Unpredictable Schedules Research Articles

Characteristics associated with freezing of gait in actual daily living in Parkinson's disease.

[Purpose] Parkinson’s disease (PD) patients often freeze in actual daily living but seldom in clinical setting. This study aimed to identify the factors contributing to freezing of gait (FOG). [Subjects and Methods] The participants included 28 adults with PD. Principal component analysis was used to investigate the characteristics of 14 common FOG situations adopted from previous studies. Cluster analysis classified the subjects into four groups. Kruskal-Wallis test was performed to compare the PD Questionnaire-39 mobility dimension between the groups. [Results] The major variables of the first principal component in 14 FOG situations were unfamiliar places, unpredictable schedule changes, entering an automatic door, when another person suddenly crossed, and change in the walking surface. These situations were unrelated to the second principal component. Getting on/off a public transport and crowded places were major variables for the second principal component, and related to both the first and second principal components. Although fatigue was the most frequent FOG situation, not all principal components were influenced. The values of the PD Questionnaire-39 revealed significant differences between the groups. [Conclusion] Actual FOG situations may be categorized into (1) task complexity, (2) both task complexity and emotional factors, and (3) fatigue as decreased attentional resources.

Truck Drivers' Use of the Internet: A Mobile Health Lifeline.

Because of their social isolation, irregular and unpredictable schedules, limited access to health care, and long periods of travel, long-haul truckers may benefit from the use of mobile health applications on Internet-capable devices. The purpose of this study was to determine Internet access and usage among a sample of long-haul truck drivers. In this cross-sectional study, truck drivers completed a pencil and paper survey with questions on demographics, work and health histories, and Internet access and usage for both personal and job reasons. A total of 106 truck drivers were recruited from trucking industry trade shows, by word of mouth, and directly from trucking companies. Overall, the truck drivers' use of the Internet was limited. Their usage for personal and job-related reasons differed. Social connectivity and access to health and wellness information were important during personal usage time. Job-related Internet use was highly practical, and applied to seeking information for directions and maps, fuel stops and pricing, and communicating with employers or transmitting documents. Age and experience were associated with Internet use. Younger, less-experienced drivers used the Internet more than older, experienced drivers. Targeted mobile health messaging may be a useful tool to inform truck drivers of health conditions and plans, and may provide links to primary care providers needing to monitor or notify drivers of diagnostic results or treatment plans.

Using Policy-Relevant Administrative Data in Mixed Methods: A Study of Employment Instability and Parents’ Use of Child Care Subsidies

In the United States, government subsidies help low-income families pay for child care when parents are working, yet policies that tie subsidy eligibility closely to employment may result in frequent disruptions in program participation for families. This paper uses a mixed methods research design that links administrative records on families and children to data collected through surveys and in-depth interviews to examine employment instability and job characteristics of parents using child care subsidies. The results suggest that parents experience substantial employment instability (employment loss and unpredictable schedules) and that exiting the subsidy program is frequently related to employment-related eligibility factors. Overall, the use of administrative data integrated with other methods provides substantial opportunities for researchers to explore complex social phenomenon and provide insights in the evaluation of social programs.

Self-Management Strategies in Emerging Adults With Type 1 Diabetes

IntroductionWe examined changes in self-management behaviors after high school graduation in a cohort of emerging adults with type 1 diabetes. MethodsSixty-four emerging adults reported on diabetes self-management behaviors at three time points over a 1-year period. Glycemic control and blood glucose monitoring frequency data were collected from the medical chart. ResultsCollaboration with parents decreased, diabetes problem-solving and communication increased, and glycemic control worsened during the first year after high school (p < .05). Problem solving appeared to be protective against worsening glycemic control; higher baseline diabetes problem solving significantly predicted better glycemic control at the 1-year follow-up. DiscussionEmerging adults demonstrate increased independence in diabetes problem solving and communication with health care providers in the year after high school. Problem-solving skills may help emerging adults adapt type 1 diabetes self-care in response to unpredictable schedules after high-school, and promoting these skills may prevent deteriorations in glycemic control during this risky period.

Daily changes in food availability, but not long-term unpredictability, determine daily torpor-bout occurrences and frequency in stripe-faced dunnarts (Sminthopsis macroura)

Daily torpor, a short-term reduction in body temperature and metabolism, is an energy-saving strategy that has been interpreted as an adaptation to unpredictable resource availability. However, the effect of food-supply variability on torpor, separately from consistent food restriction, remains largely unexamined. In this study, we investigated the effect of unpredictable food availability on torpor in stripe-faced dunnarts (Sminthopsis macroura). After a control period of ad libitum feeding, dunnarts were offered 65% of their average daily ad libitum intake over 31 days, either as a constant restriction (i.e. as equal amount of food offered each day) or as an unpredictable schedule of feed offered, varied daily as 0%, 30%, 60%, 100% or 130% of ad libitum. Both feeding groups had increased torpor-bout occurrences (as a proportion of all dunnarts on a given day) and torpor-bout frequency (average number of bouts each day) when on a restricted diet compared with ad libitum feeding, but torpor frequency did not differ between the consistently restricted and unpredictably restricted groups. Most importantly, torpor occurrence and daily bout frequency by the unpredictably restricted group appeared to change in direct association with the amount of food offered on each day; torpor frequency was higher on days of low food availability. Our data do not support the interpretation that torpor is a response to unpredictable food availability per se, but rather that torpor allowed a rapid adjustment of energy expenditure to manage daily fluctuations in food availability.

Hours, Scheduling and Flexibility for Women in the US Low‐Wage Labour Force

Research on women's experiences with work schedules and flexibility tends to focus on professional women in high‐paying careers, despite women's far greater prevalence in low‐wage jobs. This paper seeks to contribute to our understanding of the work‐hours problems faced by women precariously employed in low‐wage jobs by addressing how work‐on‐demand scheduling and other features of part‐time labour in the neoliberal economy limit women's ability to make ends meet. Using data from 17 in‐depth interviews, we identify four themes — unpredictable schedules, inadequate hours, time theft and punishment‐and‐control via hours‐reduction — and the problems they present. Results suggest that much‐championed flexible work policies that seek to encourage women's career advancement may have little bearing on the work‐hours dilemmas faced by low‐wage women workers. We conclude that social change efforts need to encompass work policies geared to low‐wage workers, such as guaranteed minimum hours and increases in the minimum wage.

Environmental factors that affect the behavior and welfare of domestic cats (Felis silvestris catus) housed in cages

Understanding environmental factors that affect the behavior of cats in cages is important if caretakers are to improve the welfare of confined cats. The aim of this study was to examine the effects of the macro (room) and micro (cage) environments on cat behavior and their implications for cat well-being. Cats (n=76) were caged singly at The Ohio State University and randomly assigned to one of four treatment groups that were combinations of a managed (M+) or unmanaged (M−) macro environment and an enriched (m+) or unenriched (m−) micro environment. Cats housed in the M+ environment experienced minimal noise or disruption and a consistent schedule while cats in the M− environment experienced random disturbances and an unpredictable schedule. The m+ environment included hiding and perching opportunities while the m− environment had no hiding and perching opportunity. Cats were observed for 48h for maintenance, affiliative behaviors (e.g., eating, elimination, soliciting attention), agonistic, avoidant behaviors (e.g., growling, hissing, hiding) using scan sampling and 5-min, continuous focal sampling. At the end of day 2, a stranger approach test was conducted to assess the cats’ reactions to the approach of an unfamiliar person. Data analysis of food intake revealed that the effect of treatment (P=0.03), day (P<0.0001) and the interaction (P=0.03) were statistically significant. Cats housed in the M+ environment had a significant decrease in the mean (SD) number of sickness behaviors from day 1 to day 2 (M+m+ 1.6 (0.5), 1.0 (0.9), P=0.02; M+m− 1.9 (0.5), 1.0 (0.9), P=0.002) and hiding behavior (M+ 0.6 (0.3), 0.3 (0.4); M− 0.5 (0.4), 0.4 (0.4); P=0.01), while cats housed in the M− environments did not show such decreases. Significantly more cats exhibited affiliative and maintenance behaviors at the end of day 1 (P<0.001) when housed in the M+ environment (27/36, 75%) compared to cats housed in the M− environment (4/40, 10%). Differences between cats in M+ and M− in step 3 of the approach test included a shorter latency to interact (M+ 8.6(13.1), M− 15.6(14.8); P=0.03), longer duration of interaction (M+ 21.1(13.3), M− 13.6(14.6); P=0.03) and more affiliative behaviors in response to approach by a stranger (M+ 3.7(1.6), M− 2.8(1.7); P=0.008). These results suggest that the macro environment may be at least as relevant to the cat as the micro environment, indicating that attention to cage enrichment without consideration for the effect of the room may be insufficient to optimize caged cat behavior and welfare.

Strategies for managing work/life interaction among women and men with variable and unpredictable work hours in retail sales in Québec, Canada.

Increasingly, work schedules in retail sales are generated by software that takes into account variations in predicted sales. The resulting variable and unpredictable schedules require employees to be available, unpaid, over extended periods. At the request of a union, we studied schedule preferences in a retail chain in Québec using observations, interviews, and questionnaires. Shift start times had varied on average by four hours over the previous week; 83 percent had worked at least one day the previous weekend. Difficulties with work/life balance were associated with schedules and, among women, with family responsibilities. Most workers wanted: more advance notice; early shifts; regular schedules; two days off in sequence; and weekends off. Choices varied, so software could be adapted to take preferences into account. Also, employers could give better advance notice and establish systems for shift exchanges. Governments could limit store hours and schedule variability while prolonging the minimum sequential duration of leave per week.

Scheduling challenges among workers in low-wage hourly jobs: similarities and differences among workers in standard- and nonstandard-hour jobs

Work schedules are a central theme in the work–family challenges of low-wage hourly workers. Yet, research on scheduling patterns among this worker population has primarily focused on nonstandard schedules. We know very little about the scheduling patterns of workers in hourly jobs with standard fixed schedules. Knowledge about the key scheduling challenges by schedule type is necessary to develop targeted workplace solutions, such as flexible work arrangements, to enhance work–life fit among workers in low-wage hourly jobs. Using the 2008 National Study of the Changing Workforce, bivariate and multivariate analyses were employed to determine (1) the prevalence of rigid, unpredictable and unstable work schedules among low-wage hourly workers employed in jobs with standard and nonstandard schedules and whether there is variation in these scheduling practices among full- and part-time workers; and (2) the individual or job characteristics that influence the odds of experiencing rigid, unpredictable or unstable work schedules. Results indicate that rigid and unpredictable schedule practices are most prevalent among low-wage hourly workers in full-time standard-hour jobs and part-time nonstandard-hour jobs, while unstable scheduling practices are most prevalent among hourly workers in full- and part-time nonstandard-hour jobs. Implications and limitations of the research are discussed.

VieCuri clears complexities from course administration and compliance

Purpose – The purpose of this paper is to reveals how a 3,000-employee general hospital in The Netherlands has replaced a complicated and cumbersome system for the administration of learning and compliance with learning and development that is efficient, flexible and easy to use. Design/methodology/approach – Deals with the causes of the problems, the solutions and the results achieved. Findings – Charts how a the learning-management system (LMS) helped to simplify administration, support the strategic goal of developing e-learning, dynamically collate results of e-learning and practical examinations on one platform and facilitate on-the-go learning for employees with unpredictable schedules. Practical implications – Explains how the hospital implemented SumTotal’s LMS to support the administration of learning. Details how the medical center worked with SumTotal partner Atrivision to implement the LMS, which formed the basis for the VieCuri learning portal for learning and compliance tracking. Social implications – Highlights how compliance – critical in health care – can be ensured using the LMS. Originality/value – Provides a rare case study of the introduction of an LMS at a large hospital in The Netherlands.

Perspectives of Being Spouse, Parent, and Surgeon

Achieving a balance between one's career and personal life is a never-ending challenge. As a surgeon, add-on cases and double-booked clinics can lead to long hours at work and make availability for family time unpredictable. It may seem like the threat of interruption because of patient needs always loom. Disruptions to family time extend beyond the long hours spent in surgery and clinics. Inattentiveness at home because of the technology tethers that keep one available for constant questions and patient care issues can also distract from time spent with family. Although the practice of an orthopaedic trauma surgeon can involve unpredictable schedules and patient care issues, there are means of mitigating the chaos that can envelop one's personal life as a result of a chosen career track. Clear priorities and expectations in both personal and professional arenas can improve the work-life balance. Flexible jobs that allow for more time with family do exist. Negotiating for this flexibility and self-assurance in holding fast to personal ideals are important in achieving a successful balance.

O1 * FREE ORAL COMMUNICATIONS 1: BASIC NEUROBIOLOGICAL MECHANISMS OF ALCOHOL ADDICTION

O1 * FREE ORAL COMMUNICATIONS 1: BASIC NEUROBIOLOGICAL MECHANISMS OF ALCOHOL ADDICTION

Case Studies in Public-Sector Leadership: Addressing the Problem of Appointment Nonadherence With a Plan for a Walk-In Clinic

Introduction by the column editors: This column is based on the use of an electronic mailing list (e-list) to generate a collaborative problem-solving process. Dr. Runnels asked e-list members of the American Association of Community Psychiatrists for suggestions regarding the establishment of a walk-in program for patients who regularly miss scheduled appointments. Readers are invited to submit suggestions for e-list discussions of management problems to column editors JulesM. Ranz,M.D., at jmr1@columbia.edu, or Susan M. Deakins,M.D., at smd3@columbia.edu.

The Interconnections Project: Development and Evaluation of a Community-Based Depression Program for African American Violence Survivors

Multi-faceted depression care programs based within the healthcare system have been found to be effective, but may not fully address the needs of African American Intimate Partner Violence (IPV) survivors, many of whom are not seeking depression care in healthcare settings. To develop and evaluate a multifaceted, community-based depression care program (the Interconnections Project) for African American women with a history of IPV. We used a community-based participatory research (CBPR) approach to develop, implement, and evaluate the intervention. Participants were African American women who had current depressive symptoms and a lifetime history of IPV. They participated in a 6-month intervention where a peer advocate provided education, skills training, and case management services, and used Motivational Interviewing to support self-management behaviors. We conducted pre-intervention and post-intervention assessments using quantitative and qualitative data. Fifty-nine women participated, with 92 % attending any sessions and 51 % attending at least 6 h of intervention activities. Intervention changes made to better accommodate participants' unpredictable schedules improved participation rates. Participants noted high levels of satisfaction with the program. There were significant improvements in depression severity (PHQ-9 13.9 to 7.9, p < 0.001), self-efficacy, self-management behaviors, and self-esteem (all p < 0.001), but no increase in use of antidepressants. Common themes related to why the program was helpful included that the program was by and for African American women, that it fostered trust, and that it taught self-management strategies with practical, lasting value. Culturally specific, community-based interventions led by peer advocates may be a promising way to help African American IPV survivors effectively address depression.

An Unusual Pattern of CPAP Usage

An Unusual Pattern of CPAP Usage

Families with School-Age Children

Most working parents face a common dilemma--how to care for their children when they are not in school but the parents are at work. In this article Kathleen Christensen, Barbara Schneider, and Donnell Butler describe the predictable and unpredictable scheduling demands school-age children place on working couples and single working parents. The authors assess the potential capacity of schools to help meet the needs of working families through changes in school schedules and after-school programs and conclude that the flexibility parents need to balance family-work responsibilities probably cannot be found in the school setting. They argue that workplaces are better able than schools to offer the flexibility that working parents need to attend to basic needs of their children, as well as to engage in activities that enhance their children's academic performance and emotional and social well-being. Two types of flexible work practices seem especially well suited to parents who work: flextime arrangements that allow parents to coordinate their work schedules with their children's school schedules, and policies that allow workers to take short periods of time off--a few hours or a day or two-to attend a parent-teacher conference, for example, or care for a child who has suddenly fallen ill. Many companies that have instituted such policies have benefited through employees' greater job satisfaction and employee retention. Yet despite these measured benefits to employers, workplaces often fall short of being family friendly. Many employers do not offer such policies or offer them only to employees at certain levels or in certain types of jobs. Flexible work practices are almost nonexistent for low-income workers, who are least able to afford alternative child care and may need flexibility the most. Moreover the authors find that even employees in firms with flexible practices such as telecommuting may be reluctant to take advantage of them, because the workplace culture explicitly or implicitly stigmatizes or penalizes employees for choosing these work arrangements. The authors conclude by making a case for creating a workplace culture that supports flexibility. Such a culture, they argue, would enable working parents to better meet the responsibilities of their jobs as they care for and build strong relationships with their children.

Region‐specific response of the hippocampus to chronic unpredictable stress

The objective of the present study was to determine whether chronic unpredictable stress (CUS) would induce hippocampal neuroplasticity in a region-specific manner. Recent evidence suggests that the hippocampus has two functionally distinct subsections. The dorsal (septal) portion appears to be primarily associated with spatial navigation, while the ventral (temporal) region has been linked to affect-related functions, such as anxiety. Chronic stress has previously been shown to negatively affect the hippocampus by decreasing survival of progenitor cells, although it has also been shown to increase adaptive responses, such as increased expression of neuropeptide Y (NPY) and ΔFosB. Whether such events occur in a region-specific manner has not been investigated. We hypothesized that CUS would selectively impact cell survival, NPY, and ΔFosB expression in the more affect-related ventral subregion. Individually housed Long-Evans rats (n = 31) were divided into two groups: stressed and control. Stressed animals were exposed daily to an unpredictable schedule of ethologically relevant stressors, such as predator odors, forced swim, and open field exposure. All rats were injected with bromodeoxyuridine (BrdU) daily during the first 5 days of CUS in order to label dividing progenitor cells. Unbiased stereology was used to quantify BrdU+, NPY+, and ΔFosB+ cells in dorsal and ventral hippocampal subregions. In support of our hypothesis, we found that CUS selectively decreased cell survival in the ventral subregion. However, both NPY and ΔFosB were significantly increased only in the dorsal hippocampus. These results suggest that stress-induced adaptive neuroplasticity occurs primarily in the dorsal subregion, which may coincide with behavioral aspects of the stress response, such as avoidance or amelioration of the stressor.

Nurses’ perception of nursing workforce and its impact on the managerial outcomes in emergency departments

(1) To understand nurses' subjective perceptions of the current nursing workforce in their emergency departments, (2) to examine the relationship between nurses' workforce perceptions and its impact on the managerial outcomes and (3) to analyse the correlation between nurses' characteristics and the scores on workforce perception. While the association between workforce perceptions and nurse outcomes is well-documented, few studies have examined how emergency department nurses perceive current workforce and related outcomes. A cross-sectional questionnaire survey. A self-reported workforce perception questionnaire was used to survey 538 registered nurses in the emergency departments of 19 hospitals in northern Taiwan, during May to October 2006. Data were analysed using descriptive statistics, chi-square test, independent t-test, Pearson correlation and one-way anova. The mean score of workforce perception was 6.28 points (total = 10 points). Both overtime (p = 0.02) and number of callbacks on days off (p = 0.01) were significantly correlated to current nursing workforce and hospital level. Older nurses tended to have more emergency department experience (r = 0.37; p = 0.01) and those with more emergency department experience tended to have vacation accumulation (r = 0.09; p = 0.04), overtime (r = 0.10; p = 0.03) and better perception of their emergency department's current workforce (r = 0.09; p = 0.05). Although nurses' perceptions were found to be only moderate, overtime and number of callbacks on days off are potential problems that should be addressed by nursing leaders to benefit future emergency nurses. The findings can help drive strategies to ensure adequate staffing, to stabilise the nursing workforce and to prevent nurses from burnout factors such as working long hours, unpredictable schedules and a stressful work environment that may impact both the quality of emergency care and the quality of the nurses' work environment.

Temporal predictability in food availability: effects upon the reproductive axis in Scrub‐Jays

Florida Scrub-Jays (Aphelocoma coerulescens) in a suburban environment with year-round access to multiple sources of abundant, human-source foods consistently breed earlier each year and have lower baseline levels of circulating corticosterone (CORT) than jays in a nearby wildland setting. These findings suggest that food supplies influence CORT levels, which in turn may partially determine the timing of reproduction. However, wildland birds with access to high-quality supplemental foods did not advance breeding or lower CORT levels to the degree observed in the suburbs. Therefore, rather than quality or quantity of food consumed, the perception of a reliable and predictable food supply may be an important factor in determining laying dates. If a predictable food supply accelerates the reproductive process, it follows that food provided on an unpredictable schedule may slow reproduction. We subjected captive Western Scrub-Jays (A. californica) to a 30-day photoperiod transition from short- to long-days and tested whether birds with access to food on an unpredictable schedule exhibited delayed or reduced production of reproductive hormones compared with birds given food on a predictable schedule. Baseline CORT concentrations increased slightly during the experiment, but did not differ between treatment groups. Birds with unpredictable food had slightly lower testosterone levels relative to controls, but there was no effect on estradiol or luteinizing hormone. Our findings offer weak support for the hypothesis that an unpredictable food supply will delay the onset of reproduction; however, the artificial lab environment may limit the application of these findings to free-living populations.

Developing Effective Screening Strategies in Multiple Endocrine Neoplasia Type 1 (MEN 1) on the Basis of Clinical and Sequencing Data of German Patients with MEN 1

Multiple-endocrine-neoplasia-type-1 (MEN1) is an autosomal-dominant inherited disorder characterized by the combined occurrence of primary hyperparathyroidism (pHPT), gastroenteropancreatic neuroendocrine tumors (GEP), adenomas of the pituitary gland (APA), adrenal cortical tumors (ADR) and other tumors. As the tumors appear in an unpredictable schedule, uncertainty about screening programs is persisting. To optimize screening and to analyze possible differences in sporadic versus familial cases. We analyzed data of 419 individuals including 306 MEN-1 patients (138 isolated and168 familial cases out of 102 unrelated families). A total of 683 tumors occurred consisting of 273 pHPT, 138 APA, 166 GEP, 57 ADR, 24 thymic- and bronchial-carcinoids as well as 25 neoplasms of other tissues. The age-related penetrance was determined as 10%, 35%, 67%, 81% and 100% at 20, 30, 40, 50 and 65 years respectively. Although pHPT being the most frequent first manifestation (41%), also GEP (22%) or APA (21%) were found to be the first presentation. APA occurred significantly more frequent (p<0,05) in isolated (n=138) than in familial (n=168) cases, whereas GEP showed a tendency to occur more often in familial cases. Genotype/phenotype correlation in 140 clinically affected MEN-1 cases showed a tendency for truncating mutations, especially nonsense mutations to be associated to GEP and carcinoids of the lungs and thymus. In view of the morbidity and frequency in familial cases an effective screening programme should aim at an early diagnosis of GEP particularly when truncating, especially nonsense mutations are found.