High-intensity Work Research Articles

Low Back Pain (LBP), work and absenteeism.

Occupational physical demands are commonly assumed the cause of work-related Low Back Pain (LBP) and absenteeism. To analyse relationships between LBP at work, physical demands and absenteeism. Workers filled out a questionnaire on socio-demographic and work-related factors, general health, LBP (number of episodes in a 12-month period, pain severity and intensity), and occupational hazards related with physical demands. 735 workers completed the questionnaire (male n = 359). A high proportion of workers n = 507 (69%), from different occupational backgrounds, reported at least one LBP episode in the previous 12-month period. The highest ratio of subjects with more than 6 episodes of LBP per year was found among public services employees (31.8%) and the lowest ratio among administrative workers (10.3%). The highest ratio of workers (39%) were classified as sedentary workers, 34% of workers having a low or moderate level of physical demands in their work, and 27% reported high levels of physical demands in their work. There was a 4 % absenteeism rate in a 12-month period, which was significantly higher in the group with physically demanding work. Those subjects with higher physical requirements at work have increased odds of having more than 3 episodes of LBP during the previous year (p < 0.05) in comparison with subjects with more sedentary jobs and those with low or moderate physical demands. High intensity work, compared to sedentary work, is associated with an increased probability of being absent of work because of LBP in a previous 12-month period (OR = 3.12; CI 1.23-7.89; p = 0.016). Our findings suggest there is an association between highly physically demanding jobs, LBP and absenteeism. These results may contribute to the improvement of LBP assessment and prevention programs in Occupational Health Services.

A global analysis of heat-related labour productivity losses under climate change\u2014implications for Germany\u2019s foreign trade

We investigate climate change impacts transferred via foreign trade to Germany, a country that is heavily engaged in international trade. Specifically, we look at temperature changes and the associated labour productivity losses at a global scale until 2050. We assess the effects on Germany’s imports and exports by means of a global computable general equilibrium (CGE) model. To address uncertainty, we account for three Shared Socioeconomic Pathways (SSP1, SSP2 and SSP3) and two Representative Concentration Pathways (RCP4.5 and RCP8.5) using projections from five global climate models. We find that average annual labour productivity for high intensity work declines by up to 31% for RCP4.5 (and up to 38% for RCP8.5) in Southeast Asia and the Middle East by 2050, all relative to a 2050 baseline without climate change. As a consequence, for RCP8.5, Germany’s imports from regions outside Europe are lower by up to 2.46%, while imports from within Europe partly compensate this reduction. Also, Germany’s exports to regions outside Europe are lower, but total exports increase by up to 0.16% due to higher exports to EU regions. Germany’s GDP and welfare, however, are negatively affected with a loss of up to − 0.41% and − 0.46%, respectively. The results highlight that overall positive trade effects for Germany constitute a comparative improvement rather than an absolute gain with climate change.

Depression in Physicians: An Overlooked Issue in Mental Health

Depression is a common mental disorder that presents with depressed mood, loss of interest, feelings of guilt or low self-esteem. It affects an estimated one in 15 adults (6.7%) in any given year. One in six people (16.6%) will experience depression at some point in their lifetime. It can strike at any time; but usually it first appears during the late teens to mid-20s. Women usually experience depression more than men. Depression is one of the most common mental health issues among physicians worldwide due to high-intensity training and work overload. Recent systematic reviews and meta-analysis indicated that the prevalence of depression among physicians worldwide was around 28.8% which is quite higher than in the rest of the general population. Depressed physician makes more medical error than others. The burden of depression could lead to a low quality of life, ultimately suicidal attempts. So identifying risk factors for depression must be addressed and solved properly with utmost priority. This article reviews the prevalence of depression in physicians based on recently published literature related to this arena.&#x0D; J Enam Med Col 2020; 10(1): 39-42

Was ist heute noch ein Tagewerk? Hohe Arbeitsintensität und Arbeitsschutz

Da hohe Arbeitsintensität mit Unfallrisiken und gesundheitlichen Beeinträchtigungen der Beschäftigten einhergeht, ist der staatliche Ar­beitsschutz gefordert, sich mit den damit verbundenen Gefährdungen zu befassen. Aufgrund seiner Funktionsweise sind damit jedoch erhebliche Herausforderungen verbunden, denn betriebliche Leistungserwartungen an Beschäftigte auf der Tätigkeitsebene sind facettenreich und ergeben sich aus vielschichtigen betrieblichen Steuerungs- und Arbeitsgestaltungsprozessen. Vor diesem Hintergrund behandelt der Beitrag drei Gründe, die dem staatlichen Arbeitsschutz den Umgang mit Gesundheitsgefährdungen durch hohe Arbeitsintensität erschweren: die Spartenlogik seines gefährdungsbezogenen Ansatzes, seine Bindung an einen definierten Stand der arbeitswissenschaftlichen Forschung sowie den Tätigkeitsbezug und die Maßgabe, allgemeinverbindlich konkrete Schutzmaßnahmen gegen identifizierte Gefährdungen zu definieren. Diese drei institutionellen Gegebenheiten bestimmen – zusammen mit seinen Kontroll- und Sanktionsrechten gegenüber Arbeitsgebern – die Einflussmöglichkeiten des staatlichen Arbeitsschutzes im Bereich hoher Arbeitsintensität.

The role of interval training in the physical rehabilitation of strength sports athletes with hypertension: a randomized controlled study

To evaluate the effect of high-intensity interval aerobic work on blood pressure and body composition in strength sports athletes of heavy weight categories. The examination and physical rehabilitation of 55 strength sports athletes of heavy weight categories with arterial hypertension were performed. Athletes were randomized into two groups: the main group (n=35) and the control group (n=20). The main group athletes trained 120 days (3 times a week) on a bicycle ergometer according to the high-intensity interval protocol, and the control group participants trained 120 days (3 times a week) according to their traditional strenght protocol. All athletes underwent a complex examination, including: a survey, examination, three-time measurement of blood pressure, bioelectrical impedance analysis and calculations of body composition indices, Before and after the physical rehabilitation. After 120 days of physical rehabilitation, there was an improvement in body composition and a significant decrease in blood pressure: systolic blood pressure by 4.7%, diastolic blood pressure by 5.6%. High-intensity aerobic interval work, regardless of the athlete's body composition, has a therapeutic and prophylactic effect on the cardiovascular system. The aerobic workout training protocol taking into account metabolic variables, that we developed, will allow athletes to effectively and safely influence the prevention and treatment of hypertension.

Arbeitsintensität als Gegenstand empirischer Erhebungen. Das Potenzial repräsentativer Erwerbstätigenbefragungen für die Forschung

Bei der Debatte um Arbeitsintensität und Arbeitsintensivierung handelt es sich häufig um eine eher emotionale und sensible Debatte, nicht zuletzt weil sie für betroffene Beschäftigte häufig mit dem Gefühl der Überforderung und des Ungenügens verbunden ist. Auch gibt es vielfältige Hinweise, dass eine langanhaltende hohe Arbeitsintensität eine gesundheitsgefährdende Belastung für Beschäftigte darstellen kann. Vor diesem Hintergrund sind insbesondere wissenschaftliche Studien von hoher Bedeutung, die einen Beitrag zur Versachlichung dieser Debatte leisten können. Aus diesem Grund beschäftigt sich der Beitrag tiefergehend mit der Frage, welche empirische Datengrundlage es gibt, um die Verbreitung und insbesondere die Determinanten von Arbeitsintensität in Deutschland zu beschreiben. Die Autorinnen diskutieren die Verbreitung einer hohen Arbeitsintensität anhand verschiedener Datensätze. Ferner thematisieren sie empirische Lücken, die sich vor dem Hintergrund einer komplexeren Arbeitswelt in aktuell bestehenden Befragungen identifizieren lassen, und zeigen Weiterentwicklungsmöglichkeiten auf.

Tractor Assistant Driving Control Method Based on EEG Combined With RNN-TL Deep Learning Algorithm

Nowadays, fieldwork is often accompanied by tight schedules, which tends to strain the shoulder muscles due to high-intensity work. Moreover, it is difficult and stressful for the disabled to drive agricultural machinery. Besides, current artificial intelligence technology could not fully realize tractor autonomous driving because of a high uncertain filed environment and short interruptions of satellite navigation signal shaded by trees. To reduce manual operations, a tractor assistant driving control method was proposed based on the human-machine interface utilizing the electroencephalographic (EEG) signal. First, the EEG signals of the tractor drivers were collected by a low-cost brain-computer interface (BCI), followed by denoising using a wavelet packet. Then the spectral features of EEG signals were calculated and extracted as the input of Recurrent Neural Network (RNN). Finally, the EEG-aided RNN driving model was trained for tractor driving robot control such as straight going, brake, left turn, and right turn operations, which control accuracy was 94.5% and time cost was 0.61 ms. Also, 8 electrodes were selected by the PCA algorithm for the design of a portable EEG controller. And the control accuracy reached 93.1% with the time cost of 0.48 ms. To solve the incomplete driving data set in the actual world because some driving manners may cause dangerous or even death, RNN-TL algorithm was employed by creating the complete driving data in the virtual environment followed by transferring the driving control experience to the actual world with small actual driving data set in the field, which control accuracy was 93.5% and time consumption was 0.48 ms. The experimental results showed the feasibility of the proposed tractor driving control method based on EEG signal combined with RNN-TL deep learning algorithm which can work with the displacement error less than 6.7 mm when the tractor speed is less than 50 km/h.

The DIRAC interware: current, upcoming and planned capabilities and technologies

Efficient access to distributed computing and storage resources is mandatory for the success of current and future High Energy and Nuclear Physics Experiments. DIRAC is an interware to build and operate distributed computing systems. It provides a development framework and a rich set of services for the Workload, Data and Production Management tasks of large scientific communities. A single DIRAC installation provides a complete solution for the distributed computing of one, or more than one collaboration. The DIRAC Workload Management System (WMS) provides a transparent, uniform interface for managing computing resources. The DIRAC Data Management System (DMS) offers all the necessary tools to ensure data handling operations: it supports transparent access to storage resources based on multiple technologies, and is easily expandable. Distributed Data management can be performed, also using third party services, and operations are resilient with respect to failures. DIRAC is highly customizable and can be easily extended. For these reasons, a vast and heterogeneous set of scientific collaborations have adopted DIRAC as the base for their computing models. Users from different experiments can interact with the system in different ways, depending on their specific tasks, expertise level and previous experience using command line tools, python APIs or Web Portals. The requirements of the diverse DIRAC user communities and hosting infrastructures triggered multiple developments to improve the system usability: examples include the adoption of industry standard authorization and authentication infrastructure solutions, the management of diverse computing resources (cloud, HPC, GPGPU, etc.), the handling of high-intensity work and data flows, but also advanced monitoring and accounting using no-SQL based solutions and message queues. This contribution will highlight DIRAC’s current, upcoming and planned capabilities and technologies.

Influence of Fluid Viscous Damper on the Dynamic Response of Suspension Bridge under Random Traffic Load

Fluid viscous dampers (FVDs) are widely used in long‐span suspension bridges for earthquake resistance. To analyze efficiently the influences of FVDs on the dynamic response of a suspension bridge under high‐intensity traffic flow, a bridge‐vehicle coupling method optimized by isoparametric mapping and improved binary search in this work was first developed and validated. Afterwards, the traffic flow was simulated on the basis of monitored weigh‐in‐motion data. The dynamic responses of bridge were analyzed by the proposed method under different FVD parameters. Results showed that FVDs could positively affect bridge dynamic response under traffic flow. The maximum accumulative longitudinal girder displacement, longitudinal girder displacement, and longitudinal pylon acceleration decreased substantially, whereas the midspan girder bending moment, pylon bending moment, longitudinal pylon displacement, and suspender force were less affected. The control efficiency of maximum longitudinal girder displacement and accumulative girder displacement reached 33.67% and 57.71%, longitudinal pylon acceleration and girder bending moment reached 31.51% and 7.14%, and the pylon longitudinal displacement, pylon bending moment, and suspender force were less than 3%. The increased damping coefficient and decreased velocity exponent can reduce the bridge dynamic response. However, when the velocity exponent was 0.1, an excessive damping coefficient brought little improvement and may lead to high‐intensity work under traffic flow, which will adversely affect component durability. The benefits of low velocity exponent also reduced when the damping coefficient was high enough, so if the velocity exponent has to be increased, the damping coefficient can be enlarged to fit with the velocity exponent. The installation of FVDs influences dynamic responses of bridge structures in daily operations and this issue warrants investigation. Thus, traffic load should be considered in FVD design because structural responses are perceptibly influenced by FVD parameters.

Lean production, work intensification and employee wellbeing: Can line-manager support make a difference?

Using a two-wave survey of 315 workers in a lean manufacturing plant, this study examines how work intensification affects employee wellbeing and how its effects may be ameliorated. It demonstrates that work intensification is transmitted into poorer wellbeing through greater emotional exhaustion. It shows that this mediation process is moderated by line-manager support, which buffers the relationship between emotional exhaustion and wellbeing. The study suggests that the health-impairing risks of high work intensity in lean settings can be reduced through better supervisory support. Ensuring that line managers have the opportunity, skills and motivation to offer good support to workers is a vital aspect of the interventions needed to counteract the health risks posed by lean production.

4099High intensity endurance and strength training in water polo Olympic team players: impact on arterial wall properties

Abstract Background Regular physical activity is recommended for health improvement. However the upper intensity threshold associated with best health outcome is difficult to determine. Water polo (WP) Olympic athletes present unique characteristics with very high intensity work, long training sessions and a combination of endurance and strength training. Purpose To examine how long term, intense mixed endurance and strength training affect peripheral and central hemodynamics and biomarkers of cardiovascular health. Methods The study population consisted of 20 WP Olympic team player's, 20 matched recreational active subjects (RA) and 20 sedentary control subjects (Cl). Reflected waves were assessed with the Augmentation index (AIx), central aortic stiffness with pulse wave velocity (PWV) and endothelial function with flow mediated dilation (FMD). Results From Cl subjects to RA active subjects and to WP players there was a stepwise decrease in aortic systolic pressure (116±16 mmHg vs. 107±14 mmHg vs. 106±6 mmHg, p=0.03) while there was no difference in branchial systolic pressure (p=0.52). There was also a stepwise improvement in AIx (−4.22±9.97% vs. −6.97±11.28% vs. −12.14±6.62%, p=0.03) and FMD (6.61±1.78% vs. 7.78±1.98% vs. 8.3±2.05%, p=0.04) according to the intensity of exercise and WP players had lower AIx and higher FMD compared to RA subjects and to Cl subjects. Conclusions In young WP Olympic team players intense mixed endurance and strength training has no adverse impact on arterial wall properties and endothelial function with a parallel improvement in central hemodynamics. These findings highlight that there are no definitive data to support on any adverse vascular related impact of ultra-endurance training while mixed endurance and strength training may be associated with a favorable vascular profile.

P4425The exercise-induced troponin I elevation is highly correlated with power output during exercise in recreational cyclists with coronary atherosclerosis

Abstract Background Following strenuous exercise there is an increase cardiac Troponins (cTn) elevation considered being a physiological response. During prolonged strenuous physical activity, high work-loads may induce demand myocardial ischemia due to an oxygen demand/supply mismatch in susceptible subjects, causing an excessive cTn elevation. Purpose This study aimed to assess the relationship between exercise-induced cTnI elevation and direct measurement of work performed during prolonged strenuous exercise in subjects with and without atherosclerotic CAD. Methods Work during a 91 km mountain bike race was quantified by Stages™ power meters. Power (Watt) and heart rate data were stored in Garmin™ Forerunner 935 monitors. Coronary computed tomography angiography was performed after the race. Blood pressure was measured 4 times during the race. Blood samples (hs-cTnI from Abbot Diagnostics) were obtained one day prior to the race and at 3 and 24 h after the race. Data are presented as mean±SD or median (25th and 75th percentile). Results 40 subjects (10 women) were included in the final analysis. 15 Participants (4 women) had atherosclerosis, none had obstructive CAD. These participants were significantly older (55±8 years vs. 46±8 years p=0.007) and had higher training volumes (METS: 69 (64–102) hrs/week) compared with normal subjects (METS: 51 (33–88) hrs/week) (p=0.03). Baseline cTnI was higher (p=0.04) in the atherosclerotic group (4.5 (3.4–8.8) ng/L) compared with normals (2.6 (1.6–4.8) ng/L). There were no differences in baseline blood pressure, peak VO2 max, heart rate or BMI. There was no significant difference in race duration between normals (3.9 (3.5–4.5) hrs) and subjects with atherosclerosis (4.1 (3.6–4.5) hrs). During the race there were no differences in peak power or peak Watt/kg. cTnI increased after the race in all participants, but there were no differences between groups: 3h: atherosclerosis: 89 (27–131) ng/L vs. normal 77 (36–104) ng/L, 24h: atherosclerosis: 13 (6.3–23.7) ng/L vs. normal: 17 (12–37) ng/L. There were no significant difference between the groups in average power during the race: atherosclerosis: 167±50 Watt vs. 174 (±50) Watt or ratio: 2.0±0.49 Watt/kg vs 2.2±0.58 Watt/kg during the race. Maximal systolic and diastolic blood pressures during the race were higher (p=0.002) in the atherosclerotic group: SBP: 241±14 mmHg vs. 219±26 mmHg, DBP: 107±8 vs 95±8 mmHg. In atherosclerotic subjects cTnI both at 3h and 24 h were highly correlated (p&lt;0.001) with Watt/kg ratio during the race in contrast to no correlations in the normal group (Figure). Conclusions Our findings suggest that the presence of coronary atherosclerosis, even in the absences of significant stenosis, alters the relationship between workload and the troponin response. This indicates different release kinetics in exercise-induced cTn in participants with and without CAD, with prolonged elevation in cTnI in CAD subjects exceeding the highest work-intensities. Acknowledgement/Funding Grant Western Norway Health service, Grant ConocoPhillips, Grant Simon Fougner Hartmanns Familyfund

Development of Robotic Coordinated Control System for Bowl Food Packaging

The processing of the bowled food is relatively mechanical, repetitive and cumbersome, resulting in high work intensity, low efficiency, and high defect rate, and meets the working cycle:13.5s, positioning accuracy: 2mm.A PLC-based automatic feeding control system for food packaging line was designed. Including the conveyor line for bowl feeding, the numerical controlled manipulator and package process following control system for reclaiming and discharging functions, the system control scheme was proposed and 3D modeling construction was carried out. The design of hardware and software for feeding, reclaiming and discharging in the system is elaborated in detail. Finally, through the actual on-site commissioning and production operation, it is proved that the equipment has fully met the design requirements and greatly improved the production efficiency.

Scheduling Emergency Physicians Based on a Multiobjective Programming Approach: A Case Study of West China Hospital of Sichuan University.

In China, emergency room residents (EMRs) generally face high working intensity. It is particularly important to arrange the working shifts of EMRs in a scientific way to balance their work and rest time. However, in existing studies, most of the scheduling models are based on the individual doctor or nurse as a unit, less considering the actuality of operation and management of emergency department (ED) in large public hospitals in China. Besides, the depiction of the hard and soft constraints of EMR scheduling in China is insufficient. So in order to obtain the scientific and reasonable scheduling shifts, this paper considers various management rules in a hospital, physicians' personal preferences, and the time requirements of their personal learning and living and takes the minimum deviation variables from the soft constraints as the objective function to construct a mixed integer programming model with the doctor group as the scheduling unit. The analytic hierarchy process (AHP) is used to determine the weights of deviation variables. Then, IBM ILOG CPLEX 12.8 is used to solve the model. The feasibility and effectiveness of the scheduling method are verified by the actual case from West China Hospital of Sichuan University. The scheduling results can meet the EMRs' flexible work plans and the preferences of the doctor teams for the shifts and rest days. Compared with the current manual scheduling, the proposed method can greatly improve the efficiency and rationality of shift scheduling. In addition, the proposed scheduling method also provides a reference for EMR scheduling in other China's high-grade large public hospitals.

Transcranial Direct Current Stimulation of the Temporal Lobe Does Not Affect High-Intensity Work Capacity.

Ciccone, AB, Deckert, JA, Schlabs, CR, Tilden, MJ, Herda, TJ, Gallagher, PM, and Weir, JP. Transcranial direct current stimulation of the temporal lobe does not affect high-intensity work capacity. J Strength Cond Res 33(8): 2074-2086, 2019-Stimulation of the left insular cortex may affect heart rate variability (HRV) and exercise effort perception. These studies investigated the effects transcranial direct current stimulation (tDCS) and electrode orientation on HRV and repeated maximal knee extensions. In study 1, after sham stimulation, anodal left temporal lobe stimulation, or anodal right temporal lobe stimulation, 10 male and 10 female subjects (age = 21.0 ± 1.5 years) completed 50 maximum isokinetic extensions at 180°·s. There was a significant effect of stimulation condition on HRV for only 1 (SD2; p = 0.037; η = 0.159) of 5 HRV metrics. There was no significant effect on isokinetic fatigue percent or isokinetic work (all p ≥ 0.278; all η ≤.065). It has been proposed that placing the cathode electrode on the shoulder may differentially affect tDCS. Therefore, in study 2, the effects of electrode orientation on tDCS-induced changes in HRV was assessed in 10 healthy females and 8 healthy males (21.6 ± 2.5 years) who completed cephalic, extracephalic, and sham trials. In the cephalic montage, the anode was placed over the left temporal lobe and the cathode was placed over right prefrontal cortex. In the extracephalic montage, the cathode was placed on the shoulder on the same side of the body as the anode. Neither cephalic nor extracephalic montages affected HRV (all p ≥ 0.152; all η ≤.105). These data suggest that anodal tDCS of the insular cortex has little effect on HRV, and does not improve high-intensity exercise performance in the current population. Therefore, anodal tDCS applied over the left temporal lobe is not recommended for high-intensity performance enhancement.

Live maintenance robot for high-voltage transmission lines

Purpose The purpose of this paper is to improve the operation and maintenance intelligence of power systems, and summarize the transmission line robots and their key technologies. High-voltage power cables are important channels for power transmission systems. Their special geographical environment and harsh natural environment can lead to many different faults. At present, such special operations in dangerous and harsh environments are performed manually, which have not only high labor intensity and low work efficiency but also great personal safety risks. Design/methodology/approach For maintenance works that are far away from the tower, power outages are required. With the increasing evaluation of transmission quality and operational safety, and the urgent need for automation and operation of modern power systems, the contradiction between this manual operation and modern high-quality power transmission has become increasingly prominent. An effective method to replace the manual maintenance work is to use the mobile robot to carry the operation manipulator and its end tool, that is, the live maintenance robot. Findings Some achievements have been made in the key technologies of live maintenance robots, the work to be done to meet the basic requirements of complex and changeable line environment and practical application. Based on the existing research results of live overhaul robot, the follow-up research will focus on the practical application needs and the frontier of scientific and technological development, and truly realize the human–machine integration between live overhaul robot–human working environment. Only in this way can the robot better serve the operation and maintenance of the power system. Originality/value This paper reviews the system platform, operation function, structural characteristics and key technologies involved in the power cable robot, and the combination of live maintenance robots and modern high-tech such as big data and cloud computing is also given, and finally, the future development direction of the special operation robot is pointed out.

Field test of thermal environment and thermal adaptation of workers in high geothermal tunnel

During the process of constructing high geothermal tunnels on plateaus, people easily feel uncomfortable in the extremely hot (>45 °C), humid(>70%), and low-oxygen(19.6%) environments. In addition, the increase in work intensity further exacerbates this effect. In order to ensure productivity and health of workers, it is necessary to evaluate the influence of temperature, relative humidity, and work intensity on the workers’ physiology and psychology under these kind of extreme conditions. At a construction site, workers doing different jobs (such as installing explosives (LW), setting arches (MW), and drilling (HW)) were exposed to different combinations of air temperature (Ta = 35 °C, 40 °C, or 45 °C) and relative humidity (RH = 50% or 70%); their physiological and psychological responses to the environment were then investigated. Based on the field test results, a new thermal damage classification has been proposed, which shows that work intensity greatly influences heart-rate, especially when the temperature exceeds 40 °C. Under the conditions of Ta40°CRH70% and Ta45°CRH70%, high work intensity can cause a significant increase in thermal sensation. Heart-rate, skin temperature, and thermal acceptability are second-order polynomial functions of the wet-bulb globe temperature (WBGT), while thermal sensation is a linear function of it. There are four grades of thermal working levels in high-temperature operations; the upper limits of the WBGT for LW, MW, and HW are 40.4 °C, 38.4 °C, and 37.3 °C, respectively. Environmental conditions have a more prominent influence on people as compared to work intensity when the heat damage level is above III.

Afternoon ward rounds: bad for patients, bad for doctors?

Hospital medicine in the UK is under unprecedented pressure, with increasing demand on physicians as well as challenges in recruiting new doctors into the physicianly specialties. We sought to assess the prevalence of the afternoon ward round and its effect on those undertaking them. We sampled each hospital within our postgraduate region, surveying junior doctors working on inpatient medical wards. We surveyed roughly two-thirds of eligible doctors, -finding that 30% of juniors had some commitment, of varying frequency, to ward rounds beginning after 1.00pm. Of the -doctors involved in afternoon ward rounds, the majority felt they contributed to late finishes, delayed discharge of -patients, reduced team efficiency and reduced job -satisfaction. Just under 80% felt they were less likely to consider a career in hospital medicine as a result The afternoon ward round lives on, and we should not -underestimate its effect. Low junior doctor morale coupled with high work intensity can lead to burnout as well as -impairing the effectiveness of the clinical service. Clinical -leaders should consider leaving this practice in the past so we can cope with the challenges of the future.

Validation Of Gas Analysis Over Incremental Work Intensities - A Comparison Of Two Metabolic Measurement Systems

Indirect calorimetry is a practical and accurate method of measuring metabolic gas exchange rate, specifically volume of oxygen and carbon dioxide (V̇O2 and V̇CO2). Commercial stationary and mobile systems typically include automated metabolic gas analyses. Metabolic cart systems are considered the standard; however, they pose limitations due to cost and portability. PURPOSE: To compare the accuracy of a commercially available mobile system (CareFusion Oxycon Mobile®, OXYCON) to a criterion stationary cart system (ParvoMedics TrueOne 2400®, PARVO). METHODS: Fifteen volunteers (13 Male, 2 Female; 24 ± 6 y (mean ± SD), 77 ± 13 kg BW, VO2peak 3.9 ± 0.7 L∙min-1) completed four trials over two non-consecutive study days. Trials consisted of a rest period, followed by three incremental treadmill work rates: walk (23-36% VO2peak), jog (49-67% VO2peak), and run (60-76% VO2peak) in controlled laboratory conditions (20 ± 0.5 °C; 45 ± 22 % RH). Metabolic system order was randomized and data collected was averaged over 3-4 minute steady-state periods from each work intensity. Correlation coefficients and systematic bias were used to evaluate the agreement between the systems. RESULTS: Measurements of V̇O2 from the OXYCON and PARVO were highly correlated (R2= 0.99). The OXYCON showed some positive bias (0.18 ± 0.16 L∙min-1) that increased with work intensity: rest (V̇O2 0.05 ± 0.06 L∙min-1), walk (V̇O2 0.15 ± 0.09 L∙min-1), jog (V̇O2 0.26 ± 0.16 L∙min-1), and run (V̇O2 0.31 ± 0.16 L∙min-1). CONCLUSION: The mobile OXYCON is an acceptable alternative to stationary metabolic cart systems for measuring metabolic gas exchange rate during rest and low intensity exercise. Clinicians may consider alternative devices for assessments at higher work intensities.

Patients’ Expectations of osteotomies around the knee

Aims and Objectives: This multicentre study was conducted to investigate patients’ expectations on osteotomies around the knee in different health-related domains. It was hypothesized that these expectations are high, yet realistic. Materials and Methods: A total of 264 Patients (age 47y±11) were enrolled from March 2015 until May 2016 in seven specialised departments of orthopaedic surgery in Germany. Data was collected via a standardized questionnaire relating to the expected outcomes of osteotomies around the knee 24 h to 48 h prior to surgery. In addition, KOOS and selfefficacy were assessed. Results: According to the KOOS results all patients suffered from a burden due to their knee impairments; women suffered significantly more than men. All participants had high expectations in all domains concerning the surgical outcome. For patients who had a high work intensity the ability to keep stressful working postures was even more important than for the others (i.e. to kneel, to squat). Furthermore, a lower quality of life was associated with higher importance of improving the ability to walk, to achieve improvements in daily activities and social well-being. Conclusion: Patients’ expectations of osteotomies around the knee are high, and mostly outperform the average results reported in the literature. Detailed patient information giving an overview of the realistic results of osteotomies around the knee seems to be mandatory to prevent patients’ dissatisfaction.