Regular Rest Research Articles

Subjective Reports of Fatigue During Early Recovery From Traumatic Brain Injury

To determine whether patients with traumatic brain injury (TBI) report higher levels of fatigue than do normal controls and to identify demographic and cognitive correlates of self-reported fatigue. Prospective study. Inpatient neurorehabilitation unit in a medical center and neurological institute. Forty-seven neurorehabilitation inpatients with TBI. Barrow Neurological Institute (BNI) Fatigue Scale and BNI Screen for Higher Cerebral Functions. Patients reported significantly greater levels of fatigue compared to the levels reported by normal controls, although fatigue was found to be unrelated to injury severity, number of days from injury to assessment, cognitive impairment, and gender. Inspection of individual items revealed no significant differences between severe versus moderate versus mild TBI groups. However, being able to last the day without taking a nap (ie, item 10) was found to be the most sensitive item associated with fatigue in the TBI group. Results of this study suggest the need to integrate activities and interventions to increase endurance in patients with TBI during early rehabilitation. Accommodating regular rest breaks and increasing restful sleep should be a focus of inpatient neurorehabilitation units.

ADA Accommodation of Therapists with Disabilities in Clinical Training

The authors discuss the need for reasonable accommodation at clinical practicum, clerkship, and internship sites. They summarize the key types of disability legislation and data on general compliance with the Americans with Disabilities Act. They discuss accommodation needs in the classroom and the clinic, focusing on time, space, and procedural accommodations; accommodations in test administration procedures; and accommodations for mental illness and substance abuse. They end with a plea for APA-accredited half-time internships to permit equal access for women with fatigue-related disabilities that involve the need for regular rest and a reduced schedule.

Modelling the Effectiveness of Techniques for Reducing Heat Strain in Royal Navy Nuclear, Biological and Chemical Cleansing Stations' Teams

High temperatures, combined with wearing nuclear biological chemical (NBC) individual protective equipment (IPE), produce significant heat strain in personnel working in ships' NBC cleansing stations (CS) and limit the ability of ships to operate in a contaminated environment. This report reviews the potential solutions to this problem and concludes that only a method of actively cooling personnel will reduce heat strain and increase the number of people that can be processed through ships' NBC CS. Amongst the wide range of cooling equipment that might offer a benefit, only hand immersion in cold water and ice-vests are practically useful for use in NBC CS. To assess how effective these techniques are likely to be INM has modelled the thermal effects under environmental conditions expected in the CS when operating in a hot climate. The model predicted that hand immersion in cold water (10 degrees C) would be the most effective cooling method, providing that personnel were able to take regular rest periods to immerse the hands. If it is preferred that personnel in the CS be able to work continuously, then ice-vests would be effective. The safe total work time that can be achieved in a three hour period without a cooling intervention is approximately 72 minutes, regular rest periods must be taken throughout the three hour work period, to total of 108 minutes. Safe work times can be increased to 99 minutes by using an ice-vest and 117 minutes by using hand immersion in 10 degrees C water, with required rest times reduced accordingly, thereby increasing capacity of CS teams to decontaminate personnel.

Rest breaks and accident risk

Regular rest breaks are recommended to prevent accumulation of accident risk during sustained activities. We examined the effect of rest breaks on temporal trends in industrial accident risk, by assessment of accident records from a large engineering company, obtained over 3 years. In 2 h of continuous work, relative risk of an accident in the last half-hour of a shift was 2.08 (95% CI 1.73-2.43) higher than in the first half-hour. Trends in risk did not seem to differ between three 2-h work periods. Regular rest breaks seem to be an effective way to control accumulation of risk during industrial shift-work.

Anti‐stress effect of yoga‐type breathing: modification of salivary cortisol, heart rate and blood pressure following a step‐climbing exercise

AbstractThis paper reports salivary cortisol levels and cardiovascular adjustments monitored after the performance of physical exercise in a subject (healthy man, 58 years old) who had practised and taught yoga techniques for a number of years. The subject performed two different step‐climbing trials which were varied according to the different breathing recovery techniques used. Immediately after the step‐climbing, the subject was asked either to get his breath back spontaneously (as reference) or by 3 min breathing using the ‘Istity Method’, based on the prolongation or amplification of the steps of the breath (breathing in–out) with short regular rest intervals. The measurements of the basal heart rate, blood pressure and cortisol concentration in the saliva were made just before starting, and 5, 15 and 30 min after the end of step‐climbing. Results suggest that the Istity breathing method can induce rapid modification of the cardiovascular function and attenuation of the cortisol level after exposure to physical stress. It might be of interest to pursue further studies of this effect, perhaps not confined to yoga experts, since the ‘Istity Method’ can be implemented by anyone after a short and simple training period. Copyright © 2002 John Wiley & Sons, Ltd.

METABOLIC ANALYSIS OF A TENNIS MATCH WITH HIGHLY SKILLED PLAYERS

Tennis is a sport with repeated high intensity, short work bouts, interspersed with regular rest periods. Despite the popularity of tennis, limited data is available regarding the metabolic cost of tennis. The purpose of this study was to perform a metabolic analysis of players during match play. Two female Division I collegiate athletes (means: age = 24 ± 0yrs, ht = 159 ± 1.8cm, wt = 57.2 ± 1.9 kg, %BF = 23.7 ± 2.8, treadmill V02max = 48.6 ± 4.8 ml/kg/min) participated. Subject 1 played two tennis sets, and Subject 2 played one set. V02 (ml/kg/min) was monitored with a KB1-C portable metabolic analyzer and heart rate (HR) with a Polar HR monitor during play. Blood lactate (BL) (mmol/L) was assessed using an Accusport BL analyzer at odd game changeovers. Results were compared to a treadmill V02 max test, then caloric cost was calculated. Results: V02 averaged 56% of treadmill V02max (27 ml/kg/min, (range = 4.8 to 47.0 ml/kg/min). HR averaged 70% (135 bpm) of treadmill max HR (range = 82 to 175 bpm). Average RQ = 1.0 (range = 0.6 to 1.2). BL averaged 3.8 mmol/L (range = 1.7 to 7.4 mmol/L). Average caloric cost for the tennis sets was 240 kcal (range = 222 to 266 kcal), with an average composition of 46g CHO and 6g fat. Conclusions: Metabolic data from this study confirms that tennis is a highly intermittent activity with a range of energy requirements. Energy expenditure of tennis observed in this study compares favourably with other recreational activities such as jogging at 5 mph (12 min/mile) or cycling at 12 to 14 mph. To achieve a comparable caloric burn, subjects in this study would have to walk at 4 mph for ≈60 minutes.

Actigraphy to measure day structure as a therapeutic variable in the treatment of schizophrenic patients

A component of social skills is the ability to adapt to the social rhythms of the environment. Patients with schizophrenia are often disabled in this adaptation. Thus, structuring activities throughout the day has long been known as part of psychosocial treatments. Actigraphy as a tool to measure acitvity and circadian rhythms may even serve as an indicator for the day-structuring of schizophrenic patients. Actigraphy was used in a patient with affective disorder and one with chronic schizophrenia for more than 2 weeks. In comparison to a regular 24-hour rest-activity cycle in a depressed patient, the actigraph of the patient with schizophrenia presents active phases at night, irregular activity levels at day and signs of a delayed-sleep-phase syndrome. Actigraphy could serve as a tool to investigate activity levels and circadian rest-activity phases, even in schizophrenia. There may be some further benefit of actigraphy as a tool in psychosocial treatments.

Management of post-polio syndrome

Many patients with post-poliomyelitis syndrome can benefit from a management program. When a post-polio patient presents with new symptoms, it is first essential to identify and treat other medical and neurological conditions which could produce these symptoms. New weakness can be managed with exercise (stretching, strengthening, and aerobic), avoidance of muscular overuse, weight loss, orthoses, and assistive devices. Fatigue can be managed with energy conservation techniques, lifestyle changes, pacing, regular rest periods or naps during the day, amitriptyline to improve sleep, and possibly pyridostigmine (trial in progress). The management of pain is dependent upon its cause. The treatment of post-polio muscular pain can include activity reduction, pacing (rest periods during activity), moist heat, ice, and stretching, use of assistive devices, and life style modifications. Fibromylagia can be treated with amitriptyline, cyclobenzaprine, and aerobic exercise. Joint and soft tissue abnormalities can be managed with modification of extremity use, physiotherapy, orthoses, assistive devices, non-steroidal anti-inflammatory medications, and rarely steroid injections and surgery. Superimposed neurological disorders may produce pain, and should be identified and treated. The identification and treatment of pulmonary dysfunction in a post-polio patient is an important aspect of management, and is discussed elsewhere in this issue. Dysphagia can be managed with diet changes, use of special breathing and swallowing techniques, monitoring fatigue and taking larger meals earlier and smaller meals later, and avoiding eating when fatigued. The management of psychosocial difficulties usually requires an interdisciplinary approach, and may include a post-polio support group, social worker, psychologist, and psychiatrist.

Ocular movement during reading in patients with congenital nystagmus.

When a healthy person reads sentences arranged horizontally, the eye movement pattern is a series of regular saccades and rest periods. However, eye movements while patients with oculomotor disturbances are reading remain to be defined. In this study, 4 patients with congenital nystagmus (CN) were studied. Coordinated movements of eye and head are also studied by a new apparatus with terrestrial magnetism sensor. While subjects were reading, an eye movement pattern was superimposed by the CN waveform and showed few rest periods. Eye velocity of less than 4 degrees/s was noted in almost every cycle of the eye movements while the patients with CN were reading. When they were requested to read sentences and simultaneously rotate their head naturally, the head movements had the effect of cancelling the eye instability. This finding may be interpreted as a kind of "eye-head coordination".

Sex Biases in the Measurement of Moral Judgment

The most commonly used method for measuring levels of moral reasoning has been the Kohlberg/Rest technique of presenting subjects wirh a story in which the main character is faced with a moral dilemma (2, 3). Holstein (1) has argued that this method may be biased in favor of men, since all of the main story characters are males. The present study is designed to determine whether altering the sex of the story characters on Rest's Defining Issues Test differentially affects male and female subjects' test scores. A total of 84 freshman men and women completed either the standard short form of the test (N = 38) or a sex-reversed form (N = 46). For this latter form, each of the main story characters was a woman. Subjects also responded to questions asking them to report how believable and realistic the story characters' acrions were, and how easily the subjects could identify wirh the main story character. In scoring the protocols, a P-score is computed for each subject. The P-score is the percentage of items representing principled reasoning (Kohlberg's Stages 5 and 6) rated as important considerations by the subject. P-scores for the present sample 'ranged from 3 to 70. The mean score for the regular form was 33.6 (SD = 18.1), while [he mean score for the sex-reversed form was 32.0 (SD = 16.2). Application of a 2 (sex of subject) X 2 (form of test) analysis of variance yielded non-significant main effects for sex and form. - The interaction, however, was significant (F,,so = 4.05, ? = .05). Examination of the means showed differences between groups in the non-predicted dlrectlon. Males who took the form with female characters (sex-reversed form) had higher P-scores than males who took the regular rest with male characters (134 = 36.2, SD = 18.6 for the sex-reversed form, and M = 30.2, SD = 19.9 for the regular form). However, females who took the regular version had higher P-scores (M = 37.0. SD = 16.3) than females who took the test with female story characters (M = 27.9, SD = 13.9). Thus, individuals who read dilemmas with main characters who were the opposite sex had higher moral judgment scores than those who read stories in which the main characters were the same sex as themselves. The analysis of the subjects' responses to the believabiliry and identifiabiAity items showed no significant differences associated with subject sex or story character sex. The present results do nor support Holstein's (1) contention that tests such as the Defining Issues Test are biased in favor of males. The results do suggest, however, that the sex of the story characters can be a confounding variable in measuring moral judgment on this test. Research should attempt to replicate and extend these preliminary findings.

On the integral equation method for the plane mixed boundary value problem of the Laplacian

AbstractAlthough the plane boundary value problem for the Laplacian with given Dirichlet data on one part Γ2 and given Neumann data on the remaining part Γ2 of the boundary is the simplest case of mixed boundary value problems, we present several applications in classical mathematical physics. Using Green's formula the problem is converted into a system of Fredholm integral equations for the yet unknown values of the solution u on Γ2 and the also desired values of the normal derivatie on Γ1. One of these equations has principal part of the second kind, whereas that one of the other is of the first kind. Since any improvement of constructive methods requires higher regularity of u but, on the other hand, grad u possesses singularities at the collision points Γ1 ∩ Γ2 even for C∞ data, u is decomposed into special singular terms and a regular rest. This is incorporated into the integral equations and the modified system is solved in appropriate Sobolev spaces. The solution of the system requires to solve a Fredholm equation of the first kind on the arc Γ2 providing an improvement of regularity for the smooth part of u. Since the integral equations form a strongly elliptic system of pseudodifferential operators, the Galerkin procedure converges. Using regular finite element functions on Γ1 and Γ2 augmented by the special singular functions we obtain optimal order of asymptotic convergence in the norm corresponding to the energy norm of u and also superconvergence as well as high orders in smoother norms if the given data are smooth (and not the solution).

ON PERSONNEL BUDGETING FOR CONTINUOUS OPERATIONS (WITH EMPHASIS ON HOSPITALS)

ABSTRACTThis paper develops an approach for determining staff size when Nj personnel are needed on weekday j, j= 1, 2,…,7. The method explicitly incorporates the fact that staff size will vary with both regular rest policy and fringe‐benefit days. The typical hospital case where N employees are needed weekdays and n on weekends is developed in detail.

Factors contributing to a nursing protocol on hypertensive patients with essential and secondary hypertension

The results from the current study are relevant to examining the symptomatology of the factors on long-term effects of hypertensive patients. The dimensions of medical and psychiatric data from the CMI were identified from factor analysis of the item data. In spite of the sophisticated interview tool and well characterized patients, the results from the stepwise discriminant analysis suggest that a discrete pattern of six symptoms separate the essential hypertensives from the secondary ones. One could argue that the analysis allowed the researchers to separate the essential from the secondary hypertensive, but there is no physical reason why these responses would do so. The medically supervised hypertensive group gave evidence of undergoing exhaustion with cardiovascular symptoms and headaches. They felt exhausted and worn out by weak stimuli. They acknowledged that nervousness and worrying ran in the family. It was surmised that exaggerated physical reactions of various kinds such as clearing of throat, having hot or cold spells, sweating in cold weather, and stiffness of muscles and joints were related to irritability. They gave evidence of undergoing irritability; acknowledging nervousness, annoyances and emotional upsets to the point that sudden noises or sudden movements made them scared and jumpy. It was felt that this could be a psychosomatic process whereby hypertension and irritability aggravate each other. Establishing regular rest and exercise patterns on a daily basis was not possible for the majority of patients in this study. These long-term effect symptoms agreed with those of Dollery et al. (1977) and to those of Peart (1977). This study was in agreement with their statement on exertion (Factor I), but the researchers' subjects became exhausted with many other symptoms spelling out an exhaustive complex. In their work they listed depression as a symptom of hypertension, while in this study, Factor VI reveals irritability unspecified. They mentioned cramps in feet and calves, while respondents recognized leg cramps. They listed headaches, which are also a predominant factor (III) in the present work. Chest pains in general were a predominate factor in this study which Dollery et al. (1977) have broken down to a specified pain of angina. The reader is referred to Dollery et al. (1977) for an added array of symptoms not presented here. Along with the findings in this study, there are programs attempting to medically control elevated blood pressure. The article in the Journal of the American Medical Association was paraphrased by an article in the Wall Street Journal. This article placed a strong link between hypertension and obesity. In agreement with this article, better nutritional and exercise habits are recommended. These recommendations coincide with the recommendations of the authors. Yet obesity and the above named problems continue to exist, although they can be controlled by health teaching and self-care. Like standing orders, the protocol must constantly be changed and revised according to discoveries in medical science. The nurse protocol should always represent the intellectual processes of the nurse which are expected to be kept up to date. Without the above considerations the protocol could not be used as a safe and reliable instrument. Protocols can ensure a minimum standard of quality nursing care based on current day standards of nursing practice.

TREATMENT OF TUBERCULOSIS OF THE SHOULDER

Some uncertainty exists as to the most suitable treatment for tuberculosis of the shoulder in adults. This is due partly to the relative rarity of this condition and partly to the inadequate follow-up after treatment. In the case of children the problem seems simpler, because there is almost complete agreement that treatment should be conservative. In this paper treatment will be evaluated on the basis of the experience at the Lakeville State Sanatorium. Since tuberculosis is a systemic illness with local manifestations, the general treatment of the patient is of great importance. If possible, a period of sanatorium care should be instituted before operative procedures are undertaken. Fresh air, an adequate and balanced diet and regular rest periods are important in restoring the patient to his optimum physical condition. Immobilization of the affected shoulder in a plaster cast is orthodox therapy. For children a long period of conservative treatment is