: (i) willingness to earn extra payments if offered (WEP) and (ii) incentives available in the current driving experience (ICD) that influence driver work-rest patterns and alertness while driving. Kruskal-Wallis test showed a significant difference among the groups of sleepy and non-sleepy drivers due to these factors (WEP and ICD). Finally, a logistic regression model showed that long driving duration, working days per week, rest patterns, insufficient sleeping hours and history of violations were found significantly associated with drowsy driving among the long-haul truck drivers. Increase in consumption of caffeine and tobacco indicated reduction in driver alertness. According to the model results, the odds of drowsy driving were 77% less for drivers between 46-55 years compared to the young drivers (<25 years). Driving under the influence of financial incentives was observed to increase the odds of falling asleep by 1.58 times among the truck drivers. This was apparently the most interesting and intriguing result of the study indicating the need for further research on the influence of financial or socio-economic motivations to sleepiness

Rest breaks from work : overview of regulations, research and practice

This report addresses the rarely discussed issue of rest breaks at work across the European Union. Based on input from the Network of Eurofound Correspondents, it reveals some of the complexities involved in defining whether such breaks should be paid or unpaid, how long they should be and where they should be taken

Usability of Upper Limb Electromyogram Features as Muscle Fatigue Indicators for Better Adaptation of Human-Robot Interactions

Human-robot interaction (HRI) is the process of humans and robots working together to accomplish a goal with the objective of making the interaction beneficial to humans. Closed loop control and adaptability to individuals are some of the important acceptance criteria for human-robot interaction systems. While designing an HRI interaction scheme, it is important to understand the users of the system and evaluate the capabilities of humans and robots. An acceptable HRI solution is expected to be adaptable by detecting and responding to the changes in the environment and its users. Hence, an adaptive robotic interaction will require a better sensing of the human performance parameters. Human performance is influenced by the state of muscular and mental fatigue during active interactions. Researchers in the field of human-robot interaction have been trying to improve the adaptability of the environment according to the physical state of the human participants. Existing human-robot interactions and robot assisted trainings are designed without sufficiently considering the implications of fatigue to the users. Given this, identifying if better outcome can be achieved during a robot-assisted training by adapting to individual muscular status, i.e. with respect to fatigue, is a novel area of research. This has potential applications in scenarios such as rehabilitation robotics. Since robots have the potential to deliver a large number of repetitions, they can be used for training stroke patients to improve their muscular disabilities through repetitive training exercises. The objective of this research is to explore a solution for a longer and less fatiguing robot-assisted interaction, which can adapt based on the muscular state of participants using fatigue indicators derived from electromyogram (EMG) measurements. In the initial part of this research, fatigue indicators from upper limb muscles of healthy participants were identified by analysing the electromyogram signals from the muscles as well as the kinematic data collected by the robot. The tasks were defined to have point-to-point upper limb movements, which involved dynamic muscle contractions, while interacting with the HapticMaster robot. The study revealed quantitatively, which muscles were involved in the exercise and which muscles were more fatigued. The results also indicated the potential of EMG and kinematic parameters to be used as fatigue indicators. A correlation analysis between EMG features and kinematic parameters revealed that the correlation coefficient was impacted by muscle fatigue. As an extension of this study, the EMG collected at the beginning of the task was also used to predict the type of point-to-point movements using a supervised machine learning algorithm based on Support Vector Machines. The results showed that the movement intention could be detected with a reasonably good accuracy within the initial milliseconds of the task. The final part of the research implemented a fatigue-adaptive algorithm based on the identified EMG features. An experiment was conducted with thirty healthy participants to test the effectiveness of this adaptive algorithm. The participants interacted with the HapticMaster robot following a progressive muscle strength training protocol similar to a standard sports science protocol for muscle strengthening. The robotic assistance was altered according to the muscular state of participants, and, thus, offering varying difficulty levels based on the states of fatigue or relaxation, while performing the tasks. The results showed that the fatigue-based robotic adaptation has resulted in a prolonged training interaction, that involved many repetitions of the task. This study showed that using fatigue indicators, it is possible to alter the level of challenge, and thus, increase the interaction time. In summary, the research undertaken during this PhD has successfully enhanced the adaptability of human-robot interaction. Apart from its potential use for muscle strength training in healthy individuals, the work presented in this thesis is applicable in a wide-range of humanmachine interaction research such as rehabilitation robotics. This has a potential application in robot-assisted upper limb rehabilitation training of stroke patients

Exploring the Wandering Mind in ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattention, hyperactivity, and impulsivity. One important candidate factor underlying the inattention deficits is a failure of cognitive control, the voluntary goal-oriented control of behavior. Mind-wandering is an example of cognitive control failure, and is characterized by a decoupling of attention from the present task context toward unrelated concerns. Heightened ADHD symptomatology has been associated with increased mind-wandering, and both increased mind-wandering and increased ADHD symptomatology have been linked to increased errors in which participants fail to inhibit a response. However, these studies have important limitations of generalizability. Furthermore, there is a need to investigate compensatory strategies that may influence performance. This dissertation had two primary objectives: (1) to evaluate the relationship between mind-wandering, response inhibition, and ADHD; (2) to assess a potential compensatory strategy to reduce performance deficits in ADHD. We used modified versions of the continuous performance task (CPT) which requires subjects to respond to the majority of trials (90%) and creates a strong prepotent tendency to respond. For the first aim, we adapted the CPT to include embedded mind-wandering probes to measure mind-wandering and ADHD symptomatology in both non-clinical and clinical samples. Results indicated that inattention is linked to increased task-unrelated thoughts, and that task-unrelated thoughts can negatively influence overall task performance and performance on a trial-by-trial level. Based on research suggesting that rest breaks can ameliorate performance declines attributed to diminished attentional control resources, for the second aim we assessed the utility of breaks for individuals with ADHD. The first experiment allowed participants to choose if and when to take breaks in a standard CPT to evaluate if they were able to monitor their thoughts and/or performance and insert breaks to benefit their performance. The second experiment added experimenter-imposed breaks to test if the initiation of the break was a critical variable. Finally, we tested ADHD participants on and off of stimulant medication in the second experiment to measure the effects of medication on performance. Results indicated that stimulant medication and the incorporation of both types of rest breaks can normalize ADHD behavior to the level of control participants.PHDPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/135880/1/hallruiz_1.pd

Extravehicular activities limitations study. Volume 1: Physiological limitations to extravehicular activity in space

This report contains the results of a comprehensive literature search on physiological aspects of EVA. Specifically, the topics covered are: (1) Oxygen levels; (2) Optimum EVA work; (3) Food and Water; (4) Carbon dioxide levels; (5) Repetitive decompressions; (6) Thermal, and (7) Urine collection. The literature was assessed on each of these topics, followed by statements on conclusions and recommended future research needs

Rest-stops as a planning engineering option to fatigue

Road accidents on the Kenyan roads claim about 3,000 lives annually. It isestimated that the economy further looses approximately Ksh. 14 billion or 5 % of its gross domestic product too on accident related expenses (MoTC, 2004). However, this intractable problem persists amidst efforts to introduce measures including enforcement to use seatbelts and insertion of speed-governors. In an effort to understand some of the underlying causes, this study examined travellers’ perception of fatigue as a  contributor to crashes. Both empirical and exploratory research  methodology was used to capture the opinions of the road users and to get statistical information by carrying out a survey of 715 road- users on  Mombasa Road. The results showed the occurrence of fatigue to be a major cause of 87 %, 83 % and 82 % of the nodding off, exhaustion and yawning experienced respectively by passengers. Similar results were reported for drivers. The effects of fatigue were attributed to poor road conditions by 76 % and long periods of sitting by 64 % of the passengers interviewed. To counter fatigue effects, 72 % and 79 % of the private car and truck drivers respectively stopped to relax at petrol stations. The use of open countryside was cited by 53 % of the passengers interviewed as an alternative place to stop. The results underscore the need to devise effective measures that will relieve fatigue but at the same time be environmentally sound. Indeed well planned rest-stops by location,  proximity to urban centres, at black spots and near scenic viewing points can provide avenues to re-energize and provide an escape from driving under hazardous conditions and also be used as a point to enjoy the special characters of region.Key words: Crash, fatigue, rest-stops, Mombasa Roa