Some aspects of psychophysiological support of crewmember's performance reliability in space flight

Crewmembers play an important role in ensuring the efficiency of "crew-spacecraft" system. However, despite of the fact that crewmembers are well trained and highly motivated persons, extreme flight factors may influence negatively on their reliability, and lead to human error occurrence. Therefore, working out methods of human error prevention is very significant to increase crewmember's performance reliability. Human error can occur in the operation of systems for a number of reasons. Within the framework of the present investigation, with use the data collected during "Mir" station missions, the significant (p<0.05) positive correlation of crewmembers errors (CE) frequency with their psychophysiological state (PPS), and work and rest schedule (WRS) intensity has been revealed. Differently, the higher WRS intensity, the crewmember's PPS is worse, and CE frequency is higher. This finding has been based on substantiations of the approach to human reliability management. Its essence will consist of the following: reducing WRS intensity, we thus can improve a crewmember's PPS and, accordingly, reduce CE frequency. This approach is discussed in the paper.

Should surgeons take a break after an intraoperative death? Attitude survey and outcome evaluation

OBJECTIVES

To investigate attitudes of cardiac surgeons and anaesthetists towards working immediately after an intraoperative death and to establish whether an intraoperative death affects the outcome of subsequent surgery.

DESIGN

Questionnaire on attitudes to working after an intraoperative death and matched cohort study.

SETTING

UK adult cardiac surgery centres and regional cardiothoracic surgical centre.

PARTICIPANTS

371 consultant cardiac surgeons and anaesthetists in the United Kingdom were asked to complete a questionnaire, and seven surgeons from one centre who continued to operate after intraoperative death.

MAIN OUTCOME MEASURES

Outcome for 233 patients operated on by a surgeon who had experienced an intraoperative death within the preceding 48 hours compared with outcome of 932 matched controls. Hospital mortality and length of stay as a surrogate for hospital morbidity.

RESULTS

The questionnaire response rate was 76%. Around a quarter of surgeons and anaesthetists thought they should stop work after an intraoperative death and most wanted guidelines on this subject. Overall, there was no increased mortality in patients operated on in the 48 hours after an intraoperative death. However, mortality was higher if the preceding intraoperative death was in an emergency or high risk case. Survivors operated on within 48 hours after an intraoperative death had longer stay in intensive care (odds ratio 1.64, 95% confidence interval 1.08 to 2.52, P = 0.02) and longer stay in hospital (relative change 1.15, 1.03 to 1.24, P = 0.02).

CONCLUSION

Mortality is not increased in operations performed in the immediate aftermath of an intraoperative death, but survivors have longer stays in intensive care and on the hospital ward.

A relation between rest and the self in the brain?

Neuroimaging techniques such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) are widely used to identify the cerebral correlates of cognitive tasks. The resting state presents the advantage to serve as a reference in all experiments but is also an ill-defined mental state because it may vary both from one subject to another and within the same subject. The most challenging question concerns the areas whose activity (revealed by PET or fMRI imaging) is greater in rest state than in an active condition. The present work reports the result of a meta-analysis including five previously published studies. The five different tasks involved are the following: attribution of intention, judgement of stimulus pleasantness, discrimination of spatial attributes, judgement of other peoples' belief and perception of gaze. For each study, the general linear model was used to assess statistical difference and a contrast resting state minus other conditions was calculated. The intersection of the five contrasts was used to search for the variation jointly observed across the different experiments. This lead to a reduced number of clusters: one cluster in the lower/anterior part of the cingulate gyrus and four clusters located in the medial/superior frontal gyrus, along the superior frontal sulcus. We discuss the location of these areas with respect to the location of activations induced by different tasks: externally focused attention, memory, general reasoning, theory of mind and self-referential tasks. We observed that medial prefrontal cortex exhibits a lower activity when the subject's attention is focused towards the external world than when the subject has to additionally refer to some internal states. By contrast, this activity is greater during resting state than during both externally directed and internally directed attention. Thus, we hypothesize that during rest, the subject is in a state where he refers only to his own self.

Effects of cycling exercise on the soleus H-reflex and state anxiety among men with low or high trait anxiety

The present study examined the effects of low- and high-intensity cycling exercise on the H-reflex and state anxiety among men having low (n=20) or high (n=20) trait anxiety. Participants completed measures of state anxiety and underwent elicitation and recording of the H-reflex in the soleus muscle before and 10 min after three 20-min conditions: (1) quiet rest, (2) cycling at 40% VO2peak, and (3) cycling at 70% VO2peak. We found that (1) exercise, but not quiet rest, resulted in a reduction of the H-reflex; the magnitude of the reduction did not differ between men having low or high trait anxiety; (2) exercise and quiet rest resulted in similar reductions of state anxiety, and the magnitude of the reductions was larger for men having high trait anxiety than low trait anxiety; and (3) reductions of the H-reflex were unrelated to reductions of self-reported state anxiety across all three conditions. Contrary to prior opinion, the postexercise reduction in the H-reflex reported by previous researchers and in the present study appears to be unrelated to self-reported anxiety after exercise.

[Psychological stress and musculoskeletal disorders: psychobiological mechanisms. Lack of rest and recovery greater problem than workload]

Psychosocial stress is assumed to contribute to musculoskeletal disorders, particularly neck and shoulder pain. Experimental studies show that mental stress induces a significant increase in muscle tension in the trapezius muscle and several explanatory models have been proposed in order to understand the mechanisms linking low sustained muscle tension to musculoskeletal disorders. Recently, it has been demonstrated that the same motor units are activated by mental stress as by physical demands, which means that mental stress may keep low threshold motor units active also during breaks at work and off the job. In the modern society, lack of rest and recovery seems even more important for health than the magnitude of stress and physical demands during work.

rCBF differences between panic disorder patients and control subjects during anticipatory anxiety and rest

BACKGROUND

Our goal was to identify brain structures involved in anticipatory anxiety in panic disorder (PD) patients compared to control subjects.

METHODS

Seventeen PD patients and 21 healthy control subjects were studied with H(2)(15)O positron emission tomography scan, before and after a pentagastrin challenge.

RESULTS

During anticipatory anxiety we found hypoactivity in the precentral gyrus, the inferior frontal gyrus, the right amygdala, and the anterior insula in PD patients compared to control subjects. Hyperactivity in patients compared to control subjects was observed in the parahippocampal gyrus, the superior temporal lobe, the hypothalamus, the anterior cingulate gyrus, and the midbrain. After the challenge, the patients showed decreases compared to the control subjects in the precentral gyrus, the inferior frontal gyrus, and the anterior insula. Regions of increased activity in the patients compared to the control subjects were the parahippocampal gyrus, the superior temporal lobe, the anterior cingulate gyrus, and the midbrain.

CONCLUSIONS

The pattern of regional cerebral blood flow activations and deactivations we observed both before and after the pentagastrin challenge was the same, although different in intensity. During anticipatory anxiety more voxels were (de)activated than during rest after the challenge.

What mothers want: a postnatal survey

Mothers in the public health care system undergo mandatory early discharge after childbirth. The challenges associated with the decreasing length of hospital stay have rarely been investigated from a service consumer perspective. The aim of this study was to identify mothers' needs in the immediate postpartum period. An inpatient survey of 500 postnatal mothers undertaking the Early Discharge Program. Survey questions aimed to elicit the needs of mothers in the immediate postnatal period; perceived barriers to optimal care; and suggestions as to how these barriers could be addressed. Forms were distributed to all women on admission to a postnatal ward over a two month period and completed prior to discharge. Of 500 eligible mothers, 151 (30.2%) responded to the anonymous open ended survey. A thematic analysis of comments revealed that women wanted specific information about mothering, the creation of a restful environment, adequate pain relief, practical assistance, education, and set visiting times. For new mothers, early discharge made the need for rest and information a high priority. Constraints within the public health care system and midwifery practice need to be examined to better serve mothers' needs. Midwifery practice within the context of early postpartum discharge should seek to better serve new mothers by giving high priority for rest and information requirements.

Innovative working schedule: introducing one short nap during the night shift

In order to test the possible long-term effects of the implementation of a short nap during night shifts, an experiment was conducted over a period of 1 year with 12 volunteer shiftworkers operating in an industrial plant. They were authorized, under certain conditions, to use individual sleeping areas, for a maximum of 1 hour, between 23h30 and 3h30. The participants were asked to fill in a short questionnaire every day during the entire study. The questions concerned the schedule of the main sleep period, the afternoon nap and the night-time nap, if any, as well as the evaluation of mood and the quality of work. This daily questionnaire was supplemented by an extensive questionnaire applied every 2 months in order to assess the main changes introduced in the life of the participants by this new working schedule. Results showed that this new organization introduced a general satisfaction about the quality and the easiness of the work at night. The vigilance level was considered to be higher during the hours following the nap. The efficacy of the nap time progressively increased for most subjects. The general quality of life improved for most subjects. While a few of them considered that falling asleep was less easy on the following morning at home, the statistical analysis did not show any detrimental effect of the short rest period on the length of the immediately consecutive main sleep period. However, different statistical analyses allow us to reveal significant differences between the main sleep durations following the night shift compared with those following both the afternoon shift and the resting period. The main sleep duration following the night shift was not statistically different from that of the morning shift. These results are very encouraging. A short nap during the night shift can be considered as a positive way to counteract the low level of vigilance that normally occurs during the late part of the night.

Work and rest planning as a way of crew member error management

Human error prevention is very important to support the safety and efficiency of human-machine systems. The approach to space crew member management error is considered in this paper. The data collected during 14 "Mir" station missions were analyzed to substantiate this approach. As a result of data processing, the significant (p<0.05) correlation of crew member errors with work and rest schedule tensity has been revealed. This finding was used to work out the mathematical model describing the dependence between the frequency (the probability) of crew member errors and work and rest schedule tensity. Based on the model, the algorithm of error management by means of efficient planning of crew members' work has been developed. The suggested approach may be used equally with other methods to raise the reliability of human-operator performance. Grant numbers: NAS-15-10110.

Coping, pain, and disability in osteoarthritis: a longitudinal study

OBJECTIVE

To establish the role of coping styles as prospective determinants of pain and disability in patients with osteoarthritis (OA) of the knee or hip.

METHODS

Data from 71 patients with OA of the hip and 119 patients with OA of the knee were used. Using regression analysis, relationships were established between the use of active and passive coping styles and the level of pain and disability 36 weeks later.

RESULTS

In patients with knee OA, the passive coping style of resting was found to predict a higher level of disability 36 weeks later after controlling for the baseline level of disability. In the same manner in patients with knee OA, the active coping style of transforming pain was found to predict higher levels of pain 36 weeks later. In patients with hip OA, no significant relationship between coping styles and pain and disability was found.

CONCLUSION

The role of resting as a prospective determinant of disability, as reported in patients with other chronic disorders, could also be established for knee OA, but not hip OA. Transforming pain was found to be a risk factor for pain in knee OA.

The perception of available social support is related to reduced cardiovascular reactivity in Phase II cardiac rehabilitation patients

OBJECTIVE

Numerous studies have observed a relationship between social support (SS) and post coronary event survival. Laboratory research suggests one mechanism regulating this relationship may be exaggerated cardiovascular reactivity (CVR). What has not been as well explored is (1) whether the SS-CVR relationship holds up for a heart diseased sample, and (2) whether this relationship is evidenced only in supportive environments or can be found as a function of generalized perception of being socially supported. Thus, the purpose of this study was to examine the relationship of perceived SS and a locally supportive presence to CVR to a speech-induced stressor in post coronary event patients.

METHOD

Forty-one Phase II cardiac rehabilitation patients participated in a research protocol that consisted of BP and HR measurement during two identical affective stress interviews where local support was systematically varied by presence or absence of a friendly small pet dog. Perception of SS was assessed by completion of psychosocial questionnaire packet that included measures of SS, anger expression and pet attachment.

RESULTS

Repeated measures ANCOVAs revealed that patients who believed they had greater SS available to them during difficult times exhibited significantly less CVR for MAP (p<.007) and DBP (p<.024). No significant main effects for local support (pet presence) and no interactions between local and perceived support were found.

CONCLUSIONS

These findings are of interest as they: (a) demonstrate an association between reduced CVR and higher (amounts of) SS in a clinical sample; (b) demonstrate this effect in a sample medicated to dampen CV levels and surges; (c) suggest that perceived amount of SS provides an ameliorative influence on CVR independent of situational support; (d) suggest that for certain conditions pet-models of support may be ineffective at establishing an local support presence.

Transcutaneous electrical nerve stimulation (TENS) improves the rest-activity rhythm in midstage Alzheimer's disease

Nightly restlessness in patients with Alzheimer's disease (AD) is probably due to a disorder of circadian rhythms. Transcutaneous electrical nerve stimulation (TENS) was previously reported to increase the strength of coupling of the circadian rest activity rhythm to Zeitgebers in early stage Alzheimer's disease (AD) patients. It was investigated in the present study whether TENS could also improve the rest activity rhythm of patients in a midstage. Sixteen patients who met the NINCDS ADRDA criteria for probable AD, and the stage 6 criteria of the Global Deterioration Scale were treated with TENS or placebo. Rest activity rhythm was assessed using actigraphy. Compared to the control group, stimulated patients showed an improvement in the rest activity rhythm of similar magnitude as observed previously in patients in an early stage. It is concluded that TENS increased the coupling between the rest activity rhythm and supposedly stable Zeitgebers in an advanced stage of AD.

The effects of a 20-min nap at noon on sleepiness, performance and EEG activity

The prophylactic effects of a 20-min nap at noon on afternoon sleepiness were studied. Ten young adults who had normal sleep-wake habits without habitual daytime napping were subjected to nap and no-nap conditions at an interval of 1 week. After a nocturnal sleep recording (00.00-08.00 h), their EEG recordings during relaxed wakefulness, mood, performance, and self-ratings of performance level were measured every 20 min from 10.00 h to 18.00 h. For the nap condition, they went to bed at 12.20 h and were awakened when 20 min had elapsed from the onset of sleep stage 1. For the no-nap condition, they rested without sleeping by sitting on a semi-reclining chair. The nap did not improve task performance, however, it improved volition and the self-rating of task performance. It also suppressed subjective sleepiness and attenuated eyes-opened EEG alpha activities. The results suggest that a 20-min nap at noon had partial positive effects on the maintenance of the daytime arousal level.

Affective responses of physically active and sedentary individuals during and after moderate aerobic exercise

BACKGROUND

This study examined the effects of aerobic fitness and exercise history on self-reported affect during and after acute aerobic exercise and quite reading.

METHODS

Active and sedentary participants (N = 41) reported their psychological affect during two separate conditions in a counterbalanced design: (1) exercise on a cycle ergometer at 50% predicted VO2 max, and (2) quiet reading in a reclining chair. Affect was assessed prior to, every 3 minutes during, and at 5 and 20 minutes after each 24-minute exercise and reading period.

RESULTS

Analysis revealed that active participants were significantly more positive than the sedentary group during exercise and at 5 minutes postexercise. The groups were similar in affect at 20 minutes postexercise. No between-group differences were found during the reading condition. Exercise enhanced affect compared to reading only for the active group. In addition, the affective responses of both groups were influenced by pre-exercise affect, with the greatest increases observed for those reporting the lowest affect before activity.

CONCLUSIONS

These results suggest that affective responses during and after aerobic exercise were influenced by exercise history and aerobic fitness, but moderated by pre-activity scores.

Effects of decreasing sedentary behaviors on activity choice in obese children

In this study, methods of decreasing highly preferred sedentary behaviors were compared and the consequent effects on activity choice were examined. Following free choice of sedentary and physical activities, 34 obese children either were positively reinforced for decreases in high-preference sedentary activity, were punished for high-preference sedentary activity, had access to high-preference sedentary activity restricted, or had no contingencies on activity (control group). Children randomized to reinforcement and punishment were more physically active on intervention days than the control group. Liking for targeted sedentary activity decreased in the reinforcement group, but increased in the restriction and control groups. Results suggest that reinforcing decreases in high-preference sedentary activity can increase physical activity and decrease liking for targeted sedentary activities.

Responses to activation and rest in patients with panic disorder and major depression

Physical activity may be a trigger for panic attacks in patients with panic disorder, while exercise may have an antidepressant effect in patients with major depression. In order to examine reactions to rest as well as to exercise periods, we assessed physiological responses (heart rate, blood pressure), subjective responses on a visual analogue scale, and attentional responses with the span of apprehension test. Twenty participants met the diagnostic criteria for panic disorder, 20 patients had major depression, and 20 participants served as controls. Patients with major depression showed slower reaction times than participants in the other groups; this difference was more pronounced with increased task difficulty. Physical activation led to lower depression scores in all groups. Patients with panic disorder had elevated anxiety scores after physical activation, but also after rest. Heart rate as well as systolic blood pressure showed the expected acceleration after physical activation, but there were no differences between the groups. Activation did not seem to influence attentional performance as measured by the span of apprehension test. Results are consistent with a cognitive view of panic disorder. In contrast to patients with panic disorder, patients with major depression seem to have an attentional deficit which is more pronounced with more complex cognitive processing.

Physiological and psychological effects of head heating during rest and work

The purpose of this study is to obtain some knowledge related to physiological and psychological effects of head heating by radiation on the vital body under varying conditions of the environmental temperature and physical activity. The study was proceeded with experiments 1 and 2 using 8 women, all in good health as subjects. In experiment 1, firstly the subject at rest was kept at an ambient temperature of 28 degrees C for 40 minutes. The, moving to a room kept at an ambient temperature of 18 degrees C or 28 degrees C, the state at rest was maintained with head heating at 3 radiant intensities (without radiation, 35 degrees C and 40 degrees C of globe temperature) for a further 40 minutes. In experiment 2, continued from the same procedure of experiment 1, work on the ergometer was performed for 30 minutes with head heating at 2 radiant intensities (without radiation and 35 degrees C of globe temperature). Items measured were tympanic temperature, skin temperatures, heart rate, and subjective sensations. The principal results obtained are as follows: 1) Tympanic temperature, forehead skin temperature and score of thermal sensation of head increased, while the others decreased at 18 degrees C. 2) Decrease of scores was inhibited by head heating in finger skin temperature, toe skin temperature and heart rate. 3) When radiant intensities at 35 degrees C and 40 degrees C were compared, statistical significant difference was noted in forehead skin temperature only, the difference of radiant conditions gives a little effect to the vital body. 4) Effects brought by head heating during rest decreased owing to the addition of work.

Rest

Rest has been examined only sporadically in the nursing literature, primarily as a physiological need closely related to sleep. The article describes the concept of rest from a variety of perspectives and lays the foundation for further analysis. Themes of physical, mental, and spiritual components of rest emerge as the concept is explored. Further analysis of the concept of rest in both health and illness is recommended. Exploration of the individual patient's perception of rest and restful activities seems to be a key to promoting and prescribing rest as a nursing intervention.

Resistance exercise decreases beta-endorphin immunoreactivity

Previous research investigating the response of plasma beta-endorphins (beta-EP) to resistance exercise has resulted in equivocal findings. To examine further the effects of resistance exercise on beta-EP immunoreactivity, 10 male and 10 female college-age students participated in a series of controlled isotonic resistance exercises. The session consisted of three sets of eight repetitions at 80% of one repetition maximum (1-RM) for each of the following exercises: (1) bench press; (2) lateral pull-downs; (3) seated arm curls; and (4) military press. Blood plasma was sampled both before and after the lifting routine and beta-endorphin levels were determined by radioimmunoassay. A Students t test for paired samples indicated that mean(s.e.) plasma beta-endorphin levels after exercise (10.5(1.3) pg beta-EP ml-1) were significantly decreased as compared with pre-exercise (control) levels (16.5(1.2), P < 0.05). While the mechanism(s) contributing to the decrease in immunoreactivity is unclear, it may be the result of the synergistic effect of beta-EP clearance during rest intervals and changes in psychological states between sampling.

Subjective and cardiovascular responses to nicotine combined with caffeine during rest and casual activity

Although nicotine and caffeine have separately been shown to acutely increase subjective arousal, their combined effects are unclear. Furthermore, their effects during casual physical activity, the condition under which individuals usually experience nicotine and caffeine, are unknown. Smokers who were regular coffee drinkers (n = 19, 9 males, 10 females) participated in eight morning sessions, involving nicotine/placebo, caffeine/no caffeine, and rest/physical activity (i.e. 2 x 2 x 2 within-subjects design). Nicotine (15 micrograms/kg) or placebo was given via measured-dose nasal spray intermittently after consumption of decaf coffee with or without added caffeine (5 mg/kg), followed by subjective [Profile of Mood States (POMS), Stress-Arousal Checklist, visual analog scales] and cardiovascular (heart rate, blood pressure) measures. Casual physical activity was standardized by low-intensity bicycle riding while sitting comfortably. Results indicated significant subjective and cardiovascular effects of nicotine and caffeine individually, with the combination of nicotine and caffeine generally producing additive or greater than additive effects for each measure. However, activity mediated some of the subjective effects of nicotine, as nicotine appeared to be "stimulating" during rest but not during activity. There were no differences between males and females. These findings suggest that nicotine per se and caffeine generally have additive subjective and cardiovascular effects, and that nicotine may influence subjective stimulation differentially depending on whether a smoker is resting or engaged in casual activity.

The influence of exercise/rest schedule on the physiological and psychophysical response to isometric shoulder-neck exercise

Six female subjects, aged 24-34 years, performed shoulder-neck exercise for 1 h or until they were exhausted by holding out their arms horizontally at 60 degrees to the sagittal plane. One continuous and six intermittent protocols were applied, all with a mean load corresponding to the torque of the arms, i.e. about 15% maximal voluntary contraction (MVC). The intermittent protocols varied according to cycle time (10 s, 60 s, 360 s) and duty cycle (0.33, 0.50, 0.67, 0.83). Electromyogram (EMG), mean arterial blood pressure (BPa), heart rate (fc) and perceived fatigue were monitored at regular intervals during exercise. Blood concentrations of potassium, lactate and ammonia were determined in pre- and postexercise samples of venous blood. Before and up to 4 h after exercise, measurements were made of MVC, pressure pain threshold, proprioceptive performance, and of EMG, BPa and fc during 1-min arm-holding at 25% MVC. Endurance times ranged from about 10 min to more than 1 h, significantly relating to both cycle time and duty cycle. The BPa, fc, EMG amplitude and perceived fatigue increased early during all protocols and continued to increase throughout the exercise period. Duty cycle influenced all of these variables, while only BPa and fatigue perception were related to cycle time. Cardiovascular and neuromuscular recovery was incomplete for hours after several of the protocols, as indicated for example by a sensitized response to the 1-min arm-holding. The protocols differed substantially as regards the relationship between different responses. Thus, ranking of the protocols in terms of physiological strain was different, depending on the criterion variable. The result stresses the relevance of applying a comprehensive selection of variables when evaluating the responses to intermittent shoulder-neck exercise.