Who is sleepier on the night shift? The influence of bio-psycho-social factors on subjective sleepiness of female nurses during the night shift

Sleepiness is a common complaint during the night shift and may impair performance. The current study aims to identify bio-psycho-social factors associated with subjective sleepiness during the night shift. Ninety-two female nurses working rotating shifts completed a sociodemographic questionnaire, the Munich ChronoType Questionaire for shift workers, the Pittsburg Sleep Quality Index, and the Pre-sleep Arousal Scale. Subjective sleepiness was measured hourly during two night shifts using the Karolinska Sleepiness Scale, and activity monitors assessed sleep duration 24-h before each shift. Findings showed that increased sleepiness was associated with increased age in nurses with early chronotypes and with more children. High cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes. The impact of bio-psycho-social factors on night shift sleepiness is complex, and depends on mutual interactions between these factors. Nurses most prone to increased sleepiness must develop personal strategies for maintaining vigilance on the night shift.

Practitioner Summary: This study aims to identify bio-psycho-social factors associated with subjective sleepiness of female nurses during the night shift. Increasing sleepiness was associated with increased age in nurses with early chronotypes and with more children. Increased cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes.     

Sleep and need for recovery in shift workers: do chronotype and age matter?

This study examined associations of chronotype and age with shift-specific assessments of main sleep duration, sleep quality and need for recovery in a cross-sectional study among N = 261 industrial shift workers (96.6% male). Logistic regression analyses were used, adjusted for gender, lifestyle, health, nap behaviour, season of assessment and shift schedule. Shift workers with latest versus earliest chronotype reported a shorter sleep duration (OR 11.68, 95% CI 3.31–41.17) and more awakenings complaints (OR 4.84, 95% CI 4.45–11.92) during morning shift periods. No associations were found between chronotype, sleep and need for recovery during evening and night shift periods. For age, no associations were found with any of the shift-specific outcome measures. The results stress the importance of including the concept of chronotype in shift work research and scheduling beyond the concept of age. Longitudinal research using shift-specific assessments of sleep and need for recovery are needed to confirm these results.

Practitioner Summary: Chronotype seems to better explain individual differences in sleep than age. In view of ageing societies, it might therefore be worthwhile to further examine the application of chronotype for individualised shift work schedules to facilitate healthy and sustainable employment.     

What is the preferred number of consecutive night shifts? results from a crossover intervention study among police officers in Denmark

Among police officers in Denmark, we studied (i) how many consecutive night shifts participants preferred at baseline; (ii) preferences regarding three intervention conditions (two, four, and seven consecutive night shifts followed by the same number of days off/day shifts: ‘2 + 2’, ‘4 + 4’, ‘7 + 7’) at follow-up; (iii) characteristics of participants preferring each of these intervention conditions. Questionnaire data from a crossover intervention study were used (baseline: n = 73; follow-up: n = 68). At baseline, 49% preferred four consecutive night shifts. At follow-up, 57% preferred ‘4 + 4’, 26% preferred ‘2 + 2’ and 26% preferred ‘7 + 7’. Participants, who preferred longer spells of night work experienced that night work was less demanding, found it easier to sleep at different times of the day, and were more frequently evening types compared with participants who preferred shorter spells of night work. The participants’ preferences are likely to be influenced by their previous shift work experience.

Practitioner Summary: We investigated police officers’ preferences regarding the number of consecutive night shifts. The majority preferred four consecutive night shifts. Those who preferred the longer spells of night work found night work less demanding, found it easier to sleep at different times of the day, and were more frequently evening types.     

Fighting fire and fatigue: sleep quantity and quality during multi-day wildfire suppression

This study examined firefighters’ sleep quantity and quality throughout multi-day wildfire suppression, and assessed the impact of sleep location, shift length, shift start time and incident severity on these variables. For 4 weeks, 40 volunteer firefighters’ sleep was assessed using wrist actigraphy. Analyses revealed that the quantity of sleep obtained on fire days was restricted, and pre- and post-sleep fatigue ratings were higher, compared to non-fire days. On fire days, total sleep time was less when: (i) sleep location was in a tent or vehicle, (ii) shifts were greater than 14 h and (iii) shifts started between 05:00 and 06:00 h. This is the first empirical investigation providing objective evidence that firefighters’ sleep is restricted during wildfire suppression. Furthermore, sleep location, shift length and shift start time should be targeted when designing appropriate controls to manage fatigue-related risk and preserve firefighters’ health and safety during wildfire events.

Practitioner Summary: During multi-day wildfire suppression, firefighters’ sleep quantity was restricted, and pre- and post-sleep fatigue ratings were higher, compared to non-fire days. Furthermore, total sleep time was less when: (i) sleep occurred in a tent/vehicle, (ii) shifts were >14 h and (iii) shifts started between 05:00 and 06:00 h.     

Daily impaired detachment and short-term effects of impaired sleep quality on next-day commuting near-accidents – an ambulatory diary study

This study investigated the short-term effects of daily recovery, that is, impaired psychological detachment from work and various actigraphical indicators of sleep quality, on near-accidents when commuting to work the next morning. Furthermore, the mediating effect of actigraphically assessed sleep quality on the relationship between impaired psychological detachment from work and near-accidents when commuting to work was analysed. Fifty-six full-time employees of a Swiss assurance company participated in the one-week study. Multilevel analyses revealed that impaired detachment was highly related to a decrease in sleep duration. Furthermore, impaired daily recovery processes, such as impaired psychological detachment from work and disturbed sleep quality, were related to commuting near-accidents. Impaired sleep quality mediated the effect of impaired psychological detachment from work on these near-accidents. Our results show that occupational safety interventions should address both impaired psychological detachment from work and sleep quality in order to prevent near accidents when commuting to work.

Practitioner Summary: Commuting accidents occur frequently and have detrimental effects on employees, organisations and society. This study shows that daily lack of recovery, that is, impaired psychological detachment and impaired sleep quality, is related to near-accidents when commuting to work the next morning. Primary prevention of commuting accidents should therefore address daily lack of recovery.     

Associations between firefighters’ physical activity across multiple shifts of wildfire suppression

The aim of this study was to examine the associations between firefighters’ physical activity levels across consecutive wildfire suppression shifts and to determine whether sleep duration moderated these associations. Forty volunteer firefighters (31 males, 9 females) wore an activity monitor to concurrently measure physical activity and sleep duration. Sedentary time and time spent in light- (LPA), moderate- (MPA), and vigorous-intensity physical activity (VPA) during each shift were determined using monitor-specific cut points. During any given shift, every additional 60 min spent in LPA was associated with 7.2 min more LPA and 27.6 min MPA the following shift. There were no other significant positive or negative associations. No significant moderating effect of total sleep time was observed. Firefighters are able to maintain and/or increase their physical activity intensity between consecutive shifts. Further research is needed to understand firefighters pacing and energy conservation strategies during emergency wildfire deployments.

Practitioner Summary: To examine associations between firefighters’ physical activity levels across consecutive shifts during a multi-day emergency wildfire and determine whether sleep duration moderated these associations. Firefighters are able to maintain and/or increase their physical activity intensity between consecutive shifts. No significant moderating effect of total sleep time was observed.     

THEORY OF CYBERNETIC AND INTELLIGENT MACHINE BASED ON LIE COMMUTATORS

Many attempts^{1, 7, 8, 35} have been made to overcome the limit imposed by the Turing Machine³⁴ to realise general mathematical functions and models of (physical) phenomena.

They center around the notion of computability.

In this paper we propose a new definition of computability which lays the foundations for a theory of cybernetic and intelligent machines in which the classical limits imposed by discrete algorithmic procedures are offset by the use of continuous operators on unlimited data. This data is supplied to the machine in a totally parallel mode, as a field or wave.

This theory of machines draws its concepts from category theory, Lie algebras, and general systems theory. It permits the incorporation of intelligent control into the design of the machine as a virtual element. The incorporated control can be realized in many (machine) configurations of which we give three:

a) a quantum mechanical realization appropriate to a possible understanding of the quantum computer and other models of the physical microworld,

b) a stochastic realization based on Kolmogorov-Gabor theory leading to a possible understanding of generalised models of the physical or thermodynamic macroworld, and lastly

c) a classical mechanical realization appropriate lo the study of a new class of robots.

Particular applications at a fundamental level are cited in geometry, mathematics, biology, acoustics, aeronautics, quantum mechanics, general relativity and. Markov chains. The proposed theory therefore opens a new way towards understanding the processes that underlie intelligence.     

DISCRETE EVENT-DYNAMIC SYSTEMS FOR MODELING DYNAMIC VALUED NETS

The last few years have seen the development of Discrete Event-Dynamic Net Systems^1,2 as instruments for modeling complex systems. They are able to achieve the following objectives:

—formality of the modeling methodology

—ability to model static and dynamic aspects

—ability to pass between levels of differently rich structures by morphisms

—uniform representation of the communication process as

—an information process

—a decision process and

—a control process

—homogeneity of the representation and modeling methods

—ability to derive qualitative and quantitative statements.

The foundation is provided by a Discrete Event-Dynamic Net System which includes the axiomatic declaration of general Petri nets. In order to calculate the structural and dynamic aspects, so-called Petri net machines are developed. It is shown that this approach can even be used to treat the following aspects:

—use of time during the process

—increase of costs during the generation and transportation of information

—augmentation, evaluation and transformation of information objects.

Recursive formulas are derived and some examples calculated.     

A comfort assessment of existing cervical orthoses

Purpose: Identify location and intensity of discomfort experienced by healthy participants wearing cervical orthoses.

Method: Convenience sample of 34 healthy participants wore Stro II, Philadelphia, Headmaster, and AspenVista^® cervical orthoses for four-hour periods. Participants reported discomfort level (scale 0–6) and location.

Results: Participants reported mean discomfort for all orthoses over the four-hour test between ‘a little discomfort’ and ‘very uncomfortable’ (mean discomfort score = 1.64, SD = 1.50). Seven participants prematurely stopped tests due to pain and six reported maximum discomfort scores. Significant linear increase in discomfort with duration of wear was found for all orthoses. Significantly less discomfort was reported with Stro II than Headmaster and Philadelphia. Age correlated with greater perceived discomfort. Orthoses differed in the location discomfort was experienced.

Conclusion: Existing cervical orthoses cause discomfort influenced by design and duration of wear with orthoses’ design the more significant factor. This work informed the design of a new orthosis and future orthoses developments.

Practitioner Summary: The purpose of this study was to gain greater knowledge about the discomfort caused by wearing of existing neck orthoses in order to inform the design and development of a new neck orthosis. This study gathers empirical data from a surrogate population and concludes that orthosis design is more influential than the duration of wear.     

Fast detection of significantly transformed areas due to illegal waste burial with a procedure applicable to Landsat images

The problem of illegal waste burial is a serious threat to human health and ecosystems. These illegal activities occur most often in areas which have been heavily modified and considered degraded, mainly quarry areas and landfills, even if it is licensed.

To identify the areas where there is suspicion of illegal waste burial, a great amount of time is often necessary. As a matter of fact, the detection of suspicious areas is often based on a comparison of available airborne images with high temporal and spatial resolution, and surveys. This is also done to gather significant aspect of change as deep soil reshuffle in small excavation areas. These methods however, take a long time to be applied because large areas have to be analysed within sub-areas. Consequently, there is loss of understanding related to a wider and complete phenomenon that allows us to have information of all the territory that has undergone heavy transformations, especially if due to illegal conduct of waste disposal. As a result, there are no enough data to strategically evaluate how to counteract such illegal activities.

Since these areas have already been heavily disturbed and subjected to continuous changes over time, one or more detection techniques in a standardized procedure might only be applicable in some contexts. The above method comparison and survey is certainly a useful tool for detecting areas affected by excavation activities or waste illegal disposal. It also provides information where significant transformations have occurred in a short time.

The purpose of this work is the development of a processing procedure with Landsat images applicable to agro-ecosystems that can produce results in heavily transformed areas where suspicion of illegal waste burial is high.     

DEVELOPMENT OF AN AUTOMATIC OBJECT-ORIENTED CONTINUOUS SIMULATION ENVIRONMENT

The construction of automatic control and modelling environments has been attempted using shallow reasoning expert systems. The inadequacy of this approach for real-life systems has become apparent, and the need for deeper knowledge—which can only be obtained by extensive simulation—is now acknowledged.

The simulation process, which consists of model building and model selection, followed by the generation and execution of a software simulator, can be partially automated if an Object-Oriented methodology is adopted. In this article, a methodology is presented, which is presently under investigation in the DESiRE (Dynamic Expert Systems in Robotic Experimentation)project

In the modelling phase, a hierarchical, uniform way of describing and manipulating continuous and discrete models is needed, if the highly desirable reusability of submodels is to be achieved. This is only possible if a clear distinction is made between bare models (and information about their intrinsic coupling) and causal simulation experiment-related data.

In the simulation phase, before generating numerical simulation code, a symbolic reduction of the continuous parts of the model is performed, thus eliminating inaccuracy introduced by the untimely application of possibly unstable numerical algorithms.

Finally, from the reduced representation, executable simulator-objects are produced for use in a distributed environment.     

Body Movement Reduces Pain Intensity in Virtual Reality–Based Analgesia

In this study we investigated the relationship between body movement during virtual reality (VR) analgesia and the experience of pain. Thermal (cold) stimulation was used to inflict pain. Two measures of pain were used—pain tolerance and pain intensity. Participants were wearing head mounted displays (Oculus Rift DK2) and were playing a game created by authors of the study.

Forty-six students of Wroclaw University participated in a within-subject design experiment. Each subject participated in a non-VR control condition and in two experimental conditions. Participants navigated the VR game using a computer mouse, but the mouse sensitivity (and therefore amount of physical movement necessary to navigate) was different in each experimental condition. We also measured feeling of presence in VR, game behavior, and attitudes toward the game.

The amount of body movement while steering the game was related to a decrease in pain intensity, but not in pain tolerance. This was an opposite result to our previously published experiment where we found an effect on pain tolerance but not on sensitivity. There was no significant correlation between presence and any of the pain measures.     

Book reviews

Computer Software: legal protection in the United Kingdom Henry Carr & Richard Arnold, 1992 London: Sweet & Maxwell, 2nd ed, xv + 312 pp., £45.00 (hardback)

Advanced Information Systems for Lawyers V. Mital & L. Johnson, 1992 London: Chapman & Hall. pp. 306, £35.00

Law of Contract Laurence Koffman & Elizabeth MacDonald, 1992 London: Fourmat Publishing, 430 pp., paperback £22.50

The Electronic Media and the Transformation of Law M. Ethan Katsh, 1991 Oxford: Oxford University Press. £13.95     

THE THEORY OF RADIALLY EVOLVING ENERGY

Evolution is a function of energy itself, and all energetic systems, including societies, evolve within the bounds of thermodynamic laws. Non-equilibrium thermodynamics, joined with ecological energetic analysis, will reveal a strong analogy between chemical, biological, social and ecosystem evolution

In the context of energy and evolution, recent self-organization theories are reviewed, synthesized and extended by the Theory of Radially Evolving Energy (TREE). Radial evolution, describing the increasing concentration of energy density in successively emerging systems, is dimensionally distinct from, yet consistent with, Darwinian theory

Human acceleration of a natural feedback between energy consumption and technology threatens the health of our populations and those of other species. This feedback, formation of intergovernmental systems, mortality of social systems, and loss of individual human freedom to governmental control are predicted by the theory of radial evolution. To understand the adaptive compromises that lie ahead, we must learn the natural parameters that drive and bound society's growth.     

Book reviews

Crime and the Computer, Martin Wasik, 1991, Oxford: Clarendon Press. £35.00.

Yearbook of Law, Computers and Technology, Volume 5. K.V. Russell (Ed.), 1991. London: Butterworths. £29.50.

Computers, Artificial Intelligence and the Law. Mervyn E. Bennun (Ed.), 1991. London: Ellis Horwood. xx +132 (including bibliography & index), £26.50

Modelling Legal Argument: reasoning with cases and hypotheticals. Kevin D. Ashley, 1990. Cambridge: MIT Press. 329 pp.     

The Proactive and Preventive Privacy (3P) Framework for IoT Privacy by Design

The Problem

Internet of Things (IoT) is providing new services and insights by sensing contextual data but there are growing concerns of privacy risks from users that need immediate attention.

The Reason

The IoT devices and smart services can capture Personally Identifiable Information (PII) without user knowledge or consent. The IoT technology has not reached the desired level of maturity to standardize security and privacy requirements.

The Solution

IoT Privacy by Design is a user-centric approach for enabling privacy with security and safety as a ‘win-win’ positive outcome of IoT offerings, irrespective of business domain. The Proactive and Preventive Privacy (3P) Framework proposed in this paper should be adopted by the IoT stakeholders for building trust and confidence in end users about IoT devices and smart services.     

Evaluation of Three Tablet Computers at Two Levels of Ambient Illumination

Background: Tablet computers are increasingly widespread in this digital era. During tablet computer use, two important factors are display quality and ambient illumination. The purpose of this experiment was to understand the effects of the display quality of tablet computers (a Sony, a Samsung, and an iPad) and ambient illumination levels (200 lx, 500 lx) on visual fatigue, comfort perception, and task performance.

Methods: Thirty-five university students (17 males and 18 females) were recruited for this experiment. They performed six 40-min trials of playing computer games in all experimental conditions. Visual fatigue, comfort perception, and task performance were collected at the end of each trial.

Results and Discussion: There were no interactions between display model and ambient illumination. Display model had a significant effect on visual fatigue and visual performance, and the best display quality caused less visual fatigue during long periods of viewing. We found no significant effect between 200 lx and 500 lx of ambient illumination on visual fatigue or visual performance; therefore, further research should be conducted to determine what levels of ambient illumination, both high and low, can affect visual fatigue and task performance.     

Sickness presenteeism: measurement and management challenges

Since work can be restorative to health, attending work when unwell should not be viewed as an inherently negative phenomenon. However, the functional benefits are likely to depend on the health condition, and the psychosocial quality of the work provided. The current study used a workforce survey to explore differences in the pattern of presenteeism and absenteeism by health condition, the association of psychosocial work factors with presenteeism compared to absenteeism, and their interaction to predict health. Findings indicate that instead of substituting absenteeism for presenteeism, the two tend to coincide, but the balance differs by health condition. Presenteeism is more likely to occur in poorer psychosocial environments, reinforcing the importance of ensuring work is designed and managed in ways that are beneficial rather than detrimental to health. The findings also highlight the methodological importance of differentiating between the act and impact of presenteeism in future research and practice.

Practitioner Summary: Effective management of work-related health requires that practitioners manage both sickness absence and presence together, since employees tend to fluctuate between the two when unwell. Interventions should be tailored to the specific health concern, paying particular attention to the psychosocial environment in enabling employees to continue working without exacerbating health.     

Push Notifications in Diet Apps: Influencing Engagement Times and Tasks

Background: Smartphones have reached levels of popularity and penetration where they are now suitable for use in population health interventions. A key feature of smartphones is push notification or in app messaging service, which can be used to alert users to messages or instructions pertaining to an installed app. Little evidence exists as to the persuasive power of these messages.

Method: We conducted a 24-week live user evaluation of push notifications used in a behavior-based mobile app for a meal replacement program to understand the role of push notifications in persuading users to engage with self-monitoring tasks.

Results: User perception of the prompts were verified through questionnaires, which in conjunction with the interaction logs show that users were tolerant of multiple daily prompts. The decline in compliance to the tasks set, however, shows that while the participants did not object to receiving prompts, they were less likely to respond to them as the study progressed.

Conclusions: Push notifications and user tasks are appropriate mechanisms to engage users with mobile technology in the short term.     

Fighter pilots’ heart rate,heart rate variation and performance during instrument approaches

Fighter pilots’ heart rate (HR), heart rate variation (HRV) and performance during instrument approaches were examined. The subjects were required to fly instrument approaches in a high-fidelity simulator under various levels of task demand. The task demand was manipulated by increasing the load on the subjects by reducing the range at which they commenced the approach. HR and the time domain components of HRV were used as measures of pilot mental workload (PMWL). The findings of this study indicate that HR and HRV are sensitive to varying task demands. HR and HRV were able to distinguish the level of PMWL after which the subjects were no longer able to cope with the increasing task demands and their instrument landing system performance fell to a sub-standard level. The major finding was the HR/HRV’s ability to differentiate the sub-standard performance approaches from the high-performance approaches.

Practitioner Summary:

This paper examined if HR and HRV were sensitive to varying task demands in a fighter aviation environment and if these measures were related to variations in pilot’s performance.