Drowsy and dangerous? Fatigue in paramedics: an overview

BackgroundFatigue is a complex phenomenon that has effects on physical characteristics, cognition, behaviours, and physical and mental health. Paramedicine crosses the boundaries of many high-risk industries, namely medicine, transport and aviation. The effects of fatigue on paramedics thus need to be explored and considered in order to begin to identify appropriate interventions and management strategies.AimThe aim of this article was to provide an overview of fatigue in paramedics and its potential effects on various areas of paramedic practice and paramedic health, and to outline potential solutions to assess and manage the risk of fatigue in paramedics as suggested by the literature.MethodsWe conducted unstructured, non-systematic searches of the literature in order to inform an overview of the literature. An overview is a summary of the literature that attempts to survey the literature and describe its characteristics. We thematically structured the review under the following headings: defining occupational activity and health status; clinical performance and patient safety; shift length and time at work; effects on paramedic health; effects on driving abilities; fatigue risk management; and, fatigue proofing.DiscussionFatigue should be considered in the context of overall paramedic health status and paramedic occupational activity. The nature of paramedic shift work, and the associated occupational activity place paramedics at increased risk from fatigue. Shift work may also contribute to sleep disorders among paramedics. Fatigue is associated with increased errors and adverse events, increased chronic disease and injury rates, depression and anxiety, and impaired driving ability.ConclusionThe issue of fatigue in paramedicine is complex and has serious consequences for patients and paramedics. Paramedic services and paramedics need to work collaboratively to identify and action appropriate measures to reduce the effects of fatigue on the wellbeing of the workforce and mitigate its effects on clinical performance and safety

Spirit, mind and body: the archaeology of monastic healing

Archaeology and material culture are used in this chapter to consider how monastic experience responded to illness, ageing and disability. The approach taken is influenced by the material study of religion, which interrogates how bodies and things engage to construct the sensory experience of religion, and by practice-based approaches in archaeology, which examine the active role of space and material culture in shaping religious agency and embodiment. The archaeology of monastic healing focuses on the full spectrum of healing technologies, from managing the body in order to prevent illness, through to the treatment of the sick and preparation of the corpse for burial

(Re)Moralizing the suicide debate

Contemporary approaches to the study of suicide tend to examine suicide as a medical or public health problem rather than a moral problem, avoiding the kinds of judgements that have historically characterised discussions of the phenomenon. But morality entails more than judgement about action or behaviour, and our understanding of suicide can be enhanced by attending to its cultural, social, and linguistic connotations. In this work, I offer a theoretical reconstruction of suicide as a form of moral experience that delineates five distinct, yet interrelated domains of understanding – the temporal, the relational, the existential, the ontological, and the linguistic. Attention to each of these domains, I argue, not only enriches our understanding of the moral realm, but provides a heuristic for examining the moral traditions and practices which constitute contemporary understandings of suicide. Keywords: Suicide; philosophy; social values; humanitie

Creating and curating an archive: Bury St Edmunds and its Anglo-Saxon past

This contribution explores the mechanisms by which the Benedictine foundation of Bury St Edmunds sought to legitimise and preserve their spurious pre-Conquest privileges and holdings throughout the Middle Ages. The archive is extraordinary in terms of the large number of surviving registers and cartularies which contain copies of Anglo-Saxon charters, many of which are wholly or partly in Old English. The essay charts the changing use to which these ancient documents were put in response to threats to the foundation's continued enjoyment of its liberties. The focus throughout the essay is to demonstrate how pragmatic considerations at every stage affects the development of the archive and the ways in which these linguistically challenging texts were presented, re-presented, and represented during the Abbey’s history

Effects of brown tide (Aureococcus anophagefferens) on hard clam, Mercenaria mercenaria, larvae and implications for benthic recruitment

Brown tides of Aureococcus anophagefferens occur in shallow mid-Atlantic bays in the USA and attain peak summer densities of ~1000 to 2800 cells \uc2\ub5l\u20131. Blooms coincide with the period of spawning and planktotrophic larval development of the hard clam Mercenaria mercenaria, a commercially important bivalve in the region. This laboratory study investigates the effects of A. anophagefferens (toxic isolate from Provasoli-Guillard Center for Culture of Marine Phytoplankton [CCMP 1708]) on hard clams throughout their larval development as a function of increasing (1) supplement and (2) contributor to total phytoplankton cell volume in the diet. Brown tide consistently inhibited veliger growth rates in a dose-dependent manner, leading to arrested development in the D-stage; yet mortalities varied greatly among larval batches and were attributed to secondary effects of nutritional stress. Growth of larvae exposed for 2 wk to brown tide at 800 cells \uc2\ub5l\u20131 was 89 to 90% less than controls fed Isochrysis galbana (clone T-iso) in both the presence and absence of alternate food. No recovery was observed when larvae were returned to the control diet. However, larvae showed variable intrapopulation susceptibility to brown tide when exposed to a mixed suspension of A. anophagefferens and I. galbana (400 and 50 cells \uc2\ub5l\u20131, respectively). Exposure to low levels of brown tide (50 cells \uc2\ub5l\u20131) resulted in relatively small but significant growth reduction. Larvae had reduced larval clearance rates (ingestion) when exposed to unialgal brown tide, as confirmed by analysis of gut autofluorescence and negative feeding selectivity for A. anophagefferens in a mixed suspension. Therefore, primarily through their inhibitory effects on growth, brown tides at ?200 cells \uc2\ub5l\u20131 are expected to cause metamorphic failure of hard clam larval populations. These will lead to extended larval life in the plankton and increased vulnerability to secondary mortality factors. In turn, hard clam larvae are expected to make a negligible contribution to microzooplankton grazing on brown tide.Peer reviewed: YesNRC publication: Ye

Effects of brown tide (Aureococcus anophagefferens) on hard clam, Mercenaria mercenaria, larvae and implications for benthic recruitment

Brown tides of Aureococcus anophagefferens occur in shallow mid-Atlantic bays in the USA and attain peak summer densities of ~1000 to 2800 cells \uc2\ub5l\u20131. Blooms coincide with the period of spawning and planktotrophic larval development of the hard clam Mercenaria mercenaria, a commercially important bivalve in the region. This laboratory study investigates the effects of A. anophagefferens (toxic isolate from Provasoli-Guillard Center for Culture of Marine Phytoplankton [CCMP 1708]) on hard clams throughout their larval development as a function of increasing (1) supplement and (2) contributor to total phytoplankton cell volume in the diet. Brown tide consistently inhibited veliger growth rates in a dose-dependent manner, leading to arrested development in the D-stage; yet mortalities varied greatly among larval batches and were attributed to secondary effects of nutritional stress. Growth of larvae exposed for 2 wk to brown tide at 800 cells \uc2\ub5l\u20131 was 89 to 90% less than controls fed Isochrysis galbana (clone T-iso) in both the presence and absence of alternate food. No recovery was observed when larvae were returned to the control diet. However, larvae showed variable intrapopulation susceptibility to brown tide when exposed to a mixed suspension of A. anophagefferens and I. galbana (400 and 50 cells \uc2\ub5l\u20131, respectively). Exposure to low levels of brown tide (50 cells \uc2\ub5l\u20131) resulted in relatively small but significant growth reduction. Larvae had reduced larval clearance rates (ingestion) when exposed to unialgal brown tide, as confirmed by analysis of gut autofluorescence and negative feeding selectivity for A. anophagefferens in a mixed suspension. Therefore, primarily through their inhibitory effects on growth, brown tides at ?200 cells \uc2\ub5l\u20131 are expected to cause metamorphic failure of hard clam larval populations. These will lead to extended larval life in the plankton and increased vulnerability to secondary mortality factors. In turn, hard clam larvae are expected to make a negligible contribution to microzooplankton grazing on brown tide.Peer reviewed: YesNRC publication: Ye

Concentration-dependent effects of toxic and non-toxic isolates of the brown tide alga Aureococcus anophagefferens on growth of juvenile bivalves

Suspension-feeding bivalve mollusks are highly susceptible to the deleterious effects of blooms of the picoplankter Aureococcus anophagefferens (brown tide) in coastal bays of the mid- Atlantic USA. Although short-term exposure to A. anophagefferens is known to cause feeding inhibition of bivalves, longer-term effects on growth and survival are poorly documented. This laboratory study examines the concentration-dependent effects of 2 Long Island, New York, isolates of A. anophagefferens on the juvenile hard clam Mercenaria mercenaria and the mussel Mytilus edulis. Concentrations =400 \uc3\u2014 103 cells ml\u20131 of a toxic A. anophagefferens isolate (CCMP 1708) arrested shell growth and caused significant soft-tissue weight loss and reduced condition in both species, effects comparable to those of starvation, but did not induce mortalities over the 3 wk study period. No histopathology was detected at the cellular level; brown tide caused reduction in digestive epithelium height and overall appearance of absorptive cells similar to that observed under starvation. Optimum concentrations of non-toxic, nutritious algae in a mixed assemblage with A. anophagefferens CCMP 1708 did not mitigate effects of brown tide at 400 \uc3\u2014 103 cells ml\u20131, but at 80 \uc3\u2014 103 A. anophagefferens cells ml\u20131 the mixture resulted in positive growth and progressive acclimation to the diet. In contrast, exposure of hard clams to 400 \uc3\u2014 103 and 1 \uc3\u2014 106 cells ml\u20131 of a non-toxic A. anophagefferens strain (CCMP 1784) supported growth rates only 18 and 29% below a volume-equivalent control diet of Isochrysis galbana respectively. We thus conclusively demonstrate that the detrimental effects of brown tide on bivalve growth are mainly attributable to cell toxicity, rather than high cell density, nutritional deficiency or poor retention of small (2 \uc2\ub5m) cells. The implications of these results to recruitment success and stock-enhancement efforts of bivalve populations in brown tide-affected estuaries are discussed.Peer reviewed: YesNRC publication: Ye