Blood pressure, sleep quality and fatigue in shift working police officers: Effects of a twelve hour roster system on cardiovascular and sleep health

© 2016 by the authors; licensee MDPI, Basel, Switzerland. Background: Police officers have been reported to exhibit a high incidence of pathologies, which present prematurely in an otherwise healthy population. Shift work has also been associated with an increased risk of cardiovascular and sleep disorders, attributable to its propensity for circadian rhythm dysfunction. However, contention exists as to whether shift work has a direct effect upon blood pressure (BP) regulation. Methods: This cross-sectional study sought to determine changes in BP and associations with the overall sleep quality and fatigue in 206 general duties police officers (n = 140 males) of the New South Wales Police Force in Australia. The subjects’ BP was assessed before and after their twelve hour shift, during which time they also completed the Lifestyle Appraisal Questionnaire, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale and Fatigue Severity Scale (FSS). Results: Poor sleep quality (PSQI) and fatigue severity (FSS) were found to predominate in the sample (69% and 51% respectively). Although there was no change in BP for male participants, female officers’ systolic blood pressure (SBP) was found to increase significantly across the shift (p < 0.001), but with no change found in females’ diastolic blood pressure (DBP). Finally, higher pre and post-shift SBP (r = ‒0.26, p = 0.001; r = ‒0.25, p = 0.001, respectively) and DBP (r = ‒0.26, p = 0.001; r = ‒0.26, p = 0.001, respectively) were significantly correlated with lower FSS scores after accounting for age, waist-hip ratio and lifestyle risk factors. Conclusions: Based on these preliminary findings, there was a significant increase in SBP of female police officers after shift work, while BP and fatigue levels in all police officers were strongly related. Moreover, the predominating poor sleep quality and impact of fatigue in this sample remain a concern. Further research is required to ensure the physiological welfare of police officers, while strategies must be implemented to manage the detrimental effects shift work may be having upon their cardiovascular and sleep health

The influence of environmental context in interpersonal observation-execution.

Cyclical upper-limb movements involuntarily deviate from a primary movement direction when the actor concurrently observes incongruent biological motion. We examined whether environmental context influences such motor interference during interpersonal observation-execution. Participants executed continuous horizontal arm movements while observing congruent horizontal or incongruent curvilinear biological movements with or without the presence of an object positioned as an obstacle or distractor. When observing a curvilinear movement, an object located within the movement space became an obstacle, and thus, the curvilinear trajectory was essential to reach into horizontal space. When acting as a distractor, or with no object, the curvilinear trajectory was no longer essential. For observing horizontal movements, objects were located at the same relative locations as in the curvilinear movement condition. We found greater involuntary movement deviation when observing curvilinear compared to the horizontal movements. Also, there was an influence of context only when observing horizontal movements, with greater deviation exhibited in the presence of a large obstacle. These findings suggest the influence of environmental context is underpinned by the (mis-)matching of observed and executed actions as incongruent biological motion is primarily coded via bottom-up sensorimotor processes, whilst the congruent condition incorporates surrounding environmental features to modulate the bottom-up sensorimotor processes

Plasma REST: a novel candidate biomarker of Alzheimer's disease is modified by psychological intervention in an at-risk population.

The repressor element 1-silencing transcription (REST) factor is a key regulator of the aging brain's stress response. It is reduced in conditions of stress and Alzheimer's disease (AD), which suggests that increasing REST may be neuroprotective. REST can be measured peripherally in blood plasma. Our study aimed to (1) examine plasma REST levels in relation to clinical and biological markers of neurodegeneration and (2) alter plasma REST levels through a stress-reduction intervention-mindfulness training. In study 1, REST levels were compared across the following four well-characterized groups: healthy elderly (n=65), mild cognitive impairment who remained stable (stable MCI, n=36), MCI who later converted to dementia (converter MCI, n=29) and AD (n=65) from the AddNeuroMed cohort. REST levels declined with increasing severity of risk and impairment (healthy elderly&gt;stable MCI&gt;converter MCI&gt;AD, F=6.35, P&lt;0.001). REST levels were also positively associated with magnetic resonance imaging-based hippocampal and entorhinal atrophy and other putative blood-based biomarkers of AD (Ps&lt;0.05). In study 2, REST was measured in 81 older adults with psychiatric risk factors for AD before and after a mindfulness-based stress reduction intervention or an education-based placebo intervention. Mindfulness-based training caused an increase in REST compared with the placebo intervention (F=8.57, P=0.006), and increased REST was associated with a reduction in psychiatric symptoms associated with stress and AD risk (Ps&lt;0.02). Our data confirm plasma REST associations with clinical severity and neurodegeneration, and originally, that REST is modifiable by a psychological intervention with clinical benefit

Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey.

OBJECTIVES: Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. DESIGN/SETTING: Secondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects. MAIN OUTCOME MEASURES: Primary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services. RESULTS: Depending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors. CONCLUSIONS: While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would 'cream-skim' by not enrolling patients from vulnerable socio-demographic groups.The study was funded by a grant from the UK Department of Healt

Effector mass and trajectory optimization in the online regulation of goal-directed movement

Goal-directed aiming movements are planned and executed so that they optimize speed, accuracy and energy expenditure. In particular, the primary submovements involved in manual aiming attempts typically undershoot targets in order to avoid costly time and energy overshoot errors. Furthermore, in aiming movements performed over a series of trials, the movement planning process considers the sensory information associated with the most recent aiming attempt. The goal of the current study was to gain further insight into how the sensory consequences associated with the recent and forthcoming aiming attempts impact performance. We first examined whether performers are more conservative in their aiming movements with a heavy, as opposed to a light, stylus by determining whether primary submovements undershot the target to a greater extent in the former due to an anticipated increase in spatial variability. Our results show that movements with the heavy stylus demonstrated greater undershoot biases in the primary submovements, as well as greater trial-to-trial spatial variability at specific trajectory kinematic landmarks. In addition, we also sought to determine whether the sensory information experienced on a previous aiming movement affected movement planning and/or online control on the subsequent aiming attempt. To vary the type sensory consequences experienced on a trial-to-trial basis, participants performed aiming movements with light and heavy styli in either blocked or random orderings of trials. In the random-order conditions, some participants were provided advance information about stylus mass for the upcoming trial, while others were not. The blocked and random trial orders had minimal impacts on end point aiming performance. Furthermore, similarities in the times to key kinematic landmarks in the trajectories of the random-order groups suggest that recent trial experience had a greater effect on the upcoming aiming movement compared with advance task knowledge

Comparing open and minimally invasive surgical procedures for oesophagectomy in the treatment of cancer: the ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) feasibility study and pilot trial

Localised oesophageal cancer can be curatively treated with surgery (oesophagectomy) but the procedure is complex with a risk of complications, negative effects on quality of life and a recovery period of 6-9 months. Minimal-access surgery may accelerate recovery.The ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) study aimed to establish the feasibility of, and methodology for, a definitive trial comparing minimally invasive and open surgery for oesophagectomy. Objectives were to quantify the number of eligible patients in a pilot trial; develop surgical manuals as the basis for quality assurance; standardise pathological processing; establish a method to blind patients to their allocation in the first week post surgery; identify measures of postsurgical outcome of importance to patients and clinicians; and establish the main cost differences between the surgical approaches.Pilot parallel three-arm randomised controlled trial nested within feasibility work.Two UK NHS departments of upper gastrointestinal surgery.Patients aged ≥ 18 years with histopathological evidence of oesophageal or oesophagogastric junctional adenocarcinoma, squamous cell cancer or high-grade dysplasia, referred for oesophagectomy or oesophagectomy following neoadjuvant chemo(radio)therapy.Oesophagectomy, with patients randomised to open surgery, a hybrid open chest and minimally invasive abdomen or totally minimally invasive access.The primary outcome measure for the pilot trial was the number of patients recruited per month, with the main trial considered feasible if at least 2.5 patients per month were recruited.During 21 months of recruitment, 263 patients were assessed for eligibility; of these, 135 (51%) were found to be eligible and 104 (77%) agreed to participate, an average of five patients per month. In total, 41 patients were allocated to open surgery, 43 to the hybrid procedure and 20 to totally minimally invasive surgery. Recruitment is continuing, allowing a seamless transition into the definitive trial. Consequently, the database is unlocked at the time of writing and data presented here are for patients recruited by 31 August 2014. Random allocation achieved a good balance between the arms of the study, which, as a high proportion of patients underwent their allocated surgery (69/79, 87%), ensured a fair comparison between the interventions. Dressing patients with large bandages, covering all possible incisions, was successful in keeping patients blind while pain was assessed during the first week post surgery. Postsurgical length of stay and risk of adverse events were within the typical range for this group of patients, with one death occurring within 30 days among 76 patients. There were good completion rates for the assessment of pain at 6 days post surgery (88%) and of the patient-reported outcomes at 6 weeks post randomisation (74%).Rapid recruitment to the pilot trial and the successful refinement of methodology indicated the feasibility of a definitive trial comparing different approaches to oesophagectomy. Although we have shown a full trial of open compared with minimally invasive oesophagectomy to be feasible, this is necessarily based on our findings from the two clinical centres that we could include in this small preliminary study.Current Controlled Trials ISRCTN59036820.This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 48. See the NIHR Journals Library website for further project information

Salt enhanced solvent relaxation and particle surface area determination via rapid spin-lattice NMR

This paper demonstrates the influence of surface charge chemistry on the application of nuclear magnetic relaxation measurements (NMR relaxometry) for the in situ determination of particle surface area, in the presence of high electrolyte concentration. Specifically, dispersions of titania, calcite and silica with and without 1 M KCl were investigated. The addition of salt, showed no significant change to relaxation measurements for titanium dioxide; however, a significant rate enhancement was observed for both calcite and silica systems. These differences were attributed to counterion layers forming as a result of the particles surface charge, leading to an increase in the relaxation rate of bound surface layer water. Further, changes appeared to be more pronounced in the silica systems, due to their larger charge. No enhancement was observed for titania, which was assumed to be due to the particles being at their isoelectric point, with no resulting counterion layer formation. Solvent relaxation was further used to successfully determine the surface area of particles in a dispersion using a silica standard reference material, with results compared to Brunauer-Emmett-Teller (BET) and spherical equivalent estimations. Two different dispersions of titanium dioxide, of different crystal phases, were shown to have NMR surface area measurements in good agreement with BET. Thus showing the technique was able to measure changes in surface charge when surface chemistry remained relatively similar, due to the reference silica material also being an oxide. In contrast, the NMR technique appeared to overestimate the calcite surface areas in reference to BET, which was assumed to occur due to both better dispersion in the liquid state of nanocrystallites and potential ion enhancement from the solubility of the calcite. These results highlight the potential of this technique as a fast, non-destructive and non-invasive method for dispersion analysis, but also show the competition between surface area and surface chemistry interactions on measured relaxation rates

The Influence of Visual Feedback and Prior Knowledge About Feedback on Vertical Aiming Strategies

Two experiments were conducted to examine time and energy optimization strategies for movements made with and against gravity. In Experiment 1, we manipulated concurrent visual feedback, and knowledge about feedback. When vision was eliminated upon movement initiation, participants exhibited greater undershooting, both with their primary submovement and their final endpoint, than when vision was available. When aiming downward, participants were more likely to terminate their aiming following the primary submovement or complete a lower amplitude corrective submovement. This strategy reduced the frequency of energy-consuming corrections against gravity. In Experiment 2, we eliminated vision of the hand and the target at the end of the movement. This procedure was expected to have its greatest impact under no vision conditions where no visual feedback was available for subsequent planning. As anticipated, direction and concurrent visual feedback had a profound impact on endpoint bias. Participants exhibited pronounced undershooting when aiming downward and without vision. Differences in undershooting between vision and no vision were greater under blocked feedback conditions. When performers were uncertain about the impending feedback, they planned their movements for the worst-case scenario. Thus movement planning considers the variability in execution, and avoids outcomes that require time and energy to correct

Gravitino dark matter in the constrained next-to-minimal supersymmetric standard model with neutralino next-to-lightest superpartner

The viability of a possible cosmological scenario is investigated. The theoretical framework is the constrained next-to-minimal supersymmetric standard model (cNMSSM), with a gravitino playing the role of the lightest supersymmetric particle (LSP) and a neutralino acting as the next-to-lightest supersymmetric particle (NLSP). All the necessary constraints from colliders and cosmology have been taken into account. For gravitino we have considered the two usual production mechanisms, namely out-of equillibrium decay from the NLSP, and scattering processes from the thermal bath. The maximum allowed reheating temperature after inflation, as well as the maximum allowed gravitino mass are determined.Comment: 20 pages, 5 figure

Maximum Likelihood Estimator for Hidden Markov Models in continuous time

The paper studies large sample asymptotic properties of the Maximum Likelihood Estimator (MLE) for the parameter of a continuous time Markov chain, observed in white noise. Using the method of weak convergence of likelihoods due to I.Ibragimov and R.Khasminskii, consistency, asymptotic normality and convergence of moments are established for MLE under certain strong ergodicity conditions of the chain.Comment: Warning: due to a flaw in the publishing process, some of the references in the published version of the article are confuse