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  1. Physical Restraint in School

    ERIC Educational Resources Information Center

    Ryan, Joseph B.; Peterson, Reece L.

    2004-01-01

    The current emphasis on educating children in the least restrictive environment has resulted in the use of physical restraint procedures across all educational placement settings, including public schools. Since its initial use, restraint has been controversial. Professionals who use physical restraint claim that it is necessary to safely manage…

  2. [Physical restraint and procedure].

    PubMed

    Van de Vyvere, A; Dumont, C

    2013-09-01

    The widespread practice of physical restraint of the elderly has used in most case in order to protect elders against injuries after falls or to manage behaviour agitation during delirium for example. However, "protect" isn't correct because of the adverse effects have been reported as falls increase, pressures sores, depression, aggression and death. In fact, efficacy of restraints for safeguarding patients from injury has not been demonstrated clinically. This paper reviews the current medico-legal knowledge regarding physical restraint use in this frail population and suggests some considerations about ethical practice and procedure evaluation.

  3. The Physical Restraint Controversy.

    ERIC Educational Resources Information Center

    Mullen, Joseph K.

    2000-01-01

    Professional and government committees are examining use of physical restraints with troubled youth as a result of reports of problems with its use. Examples of what is being done to improve practice standards in area of crisis intervention include limiting how often restrictive procedures can be use; stating the technique must never negatively…

  4. The Physical Restraint Controversy.

    ERIC Educational Resources Information Center

    Mullen, Joseph K.

    2000-01-01

    Professional and government committees are examining use of physical restraints with troubled youth as a result of reports of problems with its use. Examples of what is being done to improve practice standards in area of crisis intervention include limiting how often restrictive procedures can be use; stating the technique must never negatively…

  5. Social Behavior and Physical Restraints.

    ERIC Educational Resources Information Center

    Folmar, Steven; Wilson, Holly

    1989-01-01

    Examined whether physical restraints are related to decreased social behavior among nursing home residents. Data collected from 112 nursing home residents suggest that low social performance puts resident at risk of being restrained, but more frequently use of restraint hampers resident's performance of social behavior. (Author/NB)

  6. Deaths due to physical restraint.

    PubMed

    Berzlanovich, Andrea M; Schöpfer, Jutta; Keil, Wolfgang

    2012-01-01

    Physical restraint is used primarily for patients at risk of falling, those with motor unrest and agitated behavior, and those who manifest an intention of doing harm to themselves or are at risk of suicide. The use of freedom-restraining measures (FRM), and, in particular, the use of physical restraints against the patient's will, can be a serious intrusion of basic human rights and, as such, an act of violence against the patient. The improper use of physical restraints can cause injuries of varying severity, which can sometimes be fatal. We analyzed all cases of death under physical restraint that were recorded in the autopsy reports of the Institute of Forensic Medicine in Munich from 1997 to 2010. Among the 27 353 autopsies conducted over the period of the study, there were 26 cases of death while the individual was physically restrained. Three of these cases involved patients who died of natural causes while restrained, and one was a suicide. The remaining 22 deaths were caused solely by physical restraint; all of them occurred in patients under nursing care who were not continuously observed. The immediate cause of death was strangulation (11 cases), chest compression (8 cases), or dangling in the head-down position (3 cases). In 19 of these 22 patients, the restraints were incorrectly fastened, including two cases in which improvised non-standard restraints were used. One nursing-home patient died because of an abdominal restraint even though it had been correctly applied: She was mobile enough to slip through the restraint till it compressed her neck, and then unable to extricate herself from it, so that she died of strangulation. To prevent such deaths, we recommend from a forensic medical standpoint that all possible alternatives to FRM should be used instead. If direct-contact restraints are truly necessary, they must be applied as recommended and the restrained person must be closely observed.

  7. Physical Restraint Initiation in Nursing Homes and Subsequent Resident Health

    ERIC Educational Resources Information Center

    Engberg, John; Castle, Nicholas G.; McCaffrey, Daniel

    2008-01-01

    Purpose: It is widely believed that physical restraint use causes mental and physical health decline in nursing home residents. Yet few studies exist showing an association between restraint initiation and health decline. In this research, we examined whether physical restraint initiation is associated with subsequent lower physical or mental…

  8. Physical Restraint Initiation in Nursing Homes and Subsequent Resident Health

    ERIC Educational Resources Information Center

    Engberg, John; Castle, Nicholas G.; McCaffrey, Daniel

    2008-01-01

    Purpose: It is widely believed that physical restraint use causes mental and physical health decline in nursing home residents. Yet few studies exist showing an association between restraint initiation and health decline. In this research, we examined whether physical restraint initiation is associated with subsequent lower physical or mental…

  9. Physical restraint in healthcare settings.

    PubMed

    Haidrani, Layla

    2017-03-30

    Essential facts In January, new guidance was drawn up for police and healthcare professionals, outlining for the first time how and when police officers should be involved in physically restraining people in healthcare settings in England and Wales.

  10. Physical Restraint in Critical Care Settings: Will They Go Away?

    PubMed Central

    Mion, Lorraine C.

    2015-01-01

    The critical care setting is perhaps the last major health care setting in which physical restraint remains a common, and oftentimes unquestioned, practice. This is despite the numerous regulations and accrediting standards that have limited or even eliminated practitioners’ use of physical restraints in other health care settings. The decision to use physical restraint in the care of critically ill patients can be complex and is influenced by characteristics of the patient, the practitioner, and the environment. What do we know about physical restraint practice in critical care settings, and what steps must we take if we are, indeed, to become “restraint-free” environments? PMID:19064141

  11. The Effects of Physical Restraint on Self-Injurious Behaviour.

    ERIC Educational Resources Information Center

    Singh, N. N.; And Others

    1981-01-01

    Two experiments investigated the effects of two durations (1 and 3 minutes) of physical restraint on the rate of self injurious behavior (SIB) of a profoundly retarded adolescent girl. In both experiments one minute restraint was found to be more effective than three minute restraint in reducing the rate of SIB. (Author/SB)

  12. Physical restraint usage at a teaching hospital: a pilot study.

    PubMed

    Barton-Gooden, Antoinette; Dawkins, Pauline E; Bennett, Joanna

    2015-02-01

    This mixed method study examines the prevalence of restraint usage; perception of nurses and doctors about the practice and whether they were trained to apply physical restraints. The physical restraint prevalence tools were used to observe 172 adult patients and conduct 47 chart audits in the medical-surgical wards and a psychiatric unit in November 2011. Focus group discussions with nurses and doctors were conducted. Quantitative data were analyzed using the SPSS and focus group discussions thematically analyzed. The prevalence of physical restraints between the medical-surgical wards was 75%. Nurses and medical doctors were not formally trained to apply restraint, and had learnt from peer observation. They expressed sadness, guilt, and fear when restraints are used and identified that inadequate institutional support existed. Restraint usage was high, and nurses and doctors experienced moral dilemma when they perceived that lack of formal training and inadequate institutional support may contribute to patient injury.

  13. Physical restraints practice in adult intensive care units in Egypt.

    PubMed

    Kandeel, Nahed Attia; Attia, Amal Kadry

    2013-03-01

    Physical restraints are commonly used in intensive care units to reduce the risk of injury and ensure patient safety. However, there is still controversy regarding the practice of physical restraints in such units. The purpose of this study was to investigate the practices of physical restraints among critical care nurses in El-Mansoura City, Egypt. The study involved a convenience sample of 275 critically ill adult patients, and 153 nurses. Data were collected from 11 intensive care units using a "physical restraint observation form" and a "structured questionnaire." The results revealed that physical restraint was commonly used to ensure patient safety. Assessment of physical restraint was mainly restricted to peripheral circulation. The most commonly reported physically restrained site complications included: redness, bruising, swelling, and edema. The results illustrated a lack of documentation on physical restraint and a lack of education of patients and their families about the rationale of physical restraint usage. The study shed light on the need for standard guidelines and policies for physical restraint practices in Egyptian intensive care units.

  14. Nurses' perceptions and practice of physical restraint in China.

    PubMed

    Jiang, Hui; Li, Chen; Gu, Yan; He, Yanan

    2015-09-01

    There is controversy concerning the use of physical restraint. Despite this controversy, some nurses still consider the application of physical restraint unavoidable for some of their clients. Identify the perceptions and practice of physical restraint in China. This was a descriptive study that combined qualitative interviews with a quantitative cross-sectional survey. A total of 18 nurses were interviewed and 330 nurses were surveyed. Approval of the study was obtained from the hospital ethics committee. Permission to conduct the study was obtained from the director of nursing. Participants were assured that their participation is voluntary. Physical restraint was commonly used to protect patients' safety. Naturally, intensive care unit nurses used physical restraint much more frequently than general medical/surgical ward nurses (p < 0.01). In addition, night shift nurses tended to use physical restraint more frequently. Nursing managers should be aware of the role nurses play in the use of physical restraint. In-service training regarding the proper use of physical restraint should be strengthened and nurse staffing levels should be improved in order to minimize the use of physical restraint in China. © The Author(s) 2014.

  15. Psychiatric Nurses’ Perceptions about Physical Restraint; A Qualitative Study

    PubMed Central

    Fereidooni Moghadam, Malek; Fallahi Khoshknab, Masoud; Pazargadi, Mehrnoosh

    2014-01-01

    Background: The use of physical restraint as an intervention in the care of psychiatric patients dates back to the beginning of psychiatry. Although it is a challenging question, it is still one of the common procedures in psychiatry. Considering that very little research has been done in Iran in relation to physical restraint, this qualitative study aimed to investigate the experiences of  nurses working in psychiatric wards regarding physical restraint. Methods: This qualitative study was done on 14 nurses working in the psychiatric hospitals of Ahvaz city, southern Iran, during 2011-2012. The participants were selected by purposive sampling. Semi-structured interviews were used for data collection, which were continued until data saturation and emergence of themes. Inductive content analysis was used to analyze the data. Results: Four categories emerged: (1) Restraint as a multi-purpose procedure, (2) Processing of physical restraint, (3) Restraint as a challenging subject and (4) The effects of restraint on the spectrum. Each category has several different sub-categories. Conclusion: The participants described using physical restraint as one of the main strategies to control psychiatric patients, and despite having negative consequences, it is extensively used. Given the risks and challenges of using physical restraint, nursing education should find alternative methods. PMID:25349842

  16. Psychiatric Nurses' Perceptions about Physical Restraint; A Qualitative Study.

    PubMed

    Fereidooni Moghadam, Malek; Fallahi Khoshknab, Masoud; Pazargadi, Mehrnoosh

    2014-01-01

    The use of physical restraint as an intervention in the care of psychiatric patients dates back to the beginning of psychiatry. Although it is a challenging question, it is still one of the common procedures in psychiatry. Considering that very little research has been done in Iran in relation to physical restraint, this qualitative study aimed to investigate the experiences of  nurses working in psychiatric wards regarding physical restraint. This qualitative study was done on 14 nurses working in the psychiatric hospitals of Ahvaz city, southern Iran, during 2011-2012. The participants were selected by purposive sampling. Semi-structured interviews were used for data collection, which were continued until data saturation and emergence of themes. Inductive content analysis was used to analyze the data. Four categories emerged: (1) Restraint as a multi-purpose procedure, (2) Processing of physical restraint, (3) Restraint as a challenging subject and (4) The effects of restraint on the spectrum. Each category has several different sub-categories. The participants described using physical restraint as one of the main strategies to control psychiatric patients, and despite having negative consequences, it is extensively used. Given the risks and challenges of using physical restraint, nursing education should find alternative methods.

  17. The Effects of Physical Restraint on Self-Injurious Behaviour.

    ERIC Educational Resources Information Center

    Singh, N. N.; And Others

    1981-01-01

    Brief (one minute) response contingent physical restraint was shown in two experiments with a 16-year-old profoundly retarded institutionalized girl to be more effective in controlling self-injurious behavior (SIB) than three minute physical restraint, which in the first study produced an increase in SIB. (CL)

  18. Physical restraint in the ICU: does it prevent device removal?

    PubMed

    Perren, A; Corbella, D; Iapichino, E; Di Bernardo, V; Leonardi, A; Di Nicolantonio, R; Buschbeck, C; Boegli, L; Pagnamenta, A; Malacrida, R

    2015-10-01

    Physical restraint is frequently used in the intensive care setting but little is known regarding its clinical scenario and effectiveness in preventing adverse events (AEs), defined as device removal. We carried out a prospective observational study in three Intensive Care Units on 120 adult high-risk patients. The effectiveness of physical restraint was evaluated using the propensity score methodology in order to obtain comparable groups. Physical restraint was applied in 1371 of 3256 (43%) nurse shifts accounting for 120 patients. Substantial agitation, the nurse's judgement of insufficient sedation and sedative drug reduction were positively associated with physical restraint, whereas the presence of analgesics at admission, increased disease gravity and the treating hospital as the most substantial variable showed a negative association. Eighty-six AEs were observed in 44 patients. Quiet (SAS=1-4), unrestrained patients accounted for 40 cases, and agitated (SAS≥5) but physically restrained patients for 17 cases. The presence of any type of physical restraint had a protective effect against any type of AE (OR=0.28; CI 0.16-0.51). The observed AEs showed a limited impact on the patients' course of illness. No physical harm related to physical restraint was reported. Physical restraint efficiently averts AEs. Its application is mainly driven by local habits. Typically, the almost recovered, apparently calm and hence unrestrained patient is at greatest risk for undesirable device removal. The control/interpretation of the patient's analgo-sedation might be inappropriate.

  19. Freedom from restraint: consequences of reducing physical restraints in the management of the elderly.

    PubMed Central

    Powell, C; Mitchell-Pedersen, L; Fingerote, E; Edmund, L

    1989-01-01

    Physical restraint is commonly used in the management of elderly people in North American hospitals and nursing homes. Between December 1981 and March 1982 the Department of Geriatric Medicine, St. Boniface General Hospital, Winnipeg, changed its practice regarding the use of such restraints. In the fiscal year 1980-81 the rate of application of physical restraints was 52 per 1000 patient-days and the frequency of falls 7 per 1000 patient-days. By 1986-87 the figures were 0.3 and 8.7 per 1000 patient-days respectively; the increase in falls was not clinically significant. During the study period there was a 40% reduction in the use of chemical restraints (psychotropic drugs other than hypnotic and antidepressant agents). Here we record how this change in practice occurred and persisted. PMID:2776096

  20. Psychiatric Nurses' Attitude and Practice toward Physical Restraint.

    PubMed

    Mahmoud, Amal Sobhy

    2017-02-01

    This study was to assess psychiatric nurses' attitude and practice toward physical restraint among mentally ill patients. A descriptive research design was used to achieve the study objective. The present study was carried out in three specialized governmental mental hospitals and two psychiatric wards in general hospital. A convenient purposive sample of 96 nurses who were working in the previously mentioned setting was included. The tool used for data collection was the Self-Administered Structured Questionnaire; it included three parts: The first comprised items concerned with demographic characteristics of the nurses, the second comprised 10 item measuring nurses' attitudes toward physical restraint, and the third was used to assess nurses' practices regarding use of physical restraint. There were insignificant differences between attitudes and practices in relation to nurses' sex, level of education, years of experience and work place. Moreover, a positive significant correlation was found between nurses' total attitude scores, and practices regarding use of physical restraint. Psychiatric nurses have positive attitude and adequate practice toward using physical restraints as an alternative management for psychiatric patients. It is important for psychiatric nurses to acknowledge that physical restraints should be implemented as the last resort. The study recommended that it is important for psychiatric nurses to acknowledge that physical restraints should be implemented as the last resort. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Physical restraint use and older patients' length of hospital stay.

    PubMed

    Bai, Xue; Kwok, Timothy C Y; Ip, Isaac N; Woo, Jean; Chui, Maria Y P; Ho, Florence K Y

    2014-01-01

    In both acute care and residential care settings, physical restraints are frequently used in the management of patients, older people in particular. Recently, the negative outcomes of physical restraint use have often been reported, but very limited research effort has been made to examine whether such nursing practice have any adverse effects on patients' length of stay (LOS) in hospitals. The aim of this study was to examine the association between physical restraint use on older patients during hospitalization and their LOS. Medical records of 910 older patients aged 60 years and above admitted to one of the Hong Kong public hospitals in 2007 were randomly selected and recorded during July to September 2011. The recorded items included patients' general health status, physical and cognitive function, the use of physical restraints, and patients' LOS. Hierarchical regression analysis was conducted to analyze the data. The results indicated that older patients' general health status, physical, and cognitive function were important factors affecting their LOS. Independent of these factors, the physical restraint use was still significantly predictive of longer LOS, and these two blocks of variables together served as an effective model in predicting older patients' LOS in the hospital. Since physical restraint use has been found to be predictive of longer hospital stay, physical restraints should be used with more caution and the use of it should be reduced on older patients in the hospital caring setting. All relevant health care staff should be aware of the negative effects of physical restraint use and should reduce the use of it in hospital caring and nursing home settings.

  2. Psychiatric patients' perception of physical restraint.

    PubMed

    Fugger, G; Gleiss, A; Baldinger, P; Strnad, A; Kasper, S; Frey, R

    2016-03-01

    To investigate psychiatric patients' subjective perception during and after belt fixation. All patients who were involuntarily admitted and physically restrained at a psychiatric intensive care unit within an 18-month study period were analysed. Ratings were obtained at four visits when questioning was possible. Within a heterogeneous diagnostic sample of 47 patients, only 12 patients were eligible to participate during belt fixation. After cessation of fixation, eight patients lacked any memory of restraint, while 36 could be questioned. Visual analogue scale median scores indicated powerlessness and depressiveness rather than anxiety and aggression. Patients' acceptance of the coercive measure was significantly higher (P = 0.003), while patients' memory was significantly lower than expected (P < 0.001). About 50% of the patients documented high perceived coercion, and post-traumatic stress disorder (PTSD) could be supposed in a quarter of the restrained individuals. Subjective perceptions concerning fixation showed no significant changes over time. Results showed high interindividual variability. Visual analogue scale revealed that belt fixation seemed to be forgotten or accepted in the majority of patients, probably due to psychiatric intensive care, psychopharmacological treatment and clinical improvements. The responses of a quarter of the patients assessed before discharge may be in accordance with symptoms of PTSD. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Physical restraint in a therapeutic setting; a necessary evil?

    PubMed

    Perkins, Elizabeth; Prosser, Helen; Riley, David; Whittington, Richard

    2012-01-01

    Physical restraint of people experiencing mental health problems is a coercive and traumatic procedure which is only legally permitted if it is proportionate to the risk presented. This study sought to examine the decision-making processes used by mental health staff involved in a series of restraint episodes in an acute care setting. Thirty nurses were interviewed either individually or in focus groups to elicit their views on restraint and experience in specific incidents. Four factors which influenced the decision to restrain were identified: contextual demands; lack of alternatives; the escalatory effects of restraint itself; and perceptions of risk. While some of these factors are amenable to change through improvements in practice, training and organisational culture, nurses viewed restraint as a necessary evil, justified on the basis of the unpredictable nature of mental illness and the environment in which they worked. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Physical Restraint Procedures for Managing Challenging Behaviours Presented by Mentally Retarded Adults and Children.

    ERIC Educational Resources Information Center

    Harris, John

    1996-01-01

    The literature on the use of physical restraint with adults and children with mental retardation is reviewed, including person-to-person restraint, mechanical devices, and voluntary self-restraint. Conclusions regarding outcomes of contingent and noncontingent restraint, maintenance, reinforcing effects of restraint, and risk of injury are…

  5. Physical restraint initiation in nursing homes and subsequent resident health.

    PubMed

    Engberg, John; Castle, Nicholas G; McCaffrey, Daniel

    2008-08-01

    It is widely believed that physical restraint use causes mental and physical health decline in nursing home residents. Yet few studies exist showing an association between restraint initiation and health decline. In this research, we examined whether physical restraint initiation is associated with subsequent lower physical or mental health. We used all nursing homes (N = 740) in Pennsylvania in 2001, with 12,820 residents. We used the Minimum Data Set data; Online Survey, Certification and Reporting data; and the Area Resource File as data sources. We restricted our sample to newly admitted nursing home residents who were not restrained in the first two quarters of their residency. We examined which facility and individual characteristics during those first two quarters were associated with restraint initiation during the third quarter. We then examined the association of third-quarter restraint initiation with fourth-quarter health outcomes, using regressions that controlled for first- and second-quarter health status as well as other resident, facility, and market characteristics. The physical health outcomes examined consisted of falls, walking dependence, activities of daily living (ADLs), pressure ulcers, and contractures. Mental health outcomes examined consisted of cognitive performance, depression, and behavior problems. The initiation of restraint use was associated with a previous fall (p <.01), psychoactive medication use (p <.05), low cognition (p <.01), ADL scores (p <.01), and the absence of pressure ulcers (p <.10), as well as a variety of facility characteristics. Subsequent to restraint initiation, we found an association with lower cognitive performance (p <.01), lower ADL performance (p <.01), and higher walking dependence (p <.01). We found that an association between restraint initiation and subsequent adverse health consequences exists and is substantial. Moreover, these results would appear to have practical as well as statistical

  6. The Use of Physical Restraint in Norwegian Adult Psychiatric Hospitals.

    PubMed

    Wynn, Rolf

    2015-01-01

    Background. The use of coercion within the psychiatric services is problematic and raises a range of ethical, legal, and clinical questions. "Physical restraint" is an emergency procedure used in psychiatric hospitals to control patients that pose an imminent physical danger. We wished to review the literature published in scientific peer-reviewed journals describing studies on the use of physical restraint in Norway, in order to identify the current state of knowledge and directions for future research. Design. The databases PubMed, PsycINFO, CINAHL, Web of Science, and Embase were searched for studies relating to physical restraint (including holding) in Norwegian psychiatric hospitals, supplemented with hand searches. Results. 28 studies were included. Most of the studies were on rates of restraint, but there were also some studies on perceptions of patients and staff, case studies, and ethnographic studies. There was only one intervention study. There are differences in use between wards and institutions, which in part may be explained by differences in patient populations. Staff appear to be less negative to the use of restraint than patients. Conclusions. The studies that were identified were primarily concerned with rates of use and with patients' and staff's perspectives. More interventional studies are needed to move the field forward.

  7. The Effect of a Restraint Reduction Program on Physical Restraint Rates in Rehabilitation Settings in Hong Kong

    PubMed Central

    Lai, Claudia K. Y.; Chow, Susan K. Y.; Suen, Lorna K. P.; Wong, Ivan Y. C.

    2011-01-01

    Background. In view of the adverse effects of using restraints, studies examining the use of restraint reduction programs (RRPs) are needed. Objectives. To investigate the effect of an RRP on the reduction of physical restraint rates in rehabilitation hospitals. Methods. A prospective quasi-experimental clinical trial was conducted. Demographic data, medical and health-related information on recruited patients from two rehabilitation hospitals, as well as facility data on restraint rates were collected. Results. The increase in the restraint rate in the control site was 4.3 times greater than that in the intervention site. Changes in the restraint mode, from continuous to intermittent, and the type of restraint used were found between the pre- and postintervention periods in both the control site and the intervention site. Discussion. Compared with that in the control site, the RRP in the intervention site helped arrest any increase in the restraint rate although it had no effect on physical restraint reduction. The shift of restraint mode from continuous to intermittent in the intervention site was one of the positive outcomes of the RRP. PMID:22110972

  8. Fatal thromboembolism following physical restraint in a patient with schizophrenia.

    PubMed

    Cecchi, Rossana; Lazzaro, Antonella; Catanese, Miriam; Mandarelli, Gabriele; Ferracuti, Stefano

    2012-05-01

    Fatal thromboembolism during physical restraint in patients suffering from psychotic disorders is a very rare occurrence. In the case we present here, the criteria used in forensic pathology for the age determination of venous thrombi are applied to a case of pulmonary embolism in a patient suffering from schizophrenia who died after physical restraint. The possible association between conventional antipsychotic drugs and deep venous thrombosis, followed by pulmonary embolism, in a man with no predisposing risk factors, as well as the question concerning the appropriateness of medical care, are discussed.

  9. Physical Restraint of People with Intellectual Disability: A Review of Implementation Reduction and Elimination Procedures

    ERIC Educational Resources Information Center

    Luiselli, James K.

    2009-01-01

    Background: This review describes procedures to reduce and eliminate physical restraint of people with intellectual disability. One approach is to assess antecedent conditions associated with restraint and change them so that they no longer produce restraint-provoking behaviour. A second approach is to decrease the duration of restraint by…

  10. Physical Restraint of People with Intellectual Disability: A Review of Implementation Reduction and Elimination Procedures

    ERIC Educational Resources Information Center

    Luiselli, James K.

    2009-01-01

    Background: This review describes procedures to reduce and eliminate physical restraint of people with intellectual disability. One approach is to assess antecedent conditions associated with restraint and change them so that they no longer produce restraint-provoking behaviour. A second approach is to decrease the duration of restraint by…

  11. The Use of Physical Restraint in Norwegian Adult Psychiatric Hospitals

    PubMed Central

    Wynn, Rolf

    2015-01-01

    Background. The use of coercion within the psychiatric services is problematic and raises a range of ethical, legal, and clinical questions. “Physical restraint” is an emergency procedure used in psychiatric hospitals to control patients that pose an imminent physical danger. We wished to review the literature published in scientific peer-reviewed journals describing studies on the use of physical restraint in Norway, in order to identify the current state of knowledge and directions for future research. Design. The databases PubMed, PsycINFO, CINAHL, Web of Science, and Embase were searched for studies relating to physical restraint (including holding) in Norwegian psychiatric hospitals, supplemented with hand searches. Results. 28 studies were included. Most of the studies were on rates of restraint, but there were also some studies on perceptions of patients and staff, case studies, and ethnographic studies. There was only one intervention study. There are differences in use between wards and institutions, which in part may be explained by differences in patient populations. Staff appear to be less negative to the use of restraint than patients. Conclusions. The studies that were identified were primarily concerned with rates of use and with patients' and staff's perspectives. More interventional studies are needed to move the field forward. PMID:26682211

  12. [Pulmonary embolism in an acute manic patient following physical restraint].

    PubMed

    Pirsoul, S; De Backer, L; Schrijvers, D

    2014-01-01

    Immobilisation is a risk factor for the development of deep venous thrombosis and pulmonary embolism. We present a case-study in which a patient developed a pulmonary embolism after being immobilised after a short period while subjected to physical restraint. We discuss the risk factors involved and stress the need for research into the prevention of such incidents.

  13. [Medical-legal issues of physical and pharmacological restraint].

    PubMed

    Gómez-Durán, Esperanza L; Guija, Julio A; Ortega-Monasterio, Leopoldo

    2014-03-01

    The use of physical and pharmacological restraint is controversial but is currently accepted as inevitable. It is indicated for controlling behavioral disorders and psychomotor agitation that put patients and third parties at risk. Its indication should be medical, and we should opt for the least restrictive measure. Restraints represent a possible infringement of patients' fundamental rights and require understanding and strict respect for the medical-legal precepts by physicians and other practitioners involved in its application. This article reviews the current legal framework, as well as the medical-legal premises and aspects of applying restraints, with the objective of ensuring maximum respect for patients' rights and the appropriate legal safety in the activity of practitioners. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  14. Physical restraint and near death of a psychiatric patient.

    PubMed

    Nissen, Trygve; Rørvik, Per; Haugslett, Laila; Wynn, Rolf

    2013-01-01

    Physical restraint is used as a last resort emergency measure to calm and safeguard agitated and/or aggressive psychiatric patients. This can sometimes cause injuries, and rare fatalities have occurred. One mechanism of injury and death while in physical restraint is that of severe asphyxiation. We present the case of a hospitalized man in his mid-30s, suffering from schizophrenia. The patient was obese. He became aggressive and had to be manually restrained with a "takedown." After having been put in the prone position on the floor with a significant weight load on his body, he lost respiration and consciousness. Subsequently, he was given CPR. He regained consciousness and respiration, while the cyanosis receded in 1-2 min. Psychiatrists and pathologists should be aware that physically restraining a patient in the prone position with a significant weight load on the torso can, in rare cases, lead to asphyxiation. © 2012 American Academy of Forensic Sciences.

  15. Public Policy on Physical Restraint of Children with Disabilities in Public Schools

    ERIC Educational Resources Information Center

    McAfee, James K.; Schwilk, Christopher; Mitruski, Megan

    2006-01-01

    The US Constitution, federal and state legislatures, courts, and regulations permit physical restraint for both therapeutic (i.e., behavior change) and risk prevention purposes. Although most venues limit restraint as punishment, no government entity prohibits use of physical restraint as a response to imminent danger. This paper provides a…

  16. Physical restraint produces rapid acquisition of the pigeon's key peck

    PubMed Central

    Locurto, C. M.; Travers, Tania; Terrace, H. S.; Gibbon, John

    1980-01-01

    The acquisition and maintenance of autoshaped key pecking in pigeons was studied as a function of intertrial interval. At each of six intervals, which ranged from 12 seconds to 384 seconds, four pigeons were physically restrained during training while four other pigeons were not restrained. Restrained subjects acquired key pecking faster and with less intragroup variability at each interval. The effects of restraint were specific to acquisition and were not evident in maintained responding after five postacquisition sessions. PMID:16812175

  17. [Physical restraint use in critical care units. Perceptions of patients and their families].

    PubMed

    Pérez de Ciriza Amatriain, A I; Nicolás Olmedo, A; Goñi Viguria, R; Regaira Martínez, E; Margall Coscojuela, M A; Asiain Erro, M C

    2012-01-01

    The use of physical restraints in Intensive Care Units (ICU) is common although little is known about patients' and relatives' perceptions of this use. 1) To analyze the prevalence and use of physical restraints in a general adult ICU; 2) to know the perceptions of patients who experienced use of physical restraints and; 3) to know the perceptions of relatives of patients who used physical restraints. This descriptive study, which used both quantitative and qualitative methods, was carried out in an adult ICU. For the first objective, all the patients (101) who had used any kind of physical restraint were analysed. For the second and third objectives, 30 patients and 30 relatives were interviewed using the guidelines of Strumpf & Evans as modified by Hardin (1993). All interviews were recorded, fully transcribed and then submitted to a language content analysis using the method of Hsieh & Shannon. The only physical restraint used was the wrist restraint with a prevalence of 43.47%. Seventy-two percent of patients wore the restraint ≤12h and 28%>12h. Analysis of the patient interviews revealed 4 main themes: acceptance of the restraint conditioned by beliefs and information provided; feelings and sensations caused by the use of the restraint; alternatives proposed and future repercussions. Three themes emerged from the interviews with relatives: impressions caused by the use of the restrictions; reasons for accepting or rejecting them; alternatives to the use of restraints. Most patients used physical restraints for a short period of time and only the wrist restraint was used. Patients using physical restraints and their relatives expressed a wide range of feelings and sensations, with no negative future repercussions. In general, they agreed with the use of restraints although more precise information would lead to greater acceptance. Copyright © 2011 Elsevier España, S.L. y SEEIUC. All rights reserved.

  18. Predictors of physical restraint in a psychiatric emergency setting.

    PubMed

    Hadi, Fatemeh; Khosravi, Termeh; Shariat, Seyed Vahid; Jalali Nadoushan, Amir Hossein

    2015-01-01

    Considering the negative consequences of using physical restraints, we conducted this study to identify patients who are more frequently restrained in a psychiatric emergency ward as an initial step to limit the use of restraint to the minimum possible. This was a retrospective case control study conducted in Iran Psychiatric Hospital in Tehran, Iran. We reviewed the files of 607 patients who were admitted during a one year period using convenience sampling; of them, 186 were in the restrained group and 421 in the unrestrained group. Surprisingly, no significant difference was found between the restrained and unrestrained groups in demographic characteristics. The patients who were referred because of violence were diagnosed as having methamphetamine induced psychotic disorder or bipolar I disorder in manic 1episode and had a higher odds of being restrained (OR=2.51, OR=1.61, and OR=1.57 respectively). Being restrained was also associated with a longer duration of hospitalization and duration of staying in the emergency ward. Moreover, patients in their first admission were more frequently restrained. Medical and nursing staff should consider special measures for the patients who are at a higher risk for being restrained. More frequent visits and education for both patients and staff may be effective in reducing the number of physical restraints for these groups of patients.

  19. Predictors of physical restraint in a psychiatric emergency setting

    PubMed Central

    Hadi, Fatemeh; Khosravi, Termeh; Shariat, Seyed Vahid; Jalali Nadoushan, Amir Hossein

    2015-01-01

    Background: Considering the negative consequences of using physical restraints, we conducted this study to identify patients who are more frequently restrained in a psychiatric emergency ward as an initial step to limit the use of restraint to the minimum possible. Methods: This was a retrospective case control study conducted in Iran Psychiatric Hospital in Tehran, Iran. We reviewed the files of 607 patients who were admitted during a one year period using convenience sampling; of them, 186 were in the restrained group and 421 in the unrestrained group. Results: Surprisingly, no significant difference was found between the restrained and unrestrained groups in demographic characteristics. The patients who were referred because of violence were diagnosed as having methamphetamine induced psychotic disorder or bipolar I disorder in manic 1episode and had a higher odds of being restrained (OR=2.51, OR=1.61, and OR=1.57 respectively). Being restrained was also associated with a longer duration of hospitalization and duration of staying in the emergency ward. Moreover, patients in their first admission were more frequently restrained. Conclusion: Medical and nursing staff should consider special measures for the patients who are at a higher risk for being restrained. More frequent visits and education for both patients and staff may be effective in reducing the number of physical restraints for these groups of patients. PMID:26913259

  20. The Social Validation of Three Physical Restraint Procedures: A Comparison of Young People and Professional Groups.

    ERIC Educational Resources Information Center

    McDonnell, Andrew A.; Sturmey, Peter

    2000-01-01

    Forty-one special education professionals and classroom aides, 47 residential care staff, and 74 high school students rated the treatment acceptability of three forms of physical restraint. A chair method of restraint was rated as more acceptable than other floor restraint methods by all three groups. (Contains references.) (Author/CR)

  1. Physical restraint use in intensive care units across Europe: the PRICE study.

    PubMed

    Benbenbishty, Julie; Adam, Sheila; Endacott, Ruth

    2010-10-01

    The use of physical restraint has been linked to delirium in ICU patients and a range of physical and psychological outcomes in non-ICU patients. However, the extent of restraint practice in ICUs is largely unknown. This study was designed to examine physical restraint practices across European ICUs. A prospective point prevalence survey was conducted in adult ICUs across European countries to examine: physical and chemical restraint use during the weekend and weekdays, reasons for physical restraint use, timing of restraint use, type of restraint used and availability of restraint policies. Thirty-four general (adult) ICUs in nine countries participated in the study providing information on 669 patients with details of physical and chemical restraint use in 566 patients. Prevalence of physical restraint use in individual units ranged from 0 to 100% of patients. Thirty-three per cent of patients were physically restrained; those that were restrained were more likely to be ventilated (χ(2)=87.56, p<0.001), sedated (χ(2)34.66, p<0.001), managed in a larger unit (χ(2)=10.741, p=.005) and managed in a unit with a lower daytime nurse:patient ratio (χ(2)=17.17, p=0.001). Larger units were more likely to use commercial wrist restraints and smaller units were more likely to have a restraint policy, although these results did not reach significance. As an initial exploration, this study provides evidence of the range of restraint practice across Units in Europe. Variation in the number of units per country limits generalization of findings. However, further examination is needed to determine whether there is a causal element to these relationships. Attention should be paid to developing evidence based guidelines to underpin restraint practices.

  2. Evidence-Based Practice Guideline: Changing the Practice of Physical Restraint Use in Acute Care.

    PubMed

    Lach, Helen W; Leach, Kathy M; Butcher, Howard K

    2016-02-01

    Physical restraints continue to be used in acute care settings, despite the challenges and calls to reduce this practice. The current guideline on restraint use is updated with evidence that includes critical care settings and issues related to restraint use in acute care units. Nurses play a significant role in the use of restraints. Factors such as nurse's knowledge and patient characteristics combined with the culture and resources in health care facilities influence the practice of physical restraint use. Nurses can identify patients at high risk for restraint use; assess the potential causes of unsafe behaviors; and target interventions in the areas of physiological, psychological, and environmental approaches to address those unsafe behaviors. Members of the interdisciplinary team can provide additional consultation, and institutions can provide resources and education and implement monitoring processes and quality improvement practices to help reduce the practice of physical restraint use. [Journal of Gerontological Nursing, 42(2), 17-26.]. Copyright 2016, SLACK Incorporated.

  3. The detrimental effects of physical restraint as a consequence for inappropriate classroom behavior.

    PubMed

    Magee, S K; Ellis, J

    2001-01-01

    Functional analyses produced inconclusive results regarding variables that maintained problem behavior for 2 students with developmental disabilities. Procedures were modified to include a contingent physical restraint condition based on in-class observations. Results indicated that tinder conditions in which physical restraint (i.e., basket-hold timeout) was applied contingent on problem behavior, rates of these behaviors increased across sessions for both subjects. Implications for the use of physical restraint in the classroom are discussed.

  4. The detrimental effects of physical restraint as a consequence for inappropriate classroom behavior.

    PubMed Central

    Magee, S K; Ellis, J

    2001-01-01

    Functional analyses produced inconclusive results regarding variables that maintained problem behavior for 2 students with developmental disabilities. Procedures were modified to include a contingent physical restraint condition based on in-class observations. Results indicated that tinder conditions in which physical restraint (i.e., basket-hold timeout) was applied contingent on problem behavior, rates of these behaviors increased across sessions for both subjects. Implications for the use of physical restraint in the classroom are discussed. PMID:11800190

  5. Use of physical restraint: Nurses' knowledge, attitude, intention and practice and influencing factors.

    PubMed

    Eskandari, Fatemeh; Abdullah, Khatijah Lim; Zainal, Nor Zuraida; Wong, Li Ping

    2017-02-23

    To investigate the knowledge, attitude, intention and practice of nurses towards physical restraint and factors influencing these variables. A literature review showed a lack of studies focused on the intention of nurses regarding physical restraint throughout the world. Considering that very little research on physical restraint use has been carried out in Malaysia, assessment of nurses' knowledge, attitude, intention and practice is necessary before developing a minimising programme in hospitals. A cross-sectional study was used. A questionnaire to assess the knowledge, attitude, intention and practice was completed by all nurses (n = 309) in twelve wards of a teaching hospital in Kuala Lumpur. Moderate knowledge and attitude with strong intention to use physical restraint were found among the nurses. Less than half of nurses considered alternatives to physical restraint and most of them did not understand the reasons for the physical restraint. Nurses' academic qualification, read any information source during past year and nurses' work unit showed a significant association with nurses' knowledge. Multiple linear regression analysis found knowledge, attitude and intention were significantly associated with nurses' practice to use physical restraint. This study showed some important misunderstandings of nurses about using physical restraint and strong intention regarding using physical restraint. Findings of this study serve as a supporting reason for importance of educating nurses about the use of physical restraint. Exploring the knowledge, attitude, intention and current practice of nurses towards physical restraint is important so that an effective strategy can be formulated to minimise the use of physical restraints in hospitals. © 2017 John Wiley & Sons Ltd.

  6. Aceh Free Pasung: Releasing the mentally ill from physical restraint.

    PubMed

    Puteh, Ibrahim; Marthoenis, M; Minas, Harry

    2011-05-14

    Physical restraint and confinement of the mentally ill (called pasung in Indonesia) is common in Aceh. In early 2010, the local government initiated a program called Aceh Free Pasung 2010. The main goal of the program is to release the mentally ill in the province from restraint and to provide appropriate medical treatment and care. The aim of the paper is to report the findings of a preliminary investigation of the demographic and clinical characteristics of patients who have been admitted to the Banda Aceh Mental Hospital as part of the Aceh Free Pasung program. This is a cross-sectional descriptive study conducted at the Banda Aceh Mental Hospital, where people who had been restrained or confined in the community are being admitted for psychiatric treatment and, where necessary, physical rehabilitation, as part of the Aceh Free Pasung program. Fifty-nine of former ex-pasung patients were examined. The majority (88.1%) of the patients were male, aged 18 to 68 years. The duration of pasung varied from a few days to 20 years, with a mean duration of 4.0 years. The reasons for applying pasung are many, with concerns about dangerousness being most common. The great majority (89.8%) had a diagnosis of schizophrenia. The development of a community mental health system and the introduction of a health insurance system in Aceh (together with the national health insurance scheme for the poor) has enabled access to free hospital treatment for people with severe mental disorders, including those who have been in pasung. The demographic and clinical characteristics of this group of ex-pasung patients are broadly similar to those reported in previous studies. The Aceh Free Pasung program is an important mental health and human rights initiative that can serve to inform similar efforts in other parts of Indonesia and other low and middle-income countries where restraint and confinement of the mentally ill is receiving insufficient attention.

  7. Incidence Rate and Patterns of Physical Restraint Use Among Adult Patients in Malaysia.

    PubMed

    Eskandari, Fatemeh; Abdullah, Khatijah Lim; Zainal, Nor Zuraida; Wong, Li Ping

    2016-11-16

    Incidence rate and patterns of physical restraint use were examined based on a cross-sectional study in 22 wards of a large teaching hospital in Malaysia. Results indicated that the highest rate of physical restraint (19.7%) was reported from neurology-neurosurgery wards. "Un-cooperative for electroconvulsive therapy" and "trying to pull out catheters" were the most commonly reported reasons to use restraint in psychiatric and non-psychiatric wards, respectively. There were some relationships between patterns of physical restraint in this study. Exploring the incidence rate and patterns of physical restraint is important so that effective strategies can be formulated to minimize using restraint in hospitals. © The Author(s) 2016.

  8. A national survey of the use of physical restraint in long-term care hospitals in Japan.

    PubMed

    Chiba, Yumi; Yamamoto-Mitani, Noriko; Kawasaki, Maki

    2012-05-01

    To investigate the prevalence of physical restraints in the long-term care hospitals in Japan and to examine the factors of physical restraint use, including the specific skills/techniques that the staff use to minimise the restraints. Background.  Despite the national efforts to nullify physical restraint, it is still prevalent in long-term care facilities in and out of Japan. More detailed information regarding what affects physical restraint is needed. Cross-sectional mail survey. A questionnaire was sent to a nursing ward manager of the random sample of long-term care facilities in Japan. The average rate of physical restraint was 25·5%. Altogether, 81·0% of the restrained clients were under restraint for more than one month. The most prevalent method of restraint was bilateral bedrails, followed by the use of coveralls and gloves. Factors of restraint were different depending on the type of restraint, suggesting specific approaches are needed for specific type of restraint. Physical restraint is still prevalent in Japanese long-term care hospitals, and nurses need to develop effective intervention approach to redesigning practice related to physical restraints. Specialised intervention approach seems needed depending on the types of restraint. Specific approach should be developed to minimise the physical restraint in long-term care hospitals in Japan. © 2012 Blackwell Publishing Ltd.

  9. Staffing levels and the use of physical restraints in nursing homes: a multicenter study.

    PubMed

    Heeren, Pieter; Van de Water, Geert; De Paepe, Leen; Boonen, Steven; Vleugels, Arthur; Milisen, Koen

    2014-12-01

    There is an unclear relation between staffing levels and the use of physical restraints in nursing homes (NHs). A survey design was used in 570 older adults (median age = 86; 77.2% women), living on 23 wards within seven NHs. Restraint use was high (50% of residents, of which 80% were restrained on a daily basis). Multivariate analysis was conducted at the level of the individual wards. Neither staff intensity nor staff mix was a determinant of restraint use. Bathing dependency, transfer difficulties, risk for falls, frequent restlessness/agitation, and depression were independent predictors of restraint use. Patient characteristics have significant greater impact on physical restraint use than staffing levels. Therefore, improving knowledge and skills of NH staff to better deal with restlessness/agitation, mobility problems, and risk for falls is encouraged to decrease the use of physical restraints in NH residents.

  10. Physical restraint deaths in a 13-year national cohort of nursing home residents.

    PubMed

    Bellenger, Emma; Ibrahim, Joseph Elias; Bugeja, Lyndal; Kennedy, Briohny

    2017-07-01

    this paper aims to investigate the nature and extent of physical restraint deaths reported to Coroners in Australia over a 13-year period. the study comprised a retrospective cohort study of residents dwelling in accredited nursing homes in Australia whose deaths were reported to the Coroners between 1 July 2000 and 30 June 2013 and was attributed to physical restraint. five deaths in nursing home residents due to physical restraint were reported in Australia over a 13-year period. The median age of residents was 83 years; all residents had impaired mobility and had restraints applied for falls prevention. Neck compression and entrapment by the restraints was the mechanism of harm in all cases, resulting in restraint asphyxia and mechanical asphyxia, respectively. this national study confirms that the use of physical restraint does cause fatalities, although rare. Further research is still needed to identify which alternatives strategies to restraint are most effective, and to examine the reporting system for physical restraint-related deaths.

  11. [Vision on and use of physical restraints and 'smart technology' in nursing homes in Flanders].

    PubMed

    Carlassara, V; Lampo, E; Degryse, B; Van Audenhove, C; Spruytte, N

    2017-04-01

    The STAFF-project investigates in what way 'smart technology' can offer an alternative for physical restraints in nursing homes. A survey is realized aimed at gaining more insight into the vision on and the use of physical restraints and 'smart technology'. Two partly overlapping structured questionnaires were developed and sent to nursing home staff in Flanders (Belgium). One hundred fifty six administrators (managers or assistant-managers) and 238 caregiving staff (nurses, nursing aids, paramedical staff and other) completed the online questionnaire. In general there is a low acceptability of physical restraint use, however, a more nuanced picture of acceptability is present depending on the specific motivation for using physical restraints and on the specific means of physical restraints. About half of the administrators say they use smart technology in the nursing home. The two main reasons for not applying (yet) smart technology are 'too high price for smart technology' and 'inadequate infrastructure of the nursing home'. All respondents underscore the importance of multiple strategies to diminish the use of physical restraints in nursing homes. Physical restraint use is a complex theme and needs a nuanced analysis and management. This study shows that there is still room for improvement in diminishing the use of physical restraints and that nursing homes in Flanders are open to use smart technology.

  12. Suppression of Pica by Overcorrection and Physical Restraint: A Comparative Analysis.

    ERIC Educational Resources Information Center

    Singh, Nirbhay N.; Bakker, Leon W.

    1984-01-01

    Each occurrence of pica (ingestion of inedible objects) in two profoundly retarded adults was followed by either overcorrection or physical restraint. Although both procedures reduced the occurrence of pica and had a similar effect on collateral behaviors, physical restraint was clinically more effective in terms of immediate response reduction.…

  13. CCBD's Position Summary on Physical Restraint & Seclusion Procedures in School Settings

    ERIC Educational Resources Information Center

    Peterson, Reece; Albrecht, Susan; Johns, Bev

    2009-01-01

    This document is a summary of policy recommendations from two longer and more detailed documents available from the Council for Children with Behavioral Disorders (CCBD) regarding the use of physical restraint and seclusion procedures in schools. These recommendations include: (1) CCBD believes that physical restraint or seclusion procedures…

  14. Suppression of Pica by Overcorrection and Physical Restraint: A Comparative Analysis.

    ERIC Educational Resources Information Center

    Singh, Nirbhay N.; Bakker, Leon W.

    1984-01-01

    Each occurrence of pica (ingestion of inedible objects) in two profoundly retarded adults was followed by either overcorrection or physical restraint. Although both procedures reduced the occurrence of pica and had a similar effect on collateral behaviors, physical restraint was clinically more effective in terms of immediate response reduction.…

  15. Using Seclusion Timeout and Physical Restraint: An Analysis of State Policy, Research, and the Law

    ERIC Educational Resources Information Center

    Rozalski, Michael E.; Yell, Mitchell L.; Boreson, Lynn A.

    2006-01-01

    Seclusion timeout and physical restraint are aversive procedures designed to reduce or eliminate students' serious problem behavior. Using these procedures with students in special education has become commonplace in the last decade. Nevertheless, both seclusion timeout and physical restraint procedures have been, and continue to be, quite…

  16. CCBD's Position Summary on Physical Restraint & Seclusion Procedures in School Settings

    ERIC Educational Resources Information Center

    Peterson, Reece; Albrecht, Susan; Johns, Bev

    2009-01-01

    This document is a summary of policy recommendations from two longer and more detailed documents available from the Council for Children with Behavioral Disorders (CCBD) regarding the use of physical restraint and seclusion procedures in schools. These recommendations include: (1) CCBD believes that physical restraint or seclusion procedures…

  17. Physical Restraint in Residential Childcare: The Experiences of Young People and Residential Workers

    ERIC Educational Resources Information Center

    Steckley, Laura; Kendrick, Andrew

    2008-01-01

    There have long been concerns about the use of physical restraint in residential care. This article presents the findings of a qualitative study that explores the experiences of children, young people and residential workers of physical restraint. The research identifies the dilemmas and ambiguities for both staff and young people, and…

  18. CCBD's Position Summary on the Use of Physical Restraint Procedures in School Settings

    ERIC Educational Resources Information Center

    Peterson, Reece; Albrecht, Susan; Johns, Bev

    2009-01-01

    This document provides policy recommendations of the Council for Children with Behavioral Disorders regarding the use of physical restraint procedures in schools. It includes (a) an introduction, (b) a declaration of principles, and (c) recommendations regarding the use of physical restraint in school settings. Explanation or elaboration of…

  19. Physical Restraint of Students with Behavior Disorders in Day Treatment and Residential Settings

    ERIC Educational Resources Information Center

    Fogt, Julie B.; George, Michael P.; Kern, Lee; White, George P.; George, Nancy L.

    2008-01-01

    This study explored administrators' attitudes about the use of physical restraint in their school settings. Administrators of day treatment and residential programs for elementary students with emotional and behavioral disorders in the Mid-Atlantic states were surveyed on their attitudes toward, and the use of, physical restraint within their…

  20. CCBD's Position Summary on the Use of Physical Restraint Procedures in School Settings

    ERIC Educational Resources Information Center

    Peterson, Reece; Albrecht, Susan; Johns, Bev

    2009-01-01

    This document provides policy recommendations of the Council for Children with Behavioral Disorders regarding the use of physical restraint procedures in schools. It includes (a) an introduction, (b) a declaration of principles, and (c) recommendations regarding the use of physical restraint in school settings. Explanation or elaboration of…

  1. Beyond emergencies: the use of physical restraints in medical and psychiatric settings.

    PubMed

    Glezer, Anna; Brendel, Rebecca Weintraub

    2010-01-01

    Physical restraints, such as locked-door seclusion and two- or four-point leather restraints, are frequently used in both the medical and psychiatric settings. Efforts are currently under way to reduce the use of physical restraints in psychiatric settings; various institutional, state, and federal policies are place. However, using these same restraints in the context of providing medical care for psychiatric patients is more complicated, as it is uncertain which principles and regulations apply in a particular setting. For example, is the restraint governed by the policies that regulate the psychiatric application of restraints, by those that regulate the medical application of restraints, or by both? This article reviews the principles and regulations governing the use of restraints on psychiatric patients, with specific attention to the use of restraints in providing medical treatment to that patient population. Also addressed are general principles of risk management to help avoid negative outcomes and to reduce the risk of litigation for unauthorized or unlawful restraint. A case example is used to illustrate these concepts.

  2. Use of physical restraint in nursing homes: clinical-ethical considerations.

    PubMed

    Gastmans, C; Milisen, K

    2006-03-01

    This article gives a brief overview of the state of the art concerning physical restraint use among older persons in nursing homes. Within this context we identify some essential values and norms that must be observed in an ethical evaluation of physical restraint. These values and norms provide the ethical foundation for a number of concrete recommendations that could give clinical and ethical support to caregivers when they make decisions about physical restraint. Respect for the autonomy and overall wellbeing of older persons, a proportional assessment of the advantages and disadvantages, a priority focus on the alternatives to physical restraint, individualised care, interdisciplinary decision making, and an institutional policy are the central points that make it possible to deal responsibly with the use of physical restraint for older persons in nursing homes.

  3. Use of physical restraint in nursing homes: clinical‐ethical considerations

    PubMed Central

    Gastmans, C; Milisen, K

    2006-01-01

    This article gives a brief overview of the state of the art concerning physical restraint use among older persons in nursing homes. Within this context we identify some essential values and norms that must be observed in an ethical evaluation of physical restraint. These values and norms provide the ethical foundation for a number of concrete recommendations that could give clinical and ethical support to caregivers when they make decisions about physical restraint. Respect for the autonomy and overall wellbeing of older persons, a proportional assessment of the advantages and disadvantages, a priority focus on the alternatives to physical restraint, individualised care, interdisciplinary decision making, and an institutional policy are the central points that make it possible to deal responsibly with the use of physical restraint for older persons in nursing homes. PMID:16507658

  4. Education on physical restraint reduction in dementia care: a review of the literature.

    PubMed

    De Bellis, A; Mosel, K; Curren, D; Prendergast, J; Harrington, A; Muir-Cochrane, E

    2013-01-01

    Dementia is a priority area for all countries as populations age and dementia prevalence increases. The use of physical restraint is a possible clinical practice for persons with dementia across settings when behaviours indicate a perceived need. Indeed, this may be the first choice in practice, occurring in part because of lack of education, safety concerns, perceived costs and staffing issues. This article reviews the literature on the issues surrounding, and use of, physical restraint for people with dementia, highlighting the rationales for use and the benefits and barriers to physical restraint. Recommendations include the importance of education and policy to reduce or eliminate physical restraint of persons with dementia to overcome identified barriers at the individual, cultural and organizational levels. An educational programme from the literature review is proposed specific to the reduction or elimination of physical restraint.

  5. Characteristics of nursing home residents and physical restraint: a systematic literature review.

    PubMed

    Hofmann, Hedi; Hahn, Sabine

    2014-11-01

    To analyse and to summarise factors associated with nursing home residents' characteristics which could lead to physical restraint, and to investigate the consequences of physical restraint use for this population. Even though the application of physical restraint is highly controversial, prevalence rates show that it is a common intervention in nursing homes. Residents' characteristics seem to be important to predict the use of physical restraint. Evidence suggests that restrained nursing home residents may have physical and psychological disadvantages as a consequence of being restrained. A systematic literature research involving the databases PubMed, Cumulative Index to Nursing and Allied Health Literature, ISI Web of Science and Cochrane Library was carried out for articles published from January 2005-November 2011. Nine Studies fulfilled the inclusion criteria and the quality assessment. Restrained residents had low activities of daily living (ADL) scores and severe cognitive impairment. Residents with low cognitive status and serious mobility impairments were at high risk to be restrained, as well as residents with previous fall and/or fracture. Repeated verbal and physical agitation was found to be positively associated with restraint use. Possible consequences of physical restraint were as follows: lower cognitive and ADL performance, higher walking dependence, furthermore falls, pressure ulcers, urinary and faecal incontinence. This systematic literature review reveals notable resident-related factors for physical restraint use. The consequences of restraint seem to negatively influence residents' physical and psychological well-being. Physical restraint seems to be an important risk factor for residents' further health problems. Resident's characteristics appear to be decisive factors for the use of physical restraint. Nurses need a high level of expertise and competence in evaluating the individual residents' situation and deciding further steps, with

  6. The Nature and Extent of Physical Restraint-Related Deaths in Nursing Homes: A Systematic Review.

    PubMed

    Bellenger, Emma N; Ibrahim, Joseph E; Lovell, Janaka Jonathan; Bugeja, Lyndal

    2017-05-01

    The aim of this study is to conduct a systematic review of the published research to examine the extent, nature, and risk factors of mortality due to physical restraint use. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement, this review examined all peer-reviewed studies published in English describing mortality due to physical restraint in nursing home residents. The combined searches yielded 2,016 records of which eight articles were eligible for inclusion. There were 174 deaths due to physical restraint in nursing home residents across the eight studies. Neck compression ( n = 8) was the most common mechanism of harm resulting in death due to mechanical asphyxia. Physical restraint is associated with deaths in nursing home residents. Further research is needed to investigate alternative interventions to restraint use.

  7. [Use of physical restraints in an elderly population living in public nursing homes].

    PubMed

    Galán Cabello, Carlos María; Trinidad Trinidad, Diego; Ramos Cordero, Primitivo; Gómez Fernández, Juan Pedro; Alastruey Ruiz, Jesús Gregorio; Onrubia Pecharroman, Antonio; López Andrés, Engracia; Hernández Ovejero, Hilario

    2008-01-01

    To determine the prevalence of the use of physical restraints in public nursing homes through the Residents' Functional Classification Information System in order to assess the introduction of a protocol designed to reduce and rationalize the use of these devices. Twenty-five public nursing homes in the autonomous region of Madrid were included in this study. The following data on the use of physical restraints were analysed: frequency of use (daily or less than daily), type of device, level of functional dependence for activities of daily living, and severity of cognitive impairment. A total of 5346 residents were included. The prevalence of the use of restraints was 8.4%. When the use of bedrails was added, this percentage rose to 20.8%. Bedrails accounted for 63.4% of all restraints used, trunk restraints for 17.7%, limb restraints for 3%, and chairs preventing voluntary rising for 15.9%. A single device was used in 62.6%. Of the restraints, 71.4% were used daily and 28.6% were used temporarily. The results of this study represent an approximation to the current use of physical restraints in nursing homes. The prevalence found was similar to, or less than, that observed in previous studies. The most commonly used form of restraint was bedrails. The use of these devices is probably excessive, affecting even residents without cognitive impairment or physical dependence. To reduce the use of restraints and guarantee optimal care when their application is indicated, the Regional Social Welfare Service systematically applies a protocol for the prevention and use of physical restraints.

  8. Physical Restraint and Antipsychotic Medication Use Among Nursing Home Residents With Dementia.

    PubMed

    Foebel, Andrea D; Onder, Graziano; Finne-Soveri, Harriet; Lukas, Albert; Denkinger, Michael D; Carfi, Angelo; Vetrano, Davide L; Brandi, Vincenzo; Bernabei, Roberto; Liperoti, Rosa

    2016-02-01

    To explore antipsychotic (AP) medications and physical restraint use and their effects on physical function and cognition in older nursing home residents. This retrospective cohort studied involved 532 residents with dementia from 57 nursing homes participating in the Services and Health for Elderly in Long-Term Care study. Poisson log regression models explored the effect of physical restraint and/or AP medication use on cognitive or functional decline at 6 months. Physical restraint use was associated with a higher risk of both functional and cognitive decline compared with AP medication use alone. These risks were highest among residents receiving both AP medications and physical restraints, suggesting additive effects. Physical restraint use, and even more strongly, concurrent physical restraint and AP medication use, is related to function and cognitive decline in nursing home residents with dementia. Antipsychotic use is cautioned, but these results suggest physical restraint use is potentially more risky. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  9. Short-term effects of an educational intervention on physical restraint use: a cluster randomized trial

    PubMed Central

    Huizing, Anna R; Hamers, Jan PH; Gulpers, Math JM; Berger, Martijn PF

    2006-01-01

    Background Physical restraints are still frequently used in nursing home residents despite growing evidence for the ineffectiveness and negative consequences of these methods. Therefore, reduction in the use of physical restraints in psycho-geriatric nursing home residents is very important. The aim of this study was to investigate the short-term effects of an educational intervention on the use of physical restraints in psycho-geriatric nursing home residents. Methods A cluster randomized trial was applied to 5 psycho-geriatric nursing home wards (n = 167 residents with dementia). The wards were assigned at random to either educational intervention (3 wards) or control status (2 wards). The restraint status was observed and residents' characteristics, such as cognitive status, were determined by using the Minimum Data Set (MDS) at baseline and 1 month after intervention. Results Restraint use did not change significantly over time in the experimental group (55%–56%), compared to a significant increased use (P < 0.05) in the control group (56%–70%). The mean restraint intensity and mean multiple restraint use in residents increased in the control group but no changes were shown in the experimental group. Logistic regression analysis showed that residents in the control group were more likely to experience increased restraint use than residents in the experimental group. Conclusion An educational programme for nurses combined with consultation with a nurse specialist did not decrease the use of physical restraints in psycho-geriatric nursing home residents in the short term. However, the residents in the control group experienced more restraint use during the study period compared to the residents in the experimental group. Whether the intervention will reduce restraint use in the long term could not be inferred from these results. Further research is necessary to gain insight into the long-term effects of this educational intervention. PMID:17067376

  10. EFFECT OF PHYSICAL RESTRAINT ON THE LIMITS OF THERMOREGULATION IN TELEMETERED RATS

    EPA Science Inventory

    Physical restraint of rodents is often needed for nose-only exposure to airborne toxicants and is also used as a means of psychological stress. It is generally assumed that thermoregulation is impaired during restraint, leading to hyperthermia. A hyperthermic response should be r...

  11. EFFECT OF PHYSICAL RESTRAINT ON THE LIMITS OF THERMOREGULATION IN TELEMETERED RATS

    EPA Science Inventory

    Physical restraint of rodents is often needed for nose-only exposure to airborne toxicants and is also used as a means of psychological stress. It is generally assumed that thermoregulation is impaired during restraint, leading to hyperthermia. A hyperthermic response should be r...

  12. Effects of Physical Restraint on the Behavior of Hyperactive Mentally Retarded Persons.

    ERIC Educational Resources Information Center

    Singh, Nirbhay N.; And Others

    1984-01-01

    Each instance of out-of-seat behavior of four hyperactive moderately/severely mentally retarded eight and nine year olds resulted in return to seat followed by 15-second physical restraint. Out-of-seat behavior of all four Ss increased during two implementations of the restraint contingency compared to levels during alternative baseline periods.…

  13. Staff perceptions of barriers to physical restraint-reduction in long-term care: a meta-synthesis.

    PubMed

    Kong, Eun-Hi; Choi, Heeseung; Evans, Lois K

    2017-01-01

    To critically review the existing qualitative studies to identify, from the perspective of staff, the barriers to physical restraint reduction in long-term geriatric care facilities. Despite the adverse physical and psychosocial effects, physical restraints are still used frequently in many geriatric long-term care facilities around the world. There is, however, no study that synthesises the existing qualitative literature regarding the barriers to the restraint reduction from the perspective of facility staff. The metastudy research process guided this qualitative synthesis. Five electronic databases were searched, and ten studies were included in this metastudy. Five themes were identified through metasynthesis of the findings: concern about and responsibility for safety, unclear and inconsistent definitions of restraint and restraint-free care, difficulties in the transition from acceptance to removal, noninvolvement in decision-making to remove restraint and insufficient resources and education. A concept analysis of physical restraint is sorely needed, and future studies should explore the prevalence of restraint, the effects of education for staff and family on restraint reduction, and success stories related to restraint-free care. More research is needed regarding the restraint reduction effectiveness and cost issues. Physical restraints, commonly used in many geriatric long-term care facilities, result in many negative effects and ethical issues. To achieve success in reducing physical restraint use, governmental policies and long-term care institutions should underpin staff efforts with legal, educational and practical support. © 2016 John Wiley & Sons Ltd.

  14. Nurses' decision-making in cases of physical restraint: a synthesis of qualitative evidence.

    PubMed

    Goethals, Sabine; Dierckx de Casterlé, Bernadette; Gastmans, Chris

    2012-06-01

      This article is a report of a review that aimed to synthesize the available qualitative evidence on nurses' decision-making in cases of physical restraint.   The use of physical restraint in acute and residential healthcare facilities is a widespread practice in many countries. Decisions about the use of physical restraints are complex and ethically laden. The lack of evidence supporting the use of physical restraints, the negative consequences of restraint for patients, and the low availability of alternatives obviously complicate the decision-making.   Research papers published between January 1990 and January 2010 were identified in Cinahl, Embase, Medline, PsycInfo and Web of Science.   A systematic review was carried out to obtain a meta-synthesis of qualitative evidence. The process of meta-synthesis was supported by the Joanna Briggs Institute's guidelines.   The decision-making of nurses dealing with the use of physical restraints is a complex trajectory primarily focused on safety. However, thoughtful decision-making requires nurses to carefully balance different options and associated ethical values. The decision-making process of nurses is influenced by both nurse- and context-related factors.   This review provides a deeper understanding of nurses' decision-making process on the use of physical restraints. Context- and nurse-related factors can hinder nurses from making an ethical decision on the appropriate use of physical restraints. There is an urgent need to stimulate and educate nurses to arrive at an appropriate decision about the use of physical restraints. © 2011 Blackwell Publishing Ltd.

  15. Nursing Skill Mix, Nurse Staffing Level, and Physical Restraint Use in US Hospitals: a Longitudinal Study.

    PubMed

    Staggs, Vincent S; Olds, Danielle M; Cramer, Emily; Shorr, Ronald I

    2017-01-01

    Although it is plausible that nurse staffing is associated with use of physical restraints in hospitals, this has not been well established. This may be due to limitations in previous cross-sectional analyses lacking adequate control for unmeasured differences in patient-level variables among nursing units. To conduct a longitudinal study, with units serving as their own control, examining whether nurse staffing relative to a unit's long-term average is associated with restraint use. We analyzed 17 quarters of longitudinal data using mixed logistic regression, modeling quarterly odds of unit restraint use as a function of quarterly staffing relative to the unit's average staffing across study quarters. 3101 medical, surgical, and medical-surgical units in US hospitals participating in the National Database of Nursing Quality Indicators during 2006-2010. Units had to report at least one quarter with restraint use and one quarter without. We studied two nurse staffing variables: staffing level (total nursing hours per patient day) and nursing skill mix (proportion of nursing hours provided by RNs). Outcomes were any use of restraint, regardless of reason, and use of restraint for fall prevention. Nursing skill mix was inversely correlated with restraint use for fall prevention and for any reason. Compared to average quarters, odds of fall prevention restraint and of any restraint were respectively 16 % (95 % CI: 3-29 %) and 18 % (95 % CI: 8-29 %) higher for quarters with very low skill mix. In this longitudinal study there was a strong negative correlation between nursing skill mix and physical restraint use. Ensuring that skill mix is consistently adequate should reduce use of restraint.

  16. Seclusion room vs. physical restraint in an adolescent inpatient setting: patients' attitudes.

    PubMed

    Vishnivetsky, Sergey; Shoval, Gal; Leibovich, Vadim; Giner, Lucas; Mitrany, Marsel; Cohen, Dorit; Barzilay, Aliza; Volovick, Louisa; Weizman, Abraham; Zalsman, Gil

    2013-01-01

    The use of physical restraints or a seclusion room for the treatment of adolescents in a psychiatric inpatient setting raises ethical dilemmas. We investigated the attitudes of adolescents towards these two means of confinement. We used a structured questionnaire to collect data on the attitudes of 50 adolescent patients, hospitalized in a closed psychiatric ward, towards the use of physical restraint versus a seclusion room. Seventy per cent of the participants in the study preferred seclusion in the seclusion room over bed restraint, whereas 22% preferred physical restraint. Eighty-two percent described seclusion in the seclusion room as less frightening than restraint. Seventy-four per cent reported that seclusion in the seclusion room improved their mental state to a larger extent than restraint. The inpatient adolescents reported feeling the time they needed to reach a state of calm was shorter when they were confined to the seclusion room than when they were physically restrained (p>.001). The use of a seclusion room may be preferable compared to physical restraint for inpatient adolescents.

  17. The Use of Physical Restraint in the Treatment of Self-Injury and as Positive Reinforcement.

    ERIC Educational Resources Information Center

    Favell, Judith E.; And Others

    1978-01-01

    Three experiments investigated the effects of a treatment package on the self-injurious behavior of three profoundly retarded persons (ages 8-27 years) who appeared to enjoy the physical restraints used to prevent their self-injury. (Author)

  18. Effects of Differential Reinforcement, Physical Restraint and Verbal Reprimand on Stereotyped Body-Rocking.

    ERIC Educational Resources Information Center

    Jena, S. P. K.

    1995-01-01

    A boy with severe mental retardation was unresponsive to his environment and spent 80% of his day body-rocking. Stereotyped body-rocking was greatly reduced via differential reinforcement of incompatible responding (DRI), physical restraint, and reprimand. (JDD)

  19. Examination of ethical dilemmas experienced by adult intensive care unit nurses in physical restraint practices.

    PubMed

    Yönt, Gülendam Hakverdioğlu; Korhan, Esra Akin; Dizer, Berna; Gümüş, Fatma; Koyuncu, Rukiye

    2014-01-01

    Nurses are more likely to face the dilemma of whether to resort to physical restraints or not and have a hard time making that decision. This is a descriptive study. A total of 55 nurses participated in the research. For data collection, a question form developed by researchers to determine perceptions of ethical dilemmas by nurses in the application of physical restraint was used. A descriptive analysis was made by calculating the mean, standard deviation, and maximum and minimum values. The nurses expressed (36.4%) having difficulty in deciding to use physical restraint. Nurses reported that they experience ethical dilemmas mainly in relation to the ethic principles of nonmaleficence, beneficence, and convenience. We have concluded that majority of nurses working in critical care units apply physical restraint to patients, although they are facing ethical dilemmas concerning harm and benefit principles during the application.

  20. Physical restraint use in institutional care of old people in Sweden in 2000 and 2007.

    PubMed

    Pellfolk, Tony; Sandman, Per-Olof; Gustafson, Yngve; Karlsson, Stig; Lövheim, Hugo

    2012-07-01

    Physical restraint use is common in institutional care for old people and mainly used to prevent falls, despite the fall-preventive effect of physical restraints being questioned in previous research. The aim of the study was to investigate the use of physical restraints in Sweden in 2000 and 2007. Data were collected from two comparable census surveys conducted in all institutional care units for old people in 2000 (n = 3,669) and 2007 (n = 2,914). Information on residents' characteristics and physical restraint use was collected using the Multi-Dimensional Dementia Assessment Scale (MDDAS). In 2000 16.0% (95% confidence interval (CI) 14.8%-17.2%) of the residents were restrained compared to 18.2% (95% CI 16.8%-19.6%) in 2007 (p = 0.017). Adjusting for residents' characteristics showed that residents in 2007 were more likely to be physically restrained, relative to the residents in 2000 (odds ratio (OR) 1.031, 95% CI 1.005-1.058, p = 0.017). In 2007 the residents had been restrained longer, and a higher proportion were restrained for unknown reasons. Physical restraint use is still common. Moreover, the findings of this study suggest a small increase (OR 1.031) in the prevalence of physical restraint use from 2000 to 2007 adjusted for residents' characteristics.

  1. Reducing physical restraint use in alcohol withdrawal patients: a literature review.

    PubMed

    Rainier, Nicole C

    2014-01-01

    Alcohol withdrawal patients experience symptoms ranging from mild anxiety and disorientation to severe agitation and hallucinations. The most critical of these patients are treated in intensive care units. Physical restraints are often required to maintain patient safety until symptoms resolve. The use of physical restraints is contradictory to nursing values and is unsupported by evidenced-based literature. A literature review was conducted to see what, if any, alternatives have been tested to improve patient care for this complicated patient population.

  2. The cardiopulmonary effects of physical restraint in subjects with chronic obstructive pulmonary disease.

    PubMed

    Meredith, Carolyn; Taslaq, Samer; Kon, Onn Min; Henry, John

    2005-06-01

    Police officers commonly encounter violent individuals in their line of duty, with the use of physical restraint sometimes being necessary. A major criticism of previous studies of the effect of restraint on cardiac and pulmonary function has been that they have only recruited young healthy adults. This study aims to assess the cardiopulmonary effects of restraint positioning in individuals with chronic obstructive pulmonary disease (COPD). Eight patients with stable COPD were recruited. Subjects were randomly allocated to the following five positions: Wrist restraint behind the body whilst seated; wrist restraint in front of the body whilst seated; lying prone with wrists restrained behind back; lying prone with arms free; lying supine with wrists restrained in front. The outcomes measures studied were pulmonary function at 10 min. There was no significant difference in FEV1 or FVC between groups, (one way ANOVA p=0.94 and 0.99, respectively). The difference in FEV1 between the seated position and seated position with wrists restrained behind the back were also compared (p=0.8) as was the effect of wrist restraint in the prone position compared to no restraint prone (p=0.69). However, three subjects could not tolerate the prone position due to a clinical deterioration in symptoms. The response to the prone position with or without wrist restraint appears highly individual, with some individuals tolerating the prone position with no measurable clinical effects and others suffering a clinical deterioration in symptoms. The reasons for this individual variation remain unclear.

  3. [Effects of a physical restraint removal program on older people with dementia in residential care].

    PubMed

    Tortosa, M Ángeles; Granell, Rafael; Fuenmayor, Amadeo; Martínez, Mary

    2016-01-01

    To analyse the results of removing physical restraints from elderly patients with dementia living in nursing homes. This objective is part of a wider process of change in residential care. Quasi-experimental study conducted in two residences from May 2010 to May 2012. Information was collected at 7 time points and longitudinal analyses were performed. After training staff, the physical restraints in El Puig centre were phased out, while in the Conarda centre, restraints were still applied to elderly people. The main variables studied were: falls, psychotropic medication prescriptions, different indicators of mental impairment, and degree of dependence (Norton, NPI, Mini-mental, Tinetti, Barthel). In the El Puig centre all the physical restraints were removed. A slight improvement was seen in the number of falls, and their consequences. The ANOVA showed significant improvements in the centre that removed restraints in prescribing psychotropic medications, cognitive impairment, and behavioural changes. It is shown that removing physical restraints do not cause negative effects as regards the number of falls, and also positively affects the welfare and independence of elderly people (through changes in behaviour and mental impairment). Furthermore, it is demonstrated that this program must be accompanied by the reduction and control of medicines (withdrawal of the number of psychotropic prescriptions). Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

  4. Factors associated with the use of physical restraints for agitated patients in psychiatric emergency rooms.

    PubMed

    Migon, Marcelo N; Coutinho, Evandro S; Huf, Giselle; Adams, Clive E; Cunha, Geraldo M; Allen, Michael H

    2008-01-01

    To examine factors associated with physical restraint in psychiatric emergency rooms. We extracted variables likely to predict use of physical restraints from a large randomised trial undertaken in three psychiatric emergency rooms in Rio de Janeiro. We fitted a Bayesian binary multivariate model using only variables clearly preceding the restraints. Of 301 agitated, aggressive people admitted to emergency rooms, 73 (24%) were restrained during the first 2 h of admission. In Rio, younger people (OR=1.03 for each year younger), exhibiting intense (OR=2.53) or extreme agitation (OR=7.71), thought to result from substance misuse (OR=1.75) or diagnoses other than psychosis (OR=1.88), arriving in the morning (OR=1.64) were at greater risk of physical restraints than older, less severely aggressive or agitated people, arriving at the hospital during the afternoon or night. Hospital, gender, first admission to hospital and medication were not associated with risk of being restrained. Restraint practices in Rio are predictable and based on a limited clinical assessment. Predictive factors for physical restraint may vary worldwide, but should be monitored and studied to assist training, and to establish programs to evaluate and refine this controversial practice.

  5. [Physical and pharmacological restraints in geriatric and gerontology services and centers].

    PubMed

    Ramos Cordero, Primitivo; López Trigo, José Antonio; Maíllo Pedraz, Herminio; Paz Rubio, José María

    2015-01-01

    Physical and pharmacological restraints are a controversial issue in the context of geriatric care due to their moral, ethical, social and legal repercussions and, despite this fact, no specific legislation exists at a national level. The use of restraints is being questioned with growing frequency, as there are studies that demonstrate that restraints do not reduce the number of falls or their consequences, but rather can increase them, cause complications, injuries and potentially fatal accidents. Restraints are not always used rationally, despite compromising a fundamental human right, that is, freedom, protected in the Constitution, as well as values and principles, such as dignity and personal self-esteem. There are centers where restraints are applied to more than 50% of patients, and in some cases without the consent of their legal representatives. On some occasions, restraints are used for attaining organizational or environmental objectives, such as complying with tight schedules, and for reducing or avoiding the supervision of patients who walk erratically and, at times, are used indefinitely. Even greater confusion exists with respect to the emerging concept of chemical or pharmacological restraints, since no conceptual framework exists based on scientific evidence, and with sufficient consensus for guiding healthcare workers. In this context, the Sociedad Española de Geriatría y Gerontología (SEGG--Spanish Geriatrics and Gerontology Society), aware of the significance and transcendence of the issue, and in an attempt to preserve and guarantee maximum freedom, dignity and self-esteem, on the one hand, and to ensure the maximum integrity and legal certainty of the persons cared for in geriatric and gerontology services and centers, on the other, decided to create an "Interdisciplinary Committee on Restraints" made up by members from different disciplines and members of SEGG Working Groups or Committees, external health care workers, groups

  6. Effect of physical restraint on glucose tolerance in cynomolgus monkeys.

    PubMed

    Shirasaki, Yasufumi; Yoshioka, Naoya; Kanazawa, Kanpei; Maekawa, Tsuyoshi; Horikawa, Tadahiro; Hayashi, Toshiaki

    2013-06-01

    Physiologic stress has been demonstrated to impair glucose tolerance. Glucose tolerance tests were performed using six cynomolgus monkeys. Chair-restrained subjects elicited higher elevations of plasma glucose and cortisol compared with squeezing device-restrained subjects. The responses to a glucose challenge are altered by different restraint procedures.

  7. Descriptive analysis of physical restraint (protective holding) among community living adults with intellectual disability.

    PubMed

    Luiselli, James K; Sperry, James M; Magee, Christine

    2011-06-01

    We analyzed incidence and implementation patterns of physical restraint (PR) among 448 adults with intellectual disability within community-based day habilitation programs and group homes. PR was implemented exclusively as a consequence for self-harming, aggressive, and environmentally disruptive behaviors. Less than 10% of adults received PR and more than 90% of documented restraints occurred as a planned intervention procedure. Several adults accounted for the majority of PR. The clinical implications of these findings are discussed.

  8. Effect of physical restraint reduction on older patients' hospital length of stay.

    PubMed

    Kwok, Timothy; Bai, Xue; Chui, Maria Y P; Lai, Claudia K Y; Ho, Daniel W H; Ho, Florence K Y; Woo, Jean

    2012-09-01

    Physical restraints are often used to prevent falls and to secure medical devices in older people in hospitals. Restraint reduction has been advocated on the grounds that physical restraints have negative psychological effects and are not effective in preventing falls. The potential effect of restraint reduction on length of hospital stay (LOS) has not been investigated. This study was undertaken to compare the average length of stay of older patients in a convalescent medical ward setting before and after a restraint reduction program. This is a retrospective study. A convalescent hospital in Hong Kong. This study included 2000 patient episodes. The use of physical restraint, LOS, and clinical outcomes of randomly selected patient episodes in the year before and after the implementation of a restraint reduction program were compared. The clinical outcomes included Modified Functional Ambulatory Categories and modified Barthel index. Subgroup analysis was performed on those with confusion as defined by dementia diagnosis, low abbreviated mental test score, or abnormal mental domain of Norton Score. A total of 958 and 988 patient episodes admitted to 10 medical wards in a convalescent hospital in 2007 and 2009 were examined. There were no significant differences in the baseline characteristics of patients in the 2 years. With the implementation of the restraint reduction scheme, the rate of physical restraint use declined significantly from 13.3% in 2007 to 4.1% in 2009 for all patients. The average LOS of patients was significantly lower in the year after the implementation of restraint reduction (19.5 ± 20.7 versus 16.8 ± 13.4 days in 2007 and 2009 respectively, P < .001). On subgroup analysis, the reduction in LOS was significant in the cognitively impaired patients (23.0 ± 26.5 to 17.8 ± 15.0 days in 2007 and 2009 respectively, P < .001), but not in the cognitively normal patients. There were no significant differences between the 2 years in the incidence of

  9. Physical Restraints: Consensus of a Research Definition Using a Modified Delphi Technique.

    PubMed

    Bleijlevens, Michel H C; Wagner, Laura M; Capezuti, Elizabeth; Hamers, Jan P H

    2016-11-01

    To develop an internationally accepted research definition of physical restraint. Comprehensive literature search followed by a web-based, three-round, modified Delphi technique comprising reviews and feedback. Clinical care settings. An international group of 48 experts consisting of researchers and clinicians from 14 countries who have made sustained contribution to research and clinical application in the field of physical restraint in clinical care. Data were collected using an online survey program and one in-person meeting. Results of the online survey and the in-person meeting were used for distribution in subsequent rounds until consensus on a definition was reached. Consensus was defined as 90% of the participating experts agreeing with the proposed definition of physical restraint. Thirty-four different definitions were identified during the literature search and served as a starting point for the modified Delphi technique. After three rounds, 45 (95.7%) of 47 remaining experts agreed with the newly proposed definition: "Physical restraint is defined as any action or procedure that prevents a person's free body movement to a position of choice and/or normal access to his/her body by the use of any method, attached or adjacent to a person's body that he/she cannot control or remove easily." A multidisciplinary, internationally representative panel of experts reached consensus on a research definition for physical restraints in older persons. This is a necessary step toward improved comparisons of the prevalence of physical restraint use across studies and countries. This definition can further guide research interventions aimed at reducing use of physical restraints. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  10. Physical restraint: experiences, attitudes and opinions of adult intensive care unit nurses.

    PubMed

    Freeman, Samantha; Hallett, Christine; McHugh, Gretl

    2016-03-01

    Patients within the adult intensive care unit have the potential to develop delirium and agitation. This can result in the patient displaying unwanted behaviours such as attempting to remove the medical devices to which they are attached. Some adult intensive care units within the UK are starting to adopt physical restraint as a method of managing unwanted behaviours. To determine the experiences, attitudes and opinions of adult intensive care nurses in relation to the application of physical restraint. Questionnaire survey. A postal questionnaire was distributed to all nurses (n = 192) within two purposefully selected large adult intensive care units in the UK. Data were collected between November 2012 and February 2013. The questionnaire was completed by 38·9% (n = 75) of the nurses contacted. All believed that physical restraint had a place, with the majority of the view that the reason for its application was to maintain patient safety. Some expressed discomfort about the use of physical restraint. Nurses were happy to discuss the use of restraint with families. There was a perceived need for training and support for nursing staff as well as the need for medical staff to support the decision-making process. Nurses require more support and evidence to base their decision-making upon. They require guidance from professional bodies as well as support from medical colleagues. The findings have limited generalizability as they can only be applied to the units accessed and the response rate was poor. Alternative approaches such as pain management, sleep promotion and the involvement of relatives need to be explored before physical restraint policy can be written. Further research is required into the safety of physical restraint, alternative methods of managing the risk of agitation and identifying predisposing factors to accidental device removal. © 2015 British Association of Critical Care Nurses.

  11. Predictors of physical restraint use in Canadian intensive care units.

    PubMed

    Luk, Elena; Sneyers, Barbara; Rose, Louise; Perreault, Marc M; Williamson, David R; Mehta, Sangeeta; Cook, Deborah J; Lapinsky, Stephanie C; Burry, Lisa

    2014-03-24

    Physical restraint (PR) use in the intensive care unit (ICU) has been associated with higher rates of self-extubation and prolonged ICU length of stay. Our objectives were to describe patterns and predictors of PR use. We conducted a secondary analysis of a prospective observational study of analgosedation, antipsychotic, neuromuscular blocker, and PR practices in 51 Canadian ICUs. Data were collected prospectively for all mechanically ventilated adults admitted during a two-week period. We tested for patient, treatment, and hospital characteristics that were associated with PR use and number of days of use, using logistic and Poisson regression respectively. PR was used on 374 out of 711 (53%) patients, for a mean number of 4.1 (standard deviation (SD) 4.0) days. Treatment characteristics associated with PR were higher daily benzodiazepine dose (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.00 to 1.11), higher daily opioid dose (OR 1.04, 95% CI 1.01 to 1.06), antipsychotic drugs (OR 3.09, 95% CI 1.74 to 5.48), agitation (Sedation-Agitation Scale (SAS) >4) (OR 3.73, 95% CI 1.50 to 9.29), and sedation administration method (continuous and bolus versus bolus only) (OR 3.09, 95% CI 1.74 to 5.48). Hospital characteristics associated with PR indicated patients were less likely to be restrained in ICUs from university-affiliated hospitals (OR 0.32, 95% CI 0.17 to 0.61). Mainly treatment characteristics were associated with more days of PR, including: higher daily benzodiazepine dose (incidence rate ratio (IRR) 1.07, 95% CI 1.01 to 1.13), daily sedation interruption (IRR 3.44, 95% CI 1.48 to 8.10), antipsychotic drugs (IRR 15.67, 95% CI 6.62 to 37.12), SAS <3 (IRR 2.62, 95% CI 1.08 to 6.35), and any adverse event including accidental device removal (IRR 8.27, 95% CI 2.07 to 33.08). Patient characteristics (age, gender, Acute Physiology and Chronic Health Evaluation II score, admission category, prior substance abuse, prior psychotropic medication, pre

  12. The evaluation of integrating physical restraint report and care record system.

    PubMed

    Hou, I-Ching; Chen, Jimmy; Lin, Fan-Lian; Yu, Hui-Zu; Huang, Si-Fen; Huang, Yue-Jiao

    2013-01-01

    Physical restraint is the nursing intervention to protect patient safety in the hospital. Nurses should monitor and charting during the physical restraint period. Physical restraint is also the measurement of Taiwan clinical performance indicator. The traditional physical restraint quality measurement depends on the nurses' report. Lacking of integrating of report and nurses' care record induces the low report rate. In 2007, we developed the integrating physical restraint report and care record system to facilitate the report process in 2300-bed medical center in northern Taiwan. We evaluated the system with two methods after system implemented for one year. The results show it significantly increased the reporting rate from before (0.77%) to after (1.5%) and had no significance difference with the average reporting rate in Taiwan (P>0.05). Most nurses felt nature to satisfy on the system usefulness (81%) and preferred to use system then use paper form record (83.1%). Almost every nurse had correct cognitions on report physical restrain event when it occurred to patients. The system seemed to be successful implemented and helpful for the quality measurement management.

  13. Physical restraint use among nursing home residents: A comparison of two data collection methods

    PubMed Central

    Laurin, Danielle; Voyer, Philippe; Verreault, René; Durand, Pierre J

    2004-01-01

    Background In view of the issues surrounding physical restraint use, it is important to have a method of measurement as valid and reliable as possible. We determined the sensitivity and specificity of physical restraint use a) reported by nursing staff and b) reviewed from medical and nursing records in nursing home settings, by comparing these methods with direct observation. Methods We sampled eight care units in skilled nursing homes, seven care units in nursing homes and one long-term care unit in a hospital, from eight facilities which included 28 nurses and 377 residents. Physical restraint use was assessed the day following three periods of direct observation by two different means: interview with one or several members of the regular nursing staff, and review of medical and nursing records. Sensitivity and specificity values were calculated according to 2-by-2 contingency tables. Differences between the methods were assessed using the phi coefficient. Other information collected included: demographic characteristics, disruptive behaviors, body alignment problems, cognitive and functional skills. Results Compared to direct observation (gold standard), reported restraint use by nursing staff yielded a sensitivity of 87.4% at a specificity of 93.7% (phi = 0.84). When data was reviewed from subjects' medical and nursing records, sensitivity was reduced to 74.8%, and specificity to 86.3% (phi = 0.54). Justifications for restraint use including risk for falls, agitation, body alignment problems and aggressiveness were associated with the use of physical restraints. Conclusions The interview of nursing staff and the review of medical and nursing records are both valid and reliable techniques for measuring physical restraint use among nursing home residents. Higher sensitivity and specificity values were achieved when nursing staff was interviewed as compared to reviewing medical records. This study suggests that the interview of nursing staff is a more reliable

  14. The use of physical restraint in the treatment of self-injury and as positive reinforcement.

    PubMed Central

    Favell, J E; McGimsey, J F; Jones, M L

    1978-01-01

    Two experiments investigated the effects of a treatment package on the self-injurious behavior of three profoundly retarded persons who appeared to enjoy the physical restraints used to prevent their self-injury. The treatment package included physically restraining subjects contingent on increasing periods of time during which no self-injury occurred, and providing them with toys and attention during intervals between restraints. A reversal and multiple-baseline analysis documented that the rapid and complete reduction in self-injury by all subjects was due to this treatment package. Because these results suggested that physical restraint might function as a positive reinforcer, in a third experiment physical restraint was applied contingent on a marble placement response with one subject. A reversal design demonstrated that toy play systematically increased when each response resulted in restraint. The experiments have implications for the nonaversive remediation of self-injury in individuals who are restrained, as well as for the development and maintenance of self-injury in natural settings. PMID:670112

  15. Knowledge, attitudes, and practices of Turkish intern nurses regarding physical restraints.

    PubMed

    Karagozoglu, Serife; Ozden, Dilek; Yildiz, Fatma Tok

    2013-01-01

    This study was carried out to determine knowledge, attitudes, and practices of intern nurses who completed the nursing internship program on the use of physical restraints. This research was conducted using descriptive and cross-sectional research design. The study sample comprises 91 fourth-grade students who took an integrated curriculum and completed the nursing internship program. The data were collected with the Demographic Characteristics Questionnaire and the Levels of Knowledge, Attitudes and Practices of Staff Regarding Physical Restraints Questionnaire. For the assessment of the data, percentages, the arithmetic mean, and t test were used. The findings indicated that, of the intern nurses, 95.6% observed the use of physical restraints during their education, and 69.2% applied physical restraints. The mean knowledge, attitude, and practice scores of the nurses for physical restraint were 9.38 ± 1.19 (0-11 points), 34.70 ± 5.62 (12-48 points), and 37.95 ± 2.32 (14-42 points), respectively. Intern nurses' knowledge about how to use physical restraints was at a very good level; they displayed positive attitudes, and they used their knowledge and attitudes in their practices to a great extent. Although there are studies on the knowledge, attitudes, and practices of nurses working in the fields of elderly care, rehabilitation, and psychiatry in acute care units, there are no studies investigating intern nurses and other nursing students. However, intern nurses about to begin their careers should make accurate decisions regarding the use of physical restrains if they are to ensure patient safety and to fulfill this application effectively in their professional lives.

  16. Risk for physical restraint or seclusion in the psychiatric emergency service (PES).

    PubMed

    Simpson, Scott A; Joesch, Jutta M; West, Imara I; Pasic, Jagoda

    2014-01-01

    We describe risk factors associated with patients experiencing physical restraint or seclusion in the psychiatric emergency service (PES). We retrospectively reviewed medical records, nursing logs and quality assurance data for all adult patient encounters in a PES over a 12-month period (June 1, 2011-May 31, 2012). Descriptors included demographic characteristics, diagnoses, laboratory values, and clinician ratings of symptom severity. χ(2) and multivariate logistic regression analyses were performed. Restraint/seclusion occurred in 14% of 5335 patient encounters. The following characteristics were associated with restraint/seclusion: arrival to the PES in restraints; referral not initiated by the patient; arrival between 1900 and 0059 hours; bipolar mania or mixed episode; and clinician rating of severe disruptiveness, psychosis or insight impairment. Severe suicidality and a depression diagnosis were associated with less risk of restraint or seclusion. Acute symptomatology and characteristics of the encounter were more likely to be associated with restraint/seclusion than patient demographics or diagnoses. These findings support recent guidelines for the treatment of agitation and can help clinicians identify patients at risk of behavioral decompensation. © 2014.

  17. Investigating the Impact of School Administrator's on the Frequency of Physical Restraint in K-12 Schools

    ERIC Educational Resources Information Center

    Dowell, Richard; Larwin, Karen

    2016-01-01

    The purpose of a physical restraint is to control the behavior of a student. It can involve physically holding a person immobile against his or her will to using chemical or mechanical devices to control a person. This study was designed to contribute to the paucity of existing research literature in regards to a school administrator's impact on…

  18. Contextual influences on nurses' decision-making in cases of physical restraint.

    PubMed

    de Casterlé, Bernadette Dierckx; Goethals, Sabine; Gastmans, Chris

    2015-09-01

    In order to fully understand nurses' ethical decision-making in cases of physical restraint in acute older people care, contextual influences on the process of decision-making should be clarified. What is the influence of context on nurses' decision-making process in cases of physical restraint, and what is the impact of context on the prioritizing of ethical values when making a decision on physical restraint? A qualitative descriptive study inspired by the Grounded Theory approach was carried out. In total, 21 in-depth interviews were carried out with nurses working on acute geriatric wards in Flanders, Belgium. The research protocol was approved by the Ethics Committee of the Faculty of Medicine, Leuven. Relationships with nursing colleagues and the patient's family form an inter-personal network. Nurses also point to the importance of the procedural-legal context as expressed in an institutional ethics policy and procedures, or through legal requirements concerning physical restraint. Furthermore, the architectural structure of a ward, the availability of materials and alternatives for restraint use can be decisive in nurses' decision-making. All interviewed nurses highlighted the unquestionable role of the practical context of care. Context can have a guiding, supportive, or decisive role in decision-making concerning the application of physical restraint. The discussion focuses on the role of the inter-personal network of nurses on the process of decision-making. An institutional ethics policy and a value-supportive care environment can support nurses in their challenge to take ethically sound decisions. © The Author(s) 2014.

  19. Is restraint a 'necessary evil' in mental health care? Mental health inpatients' and staff members' experience of physical restraint.

    PubMed

    Wilson, Ceri; Rouse, Lorna; Rae, Sarah; Kar Ray, Manaan

    2017-10-01

    Restraint in mental health care has negative consequences, and guidelines/policies calling for its reduction have emerged internationally. However, there is tension between reducing restraint and maintaining safety. In order to reduce restraint, it is important to gain an understanding of the experience for all involved. The aim of the present study was to improve understanding of the experience of restraint for patients and staff with direct experience and witnesses. Interviews were conducted with 13 patients and 22 staff members from one UK National Health Service trust. The overarching theme, 'is restraint a necessary evil?', contained subthemes fitting into two ideas represented in the quote: 'it never is very nice but…it's a necessary evil'. It 'never is very nice' was demonstrated by the predominantly negative emotional and relational outcomes reported (distress, fear, dehumanizing, negative impact on staff/patient relationships, decreased job satisfaction). However, a common theme from both staff and patients was that, while restraint is 'never very nice', it is a 'necessary evil' when used as a last resort due to safety concerns. Mental health-care providers are under political pressure from national governments to reduce restraint, which is important in terms of reducing its negative outcomes for patients and staff; however, more research is needed into alternatives to restraint, while addressing the safety concerns of all parties. We need to ensure that by reducing or eliminating restraint, mental health wards neither become, nor feel, unsafe to patients or staff. © 2017 Australian College of Mental Health Nurses Inc.

  20. [Physical restraint of patients: historical notes relating to the nineteenth and twentieth century].

    PubMed

    Fariña-López, Emilio; Estévez-Guerra, Gabriel J

    2011-03-01

    Physical restraint has been historically considered a necessary procedure to control the behaviour of the mentally ill. In the late eighteenth century moral treatment would pave the way for new initiatives against restraint, such as those instituted by British psychiatrists. They stressed the importance of training and supervision, as well as a minimum staff ratio, as being determining factors in reducing the use of restraint. This philosophy of treatment, despite its benefits, was introduced later and to a lesser extent in the rest of Europe, although, in other countries care was also made more humane through new therapeutic procedures. By contrast, in the United States most psychiatrists disagreed with those who advocated non-restraint, and continued using controversial methods to control the behaviour of patients. In Spain many difficulties hindered the improvement of conditions in institutions, many of which were in a sorry state. The initiatives of a few professionals and some cautious legal advances tried to alleviate the harshness of the treatment methods used. In the early twentieth century professional manuals were already available, which included the care to be given during the application of physical restraints. However it was not until the 1950, when the emergence of new psychotropic drugs and the distribution of important guidelines on the protection of the rights of patients that the widespread use of this procedure would be successfully reduced.

  1. Prevalence, risk factors, and outcomes associated with physical restraint use in mechanically ventilated adults.

    PubMed

    Rose, Louise; Burry, Lisa; Mallick, Ranjeeta; Luk, Elena; Cook, Deborah; Fergusson, Dean; Dodek, Peter; Burns, Karen; Granton, John; Ferguson, Niall; Devlin, John W; Steinberg, Marilyn; Keenan, Sean; Reynolds, Stephen; Tanios, Maged; Fowler, Robert A; Jacka, Michael; Olafson, Kendiss; Skrobik, Yoanna; Mehta, Sangeeta

    2016-02-01

    The purpose was to describe characteristics and outcomes of restrained and nonrestrained patients enrolled in a randomized trial of protocolized sedation compared with protocolized sedation plus daily sedation interruption and to identify patient and treatment factors associated with physical restraint. This was a post hoc secondary analysis using Cox proportional hazards modeling adjusted for center- and time-varying covariates to evaluate predictors of restraint use. A total of 328 (76%) of 430 patients were restrained for a median of 4 days. Restrained patients received higher daily doses of benzodiazepines (105 vs 41 mg midazolam equivalent, P < .0001) and opioids (1524 vs 919 μg fentanyl equivalents, P < .0001), more days of infusions (benzodiazepines 6 vs 4, P < .0001; opioids 7 vs 5, P = .02), and more daily benzodiazepine boluses (0.2 vs 0.1, P < .0001). More restrained patients received haloperidol (23% vs 12%, P = .02) and atypical antipsychotics (17% vs 4%, P = .003). More restrained patients experienced unintentional device removal (26% vs 3%, P < .001) and required reintubation (8% vs 1%, P = .01). In the multivariable analysis, alcohol use was associated with decreased risk of restraint (hazard ratio, 0.22; 95% confidence interval, 0.08-0.58). Physical restraint was common in mechanically ventilated adults managed with a sedation protocol. Restrained patients received more opioids and benzodiazepines. Except for alcohol use, patient characteristics and treatment factors did not predict restraint use. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Mindful Staff Can Reduce the Use of Physical Restraints when Providing Care to Individuals with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Singh, Nirbhay N.; Lancioni, Giulio E.; Winton, Alan S. W.; Singh, Ashvind N.; Adkins, Angela D.; Singh, Judy

    2009-01-01

    Background: The use of physical restraints has generated immense controversy in the delivery of services to individuals with intellectual disabilities. The current "zeitgeist" is that effective positive approaches obviate the need for using physical restraints. In a multiple baseline design, we sought to assess how training staff members in…

  3. Mindful Staff Can Reduce the Use of Physical Restraints when Providing Care to Individuals with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Singh, Nirbhay N.; Lancioni, Giulio E.; Winton, Alan S. W.; Singh, Ashvind N.; Adkins, Angela D.; Singh, Judy

    2009-01-01

    Background: The use of physical restraints has generated immense controversy in the delivery of services to individuals with intellectual disabilities. The current "zeitgeist" is that effective positive approaches obviate the need for using physical restraints. In a multiple baseline design, we sought to assess how training staff members in…

  4. Use of physical restraint in hospital patients: A descriptive study in a tertiary hospital in South Africa.

    PubMed

    Kalula, Sebastiana Z; Petros, Sabela G

    2016-11-10

    The use of physical restraint in patient management is a common and emotive issue, and has legal and ethical dimensions. To document the prevalence of physical restraint use, patient characteristics associated with physical restraint use, and nurses' and doctors' knowledge and perceptions towards the practice. A cross-sectional study of 572 patients, of whom 132 were physically restrained, was conducted in acute wards of a tertiary hospital. Data were collected on the 132 physically restrained patients. Fifty-nine doctors and 159 nurses completed a specially constructed questionnaire. Descriptive statistics were derived and expressed as numbers and percentages. Prevalence of restraint use was 23% (132/572). The distribution in acute wards was: medical 54.5%; surgical 44.7%; maternity 0.8%; psychiatry none. Mean age (SD) of the restrained patients was 49 years (20.5); 53.8% were male. The commonest types of restraints used were bed rails 93% and wrist belts 12%. Restraints were used largely to protect medical devices and as protection from harm. Less than 15% of the nurses reported having received training and 36% of the doctors reported having received some guidance on the use of restraints. Only a minority of nurses and doctors knew of a hospital policy on restraint use. Documentation on the prescription and indication for the use of restraint was poor. Prevalence of restraint use is high and poorly coordinated. A policy on the use of restraint and comprehensive guidelines should be developed to guide health care practitioners in the management of patients where restraint cannot be avoided.

  5. [Effectiveness of training interventions aimed at reducing physical restraints in institutionalised older people: A systematic review].

    PubMed

    Briones-Peralta, María Ángeles; Rodríguez-Martín, Beatriz

    There is some controversy about the use of physical restraints in institutionalised elderly people. The aim of this review is to analyse studies that evaluated the effectiveness of training interventions targeting interdisciplinary teams aimed at preventing, reducing or eliminating the use of physical restraints in nursing homes. A systematic search was performed in the Cochrane Library, PubMed, PsycINFO, EMBASE, and Web of Science to find clinical trials, published in English or in Spanish, that examined training sessions for interdisciplinary teams aimed at preventing, minimising or eliminating the use of physical restrains in institutionalised people over 65 years. Ten papers fulfilled the inclusion criteria. The findings show conflicting results on the effectiveness of training sessions. Furthermore, they lack sufficient empirical evidence to be able to assert that training sessions brought about a reduction in the use of physical restraints. More studies are needed that analyse the effectiveness of these interventions to prevent or eliminate the use of physical restraints in these institutions.

  6. [Use of physical restraints on the elderly: attitudes, knowledge and practice among nursing staff].

    PubMed

    Fariña-López, Emilio; Estévez-Guerra, Gabriel J; Núñez González, Eduardo; Pérez Hernández, Domingo de Guzmán; Gandoy Crego, Manuel

    2013-01-01

    To investigate the attitudes, knowledge and practice on the use of physical restraints by nursing staff working with the elderly, as well as the relationship existing between these variables. A cross-sectional descriptive and correlational study was conducted among professionals from eight nursing homes. Three questionnaires asking about the mentioned variables were used. A total of 378 questionnaires were finally included (94 nurses and 284 auxiliary nurses). The professionals' attitude was generally against the use of restraints, although they were in favour of using them to avoid falls. With regard to knowledge, they obtained 66% of the correct answers; only 32% believed that there were alternatives to restraints, and 69.1% were unaware that these procedures could cause the death of patients. A total of 69.8% said that their training regarding restraint was limited. The practice could be considered acceptable, although the 61.9% thought it was not necessary to get informed consent from the family, and only 47.1% of the nurses always recorded its use in the patient's history. Differences between attitudes, knowledge and practice were found among the two groups. A relationship between the variables was confirmed; less knowledge and more favourable attitude towards physical restraints correlate with a worst practice. The attitude of the staff to physical restraints is ambiguous, and erroneous concepts have been detected in their knowledge and practice. Given the influence of knowledge on the rest of the variables, the training of the professionals needs to be improved. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

  7. Knowledge, attitude and practice of intensive care unit nurses about physical restraint.

    PubMed

    Suliman, Mohammad; Aloush, Sami; Al-Awamreh, Khitam

    2017-09-01

    Physical restraint is mainly used in intensive care units (ICUs) to prevent delirious or agitated patients from removing tubes and lines connected to them. However, inappropriate use of physical restraint could have many detrimental physical effects on the patient, such as nerve damage, asphyxiation or even death. The aim of the study is to investigate nurses' knowledge, attitude and practice of physical restraint in ICUs in Jordanian hospitals, about which little is known. A descriptive and cross-sectional design was used. A convenience sample of 400 nurses working in three public hospitals and one university-affiliated hospital from different geographical regions in Jordan was selected. An Arabic version of the Physical Restraint Questionnaire (PRQ) was used to collect the data. A total of 300 completed questionnaires were returned, with a response rate of 75%. Of the total sample, 51% were males, 65.7% were from public hospitals and 80.3% held a bachelor's degree. The mean score in the knowledge section was 9.7 (SD =1.7) out of 15; in the attitude section, it was 24.7 (SD = 4.8) out of 33; and in the practice section, it was 30.9 (SD = 3.5) out of 42. Nurses who reported previous related education scored higher on the knowledge section (mean = 10.7; SD = 1.4) than nurses who reported no previous related education (mean = 9.1; SD = 1.6; p < .001). However, no significant differences between these categories were found in relation to attitude and practice. The study demonstrated some lack of knowledge and unsafe practices regarding physical restraint in ICUs in Jordan. It suggests improving nurses' knowledge, attitude and practices through in-service education on best practice for physical restraint, developing policies/guidelines and providing adequate staff and equipment to maintain patient safety and prevent complications. Conducting education programmes on physical restraint for ICU nurses and providing other preventive strategies

  8. EFFECT OF PHYSICAL RESTRAINT ON THE LIMITS OF THERMOREGULATION IN TELEMETERED RATS

    EPA Science Inventory

    Physical restraint of rodents is needed for nose-only exposure to airborne toxicants and is also used as a means ofpsychological stress. Hyperthermia is often observed in restrained rats, presumably as a result of impairments in heat dissipation. However, such a hyperthermic resp...

  9. 'It's part of the job, but it spoils the job': a phenomenological study of physical restraint.

    PubMed

    Bigwood, Stuart; Crowe, Marie

    2008-06-01

    This paper examines mental health nurses' experiences of physical restraint in an acute inpatient psychiatric setting using Van Manen's descriptive hermeneutic phenomenological methodology. The aim was to understand the nurses' experiences of physical restraint. One overarching theme emerged from the analysis: It's part of the job. This theme had a subtheme of Control which was constituted by the Conflicted Nurse and the Scared Nurse. The findings suggest that mental health nurses are very uncomfortable with physical restraint despite it being taken-for-granted as integral to their role. The nurses experienced conflict and fear associated with the procedure and would prefer to utilize other de-escalation skills if it was possible. The main source of conflict related to the imperative to maintain control and the professional values of the therapeutic relationship. While the nurses could see no viable alternative in some situations, the paper concludes that while environmental issues impact on the practice of physical restraint mental health nurses need to practice it with as much care and humanity as possible.

  10. EFFECT OF PHYSICAL RESTRAINT ON THE LIMITS OF THERMOREGULATION IN TELEMETERED RATS

    EPA Science Inventory

    Physical restraint of rodents is needed for nose-only exposure to airborne toxicants and is also used as a means ofpsychological stress. Hyperthermia is often observed in restrained rats, presumably as a result of impairments in heat dissipation. However, such a hyperthermic resp...

  11. Service Users' Views of Physical Restraint Procedures in Secure Settings for People with Learning Disabilities

    ERIC Educational Resources Information Center

    Jones, Peter; Kroese, Biza Stenfert

    2007-01-01

    The appropriateness and justification of physical restraint procedures in secure learning disability settings is an emotive issue. This paper examines the views of service users (n = 10) from secure residential facilities who are restrained frequently. Using a semi-structured interview schedule, Service users were interviewed about their restraint…

  12. Review of State Policies Concerning the Use of Physical Restraint Procedures in Schools

    ERIC Educational Resources Information Center

    Ryan, Joseph B.; Robbins, Katherine; Peterson, Reece; Rozalski, Michael

    2009-01-01

    Recent injuries and fatalities among students due to the use of physical restraint procedures in schools, and the resulting media attention and litigation have started to place pressure on many state and local education agencies to develop policies or guidelines concerning their use in schools. The authors investigated existing state policies and…

  13. Service Users' Views of Physical Restraint Procedures in Secure Settings for People with Learning Disabilities

    ERIC Educational Resources Information Center

    Jones, Peter; Kroese, Biza Stenfert

    2007-01-01

    The appropriateness and justification of physical restraint procedures in secure learning disability settings is an emotive issue. This paper examines the views of service users (n = 10) from secure residential facilities who are restrained frequently. Using a semi-structured interview schedule, Service users were interviewed about their restraint…

  14. Positive School-Wide Interventions for Eliminating Physical Restraint and Exclusion.

    ERIC Educational Resources Information Center

    Fogt, Julie B.; Piripavel, Christine M.

    2002-01-01

    This article describes a school where problems of defiance and aggression were met with high levels of seclusion and physical restraints. Centennial School had a comprehensive program of interventions designed to reduce and eventually eliminate aversive management strategies. Data on the effectiveness of these interventions is shared and…

  15. Nursing staff views of barriers to physical restraint reduction in nursing homes.

    PubMed

    Kong, Eun-Hi; Evans, Lois K

    2012-12-01

    There are few studies globally regarding the barriers to restraint-reduction. The purpose of this study was to describe the views of nursing staff (both nurses and geriatric care assistants) regarding the barriers to reducing physical restraint use in Korean nursing homes. Forty registered nurse and geriatric care assistant informants participated in the first round of interviews and 16 of them participated in second confirmatory interviews. All interviews were conducted on site, one-on-one and face-to-face, using semi-structured interview protocols. Qualitative descriptive method was used and qualitative content analysis was employed. Six themes were identified: (a) being too busy, (b) lack of resources, (c) beliefs and concerns, (d) lack of education, (e) differences and inconsistencies, and (f) relationship issues. The findings of this study provide a valuable basis for developing restraint reduction education programs. Korean national leaders and nursing homes should develop and employ practice guidelines regarding restraints, support nursing staff to follow the guidelines, provide more practical and professional education, employ alternative equipment, use a multidisciplinary team approach, and engage volunteers in care support as well as employ more nursing staff to achieve restraint-free care. Copyright © 2012. Published by Elsevier B.V.

  16. Predicting change in physical activity, dietary restraint, and physique anxiety in adolescent girls: examining covariance in physical self-perceptions.

    PubMed

    Crocker, Peter; Sabiston, Catherine; Forrestor, Shannon; Kowalski, Nanette; Kowalski, Kent; McDonough, Meghan

    2003-01-01

    To examine: i) the mean changes in adolescent females' body mass index (BMI), global self-esteem, physical self-perceptions, social physique anxiety, physical activity, and dietary restraint; ii) the stability of measuring self-perceptions, BMI, self-esteem, physique anxiety, activity, and dietary restraint; and iii) the relationships among changes in these variables over 12 months. 631 female adolescents (15-16 years old) involved in a two-year study of self-report measures completed validated questionnaires in high school classroom settings. There were small but significant group increases in BMI and social physique anxiety and significant decreases in sport, conditioning, and strength physical self-perceptions and physical activity. Stability analysis indicates moderate to strong stability for all variables. Change analyses indicated that BMI, due to its high stability, is a poor predictor of change in all variables. Stronger significant correlations were noted between change in body appearance self-perceptions and change in social physique anxiety (r=-0.54) and dietary restraint (r=-0.27). There was also a significant relationship between change in physical activity and the physical self-perceptions, although conditioning was the only significant (p<0.05) predictor of change in physical activity (beta=0.340). Physical self-perceptions are a stronger predictor of change in physical activity, dietary restraint, and social physique anxiety compared to BMI. This demonstrates the importance of physical self-perceptions when investigating health-related behaviours associated with dieting and physical activity. The decline in physical activity and increase in BMI is an ongoing concern, as is the link between body appearance self-perceptions and dietary restraint and social physique anxiety.

  17. Physical restraint and the protection of the human rights of immigration detainees in hospitals.

    PubMed

    Pickles, Hilary; Norton, Emma; Ginn, Emma; Schleicher, Theresa

    2015-08-01

    Immigration detainees, like prisoners, are entitled to the same standard of healthcare as non-detained patients. When hospital attendance or admission is required, the priority for custodial staff (who for purposes of this article we refer to as 'escorts') is to prevent absconding. For that reason, they may wish to use physical restraints, such as handcuffs, and remain with the detainee at all times. This can be degrading for the patient and breach their human rights. Clinicians have professional obligations to all their patients and must object to any restraint methods that risk damaging the patient's right to confidentiality, treatment, health or the therapeutic relationship itself. The starting presumption is that restraints ought not to be used during treatment and only in the most exceptional cases ought escorts to be present during clinical examination or treatment.

  18. Ethical considerations for evaluating the issue of physical restraint in psychiatry.

    PubMed

    Petrini, Carlo

    2013-01-01

    This article examines some of the ethical issues associated with the use of physical restraint in psychiatry and neurology. It offers no specific answers to individual operational problems, but a methodological matrix is proposed as an aid to experts in the various settings in which decisions are taken. The subject is addressed mainly by considering two sources: reference documents published by eminent organisations, and the theoretical framework of ethical values (or principles). A number of analytical criteria arising from these sources are then identified and proposed. The proposed criteria can be applied in cases for which the legitimate use of restraint may be an option, bearing in mind that restraint is an extremely serious affront to human dignity and is widely held to be of no therapeutic value. Its abuse is illegitimate in both ethical and legal terms.

  19. The Eileen Skellern Lecture 2014: physical restraint: in defence of the indefensible?

    PubMed

    Duxbury, J A

    2015-03-01

    Aggression is reported to be prevalent in psychiatric inpatient care and its frequency towards healthcare professionals is well documented. While aggression may not be entirely avoidable, its incidence can be reduced through prevention and the minimization of restrictive practices such as physical restraint. The study aims to explore three common 'defences' to account for the use of physical restraint; to challenge each defence with regard to the evidence base; and to identify how services are responding to the challenge of reducing the use of restrictive interventions. Following a number of investigations to highlight serious problems with the use of physical restraint, it seems timely to examine its efficacy in light of the evidence base. In order to do this, three key defences for its use will be challenged using the literature. A combination of interventions to minimize the use of restraint including advance planning tools, and recognition of potential trauma is necessary at an organizational and individual level. Patients can be severely traumatized by the use of restrictive practices and there is a drive to examine, and reduce the use and impact of using these models that incorporate trauma informed care (TIC) and person centredness. © 2015 John Wiley & Sons Ltd.

  20. Early pharmacological treatment of delirium may reduce physical restraint use: a retrospective study.

    PubMed

    Michaud, Christopher J; Thomas, Wendy L; McAllen, Karen J

    2014-03-01

    Evidence surrounding pharmacological treatment of delirium is limited. The negative impact of physical restraints on patient outcomes in the intensive care unit (ICU), however, is well published. The objective of this study was to evaluate whether initiating pharmacologic delirium treatment within 24 hours of a positive screen reduces the number of days in physical restraints and improves patient outcomes compared with delayed or no treatment. Patients from a mixed ICU with a documented positive delirium score using the Intensive Care Delirium Screening Checklist were retrospectively grouped based on having received pharmacologic treatment within 24 hours of the first positive screen or not. Primary end points were number of days spent in physical restraints and time to extubation after delirium onset. Secondary end points included hospital and ICU length of stay (LOS) and survival to discharge. Two hundred intubated patients were either pharmacologically treated (n = 98) or not treated (n = 102) within 24 hours of the first positive delirium score. Patients receiving treatment spent a shorter median time in restraints compared with patients who were not treated (3 vs 6 days; P < .001), and had a shorter median time to extubation (3 vs 6.5 days; P < .001). The treatment group also experienced a shorter ICU LOS (9.5 vs 16 days; P < .001) and hospital LOS (14.5 vs 22 days; P < .001) compared with the no-treatment group. Delirious patients who received pharmacological treatment within 24 hours of the first positive screen spent fewer days in physical restraints and less time receiving mechanical ventilation compared with those who did not. Although delirium management is multifactorial, early pharmacological therapy may benefit patients diagnosed with delirium.

  1. Attitudes of nurses towards the use of physical restraints in geriatric care: a systematic review of qualitative and quantitative studies.

    PubMed

    Möhler, Ralph; Meyer, Gabriele

    2014-02-01

    To examine nurses' attitudes towards the use of physical restraints in geriatric care. Systematic review and synthesis of qualitative and quantitative studies. The following databases were searched: Medline, CINAHL, EMBASE, Psyndex, PsychInfo, Social SciSearch, SciSearch, Forum Qualitative Social Research (1/1990 to 8/2013). We performed backward and forward citation tracking to all of the included studies. We included in the present review all qualitative and quantitative studies in English and German that investigated nurses' attitudes towards the use of physical restraints in geriatric care. Two independent reviewers selected the studies for inclusion and assessed the study quality. We performed a thematic synthesis for the qualitative studies and a content analysis of the questionnaires' items as well as a narrative synthesis for the quantitative surveys. We included 31 publications in the review: 20 quantitative surveys, 10 qualitative and 1 mixed-method study. In the qualitative studies, nurses' attitudes towards the use of physical restraints in geriatric care were predominately characterised by negative feelings towards the use of restraints; however, the nurses also described a perceived need for using restraints in clinical practice. This discrepancy led to moral conflicts, and nurses described several strategies for coping with these conflicts when restraints were used. When nurses were in doubt regarding the use of restraints, they decided predominantly in favour of using restraints. The results of the quantitative surveys were inconsistent regarding nurses' feelings towards the use of restraints in geriatric care. Prevention of falls was identified as a primary reason for using restraints. However, the items of the questionnaires focussed primarily on the reasons for the use of restraints rather than on the attitudes of nurses. Despite the lack of evidence regarding the benefits of restraints and the evidence on the adverse effects, nurses often

  2. Effect of physical restraint on the limits of thermoregulation in telemetered rats.

    PubMed

    Aydin, Cenk; Grace, Curtis E; Gordon, Christopher J

    2011-11-01

    Physical restraint of rodents is needed for nose-only exposure to airborne toxicants and is also used as a means of psychological stress. Hyperthermia is often observed in restrained rats, presumably as a result of impairments in heat dissipation. However, such a hyperthermic response should be dependent on the prevailing ambient conditions. To understand how ambient temperature (T(a)) affects the thermoregulatory response to restraint, core temperature (T(c)) and heart rate (HR) were monitored by telemetry in rats subjected to 1 h of physical restraint while T(a) was maintained at 14-30 °C in 2 °C increments. The T(c) of unrestrained rats was unaffected by T(a). During restraint, T(c) was elevated at ambient temperatures with the exception of 14 °C, at which the rats became mildly hypothermic. There was an inverse relationship between T(a) and HR in both unrestrained and restrained rats; however, HR was significantly elevated in restrained rats at all ambient temperatures except 22 and 24 °C. Heat loss from the tail, estimated from T(c) and tail skin temperature, was markedly reduced at all but the highest ambient temperatures in restrained rats. The data suggest that the T(a) limits of normothermia are narrowed in the restrained rat. That is, between 16 and 20 °C, the rat maintains a relatively stable T(c) that is slightly elevated above that of the unrestrained rat. At ambient temperatures above or below this range, the rat shows signs of hyperthermia and hypothermia, respectively. In contrast, the limits of normothermia for unrestrained rats range from 14 (or lower) to 30 °C. Overall, the ideal T(a) for restrained rats appears to be 20 °C and no higher than 22 °C for the thermoregulatory system to maintain a regulated T(c) in rats well adapted to physical restraint.

  3. Predictors of Physical Restraint Use in Hospitalized Veterans at End of Life: An Analysis of Data from the BEACON Trial.

    PubMed

    Kvale, Elizabeth; Dionne-Odom, J Nicholas; Redden, David T; Bailey, F Amos; Bakitas, Marie; Goode, Patricia S; Williams, Beverly R; Haddock, Kathlyn Sue; Burgio, Kathryn L

    2015-06-01

    The use of physical restraints in dying patients may be a source of suffering and loss of dignity. Little is known about the prevalence or predictors for restraint use at end of life in the hospital setting. The objective was to determine the prevalence and predictors of physical restraint use at the time of death in hospitalized adults. Secondary analysis was performed on data from the "Best Practices for End-of-Life Care for Our Nation's Veterans" (BEACON) trial conducted between 2005 and 2011. Medical record data were abstracted from six Veterans Administration Medical Centers (VAMCs). Data on processes of care in the last seven days of life were abstracted from the medical records of 5476 who died in the six VAMCs. We prospectively identified potential risk factors for restraint use at the time of death from among the variables measured in the parent trial, including location of death, medications administered, nasogastric tube, intravenous (IV) fluids, family presence, and receipt of a palliative care consultation. Physical restraint use at time of death was documented in 890 decedents (16.3%). Restraint use varied by location of death, with patients in intensive settings being at higher risk. Restraint use was significantly more likely in patients with a nasogastric tube and those receiving IV fluids, benzodiazepines, or antipsychotics. This is the first study to document that one in six hospitalized veterans were restrained at the time of death and to identify predictors of restraint use. Further research is needed to identify intervention opportunities.

  4. Quality of life of nursing-home residents with dementia subject to surveillance technology versus physical restraints: an explorative study.

    PubMed

    Te Boekhorst, S; Depla, M F I A; Francke, A L; Twisk, J W R; Zwijsen, S A; Hertogh, C M P M

    2013-04-01

    As physical restraints should only be used in exceptional cases, there is an urgent need for alternatives to restraint use. Surveillance technology could be such an alternative. This study explored whether nursing-home residents with dementia subjected to surveillance technology had better quality of life scores for mood, behavioral and societal dimensions than residents with physical restraints. Quality of life was assessed longitudinally, with three measurements in six psychogeriatric nursing homes of residents with surveillance technology (n = 170) and residents with physical restraints (n = 22). QUALIDEM subscales were used to measure five dimensions of quality of life. Multilevel longitudinal univariate and multivariate regression techniques were used to analyze the data. Because physical restraints were almost exclusively used in residents with low activities of daily living (ADL) independency (18 of the 22), we restricted the regression analyses to residents with a Barthel Index score ≤ 5 (overall n = 53). Univariate results showed that highly ADL-dependent residents with surveillance technology had significantly more positive affect than highly ADL-dependent residents with physical restraints. However, this difference proved to be no longer significant after adjustment for the confounders: age, sex and stage of dementia. Quality of life of highly ADL-dependent nursing-home residents with dementia seems to be unrelated to the use of surveillance technology as opposed to physical restraints. Copyright © 2012 John Wiley & Sons, Ltd.

  5. Children with special physical health care needs: restraint use and injury risk in motor vehicle crashes.

    PubMed

    Huang, Patty; Kallan, Michael J; O'Neil, Joseph; Bull, Marilyn J; Blum, Nathan J; Durbin, Dennis R

    2011-10-01

    Physical disabilities may affect a child passenger's fit within a conventional motor vehicle restraint. The aim of this study is to describe and compare injury risk in motor vehicle crashes (MVC) among children with and without special physical health care needs (SPHCN). This analysis, conducted in 2007-2008, utilizes data collected between December 1998 and November 2002 in a cross-sectional study of children ≤15 years old involved in crashes of State-Farm insured vehicles in 15 states and the District of Columbia. Parent reports via telephone survey were used to define pre-crash SPHCN, restraint status, and occurrence of significant injuries using a validated survey. Complete data were collected for 18,852 children aged 0-15 years; 159 children were reported to have a SPHCN (0.8% and 0.7% of children aged 0-8 and 9-15 years, respectively). A greater proportion of children with SPHCN aged 0-8 years were appropriately restrained (P < 0.001), but there was no significant difference in restraint use among children with and without SPHCN aged 9-15 years. There was no significant association between the presence of a SPHCN and injury risk in either age group, after adjustment for child/driver characteristics (children aged 0-8 years: OR 1.27, 95% CI: 0.48-3.33; children aged 9-15 years: OR 1.51, 95% CI: 0.38-6.11). Children with and without SPHCN have similar injury risk in MVC, despite increased age-appropriate restraint usage among children aged 0-8 years. When counseling families about vehicle safety, practitioners should consider the fit of a child with SPHCN in a restraint system.

  6. Pasung: Physical restraint and confinement of the mentally ill in the community

    PubMed Central

    Minas, Harry; Diatri, Hervita

    2008-01-01

    Background Physical restraint and confinement (pasung) by families of people with mental illness is known to occur in many parts of the world but has attracted limited investigation. This preliminary observational study was carried out on Samosir Island in Sumatra, Indonesia, to investigate the nature of such restraint and confinement, the clinical characteristics of people restrained, and the reasons given by families and communities for applying such restraint. Methods The research method was cross-sectional observational research in a natural setting, carried out during a six-month period of working as the only psychiatrist in a remote district. Results Fifteen cases of pasung, approximately even numbers of males and females and almost all with a diagnosis of schizophrenia were identified. Duration of restraint ranged from two to 21 years. Discussion and Conclusion The provision of basic community mental health services, where there were none before, enabled the majority of the people who had been restrained to receive psychiatric treatment and to be released from pasung. PMID:18554420

  7. Protective Therapies for Monomethylhydrazine: Comparison of Pyridoxine and Physical Restraint in the Monkey

    DTIC Science & Technology

    1979-04-01

    convulsive doses of 1 , 1 - dimethylhydrazine on somatic evoked responses in the cat. Exp. Neurol 27:213-226. 8. Goff, W. R., Allison, T., Matsumiya, Y...Sterman, M. B. and Fairchild, M. D. September 1967, Effects of 1 ., 1 - dimethylhydrazine (UDMH) on evoked cerebral neuroelectric responses, AMRL-TR-67...AMRL-TR-79- 1 0 PROTECTIVE THERAPIES FOR MONOMETHYLHYDRAZINE: COMPARISON OF PYRIDOXINE AND PHYSICAL RESTRAINT IN THE MONKEY M. B. STERMAN, Ph.D. S. J

  8. Serotonin transporter in lymphocytes of rats exposed to physical restraint stress.

    PubMed

    Medina-Martel, Matilde; Urbina, Mary; Fazzino, Fili; Lima, Lucimey

    2013-01-01

    Glucocorticoids and stress cause transcriptional and functional changes on the serotonin transporter (SERT) in the central nervous system. Stress can produce specific modifications of SERT in lymphocytes, which could be associated with alterations in immune response. The aim of this study was to evaluate the effect of a physical restraint stress protocol on (1) rat lymphocyte proliferation in the presence of the selective serotonin reuptake inhibitor fluoxetine and (2) SERT kinetic parameters, i.e. binding capacity (Bmax), affinity (Kd) and Hill coefficient (nH). Male adult Sprague-Dawley rats were placed in Plexiglass boxes (5 h daily for 5 days), and blood was obtained by cardiac puncture on day 6. Serum corticosterone was quantitated by an immunoenzymatic assay. Lymphocytes were isolated by density gradients and adhesion to plastic, of which there was sufficient material for further experiments, then cultured with or without the mitogen concanavalin A (Con A, 2 μg/ml) and fluoxetine (1-50 μM). Cell proliferation was measured with tetrazolium salts, and [(3)H]paroxetine was used as a SERT-specific ligand for binding assays. Restraint produced a significant increase in serum corticosterone of stressed rats. The proliferative response to Con A was similar in the controls and stressed animals. Fluoxetine reduced cell proliferation with and without Con A. Restraint diminished the inhibitory effect of fluoxetine on proliferation. Restraint also increased Bmax and Kd, but decreased nH. Treatment of rats with actinomycin D, a transcription inhibitor, reduced Bmax in stressed animals. Restraint stress modulated the effect of fluoxetine on cell proliferation, probably through the modification of the presence and the function of SERT. Copyright © 2013 S. Karger AG, Basel.

  9. Knowledge, perceptions, and experiences of family caregivers and home care providers of physical restraint use with home-dwelling elders: a cross-sectional study in Japan

    PubMed Central

    2014-01-01

    Background The use of physical restraints by family caregivers with home-dwelling elders has not been extensively studied but it might be widespread. Furthermore, it is also not clear how home care providers who support family caregivers perceive the use of physical restraint in elders’ homes. This study assessed family caregivers’ and home care providers’ knowledge and perceptions of physical restraint used with elders living at home in Japan, a country with the highest proportion of elders in the world and where family caregiving is common. Methods We undertook a cross-sectional study of 494 family caregivers, 201 home helpers, 78 visiting nurses, 131 visiting physicians, and 158 care managers of home-dwelling frail elders needing some care and medical support in Japan, using questionnaires on knowledge of 11 physical restraint procedures prohibited in institutions and 10 harmful effects of physical restraints, perceptions of 17 reasons for requiring physical restraints, and experiences involving physical restraint use. Results Family caregivers were aware of significantly fewer recognized prohibited physical restraint procedures and recognized harmful effects of physical restraint than home care providers, and differences among home care providers were significant. The average importance rating from 1 (least) to 5 (most) of the 17 reasons for requiring physical restraints was significantly higher among family caregivers than home care providers, and significantly different among the home care providers. Moreover, these differences depended in part on participation in physical restraint education classes. While 20.1% of family caregivers had wavered over using physical restraints, 40.5% of home care providers had seen physical restraints used in elders’ homes and 16.7% had advised physical restraint use or used physical restraints themselves. Conclusions Knowledge and perceptions of physical restraints differed between family caregivers and home care

  10. Knowledge, perceptions, and experiences of family caregivers and home care providers of physical restraint use with home-dwelling elders: a cross-sectional study in Japan.

    PubMed

    Kurata, Sadami; Ojima, Toshiyuki

    2014-03-27

    The use of physical restraints by family caregivers with home-dwelling elders has not been extensively studied but it might be widespread. Furthermore, it is also not clear how home care providers who support family caregivers perceive the use of physical restraint in elders' homes. This study assessed family caregivers' and home care providers' knowledge and perceptions of physical restraint used with elders living at home in Japan, a country with the highest proportion of elders in the world and where family caregiving is common. We undertook a cross-sectional study of 494 family caregivers, 201 home helpers, 78 visiting nurses, 131 visiting physicians, and 158 care managers of home-dwelling frail elders needing some care and medical support in Japan, using questionnaires on knowledge of 11 physical restraint procedures prohibited in institutions and 10 harmful effects of physical restraints, perceptions of 17 reasons for requiring physical restraints, and experiences involving physical restraint use. Family caregivers were aware of significantly fewer recognized prohibited physical restraint procedures and recognized harmful effects of physical restraint than home care providers, and differences among home care providers were significant. The average importance rating from 1 (least) to 5 (most) of the 17 reasons for requiring physical restraints was significantly higher among family caregivers than home care providers, and significantly different among the home care providers. Moreover, these differences depended in part on participation in physical restraint education classes. While 20.1% of family caregivers had wavered over using physical restraints, 40.5% of home care providers had seen physical restraints used in elders' homes and 16.7% had advised physical restraint use or used physical restraints themselves. Knowledge and perceptions of physical restraints differed between family caregivers and home care providers and were also diverse among home care

  11. The impact of restraint reduction meetings on the use of restrictive physical interventions in English residential services for children and young people.

    PubMed

    Deveau, R; Leitch, S

    2015-07-01

    The aim was to examine the impact of post restraint reduction meetings upon the frequency and restrictiveness of restraint use in English children's residential services. Attention has been drawn to the misuse, overuse and safety of some techniques used to physically restrain children in residential services. Successful interventions to reduce restraints have been reported, mostly from the USA. Demonstrate a significant overall reduction in both, frequency and restrictiveness of restraints; the greatest percentage decrease in the most restrictive floor restraints. Whilst five services reduced both frequency and restrictiveness, five services showed some increases in frequency and/or restrictiveness of restraints employed. Restraint reduction is most effectively reduced through employing multiple strategies and that post restraint reduction meetings maybe one useful component. Organisations seeking to promote restraint reduction meetings need to allocate sufficient priority and resources to support these. © 2014 John Wiley & Sons Ltd.

  12. Educational intervention on physical restraint use in long-term care facilities - Systematic review and meta-analysis.

    PubMed

    Lan, Shao-Huan; Lu, Li-Chin; Lan, Shou-Jen; Chen, Jong-Chen; Wu, Wen-Jun; Chang, Shen-Peng; Lin, Long-Yau

    2017-08-01

    "Physical restraint" formerly used as a measure of protection for psychiatric patients is now widely used. However, existing studies showed that physical restraint not only has inadequate effect of protection but also has negative effects on residents. To analyzes the impact of educational program on the physical restraint use in long-term care facilities. A systematic review with meta-analysis and meta-regression. Eight databases, including Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science, Ovid Medline and Physiotherapy Evidence Database (PEDro), were searched up to January 2017. Eligible studies were classified by intervention and accessed for quality using the Quality Assessment Tool for quantitative studies. Sixteen research articles were eligible in the final review; 10 randomize control trail studies were included in the analysis. The meta-analysis revealed that the use of physical restraint was significantly less often in the experimental (education) group (OR = 0.55, 95% CI: 0.39 to 0.78, p < 0.001) compared to the control group. Meta-regression revealed the period of post education would have decreased the effect of the restraint educational program (β: 0.08, p = 0.002); instead, the longer education period and more times of education would have a stronger effect of reducing the use of physical restraint (β: -0.07, p < 0.001; β: -0.04, p = 0.056). The educational program had an effect on the reduced use of physical restraint. The results of meta-regression suggest that long-term care facilities should provide a continuous education program of physical restraint for caregivers. Copyright © 2017. Published by Elsevier Taiwan.

  13. Mental health outcomes and physical restraint use in nursing homes {private}.

    PubMed

    Castle, Nicholas G

    2006-11-01

    We investigate the nexus between mental health outcomes in nursing home residents and the use of physical restraints. Previous studies in this area used limited statistical tests such as correlations and t-tests, that could not account for potential biases, such as residents who become mentally disturbed may be most likely to be restrained. We use propensity matching models that are less susceptible to this bias and data from the Minimum Data Set, representing approximately 2,000 residents over a period of 6 years. Our results clearly show that restrained residents are more likely to become more impaired with respect to cognitive performance, depression, and social engagement. We conclude that if facilities reduce restraint use then the prevalence of resident mental health problems will also likely decline.

  14. The Efficacy of an In-Service Education Program Designed to Enhance the Effectiveness of Physical Restraints.

    PubMed

    Chang, Yin-Yin; Yu, Hsiu-Hui; Loh, El-Wui; Chang, Li-Yin

    2016-03-01

    Physical restraints are used to enhance the safety of patients and to avoid injury. However, physical restraints may cause injuries if improperly used or if they are used in the absence of continuous monitoring. Nursing staff who use physical restraints often lack sufficient related knowledge, which may increase the risk to patient safety. This study investigates the impact of an in-service education program for nursing staff that is designed to improve physical-restraint-related knowledge, attitudes, behaviors, and techniques. A pretest-posttest design and a quasi-experimental method were employed to evaluate the effectiveness of the in-service education program. One hundred thirty-six nursing staff from four adult intensive care units (ICUs), including two medical ICUs and two surgical ICUs, in a medical center in central Taiwan were enrolled as participants. The experimental group (EG) and the control group (CG) were composed of patients from one randomly assigned medical ICU and one randomly assigned surgical ICU each. The pretest data on physical-restraint-related knowledge, attitudes, behaviors, and techniques were collected before the in-service education program. The EG received 2 hours of classroom education on guidelines and techniques related to physical restraints. The posttest data for the two groups were collected a month after implementation of the in-service education program. General Estimation Equation was used to measure and analyze the data repeatedly. The posttest scores of the EG for knowledge and technique were significantly higher than the pretest scores (p < .0001). However, the posttest scores of the EG for attitudes and behaviors did not significantly differ from the pretest scores. In-service education for physical restraints enhances relevant knowledge and techniques but does not significantly affect attitudes or behaviors. Correct implementation of physical restraints not only promotes the quality of nursing care for patients in the

  15. A review of the scientific literature related to the adverse impact of physical restraint: gaining a clearer understanding of the physiological factors involved in cases of restraint-related death.

    PubMed

    Barnett, Richard; Stirling, Chris; Pandyan, Anand D

    2012-07-01

    Deaths occurring during and/or in close proximity to physical restraint have been attributed to positional asphyxia, a conclusion primarily based on opinion and reviews of case studies. This review sought to identify the current scientific evidence available in regard to the aetiology of adverse events or death occurring during or in close proximity to physical restraint. A systematic search of electronic databases (SPORTDiscus, AMED, CINAHL, MEDLINE, PsycINFO) for papers published in English, between 1980 and 2011, using keywords that related to restraint, restraint position and cardiovascular function resulted in 11 experimental papers being found for review. The term positional asphyxia as a mechanism for sudden death is poorly understood. The literature shows that restraint position has the ability to impede life-maintaining physiological functions, but that the imposed impediment is not uniform across all restraint positions/techniques. Further research is required to ascertain the risks posed by struggling during restraint for more prolonged periods of time and in different positions using varied techniques of restraint. This research should seek to and rank known or future risk factors of adverse events occurring during restraint, seeking to understand the interactions and if present the cumulative effect of these risk factors. Finally, future research should focus on populations other than apparently healthy male adults.

  16. Nurses' ethical reasoning in cases of physical restraint in acute elderly care: a qualitative study.

    PubMed

    Goethals, Sabine; Dierckx de Casterlé, Bernadette; Gastmans, Chris

    2013-11-01

    In their practice, nurses make daily decisions that are ethically informed. An ethical decision is the result of a complex reasoning process based on knowledge and experience and driven by ethical values. Especially in acute elderly care and more specifically decisions concerning the use of physical restraint require a thoughtful deliberation of the different values at stake. Qualitative evidence concerning nurses' decision-making in cases of physical restraint provided important insights in the complexity of decision-making as a trajectory. However a nuanced and refined understanding of the reasoning process in terms of ethical values is still lacking. A qualitative interview design, inspired by the Grounded Theory approach, was carried out to explore nurses' reasoning process in terms of ethical values. We interviewed 21 acute geriatric nurses from 12 hospitals in different regions in Flanders, Belgium in the period October 2009-April 2011. The Qualitative Analysis Guide of Leuven was used to analyse interview data. Nurses' decision-making is characterized as an ethical deliberation process where different values are identified and where the process of balancing these values forms the essence of ethical deliberation. Ethical decision-making in cases of physical restraint implies that nurses have to choose which values receive priority in the process, which entails that not all values can be respected to the same degree. As a result, decision making can be experienced as difficult, even as a dilemma. Driven by the overwhelming goal of protecting physical integrity, nurses took into account the values of dignity and justice more implicitly and less dominantly.

  17. Effects of physical restraint and electrical stunning on plasma corticosterone, postmortem metabolism, and quality of broiler breast muscle.

    PubMed

    Huang, J C; Huang, M; Wang, P; Zhao, L; Xu, X L; Zhou, G H; Sun, J X

    2014-12-01

    The objective of this study was to determine the effects of physical restraint and electrical stunning on plasma corticosterone, postmortem metabolism, and quality of broiler breast muscle. Before slaughter, a total of 160 Arbor Acres broilers were randomly categorized into 2 replicate pens (80 broilers per pen) and every pen was randomly divided into 4 groups (free struggle, physical restraint, free struggle and electrical stunning, and physical restraint and electrical stunning; n=20 per group). Glucose, lactate, and corticosterone were determined on blood plasma samples. Pectoralis major were removed after evisceration and used for determination of meat quality, energy metabolism, and calpain activity. In this study, reducing free struggle by physical restraint combined with electrical stunning improved (P<0.05) meat water holding capacity. Free struggle preslaughter and during bleeding increased (P<0.05) breast muscle redness, energy metabolism, and autolysis of μ/m-calpain and decreased (P<0.05) meat shear values. Physical restraint and electrical stunning decreased (P<0.05) plasma corticosterone level.

  18. Nurses using physical restraints: Are the accused also the victims? – A study using focus group interviews

    PubMed Central

    Lai, Claudia KY

    2007-01-01

    Background To date, the literature has provided an abundance of evidence on the adverse outcomes of restraint use on patients. Reportedly, nurses are often the personnel who initiate restraint use and attribute its use to ensuring the safety of the restrained and the others. A clinical trial using staff education and administrative input as the key components of a restraint reduction program was conducted in a rehabilitation setting to examine whether there were any significant differences in the prevalence of restraint use pre- and post-intervention. Subsequent to the implementation of the intervention program, focus group interviews were conducted to determine the perspective of the nursing staff on the use of restraints and their opinions of appropriate means to reduce their use. Method Registered nurses working in units involved in the study were invited to participate in focus group interviews on a voluntary basis. Twenty-two registered nurses (three males [13.6%] and nineteen females [86.4%]) attended the four sessions. All interviews were audio taped and transcribed verbatim. Other than the author, another member of the project team validated the findings from the data analysis. Results Four themes were identified. Participants experienced internal conflicts when applying physical restraints and were ambivalent about their use, but they would use restraints nonetheless, mainly to prevent falls and injuries to patients. They felt that nurse staffing was inadequate and that they were doing the best they could. They experienced pressure from the management level and would have liked better support. Communication among the various stakeholders was a problem. Each party may have a different notion about what constitutes a restraint and how it can be safely used, adding further weight to the burden shouldered by staff. Conclusion Studies about restraints and restraint use have mostly focused on nurses' inadequate and often inaccurate knowledge about the use of

  19. [Spanish adaptation and validation of the Perception of Restraint Use Questionnaire (PRUQ) on the use of physical restraints on the elderly].

    PubMed

    Fariña López, E; Estévez-Guerra, G J; Núñez González, E; Calvo Francés, F; Penelo, E

    2016-04-29

    To adapt and to validate in a Spanish population the Perception of Restraint Use Questionnaire (PRUQ), which assesses the importance that professionals give to the use of physical restraints when caring for older adults. After a process of forward-back translation and linguistic adaptation, a Spanish version of the original questionnaire was obtained. A descriptive cross-sectional multicenter study was then carried out. Based on non-probability sampling, 20 centers from three Spanish regions were selected; 830 professionals agreed to participate. 15 of the 17 items of the original questionnaire were translated literally and two required minor modifications.All were considered acceptable by an expert panel(content validity index of 0.89); a pilot study confirmed the adequate feasibility of the questionnaire. The principal components analysis identified three dimensions that explained 66.2% of variance. The confirmatory factor analysis of this tridimensional model showed an acceptable fit [CFI = 0.936; RMSEA = 0.080], being factor loadings and factor correlations statistically significant (p<0.001). The internal consistency (Cronbach's alpha) for the total score was 0.92 and the test-retest reliability (ICCa) was 0.87 (95%CI: 0.78 to 0.92) over an interval of three weeks. The Spanish version of the PRUQ shows good psychometric characteristics and is adapted to the cultural context of this country. It may be considered a useful tool to assess in which situations professionals consider the use of physical restraints most necessary, helping to design training activities aimed at rationalizing its application.

  20. Physical restraint in mechanically ventilated ICU patients: a survey of French practice.

    PubMed

    De Jonghe, Bernard; Constantin, Jean-Michel; Chanques, Gerald; Capdevila, Xavier; Lefrant, Jean-Yves; Outin, Hervé; Mantz, Jean

    2013-01-01

    To characterize the perceived utilization of physical restraint (PR) in mechanically ventilated intensive care unit (ICU) patients and to identify clinical and structural factors influencing PR use. A questionnaire was personally handed to one intensivist in 130 ICUs in France then collected on-site 2 weeks later. The questionnaire was returned by 121 ICUs (response rate, 93 %), 66 % of which were medical-surgical ICUs. Median patient-to-nurse ratio was 2.8 (2.5-3.0). In 82 % of ICUs, PR is used at least once during mechanical ventilation in more than 50 % of patients. In 65 % of ICUs, PR, when used, is applied for more than 50 % of mechanical ventilation duration. Physical restraint is often used during awakening from sedation and when agitation occurs and is less commonly used in patients receiving deep sedation or neuromuscular blockers or having severe tetraparesis. In 29 % of ICUs, PR is used in more than 50 % of awake, calm and co-operative patients. PR is started without written medical order in more than 50 % of patients in 68 % of ICUs, and removed without written medical order in more than 50 % of patients in 77 % of ICUs. Only 21 % of ICUs have a written local procedure for PR use. This survey in a country with a relatively high patient-to-nurse ratio shows that PR is frequently used in patients receiving mechanical ventilation, with wide variations according to patient condition. The common absence of medical orders for starting or removing PR indicates that these decisions are mostly made by the nurses.

  1. Developing School Policies and Procedures for Physical Restraint and Seclusion in Nebraska Schools. A Technical Assistance Document

    ERIC Educational Resources Information Center

    Peterson, Reece L.

    2010-01-01

    The purpose of this document is to provide information and guidance for Nebraska School districts in creating new, or revising existing policies and procedures related to the use of physical restraint and seclusion in school settings. The goal is to create policies that are informed by national policy directions, research, good practice and…

  2. Nurses' decision-making process in cases of physical restraint in acute elderly care: a qualitative study.

    PubMed

    Goethals, S; Dierckx de Casterlé, B; Gastmans, C

    2013-05-01

    The increasing vulnerability of patients in acute elderly care requires constant critical reflection in ethically charged situations such as when employing physical restraint. Qualitative evidence concerning nurses' decision making in cases of physical restraint is limited and fragmented. A thorough understanding of nurses' decision-making process could be useful to understand how nurses reason and make decisions in ethically laden situations. The aims of this study were to explore and describe nurses' decision-making process in cases of physical restraint. We used a qualitative interview design inspired by the Grounded Theory approach. Data analysis was guided by the Qualitative Analysis Guide of Leuven. Twelve hospitals geographically spread throughout the five provinces of Flanders, Belgium. Twenty-one acute geriatric nurses interviewed between October 2009 and April 2011 were purposively and theoretically selected, with the aim of including nurses having a variety of characteristics and experiences concerning decisions on using physical restraint. In cases of physical restraint in acute elderly care, nurses' decision making was never experienced as a fixed decision but rather as a series of decisions. Decision making was mostly reasoned upon and based on rational arguments; however, decisions were also made routinely and intuitively. Some nurses felt very certain about their decisions, while others experienced feelings of uncertainty regarding their decisions. Nurses' decision making is an independent process that requires nurses to obtain a good picture of the patient, to be constantly observant, and to assess and reassess the patient's situation. Coming to thoughtful and individualized decisions requires major commitment and constant critical reflection. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. Comparison of biochemical stress indicators in juvenile captive estuarine crocodiles (Crocodylus porosus) following physical restraint or chemical restraint by midazolam injection.

    PubMed

    Olsson, Annabelle; Phalen, David

    2013-07-01

    Using a prospective, randomized study design we demonstrate that midazolam sedation minimizes acidosis compared with physical restraint in captive juvenile estuarine crocodiles during handling or noninvasive procedures at preferred body temperature. A dose of midazolam (5.0 mg/kg) was administered intramuscularly into the forelimb of 20 male estuarine crocodiles weighing 2-3.5 kg. Their heart and respiratory rate and degree of sedation were monitored until recovery and then daily for 7 subsequent days. Blood samples were taken at 30, 60, 90, 180, and 360 min. We recorded lactate, partial pressure of carbon dioxide (CO2), hematocrit, glucose, and blood pH. A second group (1.9-2.6 kg) was physically restrained for 5 min and the same parameters recorded. Physically restrained animals demonstrated elevated heart rate, respiratory rate, glucose, lactate, and anion gap compared with the midazolam-treated group. Physically restrained animals had lower pH, bicarbonate, and partial pressure of CO2 compared with the midazolam-treated group. Behavior in the physically restrained group in the days following the study was disrupted, with reluctance to feed and bask, compared with midazolam-treated animals whose behavior was normal. We conclude that midazolam administered in the forelimb of captive estuarine crocodiles of 2-3.5 kg provides predictable onset and duration of sedation enabling physical examination, sample collection, and translocation of the animals with minimal disturbance to lactate, pH, and CO2. Behavior following recovery appears normal.

  4. Ethical dilemmas in social work practice with disabled people: the use of physical restraint.

    PubMed

    Wilkins, David

    2012-06-01

    This article discusses the use of restraint with disabled adults and children and uses a case study of one particular child to explore issues related to the use of restraint, including the consent of the person subjected to restraint, their human rights, and the balancing of these rights with the need to reduce the risk of harm. The case study involves a young woman who requested to be restrained in a particular way and the challenges this posed to the staff caring for her. The article concludes that in many complex situations there is no clearly right approach to take, and each situation involving restraint must be considered on an individual case-by-case basis.

  5. [Historical aspects of the use of physical restraint: from antiquity to the era of moral treatment].

    PubMed

    Fariña-López, Emilio; Estévez-Guerra, Gabriel J

    2011-03-01

    The implementation of harsh methods of restriction has been seen since ancient times as an acceptable solution to the problems caused by mental illness. This practice was hardly questioned and only a few professionals struggled to improve the hard living conditions of the patients. Amongst these can be mentioned some physicians of ancient Greece and Rome: such as, Caelius Aurelianus, Asclepiades or Soranus of Ephesus, who objected to this procedure. During the Middle Ages, Arabic culture also helped to humanize care in the first hospitals for the insane, Avicenna being one of the most important figures. By contrast, in Medieval Europe madness was seen as a form of sin, and punishment was the way to treat it. Already by the fifteenth century asylums in Valencia and Zaragoza were pioneering the removal of chains and more humane treatment. Although, undoubtedly the most notable advances in the care of mental patients occurred during the eighteenth century through moral treatment, Philippe Pinel being its most well-known practioner. Also at this time, the benevolent efforts of the Quakers stood out. As an alternative to shackles, they introduced occupational programmes to stimulate patients; in fact, this type of therapy had already been applied centuries before. To put this phenomenon in perspective, it can be said that discussions about physical restraint have been taking place since ancient times, causing debate amongst professionals for many centuries, when considering its advisability.

  6. Ethics and praxis: alternative strategies to physical restraint and seclusion in a psychiatric setting.

    PubMed

    Taxis, J Carole

    2002-03-01

    This descriptive article highlights a 42-month project in which a comprehensive program revision was implemented in a psychiatric hospital that included numerous alternative strategies to the use of patient restraint and seclusion. The results of this project include a 94% reduction in the rate of restraint and seclusion, development of extensive staff and patient education programs, and comprehensive programmatic alterations consistent with a paradigm shift emphasizing collaboration, empowerment, and ethical clinical practice.

  7. Development methods of guidelines and documents with recommendations on physical restraint reduction in nursing homes: a systematic review.

    PubMed

    Möhler, Ralph; Meyer, Gabriele

    2015-11-21

    Physical restraint, e.g. bedrails or belts in beds or chairs, are commonly used in nursing homes. However, there have been reports of pronounced differences in the prevalence between different facilities. Guidelines or other documents with recommendations for clinical practice are one approach to overcome centre variation and improve the quality of care. Rigorous development methods are deemed to ensure the validity, clarity and clinical applicability of practice recommendations. This study aims at describing the development methods of documents offering recommendations on physical restraint reduction in geriatric long-term care. We performed a systematic search (February 2014) in electronic databases (PubMed, CINAHL, Gerolit, Carelit), the World Wide Web (via google.de) and on the homepages of 34 international scientific or healthcare organisations, using various terms related to documents offering guidance for clinical practice and physical restraints. All German and English language documents with recommendations for clinical practice aimed at reducing physical restraints' in nursing homes were included. Documents targeting mental health or acute care settings were excluded. Two reviewers independently selected the documents and extracted data, using a self-developed and piloted data extraction form. We identified 28 documents from Germany, USA, Australia, Switzerland, Canada and UK, published between 2002 and 2014. The documents were developed or published by governmental organisations, nursing or healthcare organisations, non-profit organisation, research institutions and private organisations. Two documents were developed mono-disciplinary (nursing) and eight documents interdisciplinary (including different healthcare professionals, lawyers or other stakeholders). In 18 documents the composition of the development group was not described. Two documents described the methods used for developing the recommendations. In both documents, the recommendations were

  8. Factors Associated With the Trend of Physical and Chemical Restraint Use Among Long-Term Care Facility Residents in Hong Kong: Data From an 11-Year Observational Study.

    PubMed

    Lam, Kuen; Kwan, Joseph S K; Wai Kwan, Chi; Chong, Alice M L; Lai, Claudia K Y; Lou, Vivian W Q; Leung, Angela Y M; Liu, Justina Y W; Bai, Xue; Chi, Iris

    2017-08-23

    Negative effects of restraint use have been well-documented. However, the prevalence of restraints use has been high in long-term care facilities in Hong Kong compared with other countries and this goes against the basic principles of ethical and compassionate care for older people. The present study aimed to review the change in the prevalence of physical and chemical restraint use in long-term care facilities (LTCFs) over a period of 11 years in Hong Kong and to identify the major factors associated with their use. This is an observational study with data obtained from the Hong Kong Longitudinal Study on LTCF Residents between 2005 and 2015. Trained assessors (nurses, social workers, and therapists) used the Minimum Data Set Resident Assessment Instrument to collect the data from 10 residential LTCFs. Physical restraint was defined as the use of any of the following: full bedside rails on all open sides of bed, other types of bedside rails used, trunk restraint, limb restraint, or the use of chair to prevent rising during the past 7 days. Chemical restraint was defined as the use of any of the following medications: antipsychotic, antianxiety, or hypnotic agents during past 7 days, excluding elder residents with a diagnosis of psychiatric illness. Annual prevalence of restraint use over 11 years and factors that were associated with the use of physical and chemical restraints. We analyzed the data for 2896 older people (978 male individuals, mean age = 83.3 years). Between 2005 and 2015, the prevalence of restraint use was as follows: physical restraint use increased from 52.7% to 70.2%; chemical restraint use increased from 15.9% to 21.78%; and either physical or chemical restraint use increased from 57.9% to 75.7%. Physical restraint use was independently associated with older age, impaired activities of daily living or cognitive function, bowel and bladder incontinence, dementia, and negative mood. Chemical restraint use was independently associated

  9. 5-HT7 receptors and tryptophan hydroxylase in lymphocytes of rats: mitogen activation, physical restraint or treatment with reserpine.

    PubMed

    Urbina, Mary; Arroyo, Rubén; Lima, Lucimey

    2014-01-01

    Serotonin (5-HT)7 receptors in lymphocytes play a relevant role as modulators of T cell functions and might be modified by stress protocols. The aims of this work were to evaluate: (i) the presence of 5-HT7 receptors in specific lymphocyte populations, (ii) the probable modifications of them by inflammatory stress with mitogen and (iii) the effects of physical and pharmacological stress. Blood lymphocytes were isolated by density gradients and differential adhesion to plastic. Concanavalin A (Con A) was systemically administered (500 μg/kg) or added to lymphocyte cultures (2.5 μg/ml, final volume 200 μl). Physical restraint was performed in Plexiglass boxes for 5 h per day for 5 days. Reserpine administration was 2.5 mg/kg for 3 days. Immunocytochemical labeling of CD4+, CD8+ and 5-HT7 receptors, and also tryptophan hydroxylase cells was performed. mRNA of 5-HT7 receptors was evaluated by RT-PCR. Controls were included for each protocol. Con A treatment or culture exposure increased the number of lymphocytes expressing 5-HT7 receptors or tryptophan hydroxylase, as compared to absence of the mitogen. Receptors were present in 12-16% of total rat lymphocytes, in ∼10% of CD4+ and in ∼5% of CD8+ cells from control rats. CD4+ decreased, and CD8+ and 5-HT7 cells increased after physical restraint. Reserpine treatment elevated CD8+ and 5-HT7 cells. Con A and physical restraint, but not reserpine treatment, significantly augmented 5-HT7 receptor mRNA in lymphocytes. Rat lymphocytes, expressing tryptophan hydroxylase, could synthesize 5-HT, functioning as a direct autocrine modulator. The modifications of CD4+, CD8+ and 5-HT7 receptors in lymphocytes by three stress protocols could have an impact on immune responses. In addition, the differential distribution of 5-HT7 receptors indicates potential specific physiopathological roles. © 2014 S. Karger AG, Basel.

  10. "I cry every day and night, I have my son tied in chains": physical restraint of people with schizophrenia in community settings in Ethiopia.

    PubMed

    Asher, Laura; Fekadu, Abebaw; Teferra, Solomon; De Silva, Mary; Pathare, Soumitra; Hanlon, Charlotte

    2017-07-11

    A primary rationale for scaling up mental health services in low and middle-income countries is to address human rights violations, including physical restraint in community settings. The voices of those with intimate experiences of restraint, in particular people with mental illness and their families, are rarely heard. The aim of this study was to understand the experiences of, and reasons for, restraint of people with schizophrenia in community settings in rural Ethiopia in order to develop constructive and scalable interventions. A qualitative study was conducted, involving 15 in-depth interviews and 5 focus group discussions (n = 35) with a purposive sample of people with schizophrenia, their caregivers, community leaders and primary and community health workers in rural Ethiopia. Thematic analysis was used. Most of the participants with schizophrenia and their caregivers had personal experience of the practice of restraint. The main explanations given for restraint were to protect the individual or the community, and to facilitate transportation to health facilities. These reasons were underpinned by a lack of care options, and the consequent heavy family burden and a sense of powerlessness amongst caregivers. Whilst there was pervasive stigma towards people with schizophrenia, lack of awareness about mental illness was not a primary reason for restraint. All types of participants cited increasing access to treatment as the most effective way to reduce the incidence of restraint. Restraint in community settings in rural Ethiopia entails the violation of various human rights, but the underlying human rights issue is one of lack of access to treatment. The scale up of accessible and affordable mental health care may go some way to address the issue of restraint. Clinicaltrials.gov NCT02160249 Registered 3rd June 2014.

  11. A mixed-methods systematic review protocol to examine the use of physical restraint with critically ill adults and strategies for minimizing their use.

    PubMed

    Rose, Louise; Dale, Craig; Smith, Orla M; Burry, Lisa; Enright, Glenn; Fergusson, Dean; Sinha, Samir; Wiesenfeld, Lesley; Sinuff, Tasnim; Mehta, Sangeeta

    2016-11-21

    Critically ill patients frequently experience severe agitation placing them at risk of harm. Physical restraint is common in intensive care units (ICUs) for clinician concerns about safety. However, physical restraint may not prevent medical device removal and has been associated with negative physical and psychological consequences. While professional society guidelines, legislation, and accreditation standards recommend physical restraint minimization, guidelines for critically ill patients are over a decade old, with recommendations that are non-specific. Our systematic review will synthesize evidence on physical restraint in critically ill adults with the primary objective of identifying effective minimization strategies. Two authors will independently search from inception to July 2016 the following: Ovid MEDLINE, CINAHL, Embase, Web of Science, Cochrane Library, PROSPERO, Joanna Briggs Institute, grey literature, professional society websites, and the International Clinical Trials Registry Platform. We will include quantitative and qualitative study designs, clinical practice guidelines, policy documents, and professional society recommendations relevant to physical restraint of critically ill adults. Authors will independently perform data extraction in duplicate and complete risk of bias and quality assessment using recommended tools. We will assess evidence quality for quantitative studies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and for qualitative studies using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) guidelines. Outcomes of interest include (1) efficacy/effectiveness of physical restraint minimization strategies; (2) adverse events (unintentional device removal, psychological impact, physical injury) and associated benefits including harm prevention; (3) ICU outcomes (ventilation duration, length of stay, and mortality); (4) prevalence, incidence, patterns of use

  12. [Medical prescription and informed consent for the use of physical restraints in nursing homes in the Canary Islands (Spain)].

    PubMed

    Estévez-Guerra, Gabriel J; Fariña-López, Emilio; Penelo, Eva

    2016-11-30

    To identify the frequency of completion of informed consent and medical prescription in the clinical records of older patients subject to physical restraint, and to analyse the association between patient characteristics and the absence of such documentation. A cross-sectional and descriptive multicentre study with direct observation and review of clinical records was conducted in nine public nursing homes, comprising 1,058 beds. 274 residents were physically restrained. Informed consent was not included in 82.5% of cases and was incomplete in a further 13.9%. There was no medical prescription in 68.3% of cases and it was incomplete in a further 12.0%. The only statistical association found was between the lack of prescription and the patients' advanced age (PR=1.03; p <0.005). Failure to produce this documentation contravenes the law. Organisational characteristics, ignorance of the legal requirements or the fact that some professionals may consider physical restraint to be a risk-free procedure may explain these results. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Acute psychiatric treatment and the use of physical restraint in first-generation immigrants in Italy: a prospective concurrent study.

    PubMed

    Tarsitani, Lorenzo; Pasquini, Massimo; Maraone, Annalisa; Zerella, Maria Paola; Berardelli, Isabella; Giordani, Roberta; Polselli, Gian Marco; Biondi, Massimo

    2013-09-01

    and Immigrants in Europe appear at higher risk of psychiatric coercive interventions. No studies have investigated this issue in Italy. The aim of this study is to investigate whether the use of physical restraint, compulsory admission and other treatment characteristics differ in immigrated and Italian-born patients admitted to a psychiatric intensive care unit. One hundred first-generation immigrant patients were compared to 100 age-, gender- and diagnosis-matched Italian-born patients. Subjects were diagnosed according to DSM-IV-TR and rated on the Clinical Global Impression - Severity Scale and the Global Assessment of Functioning. Clinical data and treatment characteristics were collected. Immigrant patients were more likely to be physically restrained as compared to Italian-born patients (11% vs 3%; χ (2) = 4.92; p = 0.027; RR = 3.67; 95% CI = 1.05-12.7). No differences in the proportion of involuntary treatment were found. Immigrant patients did not receive higher doses of antipsychotics or benzodiazepines, but they had a longer stay in the hospital. The higher rate of physical restraint among migrants may reflect cultural, ethnic and language differences leading to communication problems between immigrant patients and mental health professionals. Since coercive interventions can be harmful, specific strategies to prevent this phenomenon in immigrants are needed.

  14. Physical restraint in acute care psychiatry: a humanistic and realistic nursing approach.

    PubMed

    Moylan, Lois Biggin

    2009-03-01

    Despite the many advances in psychiatry, violence in acute care settings continues and may be increasing. This is particularly problematic, considering the desire of mental health professionals to attain the goal of a restraint-free environment. Respecting the inherent worth, dignity, and autonomy of the patient is necessary if a therapeutic outcome is to be achieved; however, protecting the safety of the patient, other patients, and the caregivers is of no less importance, yet this responsibility also carries with it legal and ethical implications. Balancing these two responsibilities can be realized even in a situation where supportive therapeutic interventions have been ineffective in de-escalation of an aggressive patient. When used with a compassionate, humanistic approach, restraint can achieve a therapeutic outcome for the patient while protecting the safety of others.

  15. Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint.

    PubMed

    Cadore, Eduardo L; Moneo, Ana B Bays; Mensat, Marta Martinez; Muñoz, Andrea Rozas; Casas-Herrero, Alvaro; Rodriguez-Mañas, Leocadio; Izquierdo, Mikel

    2014-04-01

    This study investigated the effects of a multicomponent exercise intervention on muscle strength, incidence of falls and functional outcomes in frail elderly patients with dementia after long-term physical restraint, followed by 24 weeks of training cessation. Eighteen frail elderly patients with mild dementia (88.1 ± 5.1 years) performed a multicomponent exercise program, which consisted of 4 weeks of walking, balance and cognitive exercises, followed by 4 weeks of resistance exercise performed twice weekly [8-12 repetitions at 20-50 % of the one-repetition maximum (1RM)], combined with walking, balance and cognitive exercises. Before and after training, as well as after 24 weeks of training cessation, strength outcomes, Barthel Index, balance, gait ability, rise from a chair ability, dual task performance, incidence of falls and Mini-Mental State Examination were assessed. After the first 4 weeks of training, there was a significant improvement only in the balance test, whereas no additional changes were observed. However, after the second part of the training, the participants required significantly less time for the time-up-and-go test (P < 0.05), and improved the isometric hand grip, hip flexion and knee extension strength, as well as the leg press 1RM (P < 0.01). A significant reduction was also observed in the incidence of falls (P < 0.01). After 24 weeks of training cessation, abrupt decreases were observed in nearly all of the physical outcomes (P < 0.05). The exercise intervention improved strength, balance and gait ability in frail elderly patients with dementia after long-term physical restraint, and these benefits were lost after training cessation.

  16. Use of physical restraints among patients with bipolar disorder in Ethiopian Mental Specialized Hospital, outpatient department: cross-sectional study.

    PubMed

    Belete, Habte

    2017-12-01

    Even though United Nation announced that all persons with a mental illness shall be treated with humanity and respect for the inherent dignity of the human being, up to now, the use of coercion (physical restrain) is still considered as unavoidable in managing abnormal behavior of psychiatric patients. But, there is no information regarding the magnitude and contributing factors of physical restrain among bipolar patients in low-income countries like Ethiopia. A cross-sectional study was conducted at Amanuel Mental Specialized Hospital from May 1 to June 1, 2015 among 400 participants who were selected by systematic random sampling technique. Data were collected by interviewing; adjusted odd ratios (AOR) with 95% confidence intervals (CI) were used and p value <0.05 was considered as statistically significant. The prevalence of physical restrain was 65%. Factors like, having two or more episodes [AOR = 1.84 95% CI (1.16, 2.93)], history of aggression [AOR = 2.14, 95% CI (1.26, 3.63)], comorbid illness [AOR = 1.76, 95% CI (1.26, 3.63)], use of antipsychotic [AOR = 1.79, 95% CI (1.08, 2.95)] and current use of Khat [AOR = 1.83, 95% CI (1.10, 3.04)] were associated significantly. The prevalence of physical restraint is found high among bipolar patients and it needs public health attention.

  17. Protecting Kids in Restraint.

    ERIC Educational Resources Information Center

    Reclaiming Children and Youth, 2001

    2001-01-01

    There has been widespread concern of the death of children and adults during physical restraint. This topic was the focus of an article by Patterson, Leadbetter, and McComish (2000) in a recent issue of the "Journal of Safe Management of Disruptive and Assaultive Behavior." Following is a discussion of causes and risk factors related to…

  18. The nature and extent of the use of physical restraint and seclusion in psychiatric practice: Report of a survey

    PubMed Central

    Khastgir, Udayan; Kala, Anirudh; Goswami, Utpal; Kumar, Satindra; Behera, Debakanta

    2003-01-01

    Restraint and seclusion has been used to manage patients despite all controversies. Our study analyzed the opinions of different psychiatrists on the use of this method in their clinical practice. Most of them (80%) practice restraints as a treatment modality and believe that they are integral to the management of psychiatric patients. None is using seclusion. PMID:21206846

  19. Physical exercise and acute restraint stress differentially modulate hippocampal brain-derived neurotrophic factor transcripts and epigenetic mechanisms in mice.

    PubMed

    Ieraci, Alessandro; Mallei, Alessandra; Musazzi, Laura; Popoli, Maurizio

    2015-11-01

    Physical exercise and stressful experiences have been shown to exert opposite effects on behavioral functions and brain plasticity, partly by involving the action of brain-derived neurotrophic factor (BDNF). Although epigenetic modifications are known to play a pivotal role in the regulation of the different BDNF transcripts, it is poorly understood whether epigenetic mechanisms are also implied in the BDNF modulation induced by physical exercise and stress. Here, we show that total BDNF mRNA levels and BDNF transcripts 1, 2, 3, 4, 6, and 7 were reduced immediately after acute restraint stress (RS) in the hippocampus of mice, and returned to control levels 24 h after the stress session. On the contrary, exercise increased BDNF mRNA expression and counteracted the stress-induced decrease of BDNF transcripts. Physical exercise-induced up-regulation of BDNF transcripts was accounted for by increase in histone H3 acetylated levels at specific BDNF promoters, whereas the histone H3 trimethylated lysine 27 and dimethylated lysine 9 levels were unaffected. Acute RS did not change the levels of acetylated and methylated histone H3 at the BDNF promoters. Furthermore, we found that physical exercise and RS were able to differentially modulate the histone deacetylases mRNA levels. Finally, we report that a single treatment with histone deacetylase inhibitors, prior to acute stress exposure, prevented the down-regulation of total BDNF and BDNF transcripts 1, 2, 3, and 6, partially reproducing the effect of physical exercise. Overall, these results suggest that physical exercise and stress are able to differentially modulate the expression of BDNF transcripts by possible different epigenetic mechanisms.

  20. Effects of chronic restraint stress on the global DNA methylation profile of rat lung cells: Modulation by physical exercise.

    PubMed

    Toffoli, L V; Volpini, V L; Nascimento, L M; Silva, W R; Verissimo, L F; Estrada, V B; Pelosi, G G; Gomes, M V

    2017-07-28

    The potential of behavioral stress to affect epigenetic mechanisms of non-encephalic tissues is still underestimated. In the present study we evaluated the effects of chronic behavioral stress on the DNA methylation profile of rat lung cells. Furthermore, we evaluated the potential of physical exercise to modulate the changes evoked by behavioral stress in lung cells. Male Wistar rats were divided into four experimental groups: (1) animals submitted to chronic restraint stress (CRS) (ST group) during the period of the 67th-80th postnatal day (PND); (2) animals submitted to physical exercise (EX group) during the 53rd-79th PND; (3) animals submitted to swimming during the 53rd-79th PND and to CRS during the 67th-80th PND (EX-ST group); and (4) animals not submitted to stress or swimming protocols (CTL). Global DNA methylation was quantified using an ELISA-based approach and gene expression was evaluated by real time PCR. A decreased global DNA methylation profile was observed in the ST group, however physical exercise demonstrated protection of lung cells from this stress-related hypomethylation. Increased expression of the Dnmt1 gene was evidenced in the ST group, whereas physical exercise was shown to protect lung cells from this stress-related effect in the EX-ST group. Comparative analysis of the ST and EX groups revealed opposite effects on the expression of Dnmt3a and Dnmt3b; however, a stress-related increase in expression of Dnmt3a and Dnmt3b was not seen in the EX-ST group. Our data showed that behavioral stress induced significant changes in the DNA methylation profile of rat lung cells and that this could be modulated by physical exercise. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Physical exercise affects the epigenetic programming of rat brain and modulates the adaptive response evoked by repeated restraint stress.

    PubMed

    Kashimoto, R K; Toffoli, L V; Manfredo, M H F; Volpini, V L; Martins-Pinge, M C; Pelosi, G G; Gomes, M V

    2016-01-01

    Epigenetics has recently been linked to molecular adaptive responses evoked by physical exercise and stress. Herein we evaluated the effects of physical exercise on global DNA methylation and expression of the Dnmt1 gene in the rat brain and also verified its potential to modulate responses evoked by repeated restraint stress (RRS). Wistar rats were classified into the following experimental groups: (1) physically active (EX): animals submitted to swimming during postnatal days 53-78 (PND); (2) stress (ST): animals submitted to RRS during 75-79PND; (3) exercise-stress (EX-ST): animals submitted to swimming during 53-78PND and to RRS during 75-79PND, and (4) control (CTL): animals that were not submitted to intervention. Samples from the hippocampus, cortex and hypothalamus were obtained at 79PND. The global DNA methylation profile was assessed using an ELISA-based method and the expression of Dnmt1 was evaluated by real-time PCR. Significantly increased methylation was observed in the hypothalamus of animals from the EX group in comparison to CTL. Comparative analysis involving the EX-ST and ST groups revealed increased global DNA methylation in the hippocampus, cortex, and hypothalamus of EX-ST, indicating the potential of physical exercise in modulating the responses evoked by RRS. Furthermore, decreased expression of the Dnmt1 gene was observed in the hippocampus and hypothalamus of animals from the EX-ST group. In summary, our data indicate that physical exercise affects DNA methylation of the hypothalamus and might modulate epigenetic responses evoked by RRS in the hippocampus, cortex, and hypothalamus. Copyright © 2015 Elsevier B.V. All rights reserved.

  2. Self-reported low vitality, poor mental health, and low dietary restraint are associated with overperception of physical exertion.

    PubMed

    Chandler-Laney, Paula C; Brock, David W; Gower, Barbara A; Alvarez, Jessica A; Bush, Nikki C; Hunter, Gary R

    2010-01-01

    Objective. We investigated whether perceived exertion, in comparison to the physiological response to exercise, was associated with self-reported vitality, mental health, and physical function during daily activities, or weight control behaviors. Design. Weight-reduced, formerly overweight women (n = 126, aged 22-46 years), completed health and dietary control questionnaires, and underwent a treadmill-walking task while heart rate, ventilation, respiratory exchange ratio, and ratings of perceived exertion were recorded. Results. Overperception of exertion (perceived exertion physiological exertion) was inversely associated with vitality (r = -0.190, P < .05), mental health (r = -0.188, P < .05), and dietary control (r values range -0.231 to -0.317, P < .05). In linear regression modeling, vitality or mental health, and cognitive dietary restraint were independently associated with accuracy of perceived exertion, independent of age, ethnicity, and engagement in exercise during weight loss. Each model explained 7%-8% of the variance in accuracy of perceived exertion. Conclusion. Women with low vitality or poor mental health, and poor dietary control may overperceive exertion. Such overperception may be a barrier to engage in physical activity and thus increase susceptibility to weight gain.

  3. Effects of small-scale, home-like facilities in dementia care on residents' behavior, and use of physical restraints and psychotropic drugs: a quasi-experimental study.

    PubMed

    Verbeek, Hilde; Zwakhalen, Sandra M G; van Rossum, Erik; Ambergen, Ton; Kempen, Gertrudis I J M; Hamers, Jan P H

    2014-04-01

    Small-scale, home-like care environments are increasingly implemented in institutional nursing care as a model to promote resident-directed care, although evidence on its effects is sparse. This study focuses on the effects of small-scale living facilities on the behavior of residents with dementia and use of physical restraints and psychotropic drugs. A quasi-experimental study was conducted comparing residents in two types of long-term institutional nursing care (i.e., small-scale living facilities and traditional psychogeriatric wards) on three time points: at baseline and follow-ups after six and 12 months. Residents were matched at baseline on cognitive and functional status to increase comparability of groups at baseline. Nurses assessed neuropsychiatric and depressive symptoms, agitation, social engagement, and use of physical restraints using questionnaires. Psychotropic drug use was derived from residents' medical records. In total, 259 residents were included: 124 in small-scale living facilities and 135 controls. Significantly fewer physical restraints and psychotropic drugs were used in small-scale living facilities compared with traditional wards. Residents in small-scale living facilities were significantly more socially engaged, at baseline and after six months follow-up, and displayed more physically non-aggressive behavior after 12 months than residents in traditional wards. No other differences were found. This study suggests positive effects of small-scale living facilities on the use of physical restraints and psychotropic drugs. However, the results for behavior were mixed. More research is needed to gain an insight on the relationship between dementia care environment and other residents' outcomes.

  4. Physical restraint for psychiatric patients and its associations with clinical characteristics and the National Mental Health Law in China.

    PubMed

    An, Feng-Rong; Sha, Sha; Zhang, Qing-E; Ungvari, Gabor S; Ng, Chee H; Chiu, Helen F K; Wu, Ping-Ping; Jin, Xin; Zhou, Jian-Song; Tang, Yi-Lang; Xiang, Yu-Tao

    2016-07-30

    Physical restraint (PR) for patients is an ongoing controversial topic in psychiatry. This study examined the percentage of PR and its associations with clinical characteristics and the implementation of the National Mental Health Law (NMHL) in China. The study consecutively assessed a sample of 1364 psychiatric inpatients. Socio-demographic and clinical data including use of PR were collected from the medical records using a form designed for this study and confirmed via interview. Psychopathology and insight were measured using standardized instruments. The percentage of PR was 27.2% in the whole sample with 30.7% and 22.4% occurring respectively before and after the NMHL implementation (p=0.001). In multiple logistic regression analysis PR was positively associated with unemployment, lower income, aggression in the past month, being admitted before the NMHL implementation and poorer insight. The percentage of PR in Chinese psychiatric patients is associated with various clinical factors and appeared to decrease after the implementation of the NMHL. Focused and individualized care for patients who are unemployed, have low income, recent aggression and poor insight would be necessary at early stages of admission. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Frequency of physical restraint and its associations with demographic and clinical characteristics in a Chinese psychiatric institution.

    PubMed

    Zhu, Xiao-Min; Xiang, Yu-Tao; Zhou, Jian-Song; Gou, Lei; Himelhoch, Seth; Ungvari, Gabor S; Chiu, Helen F K; Lai, Kelly Y C; Wang, Xiao-Ping

    2014-10-01

    Physical restraint (PR) is a highly controversal topic in psychiatry. Little is known about PR among psychiatric inpatients in China. This study examined the frequency of PR and its relationships with demographic and clinical characteristics among a large psychiatric institution in the Hunan Province, China. The study included a consecutively assessed sample of 160 psychiatric inpatients. Sociodemographic and clinical data including use of PR were collected from the medical records using a form designed for this study and confirmed via interview. The frequency of PR was 51.3% in the whole sample; 63.2% among female and 39.2% among male patients. In multiple logistic regression analysis PR was independently associated with male gender (p = 0.001, odds ratio [OR] = 0.2, 95% confidence interval [CI] 0.1-0.6), less outpatient treatment prior to admission (p = 0.03, OR = 0.3, 95% CI 0.1-0.9), more frequent use of mood stabilizers (p = 0.002, OR = 5.6, 95% CI 1.9-16.7), more aggressive behavior prior to admission (p = 0.002, OR = 1.1, 95% CI 1.04-1.2), and younger age (p = 0.04, OR = 0.97, 95% CI 0.93-0.99). PR is very common in clinical practice in China. Its demographic and clinical correlates are similar to findings in Western settings. © 2013 Wiley Periodicals, Inc.

  6. Implementation of a Multicomponent intervention to Prevent Physical Restraints In Nursing home residenTs (IMPRINT): study protocol for a cluster-randomised controlled trial.

    PubMed

    Abraham, Jens; Möhler, Ralph; Henkel, Adrienne; Kupfer, Ramona; Icks, Andrea; Dintsios, Charalabos-Markos; Haastert, Burkhard; Meyer, Gabriele; Köpke, Sascha

    2015-07-21

    Physical restraints such as bedrails and belts are regularly applied in German nursing homes despite clear evidence showing their lack of effectiveness and safety. In a cluster-randomised controlled trial, the efficacy and safety of a guideline-based multicomponent intervention programme has been proven. The present study aims to evaluate the effectiveness of two different versions of the original intervention in nursing home residents in four different regions throughout Germany. The study is a pragmatic cluster-randomised controlled trial comparing two intervention groups, i.e. (1) the updated original multicomponent intervention programme and (2) the concise version of the updated programme, with a control group receiving optimised usual care. The first intervention group receives an educational programme for all nurses, additional training and structured support for nominated key nurses, printed study material and other supportive material. In the second intervention group, nurses do not receive education as part of the intervention, but may be trained by nominated key nurses who have received a short train-the-trainer module. All other components are similar to the first intervention group. The control group receives the printed study material only. Overall, 120 nursing homes including approximately 10,800 residents will be recruited and randomly assigned to one of the three groups. The primary outcome is defined as the proportion of residents with at least one physical restraint after 12 months follow-up. The use of physical restraints will be assessed by direct observation. Secondary outcomes are the residents' quality of life and safety parameters, e.g. falls and fall-related fractures. In addition, comprehensive process and economic evaluations will be performed. We expect a clinically relevant reduction in the proportion of residents with physical restraints. It is also expected that the process outcomes of this trial will enrich the knowledge about

  7. Consumption of molecular hydrogen prevents the stress-induced impairments in hippocampus-dependent learning tasks during chronic physical restraint in mice.

    PubMed

    Nagata, Kazufumi; Nakashima-Kamimura, Naomi; Mikami, Toshio; Ohsawa, Ikuroh; Ohta, Shigeo

    2009-01-01

    We have reported that hydrogen (H(2)) acts as an efficient antioxidant by gaseous rapid diffusion. When water saturated with hydrogen (hydrogen water) was placed into the stomach of a rat, hydrogen was detected at several microM level in blood. Because hydrogen gas is unsuitable for continuous consumption, we investigated using mice whether drinking hydrogen water ad libitum, instead of inhaling hydrogen gas, prevents cognitive impairment by reducing oxidative stress. Chronic physical restraint stress to mice enhanced levels of oxidative stress markers, malondialdehyde and 4-hydroxy-2-nonenal, in the brain, and impaired learning and memory, as judged by three different methods: passive avoidance learning, object recognition task, and the Morris water maze. Consumption of hydrogen water ad libitum throughout the whole period suppressed the increase in the oxidative stress markers and prevented cognitive impairment, as judged by all three methods, whereas hydrogen water did not improve cognitive ability when no stress was provided. Neural proliferation in the dentate gyrus of the hippocampus was suppressed by restraint stress, as observed by 5-bromo-2'-deoxyuridine incorporation and Ki-67 immunostaining, proliferation markers. The consumption of hydrogen water ameliorated the reduced proliferation although the mechanistic link between the hydrogen-dependent changes in neurogenesis and cognitive impairments remains unclear. Thus, continuous consumption of hydrogen water reduces oxidative stress in the brain, and prevents the stress-induced decline in learning and memory caused by chronic physical restraint. Hydrogen water may be applicable for preventive use in cognitive or other neuronal disorders.

  8. The economic cost of using restraint and the value added by restraint reduction or elimination.

    PubMed

    Lebel, Janice; Goldstein, Robert

    2005-09-01

    The purpose of this study was to calculate the economic cost of using restraint on one adolescent inpatient service and to examine the effect of an initiative to reduce or eliminate the use of restraint after it was implemented. A detailed process-task analysis of mechanical, physical, and medication-based restraint was conducted in accordance with state and federal restraint requirements. Facility restraint data were collected, verified, and analyzed. A model was developed to determine the cost and duration of an average episode for each type of restraint. Staff time allocated to restraint activities and medication costs were computed. Calculation of the cost of restraint was restricted to staff and medication costs. Aggregate costs of restraint use and staff-related costs for one full year before the restraint reduction initiative (FY 2000) and one full year after the initiative (FY 2003) were calculated. Outcome, discharge, and recidivism data were analyzed. A comparison of the FY 2000 data with the FY 2003 data showed that the adolescent inpatient service's aggregate use of restraint decreased from 3,991 episodes to 373 episodes (91 percent), which was associated with a reduction in the cost of restraint from $1,446,740 to $117,036 (a 92 percent reduction). In addition, sick time, staff turnover and replacement costs, workers' compensation, injuries to adolescents and staff, and recidivism decreased. Adolescent Global Assessment of Functioning scores at discharge significantly improved. Implementation of a restraint reduction initiative was associated with a reduction in the use of restraint, staff time devoted to restraint, and staff-related costs. This shift appears to have contributed to better outcomes for adolescents, fewer injuries to adolescents and staff, and lower staff turnover. The initiative may have enhanced adolescent treatment and work conditions for staff.

  9. Mental Illness and the Use of Restraints in Nursing Homes.

    ERIC Educational Resources Information Center

    Burton, Lynda C.; And Others

    1992-01-01

    Used data from 441 new nursing home residents to examine physical restraint use in high and low restraint use homes. Predictors of restraint use during first month and first year were inability to transfer and combination of severe activities of daily living impairment and cognitive impairment. Other predictors: wandering, inability to dress,…

  10. Mental Illness and the Use of Restraints in Nursing Homes.

    ERIC Educational Resources Information Center

    Burton, Lynda C.; And Others

    1992-01-01

    Used data from 441 new nursing home residents to examine physical restraint use in high and low restraint use homes. Predictors of restraint use during first month and first year were inability to transfer and combination of severe activities of daily living impairment and cognitive impairment. Other predictors: wandering, inability to dress,…

  11. Microgravity Workstation and Restraint Evaluations

    NASA Technical Reports Server (NTRS)

    Chmielewski, C.; Whitmore, M.; Mount, F.

    1999-01-01

    Confined workstations, where the operator has limited visibility and physical access to the work area, may cause prolonged periods of unnatural posture. Impacts on performance, in terms of fatigue and posture, may occur especially if the task is tedious and repetitive or requires static muscle loading. The glovebox design is a good example of the confined workstation concept. Within the scope of the 'Microgravity Workstation and Restraint Evaluation' project, funded by the NASA Headquarters Life Sciences Division, it was proposed to conduct a series of evaluations in ground, KC-135 and Shuttle environments to investigate the human factors issues concerning confined/unique workstations, such as gloveboxes, and also including crew restraint requirements. As part of the proposed integrated evaluations, two Shuttle Detailed Supplementary Objectives (DSOs) were manifested; one on Space Transportation System (STS)-90 and one on STS-88. The DSO on STS-90 evaluated use of the General Purpose Workstation (GPWS). The STS-88 mission was planned to evaluate a restraint system at the Remote Manipulator System (RMS). In addition, KC- 1 35 flights were conducted to investigate user/workstation/restraint integration for long-duration microgravity use. The scope of these evaluations included workstations and restraints to be utilized in the ISS environment, but also incorporated other workstations/ restraints in an attempt to provide findings/requirements with broader applications across multiple programs (e.g., Shuttle, ISS, and future Lunar-Mars programs). In addition, a comprehensive electronic questionnaire has been prepared and is under review by the Astronaut Office which will compile crewmembers' lessons learned information concerning glovebox and restraint use following their missions. These evaluations were intended to be complementary and were coordinated with hardware developers, users (crewmembers), and researchers. This report is intended to provide a summary of the

  12. Use of restraints

    MedlinePlus

    ... the United States. Alternative Names Restraint devices References Smith SF, Duell DJ, Martin BC. Safe client environment and restraints. In: Smith SF, Duell DJ, Martin BC, eds. Clinical Nursing ...

  13. Impact of a Videoconference Educational Intervention on Physical Restraint and Antipsychotic Use in Nursing Homes: Results From the ECHO-AGE Pilot Study

    PubMed Central

    Gordon, Stephen E.; Dufour, Alyssa B.; Monti, Sara M.; Mattison, Melissa L.P.; Catic, Angela G.; Thomas, Cindy P.; Lipsitz, Lewis A.

    2017-01-01

    Objectives US nursing homes care for increasing numbers of residents with dementia and associated behavioral problems. They often lack access to specialized clinical expertise relevant to managing these problems. Project ECHO-AGE provides this expertise through videoconference sessions between frontline nursing home staff and clinical experts at an academic medical center. We hypothesized that ECHO-AGE would result in less use of physical and chemical restraints and other quality improvements in participating facilities. Design A 2:1 matched-cohort study comparing quality of care outcomes between ECHO-AGE facilities and matched controls for the period July 2012 to December 2013. Setting Eleven nursing homes in Massachusetts and Maine. Participants Nursing home staff and a hospital-based team of geriatrician, geropsychiatrist, and neurologist discussed anonymized residents with dementia. Intervention Biweekly online video case discussions and brief didactic sessions focused on the management of dementia and behavior disorders. Measurements The primary outcome variables were percentage of residents receiving antipsychotic medications and the percentage of residents who were physically restrained. Secondary outcomes included 9 other quality of care metrics from MDS 3.0. Results Residents in ECHO-AGE facilities were 75% less likely to be physically restrained compared with residents in control facilities over the 18-month intervention period (OR = 0.25, P = .05). Residents in ECHO-AGE facilities were 17% less likely to be prescribed antipsychotic medication compared with residents in control facilities (OR = 0.83, P = .07). Other outcomes were not significantly different. Conclusion Preliminary evidence suggests that participation in Project ECHO-AGE reduces rates of physical restraint use and may reduce rates of antipsychotic use among long-term nursing home residents. PMID:27161317

  14. Impact of a Videoconference Educational Intervention on Physical Restraint and Antipsychotic Use in Nursing Homes: Results From the ECHO-AGE Pilot Study.

    PubMed

    Gordon, Stephen E; Dufour, Alyssa B; Monti, Sara M; Mattison, Melissa L P; Catic, Angela G; Thomas, Cindy P; Lipsitz, Lewis A

    2016-06-01

    US nursing homes care for increasing numbers of residents with dementia and associated behavioral problems. They often lack access to specialized clinical expertise relevant to managing these problems. Project ECHO-AGE provides this expertise through videoconference sessions between frontline nursing home staff and clinical experts at an academic medical center. We hypothesized that ECHO-AGE would result in less use of physical and chemical restraints and other quality improvements in participating facilities. A 2:1 matched-cohort study comparing quality of care outcomes between ECHO-AGE facilities and matched controls for the period July 2012 to December 2013. Eleven nursing homes in Massachusetts and Maine. Nursing home staff and a hospital-based team of geriatrician, geropsychiatrist, and neurologist discussed anonymized residents with dementia. Biweekly online video case discussions and brief didactic sessions focused on the management of dementia and behavior disorders. The primary outcome variables were percentage of residents receiving antipsychotic medications and the percentage of residents who were physically restrained. Secondary outcomes included 9 other quality of care metrics from MDS 3.0. Residents in ECHO-AGE facilities were 75% less likely to be physically restrained compared with residents in control facilities over the 18-month intervention period (OR = 0.25, P = .05). Residents in ECHO-AGE facilities were 17% less likely to be prescribed antipsychotic medication compared with residents in control facilities (OR = 0.83, P = .07). Other outcomes were not significantly different. Preliminary evidence suggests that participation in Project ECHO-AGE reduces rates of physical restraint use and may reduce rates of antipsychotic use among long-term nursing home residents. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

  15. The use of noncontingent reinforcement and contingent restraint to reduce physical aggression and self-injurious behaviour in a traumatically brain injured adult.

    PubMed

    Persel, C S; Persel, C H; Ashley, M J; Krych, D K

    1997-10-01

    Many different intervention programmes for reducing undesirable behaviour with people with traumatic brain injury (TBI) have been investigated in recent years. The purpose of this study was to examine the potential of using noncontingent reinforcement (NCR) in combination with contingent restraint to reduce severe behaviour. The subject (E.L.) was a 40-year-old male with TBI admitted to a rehabilitation long-term care programme. E.L. had a history of physical aggression (PA) and self-injurious behaviour (SIB). Assessment conditions included a descriptive analysis, response scatterplot and Self-Injury Trauma (SIT) Scale. Attention was identified as the maintaining positive reinforcement for PA and SIB. Treatment conditions were compared using a reversal (ABAB) design. Attention (NCR) was delivered on a fixed-time schedule that was not dependent on the subject's behaviour. Contingent restraint was applied when E.L. exhibited PA or SIB that was dangerous to himself or others. During treatment, PA occurred over 4 times less often and SIB over 2.5 times less often. Results demonstrated that PA and SIB were sensitive to NCR. NCR can be an effective procedure for reducing severe behaviour maintained by socially-mediated positive reinforcement.

  16. Air bag restraint device

    DOEpatents

    Marts, Donna J.; Richardson, John G.

    1995-01-01

    A rear-seat air bag restraint device is disclosed that prevents an individual, or individuals, from continuing violent actions while being transported in a patrol vehicle's rear seat without requiring immediate physical contact by the law enforcement officer. The air bag is activated by a control switch in the front seat and inflates to independently restrict the amount of physical activity occurring in the rear seat of the vehicle while allowing the officer to safely stop the vehicle. The air bag can also provide the officer additional time to get backup personnel to aid him if the situation warrants it. The bag is inflated and maintains a constant pressure by an air pump.

  17. Air bag restraint device

    DOEpatents

    Marts, D.J.; Richardson, J.G.

    1995-10-17

    A rear-seat air bag restraint device is disclosed that prevents an individual, or individuals, from continuing violent actions while being transported in a patrol vehicle`s rear seat without requiring immediate physical contact by the law enforcement officer. The air bag is activated by a control switch in the front seat and inflates to independently restrict the amount of physical activity occurring in the rear seat of the vehicle while allowing the officer to safely stop the vehicle. The air bag can also provide the officer additional time to get backup personnel to aid him if the situation warrants it. The bag is inflated and maintains a constant pressure by an air pump. 8 figs.

  18. Further thoughts on the process of restraint.

    PubMed

    Winship, G

    2006-02-01

    The physical restraint of a disturbed person is a subject constant of psychiatry and is a challenge that particularly faces nurses working in acute inpatient settings. While other approaches to psychiatric treatment have been discarded (e.g. punishment, blood letting, trepanation, deep insulin therapy and so on) or evolved into new treatments (the use of medication), the act of physical restraint has remained largely unmodified. Given the ubiquity of physical restraint in psychiatry, particularly as a nursing procedure, the absence of a sustained body of research is notable. This essay examines some of the historical underpinnings of the use of restraint in psychiatry brought into sharp focus by the David Bennett Inquiry Report (2003) and the National Institute of Clinical Effective (NICE) guidelines (2005) on the management of violence.

  19. Restraint removal: tension between protective custody and human rights.

    PubMed

    Koch, Susan; Nay, Rhonda; Wilson, Jacinda

    2006-09-01

    Aims and objectives.  To describe the culture of an aged care facility relating to restraint use and provide insight into the process of changing to minimal restraint care. Background.  In 1999, the accreditation process for residential aged care facilities (This term has been used in Australia since around 1997 and replaces the terms 'nursing homes' and 'hostels') in Australia was extended to include a review of restraint use, with the view to minimization. As using restraint had traditionally been viewed as acceptable, it was expected that there would be tensions involved for staff making the transition to providing minimal restraint care. Design.  The research was situated within the qualitative paradigm and guided by symbolic interactionism, grounded theory, and case study. Methods.  Data were collected through observation of instances of restraint, individual interviews with staff, and document analysis. Results.  The transition to minimal restraint care was associated with tensions for staff. Whilst efforts had been made to make the facility restraint-free, bedrails were still in evidence, and were not necessarily viewed by staff as constituting restraint. Conclusions.  Nurses may experience a tension between human rights and duty of care when adopting restraint-minimization practices. Relevance to clinical practice.  Tensions may be alleviated by adopting a universal definition of restraint, acquiring physical resources and new skills in care delivery and modifying staff, resident and family attitudes towards the delivery of care.

  20. A Chinchilla Restraint System,

    DTIC Science & Technology

    1986-01-01

    AD-A167 438 A CHINCHILLA RESTRAINT SYSTEM() TEXAS UNIV AT DALLAS l1/1 CALLIER CENTER FOR COMMUNICATION DISORDERS HARGETT ET AL. JAN 86 USRARL-96-1...86-1 0 A CHINCHILLA RESTRAINT SYSTEM By C.E. Hargett, Jr. / CALLIER CENTER FOR COMMUNICATION DISORDERS University of Texas at Dallas James H

  1. An Analysis of the Restraint Event and Its Behavioral Effects on Clients and Staff.

    ERIC Educational Resources Information Center

    Jones, Robert J.; Timbers, Gary D.

    2002-01-01

    Programs serving troubled youth continuously struggle with the issue of using physical restraints and other coercive interventions. This paper revisits the issues and motivations surrounding restraint use. It offers an analytic perspective on the physical restraint cycle and the factors that tend to support its recurrence. (JDM)

  2. The Impact of 'Being There': Psychiatric Staff Attitudes on the Use of Restraint.

    PubMed

    Dahan, Sagit; Levi, Galit; Behrbalk, Pnina; Bronstein, Israel; Hirschmann, Shmuel; Lev-Ran, Shaul

    2017-07-19

    The practice of mechanically restraining psychiatric patients is constantly under debate, and staff attitudes are considered a central factor influencing restraining practices. The aim of this study was to explore associations between psychiatric staff members' presence and participation in incidences of restraint and attitudes towards mechanical restraints. Staff members (psychiatrists, nurses, paramedical staff; N = 143 working in a government psychiatric hospital in Israel) completed a questionnaire including personal information, participation in incidents of restraint and attitudes towards mechanical restraints. Items were categorized into the following categories: security and care; humiliation and offending; control; order; education and punishment. Compared to those who were not present during restraint, staff members who were present agreed significantly less with statements indicating that restraints are humiliating and offending and agreed more with statements indicating that restraints are used primarily for security and care (p < .05). Among those present in incidences of restraint, staff members who physically participated in restraint agreed significantly more with statements indicating that restraints are a means for security, care and order, and less with statements indicating restraints are humiliating and offending, compared to those present but not physically participating in restraint (p < .05). These findings highlight the importance of proximity of staff members to incidences of restraints. This may have implications in understanding the professional and social discourse concerning mechanical restraints.

  3. [Cognitive milieu therapy and restraint within dual diagnosis populations].

    PubMed

    Lykke, Jørn; Austin, Stephen F; Mørch, Mille Metz

    2008-01-28

    The use of restraint is common practice within psychiatry and is most frequently used with patients with a co-occurring serious mental illness and substance abuse or dual diagnosis. Furthermore restraint has being shown to have a negative impact on treatment outcomes and on the psychological wellbeing of patients. Cognitive behavioural therapy has been shown to contribute to positive treatment outcomes for a range of mental health problems, including schizophrenia and substance abuse. The following study examined the incidence of restraint within a dual diagnosis inpatient ward before and after the implementation of cognitive milieu therapy. Data collected over a four-year period showed that the incidence of physical restraint was significantly reduced after the introduction of cognitive milieu therapy, and that this reduction was not offset by increases in other forms of restraint. The implications of these results are discussed regarding the use of restraint on dual diagnosis populations within psychiatric settings.

  4. [Restraint in paediatric care].

    PubMed

    Estrade, Marie; Tessier-Levêque, Mélanie; Wanquet-Thibault, Pascale

    2016-01-01

    Restraint in general, and particularly when giving paediatric care, is a sensitive subject. This practice continues to appear often as a solution when children are disorientated or struggle during care. However, it is generally traumatic for the different care agents: the child, the parent and the care-giver. Reflection on this subject has been carried out after exchanges with professionals about the use of restraint with children aged 2-4 during paediatric emergency care.

  5. Rapid Assessment of the Effects of Restraint on Self-Injury and Adaptive Behavior.

    ERIC Educational Resources Information Center

    Wallace, Michele D.; Iwata, Brian A.; Zhou, Liming; Goff, Gerald A.

    1999-01-01

    This study evaluated the effects of restraint on occurrences of self-injurious behavior (SIB) and adaptive responses exhibited by two individuals with profound mental retardation across eight response-effort conditions with varying degrees of physical restraint. Analysis identified a restraint level for each individual that reduced SIB but did not…

  6. Rapid Assessment of the Effects of Restraint on Self-Injury and Adaptive Behavior.

    ERIC Educational Resources Information Center

    Wallace, Michele D.; Iwata, Brian A.; Zhou, Liming; Goff, Gerald A.

    1999-01-01

    This study evaluated the effects of restraint on occurrences of self-injurious behavior (SIB) and adaptive responses exhibited by two individuals with profound mental retardation across eight response-effort conditions with varying degrees of physical restraint. Analysis identified a restraint level for each individual that reduced SIB but did not…

  7. Trends in Use of Seclusion and Restraint in Response to Injurious Assault in Psychiatric Units in U.S. Hospitals, 2007-2013.

    PubMed

    Staggs, Vincent S

    2015-12-01

    This study assessed trends in use of seclusion and restraint in response to injurious assault, including trends in percentage of assaults involving seclusion or restraint; average duration of seclusion; average duration of restraint using devices and holds (physical restraint); and percentages of restraint episodes involving devices, medication, and holds. Monthly administrative data from 2007 to 2013 for 438 adult psychiatric units in 317 U.S. hospitals were aggregated to compute annual measures. Time trends were assessed with nonparametric tests. There was little evidence suggesting a decline in the frequency with which seclusion and restraint are used, but there were decreasing trends in average duration of physical restraint and percentage of restraint episodes involving devices. Efforts to curb seclusion and restraint have apparently been successful in reducing use of devices in restraint and shortening restraint duration. There may be room for improvement in reducing duration of seclusion.

  8. Seat restraint contamination and cleaning.

    PubMed

    Paulson, J A

    1986-07-01

    This study was undertaken to demonstrate that seat restraints are unlikely vehicles for the transmission of pathogenic bacteria from infant to infant in seat restraint loaner programs. Simple surface cleaning with antibacterial solutions is sufficient to prepare seats for reloaning.

  9. Occupant restraint use in Canada.

    PubMed

    Boase, Paul; Jonah, Brian A; Dawson, Nancy

    2004-01-01

    Legislation regarding seat belt use in Canada is a provincial/territorial responsibility. Each of the 13 jurisdictions has enacted legislation and set the penalties regarding non-use of seat belts and appropriate child restraint systems. The federal government regulates occupant restraint systems and child restraints. In addition, Transport Canada (TC) gathers annual survey data on the use of seat belts and child restraints on Canadian roads and provides research support. National coordination toward the Canadian Road Safety Vision 2010 goal of a 40% reduction in fatalities and serious injuries related to non-belt/child restraint use and a 95% restraint usage rate is provided by the Canadian Council of Motor Transport Administrators' (CCMTA) National Occupant Restraint Program (NORP). The paper examines the history of legislation, provincial/territorial penalties, NORP, and TC involvement in promoting the use of occupant restraints.

  10. Handling and restraint.

    PubMed

    Donovan, John; Brown, Patricia

    2004-09-01

    For the safety of the handler and the animal, proper methods for handling and restraining laboratory animals should be followed. Improper handling can result in increased stress and injury to the animal. In addition, the handler risks injury from bite wounds or scratches inflicted when the animal becomes fearful or anxious. By using sure, direct movements with a determined attitude, the animal can be easily handled and restrained. Animals can be restrained either manually or in a plastic restrainer. The protocols in this unit describe handling and manual restraint of mice, rats, hamsters, and rabbits. Alternate protocols describe restraint using the plastic restrainer.

  11. Handling and restraint.

    PubMed

    Donovan, John; Brown, Patricia

    2006-07-01

    For the safety of the handler and the animal, proper methods for handling and restraining laboratory animals should be followed. Improper handling can result in increased stress and injury to the animal. In addition, the handler risks injury from bite wounds or scratches inflicted when the animal becomes fearful or anxious. By using sure, direct movements with a determined attitude, the animal can be easily handled and restrained. Animals can be restrained either manually or in a plastic restrainer. The protocols in this unit describe handling and manual restraint of mice, rats, hamsters, and rabbits. Alternate protocols describe restraint using the plastic restrainer.

  12. Component restraint system

    DOEpatents

    Blake, John C.

    1983-05-24

    An object restraint system is provided with a collar for gripping the object and a plurality of struts attached to the collar and to anchor means by universal-type joints, the struts being arranged in tangential relation about the collar.

  13. Nonstructural seismic restraint guidelines

    SciTech Connect

    Butler, D.M.; Czapinski, R.H.; Firneno, M.J.; Feemster, H.C.; Fornaciari, N.R.; Hillaire, R.G.; Kinzel, R.L.; Kirk, D.; McMahon, T.T.

    1993-08-01

    The Nonstructural Seismic Restraint Guidelines provide general information about how to secure or restrain items (such as material, equipment, furniture, and tools) in order to prevent injury and property, environmental, or programmatic damage during or following an earthquake. All SNL sites may experience earthquakes of magnitude 6.0 or higher on the Richter scale. Therefore, these guidelines are written for all SNL sites.

  14. Restraint use in acute and extended mental health services for older persons.

    PubMed

    Gerace, Adam; Mosel, Krista; Oster, Candice; Muir-Cochrane, Eimear

    2013-12-01

    Restraint of older persons in inpatient and residential care is used to control aggression, and prevent falls and other adverse outcomes. Initiatives to reduce these practices are being implemented worldwide. However, there has been little examination of restraint practice in psychiatric services for older persons. This paper reports a retrospective comparative analysis of restraint use in three acute and two extended care psychiatric inpatient wards in Australia. The analysis involved examination of restraint incidents and comparison of restrained and non-restrained patients. There was significant variation in restraint use between wards. On one acute ward, 12.74% of patients were restrained, although restraint use declined during the data collection period. Patients with dementia were restrained at higher rates than patients with other diagnoses, and restrained patients stayed in hospital for a longer duration. Restraint occurred early in admission, and few differences emerged between those restrained once or multiple times. Mechanical restraint was more prevalent than physical restraint, with restraint predominantly used to manage aggression and falls. Findings provide new data on restraint in older persons' psychiatric services. Greater conceptual understandings of behaviours associated with dementia and the unique needs of patients with these disorders may assist in reducing restraint use in these settings. © 2012 The Authors; International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

  15. Multipurpose Crew Restraints for Long Duration Space Flights

    NASA Technical Reports Server (NTRS)

    Whitmore, Mihriban; Baggerman, Susan; Ortiz, M. R.; Hua, L.; Sinnott, P.; Webb, L.

    2004-01-01

    With permanent human presence onboard the International Space Station (ISS), a crew will be living and working in microgravity, interfacing with their physical environment. Without optimum restraints and mobility aids (R&MA' s), the crewmembers may be handicapped for perfonning some of the on-orbit tasks. In addition to weightlessness, the confined nature of a spacecraft environment results in ergonomic challenges such as limited visibility and access to the activity area and may cause prolonged periods of unnatural postures. Thus, determining the right set of human factors requirements and providing an ergonomically designed environment are crucial to astronauts' well-being and productivity. The purpose of this project is to develop requirements and guidelines, and conceptual designs, for an ergonomically designed multi-purpose crew restraint. In order to achieve this goal, the project would involve development of functional and human factors requirements, design concept prototype development, analytical and computer modeling evaluations of concepts, two sets of micro gravity evaluations and preparation of an implementation plan. It is anticipated that developing functional and design requirements for a multi-purpose restraint would facilitate development of ergonomically designed restraints to accommodate the off-nominal but repetitive tasks, and minimize the performance degradation due to lack of optimum setup for onboard task performance. In addition, development of an ergonomically designed restraint concept prototype would allow verification and validation of the requirements defined. To date, we have identified "unique" tasks and areas of need, determine characteristics of "ideal" restraints, and solicit ideas for restraint and mobility aid concepts. Focus group meetings with representatives from training, safety, crew, human factors, engineering, payload developers, and analog environment representatives were key to assist in the development of a restraint

  16. A nationwide study of why and how acute adolescent psychiatric units use restraint.

    PubMed

    Furre, Astrid; Sandvik, Leiv; Friis, Svein; Knutzen, Maria; Hanssen-Bauer, Ketil

    2016-03-30

    The purpose of this study was to examine the type, reason, and duration of restraint episodes in acute adolescent psychiatric units. In a retrospective design we included data from paper-based protocols on all episodes of restraint and data from electronic patient records during 2008-2010 in all acute adolescent psychiatric in-patient units in Norway (N=16). The episodes of restraint included mechanical and pharmacological restraint, seclusion and physical holding that was not part of the implementation of forced feeding. Six-and-a-half per cent of all 4099 adolescents admitted to the acute units experienced restraint. Of the 2277 episodes, 13.4% were mechanical restraint, 1.6% were pharmacological restraint, 5.9% were seclusion and 78.7% were physical holding. The median number of restraint episodes per patient was two, the range was 1-171 and 47 patients (18%) experienced ≥10 episodes. The most common reason for using restraint was harming others. The median duration of the mechanical restraint episodes was 3.5h. The median duration of seclusion was 30min and the median duration of physical holding was 10min. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Phenomenology of Self-Restraint.

    ERIC Educational Resources Information Center

    Oliver, Chris; Murphy, Glynis; Hall, Scott; Arron, Kate; Leggett, Janice

    2003-01-01

    A study of 88 British individuals with developmental disabilities and self-injurious behavior found self-restraint was more prevalent in the group not wearing protective devices than in those wearing protective devices. Individuals not wearing protective devices showed a greater number of topographies of self-restraint than those who did wear…

  18. Psychiatric Patients Experiences with Mechanical Restraints: An Interview Study

    PubMed Central

    Lanthén, Klas; Rask, Mikael; Sunnqvist, Charlotta

    2015-01-01

    Objective. To examine psychiatric patients' experience of mechanical restraints and to describe the care the patients received. Background. All around the world, threats and violence perpetrated by patients in psychiatric emergency inpatient units are quite common and are a prevalent factor concerning the application of mechanical restraints, although psychiatric patients' experiences of mechanical restraints are still moderately unknown. Method. A qualitative design with an inductive approach were used, based on interviews with patients who once been in restraints. Results. This study resulted in an overbridging theme: Physical Presence, Instruction and Composed Behaviour Can Reduce Discontent and Trauma, including five categories. These findings implicated the following: information must be given in a calm and sensitive way, staff must be physically present during the whole procedure, and debriefing after the incident must be conducted. Conclusions. When mechanical restraints were unavoidable, the presence of committed staff during mechanical restraint was important, demonstrating the significance of training acute psychiatric nurses correctly so that their presence is meaningful. Nurses in acute psychiatric settings should be required to be genuinely committed, aware of their actions, and fully present in coercive situations where patients are vulnerable. PMID:26199931

  19. Restraint free care in older adults with dementia.

    PubMed

    Cotter, Valerie T

    2005-06-01

    During the past two decades, significant research and several government and health care quality groups have advised against the use of physical restraints in hospitals and nursing homes, yet older adults are continuing to die, become injured or experience the iatrogenic complications associated with this practice. Deaths are usually caused by asphyxiation, but also occur from strangulation, or cardiac arrest. Older adults with dementia are at high risk for restraint use because of impaired memory, language, judgment and visual perception. In moderate to severe dementia, the risk of falls is greater because of gait apraxia and unsteadiness. Agitation, disorientation, and pacing behaviors from delirium or dementia can precipitate staff to use restraints to prevent harm to the older adult or to others. Physical restraints should be eliminated as an intervention in older adults with dementia because they are also very likely to cause acute functional decline, incontinence, pressure ulcers and regressive behaviors in a short period of time. The purpose of this paper is to disseminate the dangers of this clinical practice and to summarize the latest research in restraint free care and restraint alternatives in the United States.

  20. Australian nurses' perceptions of the use of manual restraint in the Emergency Department: a qualitative perspective.

    PubMed

    Chapman, Rose; Ogle, Kaye Robyn; Martin, Catherine; Rahman, Asheq; McKenna, Brian; Barnfield, Jakqui

    2016-05-01

    To explore emergency nurses perceptions of the use of manual restraint. Manual restraint of patients has historically been an accepted practice, though little is known about the use of manual restraint in general hospitals. A qualitative, descriptive, exploratory, study was undertaken. Fifteen semi-structured interviews with emergency nurses were completed. Data were analysed using qualitative thematic analysis procedures. The following themes were identified: 'part of the job', 'reasons for manual restraint', 'restraint techniques', 'consequences' and 'lack of documentation'. Manual restraint occurred frequently each shift and most were not documented. This may be due to nurse's perceptions that manually restraining a patient did not comprise formal restraint and was the only option. Nurses used manual restraint to manage patients who were violent and aggressive or to perform procedures. However, they reported a lack of education and training in manual restraint. Nurses identified several consequences for the patient, staff and the organisation as a result of these events including psychological and physical injuries. Empirical research of prevalence and issues surrounding manual restraint events is required to inform health care organisations and government to develop, implement and evaluate appropriate policies and strategies to ensure safety of patients and staff. The employment of peer support workers and professionals with expertise in mental health and dementia may aid in the reduction of manual restraint events and improve care of all patients within the Emergency Department. Research on manual restraint in health settings is also needed. Nurses need to be aware that manual restraint is not just an accepted part of their work, but is a strategy of last resort that should be documented. Organisations must implement standardised educational programmes for nurses together with policies and processes to monitor and evaluate manual restraint events. © 2016 John

  1. Understanding Mental Health Service User Experiences of Restraint Through Debriefing: A Qualitative Analysis

    PubMed Central

    Ling, Sara; Cleverley, Kristin; Perivolaris, Athina

    2015-01-01

    Objective: To examine debriefing data to understand experiences before, during, and after a restraint (seclusion, chemical, and physical) event from the perspective of inpatients at a large urban mental health and addiction hospital. Method: Audits were conducted on a purposeful sample of inpatient charts containing post-restraint event inpatient debrief forms (n = 55). Qualitative data from the forms were analyzed thematically. Results: Loss of autonomy and related anger, conflict with staff and other inpatients, and unmet needs were the most common factors precipitating restraint events. Inpatients often reported that increased communication with staff could have prevented restraint. Inpatients described having had various negative emotional states and responses during restraint events, including fear and rejection. Post-restraint, inpatients often desired to leave the unit for fresh air or to engage in leisure activities. Conclusions: To our knowledge, our study is the first to use debriefing form data to explore mental health inpatients’ experiences of restraint. Inpatients view restraint negatively and do not experience it as a therapeutic intervention. Debriefing, guided by a form, is useful for understanding the inpatient’s experience of restraint, and should be used to re-establish the therapeutic relationship and to inform plans of care. In addition, individual and collective inpatient perspectives should inform alternatives to restraint. PMID:26454726

  2. Understanding Mental Health Service User Experiences of Restraint Through Debriefing: A Qualitative Analysis.

    PubMed

    Ling, Sara; Cleverley, Kristin; Perivolaris, Athina

    2015-09-01

    To examine debriefing data to understand experiences before, during, and after a restraint (seclusion, chemical, and physical) event from the perspective of inpatients at a large urban mental health and addiction hospital. Audits were conducted on a purposeful sample of inpatient charts containing post-restraint event inpatient debrief forms (n = 55). Qualitative data from the forms were analyzed thematically. Loss of autonomy and related anger, conflict with staff and other inpatients, and unmet needs were the most common factors precipitating restraint events. Inpatients often reported that increased communication with staff could have prevented restraint. Inpatients described having had various negative emotional states and responses during restraint events, including fear and rejection. Post-restraint, inpatients often desired to leave the unit for fresh air or to engage in leisure activities. To our knowledge, our study is the first to use debriefing form data to explore mental health inpatients' experiences of restraint. Inpatients view restraint negatively and do not experience it as a therapeutic intervention. Debriefing, guided by a form, is useful for understanding the inpatient's experience of restraint, and should be used to re-establish the therapeutic relationship and to inform plans of care. In addition, individual and collective inpatient perspectives should inform alternatives to restraint.

  3. Restraint Theory: The Search for a Mechanism.

    ERIC Educational Resources Information Center

    Lowe, Michael R.

    A review of research indicates that cognitive restraint is insufficient in accounting for the relationship between restraint and negative affect eating. To explore what mechanism may be responsible for restraint effects, college students in two samples (Total N=378) completed the Three-Factor Eating Questionnaire (TEQ), a restraint scale…

  4. 32 CFR 636.34 - Restraint systems.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Restraint systems. (a) Restraint systems (seat belts) will be worn by all operators and passengers of U.S... ensuring the use of seat belts, shoulder restraints, and child restraining systems when applicable and may... for ensuring that their seat belts/shoulder restraints are used when applicable and may be cited...

  5. 32 CFR 636.34 - Restraint systems.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... § 636.34 Restraint systems. (a) Restraint systems (seat belts) will be worn by all operators and... vehicle is responsible for ensuring the use of seat belts, shoulder restraints, and child restraining... age of 16) are responsible for ensuring that their seat belts/shoulder restraints are used...

  6. Crew Medical Restraint System Inspection

    NASA Image and Video Library

    2013-05-22

    ISS036-E-003301 (22 May 2013) --- In the Destiny lab aboard the International Space Station, NASA astronaut Chris Cassidy, Expedition 36 flight engineer, participates in a Crew Medical Restraint System (CMRS) checkout.

  7. PILOT STUDY TO ASSESS MEAL PROGRESSION THROUGH THE GASTROINTESTINAL TRACT OF HABITUATED DOGS DETERMINED BY FLUOROSCOPIC IMAGING WITHOUT SEDATION OR PHYSICAL RESTRAINT.

    PubMed

    Wrigglesworth, David J; Bailey, Michael Q; Colyer, Alison; Hughes, Kevin R

    2016-11-01

    A limiting factor of radiographic contrast studies is the requirement for restraint of the animal in order to reduce movement artifacts. To demonstrate that gastrointestinal transit can be analyzed by a barium meal in nonsedated and unrestrained dogs, a pilot study of six adult Labrador retriever dogs was undertaken. Study subjects were selected by convenience sampling from an available population of Labrador dogs and were trained to stand motionless during radiographic fluoroscopy. Following a meal containing 7% w/w powdered barium sulfate, radiographic images were generated using a digital fluoroscope C-arm, at intervals of 5, 15, and 30 min, and at 1, 2, 3, 4, 5, 6, 7, and 8 h. A qualitative assessment of fill density using a 5-point scale was made for the stomach, small intestine, and ascending, transverse, and descending regions of the colon at each timepoint. Gastric emptying half-time occurred between 1 and 2 h postmeal. Mean fill density of the small intestine increased from 15 min postmeal and reached a peak at 3 h postmeal. Mean fill density of the proximal large intestine mirrored that of the small intestine. The distal large intestine remained empty for the first 2 h postmeal, then increased between hours 2 and 5 postmeal, and was subsequently at maximum fill density from hour 6 postmeal onwards. Fluoroscopic observation of a barium contrast meal provided an effective indication of the amount and progression of ingested food through the various regions of the gastrointestinal tract in habituated, fully conscious dogs. © 2016 American College of Veterinary Radiology.

  8. Do organisational constraints explain the use of restraint? A comparative ethnographic study from three nursing homes in Norway.

    PubMed

    Øye, Christine; Jacobsen, Frode Fadnes; Mekki, Tone Elin

    2017-07-01

    To investigate (1) what kind of restraint is used in three nursing homes in Norway and (2) how staff use restraint under what organisational conditions. Restraint use in residents living with dementia in nursing homes is controversial, and at odds with fundamental human rights. Restraint is a matter of hindering residents' free movement and will by applying either interactional, physical, medical, surveillance or environmental restraint. Previous research has identified use of restraint related to individual resident characteristics such as agitation, aggressiveness and wandering. This model is embedded in an overall mixed-method education intervention design study called Modelling and evaluating evidence-based continuing education program in dementia care (MEDCED), applying ethnography postintervention to examine the use of restraint in 24 nursing homes in Norway. Based on restraint diversity measured in the trial, ethnographic investigation was carried out in three different nursing homes in Norway over a 10-month period to examine restraint use in relation to organisational constraints. Several forms of restraint were observed; among them, interactional restraint was used most frequently. We identified that use of restraint relates to the characteristics of individual residents, such as agitation, aggressiveness and wandering. However, restraint use should also be explained in relation to organisational conditions such as resident mix, staff culture and available human resources. A fluctuating and dynamic interplay between different individual and contextual factors determines whether restraint is used - or not in particular situations with residents living with dementia. Educational initiatives targeting staff to reduce restraint must be sensitive towards fluctuating organisational constraints. © 2016 John Wiley & Sons Ltd.

  9. [Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality].

    PubMed

    Acevedo-Nuevo, M; González-Gil, M T; Solís-Muñoz, M; Láiz-Díez, N; Toraño-Olivera, M J; Carrasco-Rodríguez-Rey, L F; García-González, S; Velasco-Sanz, T R; Martínez-Álvarez, A; Martin-Rivera, B E

    2016-01-01

    To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  10. Reduction of restraint of people with intellectual disabilities: an organizational behavior management (OBM) approach.

    PubMed

    Williams, Don E; Grossett, Deborah L

    2011-01-01

    We used an organizational behavior management (OBM) approach to increase behavior intervention plans and decrease the use of mechanical restraint. First, recipients were tracked as a member of the priority group if they engaged in frequent self-injurious behavior or physical aggression toward others and/or if they had been placed in mechanical restraint as a result of the problem behaviors. Second, a behavior data monitoring and feedback system was put in place. Third, organizational contingencies for the use of mechanical restraint or the occurrence of frequent self-injurious behavior or physical aggression toward others were initiated. Over the course of 17 months, behavior intervention plans were more than doubled to 124 and mechanical restraints decreased by almost 80%. This study represents the first to use an organizational behavior management (OBM) to reduce restraint with people who have intellectual disabilities.

  11. Surgical Instrument Restraint in Weightlessness

    NASA Technical Reports Server (NTRS)

    Campbell, Mark R.; Dawson, David L.; Melton, Shannon; Hooker, Dona; Cantu, Hilda

    2000-01-01

    Performing a surgical procedure during spaceflight will become more likely with longer duration missions in the near future. Minimal surgical capability has been present on previous missions as the definitive medical care time was short and the likelihood of surgical events too low to justify surgical hardware availability. Early demonstrations of surgical procedures in the weightlessness of parabolic flight indicated the need for careful logistical planning and restraint of surgical hardware. The consideration of human ergonomics also has more impact in weightlessness than in the conventionall-g environment. Three methods of surgical instrument restraint - a Minor Surgical Kit (MSK), a Surgical Restraint Scrub Suit (SRSS), and a Surgical Tray (ST) were evaluated in parabolic flight surgical procedures. The Minor Surgical Kit was easily stored, easily deployed, and demonstrated the best ability to facilitate a surgical procedure in weightlessness. Important factors in this surgical restraint system include excellent organization of supplies, ability to maintain sterility, accessibility while providing secure restraint, ability to dispose of sharp items and biological trash, and ergonomical efficiency.

  12. Design and optimization for the occupant restraint system of vehicle based on a single freedom model

    NASA Astrophysics Data System (ADS)

    Zhang, Junyuan; Ma, Yue; Chen, Chao; Zhang, Yan

    2013-05-01

    Throughout the vehicle crash event, the interactions between vehicle, occupant, restraint system (VOR) are complicated and highly non-linear. CAE and physical tests are the most widely used in vehicle passive safety development, but they can only be done with the detailed 3D model or physical samples. Often some design errors and imperfections are difficult to correct at that time, and a large amount of time will be needed. A restraint system concept design approach which based on single-degree-of-freedom occupant-vehicle model (SDOF) is proposed in this paper. The interactions between the restraint system parameters and the occupant responses in a crash are studied from the view of mechanics and energy. The discrete input and the iterative algorithm method are applied to the SDOF model to get the occupant responses quickly for arbitrary excitations (impact pulse) by MATLAB. By studying the relationships between the ridedown efficiency, the restraint stiffness, and the occupant response, the design principle of the restraint stiffness aiming to reduce occupant injury level during conceptual design is represented. Higher ridedown efficiency means more occupant energy absorbed by the vehicle, but the research result shows that higher ridedown efficiency does not mean lower occupant injury level. A proper restraint system design principle depends on two aspects. On one hand, the restraint system should lead to as high ridedown efficiency as possible, and at the same time, the restraint system should maximize use of the survival space to reduce the occupant deceleration level. As an example, an optimization of a passenger vehicle restraint system is designed by the concept design method above, and the final results are validated by MADYMO, which is the most widely used software in restraint system design, and the sled test. Consequently, a guideline and method for the occupant restraint system concept design is established in this paper.

  13. Coercive restraint therapies: a dangerous alternative mental health intervention.

    PubMed

    Mercer, Jean

    2005-08-09

    Physicians caring for adopted or foster children should be aware of the use of coercive restraint therapy (CRT) practices by parents and mental health practitioners. CRT is defined as a mental health intervention involving physical restraint and is used in adoptive or foster families with the intention of increasing emotional attachment to parents. Coercive restraint therapy parenting (CRTP) is a set of child care practices adjuvant to CRT. CRT and CRTP have been associated with child deaths and poor growth. Examination of the CRT literature shows a conflict with accepted practice, an unusual theoretic basis, and an absence of empirical support. Nevertheless, CRT appears to be increasing in popularity. This article discusses possible reasons for the increase, and offers suggestions for professional responses to the CRT problem.

  14. [Deaths due to mechanical restraint in institutions for care].

    PubMed

    Mohsenian, C; Verhoff, M A; Risse, M; Heinemann, A; Püschel, K

    2003-08-01

    The state of confusion in patients with severe disorientation and brain damage symptoms presents particular problems in gerontologic psychiatry. Six fatalities at different institutions due to improperly employed physical restraint and deficient surveillance are described. The causes of death involved strangulation which was accidentally caused by patients who become stuck between bedrails and mattress or who were fixed in an abdominal restraint belt or in a special protective blanket (mostly used for serious pre-conditions). The reconstruction of the scene of death was based in almost all the cases on the autopsy findings. We assume a considerable number of unreported emergency or fatal cases. The legal, psychiatric and nursing-related issues are discussed in this paper. Furthermore the precise documentation of the on-site appearance of the situation at discovery of death is called for. The indication for physical restraint should be limited as far as possible. Further studies in nursing homes and hospitals should focus on structural conditions with respect to the frequency of physical restraint in order to optimize the protection by quality standards.

  15. 28 CFR 552.22 - Principles governing the use of force and application of restraints.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... JUSTICE INSTITUTIONAL MANAGEMENT CUSTODY Use of Force and Application of Restraints on Inmates § 552.22...'s airways. (3) In a manner that causes unnecessary physical pain or extreme discomfort. (4) To...

  16. Comparison of restraint data from four countries.

    PubMed

    Lepping, Peter; Masood, Barkat; Flammer, Erich; Noorthoorn, Eric O

    2016-09-01

    Previous studies comparing restraint data from different countries had to rely on randomly published data and showed wide variance in the prevalence of restraint between countries. To systematically compare datasets from four similar European countries with regard to restraint prevalence. We analysed whole country or area datasets on restraint from Wales, Ireland, Germany and the Netherlands systematically, thus excluding selection, patient and setting bias. Learning disability (LD) and forensic settings were analysed separately. Differences in proportions between countries were tested by means of Chi square, with number of admissions, admission days and catchment area as denominator and counts of restraint as numerators. Full datasets were obtained allowing calculations of total admissions, total restraint numbers, numbers of patients involved and total occupied bed days. Data for Ireland is from 2012 and from 2013 for the other three countries. The percentage of patients exposed to restraint varies between 4.5 and 9.4 %. The average number of restraints per patient is stable at around 3 in all countries. Patient numbers affected by restraint per 100 occupied bed days per month vary between 0.095 and 0.200. The Netherlands have the highest use of seclusion (79 %), the longest restraint times and low use of enforced medication. Wales the lowest use of seclusion (2 %), followed by Ireland (29 %) and Germany (49 %). Events per 100 admissions per month vary between 17 and 21. Patients affected by restraint per 100 admissions per month vary between 5.4 and 7.5. LD services account for a disproportionately high number of restraint events. Patient related restraint data are remarkably similar between countries. Type and length of restraint still vary significantly.

  17. Restraint stress and social defeat: What they have in common.

    PubMed

    Motta, Simone Cristina; Canteras, Newton Sabino

    2015-07-01

    Bob Blanchard was a great inspiration for our studies on the neural basis of social defense. In the present study, we compared the hypothalamic pattern of activation between social defeat and restraint stress. As important stress situations, both defeated and immobilized animals displayed a substantial increase in Fos in the parvicellular part of the paraventricular nucleus,mostly in the region that contains the CRH neurons. In addition, socially defeated animals, but not restrained animals, recruited elements of the medial hypothalamic conspecific-responsive circuit, a region also engaged in other forms of social behavior. Of particular interest, both defeated and immobilized animals presented a robust increase in Fos expression in specific regions of the lateral hypothalamic area (i.e., juxtaparaventricular and juxtadorsomedial regions) likely to convey septo-hippocampal information encoding the environmental boundary restriction observed in both forms of stress, and in the dorsomedial part of the dorsal premammillary nucleus which seems to work as a key player for the expression of, at least, part of the behavioral responses during both restraint and social defeat. These results indicate interesting commonalities between social defeat and restraint stress, suggesting, for the first time, a septo-hippocampal–hypothalamic path likely to respond to the environmental boundary restriction that may act as common stressor component for both types of stress. Moreover, the comparison of the neural circuits mediating physical restraint and social defense revealed a possible path for encoding the entrapment component during social confrontation.

  18. Investigation of Crew Restraint System Biomechanics.

    DTIC Science & Technology

    1982-05-01

    presented for future research . (7) Restraint systems evaluation techniques have been improved through the efforts of this research . The approach taken...ARD-R12g 199 INVESTIGATION OF CREW RESTRAINT SYSTEM BIONECHANICSCU) 1/2 ’ DAYTON UNIV OH RESEARCH INST N S PHILLIPS ET AL. UNCLSSFE MAY 82 AFANRL...46FAMRL-TR-81 -103 SINVESTIGATION OF CREW RESTRAINT SYSTEM BIOMECHANICS NORMWAN S. PHILLIPS ROBERT A. THOMSON IRA B. FISCUS UNIVERSITY OF DA YTON RESEARCH

  19. A national abhorrence of physical restraint.

    PubMed

    Garrett, Dawne

    2008-07-24

    Publications such as those from the RCN and the CSCI, together with media scrutiny and the increased involvement of the legal system, are highlighting what has been a long-standing issue for many health and social care staff. The difficulties still facing staff are that every situation is unique and staff members are themselves individuals.

  20. Post-Seclusion and/or Restraint Review in Psychiatry: A Scoping Review.

    PubMed

    Goulet, Marie-Hélène; Larue, Caroline

    2016-02-01

    It has been suggested that after an incident in which a patient has been placed in seclusion or in restraints, an intervention should be conducted after the event to ensure continuity of care and prevent recurrences. Several terms are used, and various models have been suggested for post-seclusion and/or restraint review; however, the intervention has never been precisely defined. This article presents a scoping review on post-seclusion and/or restraint review in psychiatry to examine existing models and the theoretical foundations on which they rely. A scoping review of academic articles (CINAHL and Medline database) yielded 28 articles. Post-seclusion and/or restraint review has its origins in the concepts of debriefing in psychology and reflective practice in nursing. We propose a typology in terms of the intervention target, including the patient, the health care providers, or both. The analysis found that the review ought to involve both the patient and the care providers using an approach that fosters reflexivity among all those involved in order to change the practice of seclusion in psychiatric settings. • Established literature documented widely that seclusion and restraint has adverse physical and psychological consequences for patient and for health care providers. • Post-seclusion and/or restraint review is promoted in most guidelines, but there is no scoping or systematic review yet on the subject. • The origins of post-seclusion and/or restraint review are in the concepts of debriefing in psychology and reflective practice in nursing. • We propose that post-seclusion and/or restraint review should focus on both patients and health care providers.• Systematic post-seclusion and/or restraint review should be performed after each event, and its effects on patients and on mental health professionals should be rigorously assessed. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  1. The Effects of an Action Plan, Staff Training, Management Support and Monitoring on Restraint Use and Costs of Work-Related Injuries

    ERIC Educational Resources Information Center

    Sanders, Kim

    2009-01-01

    Background: Dignity and respect are at the foundation of good care and effective treatment planning and are guiding service principles. The use of physical restraints is contrary to treatment with dignity and respect. Because of the numerous risks to clients and employees associated with the use of physical restraints, an innovative plan was…

  2. The Effects of an Action Plan, Staff Training, Management Support and Monitoring on Restraint Use and Costs of Work-Related Injuries

    ERIC Educational Resources Information Center

    Sanders, Kim

    2009-01-01

    Background: Dignity and respect are at the foundation of good care and effective treatment planning and are guiding service principles. The use of physical restraints is contrary to treatment with dignity and respect. Because of the numerous risks to clients and employees associated with the use of physical restraints, an innovative plan was…

  3. Sullivan and Ride Show Sleep Restraints

    NASA Technical Reports Server (NTRS)

    1984-01-01

    Astronauts Kathryn D. Sullivan, left, and Sally K. Ride display a 'bag of worms.' The 'bag' is a sleep restraint and the majority of the 'worms' are springs and clips used with the sleep restraint in its normal application. Clamps, a bungee cord and velcro strips are other recognizable items in the 'bag.'

  4. The use of meperidine hydrochloride for chemical restraint in certain cetaceans and pinnipeds.

    PubMed

    Joseph, B E; Cornell, L H

    1988-10-01

    Meperidine HCl was administered intramuscularly by hand-syringe to a number of individuals representing several species of cetaceans (n = 95) and pinnipeds (n = 36). Dosage administered was 0.11 mg/kg, 0.23 mg/kg or 0.45 mg/kg, with the majority of animals receiving the middle dosage. Meperidine HCl provided moderate restraint in cetaceans without obvious deleterious effects. Restraint was achieved rapidly, with maximum effect occurring 20 min after intramuscular injection and lasting for 2 to 3 hr. Analgesia appeared to last as long as 4 hr and was sometimes accompanied by a restoration of appetite in animals suffering from physical discomfort. Higher doses produced increased sedation and analgesia without noticeably depressing respiration. Meperidine HCl provided moderate restraint for phocids and walrus (Odobenus rosmarus) without apparent detriment. California sea lions (Zalophus californianus) showed little restraint, but demonstrated profound respiratory depression.

  5. Restraint and the question of validity.

    PubMed

    Paterson, Brodie; Duxbury, Joy

    2007-07-01

    Restraint as an intervention in the management of acute mental distress has a long history that predates the existence of psychiatry. However, it remains a source of controversy with an ongoing debate as to its role. This article critically explores what to date has seemingly been only implicit in the debate surrounding the role of restraint: how should the concept of validity be interpreted when applied to restraint as an intervention? The practice of restraint in mental health is critically examined using two post-positivist constructions of validity, the pragmatic and the psychopolitical, by means of a critical examination of the literature. The current literature provides only weak support for the pragmatic validity of restraint as an intervention and no support to date for its psychopolitical validity. Judgements regarding the validity of any intervention that is coercive must include reference to the psychopolitical dimensions of both practice and policy.

  6. Child restraint systems: an update for physicians.

    PubMed

    Funk-Zbinden, J M; McIntosh, G C; Burns, D A; Peterson, N M; Katcher, M L

    2001-01-01

    During the past decade, many advances have been made in motor vehicle safety restraint systems, and these advancements have brought changes in the recommendations for child passenger safety. In spite of these advances, a high morbidity and mortality rate continues to be attributed to improper or absent child restraint use. Child transportation safety is a complex issue. Lack of public awareness and incomplete laws contribute to the confusion. The solution involves professional and public education, further technological advances, and advocacy for improved legislation and regulation. Physicians have a unique opportunity to incorporate advice about proper restraint use into their daily practice; however, that requires a clear understanding of the current recommendations. Both the age and weight of the child determine the appropriate child restraint system. Understanding, practicing, and promoting these recommendations will save lives. This article reviews the current recommendations for proper child restraint while traveling in a motor vehicle.

  7. 14 CFR 135.128 - Use of safety belts and child restraint systems.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    .... 213 (49 CFR 571.213)), vest- and harness-type child restraint systems, and lap held child restraints...-type child restraint system, a harness-type child restraint system, or a lap held child restraint...

  8. 14 CFR 135.128 - Use of safety belts and child restraint systems.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    .... 213 (49 CFR 571.213)), vest- and harness-type child restraint systems, and lap held child restraints...-type child restraint system, a harness-type child restraint system, or a lap held child restraint...

  9. 14 CFR 135.128 - Use of safety belts and child restraint systems.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    .... 213 (49 CFR 571.213)), vest- and harness-type child restraint systems, and lap held child restraints...-type child restraint system, a harness-type child restraint system, or a lap held child restraint...

  10. 14 CFR 135.128 - Use of safety belts and child restraint systems.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    .... 213 (49 CFR 571.213)), vest- and harness-type child restraint systems, and lap held child restraints...-type child restraint system, a harness-type child restraint system, or a lap held child restraint...

  11. 14 CFR 135.128 - Use of safety belts and child restraint systems.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    .... 213 (49 CFR 571.213)), vest- and harness-type child restraint systems, and lap held child restraints...-type child restraint system, a harness-type child restraint system, or a lap held child restraint...

  12. The use of chemical restraints reduces agitation in patients transported by emergency medical services.

    PubMed

    Weiss, Steve; Peterson, Kari; Cheney, Paul; Froman, Phil; Ernst, Amy; Campbell, Micha

    2012-11-01

    Agitated patients are the primary source of injury to patients and providers during ambulance transport. Our primary hypothesis was that the addition of a chemical restraint agent (midazolam) to a restraint protocol would reduce agitation to a greater extent than a restraint protocol with physical restraint alone. The local emergency medical services restraint protocol (RP) was implemented on October 1, 2006. It included a form for data collection about each restrained patient. On April 1, 2007, chemical restraint (CR) using midazolam in addition to physical restraints was made available through the RP, and paramedics were educated in its use. Transported patients were divided into pre-CR and post-CR. The post-CR group was split into those who received and those who did not receive midazolam. Agitation was measured on a validated agitation behavior scale with a parametric (Rasch) adjustment. There were 96 patients in the pre-CR group and 522 patients in the post-CR group. Forty-three percent of the pre-CR group and 49% of the post-CR group had a decrease in agitation during transport (NS). Of the 522 in the post-CR group, 110 were physically restrained and given midazolam (21%) and 412 were physically restrained without midazolam (79%). There was a significantly greater decrease in agitation scores (-17 ± 21 vs. -7 ± 17) in the subjects receiving midazolam compared to those who did not. If available, CR is used in about 20% of restrained patients. When CR is used, there is a decrease in the subject's agitation. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. Nuclear component horizontal seismic restraint

    DOEpatents

    Snyder, Glenn J.

    1988-01-01

    A nuclear component horizontal seismic restraint. Small gaps limit horizontal displacement of components during a seismic occurrence and therefore reduce dynamic loadings on the free lower end. The reactor vessel and reactor guard vessel use thicker section roll-forged rings welded between the vessel straight shell sections and the bottom hemispherical head sections. The inside of the reactor guard vessel ring forging contains local vertical dovetail slots and upper ledge pockets to mount and retain field fitted and installed blocks. As an option, the horizontal displacement of the reactor vessel core support cone can be limited by including shop fitted/installed local blocks in opposing alignment with the reactor vessel forged ring. Beams embedded in the wall of the reactor building protrude into apertures in the thermal insulation shell adjacent the reactor guard vessel ring and have motion limit blocks attached thereto to provide to a predetermined clearance between the blocks and reactor guard vessel ring.

  14. Characteristics of adolescents subjected to restraint in acute psychiatric units in Norway: a case-control study.

    PubMed

    Furre, Astrid; Sandvik, Leiv; Heyerdahl, Sonja; Friis, Svein; Knutzen, Maria; Hanssen-Bauer, Ketil

    2014-11-01

    Use of restraint in psychiatric treatment is controversial. This study compared social, mental health, and treatment characteristics of restrained and nonrestrained adolescents in acute psychiatric inpatient units. In a retrospective case-control design, we included all adolescents restrained during 2008-2010 (N=288) in all acute psychiatric inpatient units that accepted involuntarily admitted adolescents in Norway (N=16). A control group (N=288) of nonrestrained adolescent patients was randomly selected from the same units. Restraint included mechanical restraint, pharmacological restraint, seclusion, and physical holding. Data sources were electronic patient records and restraint protocols. Binary logistic regression analyses were performed to predict restraint use. Compared with nonrestrained adolescents, restrained adolescents were more likely to be immigrants, to live in institutions or foster care, and to have had involvement with child protection services. The restrained adolescents were more likely to have psychotic, eating, or externalizing disorders and lower scores on the Children's Global Assessment Scale (CGAS). They had multiple admissions and longer stays and were more often involuntarily referred. When the analysis adjusted for age, gender, living arrangements, child protection services involvement, and ICD-10 diagnoses, several variables were significantly associated with restraint: immigrant background, low CGAS score, number of admissions, length of stay, and involuntary referral. Restrained and nonrestrained patients differed significantly in social, mental health, and treatment characteristics. These findings may be useful in developing strategies for reducing the use of restraint in child and adolescent psychiatry.

  15. Exploring perspectives on restraint during medical procedures in paediatric care: a qualitative interview study with nurses and physicians.

    PubMed

    Svendsen, Edel Jannecke; Pedersen, Reidar; Moen, Anne; Bjørk, Ida Torunn

    2017-12-01

    The aim of this study was to explore nurses' and physicians' perspectives on and reasoning about the use of restraint during medical procedures on newly admitted preschoolers in somatic hospital care. We analysed qualitative data from individual interviews with a video recall session at the end with seven physicians and eight nurses. They had earlier participated in video recorded peripheral vein cannulations on preschool children. The data were collected between May 2012 and May 2013 at a paediatric hospital unit in Norway. The analysis resulted in three main themes: (1) disparate views on the concept of restraint and restraint use (2), ways to limit the use of physical restraint and its negative consequences, and (3) experience with the role of parents and their influence on restraint. Perspectives from both healthcare professions were represented in all the main themes and had many similarities. The results of this study may facilitate more informed and reflective discussions of restraint and contribute to higher awareness of restraint in clinical practice. Lack of guidance and scientific attention to restraint combined with conflicting interests and values among healthcare providers may result in insecurity, individual dogmatism, and a lack of shared discussions, language, and terminology.

  16. 75 FR 9613 - Draft NIJ Restraints Standard for Criminal Justice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-03

    ... of Justice Programs Draft NIJ Restraints Standard for Criminal Justice AGENCY: National Institute of Justice, Office of Justice Programs, DOJ. ACTION: Notice of Draft NIJ Restraints Standard for Criminal... Restraints Standard for Criminal Justice'' and (2) a draft companion document entitled, ``NIJ Restraints...

  17. 42 CFR 483.362 - Monitoring of the resident in and immediately after restraint.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... use of emergency safety interventions must be physically present, continually assessing and monitoring the physical and psychological well-being of the resident and the safe use of restraint throughout the duration of the emergency safety intervention. (b) If the emergency safety situation continues beyond the...

  18. 42 CFR 483.362 - Monitoring of the resident in and immediately after restraint.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... use of emergency safety interventions must be physically present, continually assessing and monitoring the physical and psychological well-being of the resident and the safe use of restraint throughout the duration of the emergency safety intervention. (b) If the emergency safety situation continues beyond the...

  19. Succeeding in Sustained Reduction in the use of Restraint using the Improvement Model.

    PubMed

    Bell, Alyssa; Gallacher, Neil

    2016-01-01

    As part of the Scottish Patient Safety Programme - Mental Health one of the main drivers was the reduction of harm to patients caused by restraint. The aim of this project was to reduce the number of restraints on our Acute Admissions ward. Through use the of the Improvement Model (PDSA), frontline staff were empowered to implement small tests of change at a grassroots level. This approach has led to frontline staff having ownership of driving the changes on a daily basis within the Clinical area. The use of a restraint data collection tool has been adapted and developed with frontline staff to ensure that the staff have ownership of data collected and is used to facilitate improvement. This data is used to inform the development of our Physical Interventions training. Most recently, following analysis, were able to introduce changes to promote the increased use of de-escalation and a shift from prone restraint to the safer seated restraint position. Patient involvement has been paramount with their inclusion in the debrief process. The information gleaned from the patients is used for staff and patient reflection. This has created a learning environment not only for staff but also patients and carers. Everyone involved is able to identify reasons and triggers and generate ideas to reduce the possibility of another restraint. The use of staff and patient safety climate surveys has ensured that we are constantly monitoring improvements in the feeling of safety amongst staff and patients. Our approach has resulted in a change in the culture of restraint resulting in a sustained reduction of 50% in restraint.

  20. Dietary restraint and cognitive performance in children.

    PubMed

    Brunstrom, Jeffrey M; Davison, Claire J; Mitchell, Gemma L

    2005-12-01

    Adults who attempt to restrict their dietary intake also tend to perform worse on a range of cognitive tasks. However, the extent to which this finding generalises to children has remained unclear. Following studies involving adults, we asked 44 girls (mean age = 10.1 years) to complete a simple reaction-time task and the Tower of London task. This group was selected from a local community school in the East Midlands (UK). Dietary restraint was measured using a version of the Dutch Eating Behaviour Questionnaire that had been adapted for use by children. Our results indicate that children with high restraint scores have longer reaction times and they also tend to perform worse on the TOL task. Other aspects of our data also suggest the dietary restraint may be correlated negatively with a measure of academic ability. We discuss reasons why restraint and performance might be related causally and we conclude that this issue warrants further scrutiny.

  1. Coercive Restraint Therapies: A Dangerous Alternative Mental Health Intervention

    PubMed Central

    Mercer, Jean

    2005-01-01

    Abstract and Introduction Abstract Physicians caring for adopted or foster children should be aware of the use of coercive restraint therapy (CRT) practices by parents and mental health practitioners. CRT is defined as a mental health intervention involving physical restraint and is used in adoptive or foster families with the intention of increasing emotional attachment to parents. Coercive restraint therapy parenting (CRTP) is a set of child care practices adjuvant to CRT. CRT and CRTP have been associated with child deaths and poor growth. Examination of the CRT literature shows a conflict with accepted practice, an unusual theoretic basis, and an absence of empirical support. Nevertheless, CRT appears to be increasing in popularity. This article discusses possible reasons for the increase, and offers suggestions for professional responses to the CRT problem. Introduction The term coercive restraint therapy (CRT) describes a category of alternative mental health interventions that are generally directed at adopted or foster children, that are claimed to cause alterations in emotional attachment, and that employ physically intrusive techniques. Other names for such treatments are attachment therapy, corrective attachment therapy, dyadic synchronous bonding, holding therapy, rage reduction therapy, and Z-therapy. CRT may be carried out by practitioners trained in extracurricular workshops, or such practitioners may instruct parents who perform all or part of the treatment. CRT practices involve the use of restraint as a tool of treatment rather than simply as a safety device. While restraining the child, CRT practitioners may also exert physical pressure in the form of tickling or intense prodding of the torso, grab the child's face, and command the child to kick the legs rhythmically. Some CRT practitioners lie prone with their body weight on the child, a practice they call compression therapy. Most practitioners restrain the child in a supine position, but some

  2. Caring through restraint: violence, intimacy and identity in mental health practice.

    PubMed

    Hejtmanek, Katie

    2010-12-01

    In this article, I discuss the meanings of "restraints," or physical intervention strategies that are used at a total institution for mentally ill adolescents in the United States. This paper argues that this particularly complex form of mental health treatment is simultaneously a violent and an intimate way in which men relate to one another and also takes on complex meanings about trust and identity in mental health recovery. Using data from 18 months of ethnographic fieldwork at one residential treatment center, this article examines what restraints reveal and embody about intimate interpersonal staff/client relationships, how Black men relate to one another in this setting and how staff members use physical interventions to link institutional mental health treatment with street violence in the outside world. I conclude that understanding these meanings of restraints provides a valuable way of understanding local knowledge in mental health practice, treatment and recovery.

  3. International Space Station Crew Restraint Design

    NASA Technical Reports Server (NTRS)

    Whitmore, M.; Norris, L.; Holden, K.

    2005-01-01

    With permanent human presence onboard the International Space Station (ISS), crews will be living and working in microgravity, dealing with the challenges of a weightless environment. In addition, the confined nature of the spacecraft environment results in ergonomic challenges such as limited visibility and access to the activity areas, as well as prolonged periods of unnatural postures. Without optimum restraints, crewmembers may be handicapped for performing some of the on-orbit tasks. Currently, many of the tasks on ISS are performed with the crew restrained merely by hooking their arms or toes around handrails to steady themselves. This is adequate for some tasks, but not all. There have been some reports of discomfort/calluses on the top of the toes. In addition, this type of restraint is simply insufficient for tasks that require a large degree of stability. Glovebox design is a good example of a confined workstation concept requiring stability for successful use. They are widely used in industry, university, and government laboratories, as well as in the space environment, and are known to cause postural limitations and visual restrictions. Although there are numerous guidelines pertaining to ventilation, seals, and glove attachment, most of the data have been gathered in a 1-g environment, or are from studies that were conducted prior to the early 1980 s. Little is known about how best to restrain a crewmember using a glovebox in microgravity. In 2004, The Usability Testing and Analysis Facility (UTAF) at the NASA Johnson Space Center completed development/evaluation of several design concepts for crew restraints to meet the various needs outlined above. Restraints were designed for general purpose use, for teleoperation (Robonaut) and for use with the Life Sciences Glovebox. All design efforts followed a human factors engineering design lifecycle, beginning with identification of requirements followed by an iterative prototype/test cycle. Anthropometric

  4. International Space Station Crew Restraint Design

    NASA Technical Reports Server (NTRS)

    Whitmore, M.; Norris, L.; Holden, K.

    2005-01-01

    With permanent human presence onboard the International Space Station (ISS), crews will be living and working in microgravity, dealing with the challenges of a weightless environment. In addition, the confined nature of the spacecraft environment results in ergonomic challenges such as limited visibility and access to the activity areas, as well as prolonged periods of unnatural postures. Without optimum restraints, crewmembers may be handicapped for performing some of the on-orbit tasks. Currently, many of the tasks on ISS are performed with the crew restrained merely by hooking their arms or toes around handrails to steady themselves. This is adequate for some tasks, but not all. There have been some reports of discomfort/calluses on the top of the toes. In addition, this type of restraint is simply insufficient for tasks that require a large degree of stability. Glovebox design is a good example of a confined workstation concept requiring stability for successful use. They are widely used in industry, university, and government laboratories, as well as in the space environment, and are known to cause postural limitations and visual restrictions. Although there are numerous guidelines pertaining to ventilation, seals, and glove attachment, most of the data have been gathered in a 1-g environment, or are from studies that were conducted prior to the early 1980 s. Little is known about how best to restrain a crewmember using a glovebox in microgravity. In 2004, The Usability Testing and Analysis Facility (UTAF) at the NASA Johnson Space Center completed development/evaluation of several design concepts for crew restraints to meet the various needs outlined above. Restraints were designed for general purpose use, for teleoperation (Robonaut) and for use with the Life Sciences Glovebox. All design efforts followed a human factors engineering design lifecycle, beginning with identification of requirements followed by an iterative prototype/test cycle. Anthropometric

  5. Does Brief Bradycardia at the Onset of Arm-Restraint Predict Infants' Emotional Reactivity during Restraint?

    ERIC Educational Resources Information Center

    Porter, Christin L.; Jones, Blake L.

    2011-01-01

    Using electrocardiogram data with 78 six-month-old infants, this study examined the presence or absence of brief orienting bradycardia during the onset of maternal arm-restraint and subsequent differences between infants on behavioral organization during restraint. Results showed that 45 of the infants exhibited brief episodes of bradycardia at…

  6. Does Brief Bradycardia at the Onset of Arm-Restraint Predict Infants' Emotional Reactivity during Restraint?

    ERIC Educational Resources Information Center

    Porter, Christin L.; Jones, Blake L.

    2011-01-01

    Using electrocardiogram data with 78 six-month-old infants, this study examined the presence or absence of brief orienting bradycardia during the onset of maternal arm-restraint and subsequent differences between infants on behavioral organization during restraint. Results showed that 45 of the infants exhibited brief episodes of bradycardia at…

  7. Special Purpose Crew Restraints for Teleoperation

    NASA Technical Reports Server (NTRS)

    Whitmore, Mihriban; Holden, Kritina; Norris, Lena

    2004-01-01

    With permanent human presence onboard the International Space Station (ISS), and long duration space missions being planned for the moon and Mars, humans will be living and working in microgravity over increasingly long periods of time. In addition to weightlessness, the confined nature of a spacecraft environment results in ergonomic challenges such as limited visibility, and access to the activity area. These challenges can result in prolonged periods of unnatural postures for the crew, ultimately causing pain, injury, and loss of productivity. Determining the right set of human factors requirements and providing an ergonomically designed environment is crucial to mission success. While a number of general purpose restraints have been used on ISS (handrails, foot loops), experience has shown that these general purpose restraints may not be optimal, or even acceptable for some tasks that have unique requirements. For example, some onboard activities require extreme stability (e.g., glovebox microsurgery), and others involve the use of arm, torso and foot movements in order to perform the task (e-g. robotic teleoperation); standard restraint systems will not work in these situations. The Usability Testing and Analysis Facility (WAF) at the NASA Johnson Space Center began evaluations of crew restraints for these special situations by looking at NASAs Robonaut. Developed by the Robot Systems Technology Branch, Robonaut is a humanoid robot that can be remotely operated through a tetepresence control system by an operator. It was designed to perform work in hazardous environments (e.g., Extra Vehicular Activities). A Robonaut restraint was designed, modeled for the population, and ultimately tested onboard the KC-135 microgravity aircraft. While in microgravity, participants were asked to get in and out of the restraint from different locations, perform maximum reach exercises, and finally to teleoperate Robonaut while in the restraint. The sessions were videotaped

  8. Special Purpose Crew Restraints for Teleoperation

    NASA Technical Reports Server (NTRS)

    Whitmore, Mihriban; Holden, Kritina; Norris, Lena

    2004-01-01

    With permanent human presence onboard the International Space Station (ISS), and long duration space missions being planned for the moon and Mars, humans will be living and working in microgravity over increasingly long periods of time. In addition to weightlessness, the confined nature of a spacecraft environment results in ergonomic challenges such as limited visibility, and access to the activity area. These challenges can result in prolonged periods of unnatural postures for the crew, ultimately causing pain, injury, and loss of productivity. Determining the right set of human factors requirements and providing an ergonomically designed environment is crucial to mission success. While a number of general purpose restraints have been used on ISS (handrails, foot loops), experience has shown that these general purpose restraints may not be optimal, or even acceptable for some tasks that have unique requirements. For example, some onboard activities require extreme stability (e.g., glovebox microsurgery), and others involve the use of arm, torso and foot movements in order to perform the task (e-g. robotic teleoperation); standard restraint systems will not work in these situations. The Usability Testing and Analysis Facility (WAF) at the NASA Johnson Space Center began evaluations of crew restraints for these special situations by looking at NASAs Robonaut. Developed by the Robot Systems Technology Branch, Robonaut is a humanoid robot that can be remotely operated through a tetepresence control system by an operator. It was designed to perform work in hazardous environments (e.g., Extra Vehicular Activities). A Robonaut restraint was designed, modeled for the population, and ultimately tested onboard the KC-135 microgravity aircraft. While in microgravity, participants were asked to get in and out of the restraint from different locations, perform maximum reach exercises, and finally to teleoperate Robonaut while in the restraint. The sessions were videotaped

  9. Restraint Procedures and Challenging Behaviours in Intellectual Disability: An Analysis of Causative Factors

    ERIC Educational Resources Information Center

    Matson, Johnny L.; Boisjoli, Jessica A.

    2009-01-01

    Background: Persons with intellectual disability often evince challenging behaviours. Efforts have been underway for some time to develop prosocial or positive skill acquisition treatments to address challenging behaviours. However, physical/mechanical and chemical restraint is still commonly used in many clinical and community settings. Such…

  10. The Relationship between Seclusion and Restraint Use and Childhood Abuse among Psychiatric Inpatients

    ERIC Educational Resources Information Center

    Hammer, Joseph H.; Springer, Justin; Beck, Niels C.; Menditto, Anthony; Coleman, James

    2011-01-01

    Seclusion and restraint (S/R) is a controversial topic in the field of psychiatry, due in part to the high rates of childhood physical and sexual abuse found among psychiatric inpatients. The trauma-informed care perspective suggests that the use of S/R with previously abused inpatients may result in retraumatization due to mental associations…

  11. Reduction of Restraint of People with Intellectual Disabilities: An Organizational Behavior Management (OBM) Approach

    ERIC Educational Resources Information Center

    Williams, Don E.; Grossett, Deborah L.

    2011-01-01

    We used an organizational behavior management (OBM) approach to increase behavior intervention plans and decrease the use of mechanical restraint. First, recipients were tracked as a member of the priority group if they engaged in frequent self-injurious behavior or physical aggression toward others and/or if they had been placed in mechanical…

  12. The Relationship between Seclusion and Restraint Use and Childhood Abuse among Psychiatric Inpatients

    ERIC Educational Resources Information Center

    Hammer, Joseph H.; Springer, Justin; Beck, Niels C.; Menditto, Anthony; Coleman, James

    2011-01-01

    Seclusion and restraint (S/R) is a controversial topic in the field of psychiatry, due in part to the high rates of childhood physical and sexual abuse found among psychiatric inpatients. The trauma-informed care perspective suggests that the use of S/R with previously abused inpatients may result in retraumatization due to mental associations…

  13. Retrain, Don't Restrain: The Educational Intervention of the National Nursing Home Restraint Removal Project.

    ERIC Educational Resources Information Center

    Dunbar, Joan M.; And Others

    1996-01-01

    Describes an educational program that contributed to a 90% reduction in the use of physical restraints in nursing homes over a two-year period. Program consists of a workshop, telephone and on-site consultations, regional meetings, and other support materials. Surveys suggest that the project can be easily adapted by care providers. (RJM)

  14. Restraint Procedures and Challenging Behaviours in Intellectual Disability: An Analysis of Causative Factors

    ERIC Educational Resources Information Center

    Matson, Johnny L.; Boisjoli, Jessica A.

    2009-01-01

    Background: Persons with intellectual disability often evince challenging behaviours. Efforts have been underway for some time to develop prosocial or positive skill acquisition treatments to address challenging behaviours. However, physical/mechanical and chemical restraint is still commonly used in many clinical and community settings. Such…

  15. Reduction of Restraint of People with Intellectual Disabilities: An Organizational Behavior Management (OBM) Approach

    ERIC Educational Resources Information Center

    Williams, Don E.; Grossett, Deborah L.

    2011-01-01

    We used an organizational behavior management (OBM) approach to increase behavior intervention plans and decrease the use of mechanical restraint. First, recipients were tracked as a member of the priority group if they engaged in frequent self-injurious behavior or physical aggression toward others and/or if they had been placed in mechanical…

  16. Passive zero-gravity leg restraint

    NASA Technical Reports Server (NTRS)

    Miller, Christopher R. (Inventor)

    1989-01-01

    A passive zero or microgravity leg restraint is described which includes a central support post with a top and a bottom. Extending from the central support post are a calf pad tab, to which calf pad is attached, and a foot pad tab, to which foot tab is attached. Also extending from central support post are knee pads. When the restraint is in use the user's legs are forced between pads by a user imposed scissors action of the legs. The user's body is then supported in a zero or microgravity neutral body posture by the leg restraint. The calf pad has semi-ridig elastic padding material covering structural stiffener. The foot pad has padding material and a structural stiffener. Knee pads have s structural tube stiffener at their core.

  17. Efficient Cooperative Restraint Training With Rhesus Macaques

    PubMed Central

    Bliss-Moreau, Eliza; Theil, Jacob H.; Moadab, Gilda

    2013-01-01

    It is sometimes necessary for nonhuman primates to be restrained during biomedical and psychosocial research. Such restraint is often accomplished using a “primate chair.” The present paper details a method for training adult rhesus macaques to cooperate with a chair restraint procedure using positive and negative reinforcement. Successful training was accomplished rapidly in approximately 14 training days. The success of this training technique suggests that this method represents a refinement to traditional techniques despite the behavioral heterogeneity in the animal sample (which includes animals previously deemed unfit for traditional pole-and-collar training). PMID:23544752

  18. 49 CFR 575.201 - Child restraint performance.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Child restraint performance. 575.201 Section 575... Recall Enhancement, Accountability, and Documentation Act; Consumer Information § 575.201 Child restraint... performance of child restraints. The agency makes the information developed under this rating...

  19. 49 CFR 575.201 - Child restraint performance.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 7 2013-10-01 2013-10-01 false Child restraint performance. 575.201 Section 575... Recall Enhancement, Accountability, and Documentation Act; Consumer Information § 575.201 Child restraint... performance of child restraints. The agency makes the information developed under this rating...

  20. 49 CFR 575.201 - Child restraint performance.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Child restraint performance. 575.201 Section 575... Recall Enhancement, Accountability, and Documentation Act; Consumer Information § 575.201 Child restraint... performance of child restraints. The agency makes the information developed under this rating...

  1. 49 CFR 575.201 - Child restraint performance.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Child restraint performance. 575.201 Section 575... Recall Enhancement, Accountability, and Documentation Act; Consumer Information § 575.201 Child restraint... performance of child restraints. The agency makes the information developed under this rating...

  2. 49 CFR 575.201 - Child restraint performance.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Child restraint performance. 575.201 Section 575... Recall Enhancement, Accountability, and Documentation Act; Consumer Information § 575.201 Child restraint... performance of child restraints. The agency makes the information developed under this rating...

  3. Dietary restraint and self-discrepancy in male university students.

    PubMed

    Orellana, Ligia; Grunert, Klaus G; Sepúlveda, José; Lobos, Germán; Denegri, Marianela; Miranda, Horacio; Adasme-Berríos, Cristian; Mora, Marcos; Etchebarne, Soledad; Salinas-Oñate, Natalia; Schnettler, Berta

    2016-04-01

    Self-discrepancy describes the distance between an ideal and the actual self. Research suggests that self-discrepancy and dietary restraint are related, causing a significant impact on the person's well-being. However, this relationship has been mostly reported in female and mixed populations. In order to further explore dietary behaviors and their relations to self-discrepancy and well-being-related variables in men, a survey was applied to a non-probabilistic sample of 119 male students from five Chilean state universities (mean age=21.8, SD=2.75). The questionnaire included the Revised Restraint Scale (RRS) with the subscales weight fluctuations (WF) and diet concern (DC), the Satisfaction with Life Scale (SWLS), the Satisfaction with Food-Related Life Scale (SWFL), the Nutrition Interest Scale (NIS), and the Self-discrepancy Index (SDI). Questions were asked about socio-demographic characteristics, eating and drinking habits, and approximate weight and height. A cluster analysis applied to the Z-scores of the RRS classified the following typologies: Group 1 (22.7%), men concerned about weight fluctuations; Group 2 (37.0%), men concerned about diet and weight fluctuations; Group 3 (40.3%), unconcerned about diet and weight fluctuations. The typologies differed in their SDI score, restriction on pastry consumption and reported body mass index (BMI). Students with higher DC and WF scores had a higher BMI, and tended to report high self-discrepancy not only on a physical level, but also on social, emotional, economic and personal levels. This study contributes to the literature on subjective well-being, dietary restraint and self-discrepancy in men from non-clinical samples. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. 42 CFR 460.114 - Restraints.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Restraints. 460.114 Section 460.114 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF... medication used to control behavior or to restrict the participant's freedom of movement and is not a...

  5. Evaluation of the Tennessee Child Restraint Law.

    ERIC Educational Resources Information Center

    Williams, Allan F.

    This paper reports on a study of the effects of a Tennessee law aimed at increasing the protection of children in cars. The law, which came into force January 1, 1978, requires parents to use child restraints properly when transporting their children who are less than 4 years old. Alternatively, the law permits children to be held in arms, a…

  6. 21 CFR 880.6760 - Protective restraint.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Protective restraint. 880.6760 Section 880.6760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use...

  7. 21 CFR 880.6760 - Protective restraint.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Protective restraint. 880.6760 Section 880.6760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use...

  8. 77 FR 11625 - Child Restraint Systems

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-27

    ... Highway Traffic Safety Administration 49 CFR Parts 571 and 572 Child Restraint Systems; Hybrid III 10-Year... pounds (lb)). This rule also amends the standard to incorporate use of a Hybrid III 10-year-old child... and 6-year-old child ATDs with their state-of-the-art Hybrid III counterparts.\\3\\ In that 2003...

  9. 42 CFR 460.114 - Restraints.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Restraints. 460.114 Section 460.114 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF... medication used to control behavior or to restrict the participant's freedom of movement and is not...

  10. RME 1327 - Crew Medical Restraint System (CMRS)

    NASA Image and Video Library

    1997-02-18

    STS081-318-031 (12-22 Jan. 1997) --- Astronauts Brent W. Jett, Jr. (left), STS-81 pilot, and John E. Blaha in the Spacehab Double Module (DM) evaluate the Crew Medical Restraint System (CMRS) carrier, onboard the Space Shuttle Atlantis. The device is an emergency aid forerunner for hardware on the International Space Station (ISS).

  11. 42 CFR 460.114 - Restraints.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Restraints. 460.114 Section 460.114 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  12. 42 CFR 460.114 - Restraints.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Restraints. 460.114 Section 460.114 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  13. Evaluation of the Tennessee Child Restraint Law.

    ERIC Educational Resources Information Center

    Williams, Allan F.

    This paper reports on a study of the effects of a Tennessee law aimed at increasing the protection of children in cars. The law, which came into force January 1, 1978, requires parents to use child restraints properly when transporting their children who are less than 4 years old. Alternatively, the law permits children to be held in arms, a…

  14. PDBStat: a universal restraint converter and restraint analysis software package for protein NMR.

    PubMed

    Tejero, Roberto; Snyder, David; Mao, Binchen; Aramini, James M; Montelione, Gaetano T

    2013-08-01

    The heterogeneous array of software tools used in the process of protein NMR structure determination presents organizational challenges in the structure determination and validation processes, and creates a learning curve that limits the broader use of protein NMR in biology. These challenges, including accurate use of data in different data formats required by software carrying out similar tasks, continue to confound the efforts of novices and experts alike. These important issues need to be addressed robustly in order to standardize protein NMR structure determination and validation. PDBStat is a C/C++ computer program originally developed as a universal coordinate and protein NMR restraint converter. Its primary function is to provide a user-friendly tool for interconverting between protein coordinate and protein NMR restraint data formats. It also provides an integrated set of computational methods for protein NMR restraint analysis and structure quality assessment, relabeling of prochiral atoms with correct IUPAC names, as well as multiple methods for analysis of the consistency of atomic positions indicated by their convergence across a protein NMR ensemble. In this paper we provide a detailed description of the PDBStat software, and highlight some of its valuable computational capabilities. As an example, we demonstrate the use of the PDBStat restraint converter for restrained CS-Rosetta structure generation calculations, and compare the resulting protein NMR structure models with those generated from the same NMR restraint data using more traditional structure determination methods. These results demonstrate the value of a universal restraint converter in allowing the use of multiple structure generation methods with the same restraint data for consensus analysis of protein NMR structures and the underlying restraint data.

  15. Restraint collars. Part I: Elizabethan collars and other types of restraint collars.

    PubMed

    Brown, Cyndi

    2006-02-01

    Restraint collars can provide an investigator with a noninvasive means to prevent certain undesirable behaviors and provide a clinician with a nonpharmaceutical method to prevent an animal from inflicting self-injury; without proper use and monitoring, however, these collars can do more harm than good. This first part of our look at restraint collars introduces collar types and proper use. Next month's installment will review specific issues associated with the use of different types of collars for different species.

  16. Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions, with special reference to seclusion and restraint.

    PubMed

    Masters, Kim J; Bellonci, Christopher; Bernet, William; Arnold, Valerie; Beitchman, Joseph; Benson, R Scott; Bukstein, Oscar; Kinlan, Joan; McClellan, Jon; Rue, David; Shaw, Jon A; Stock, Saundra

    2002-02-01

    This parameter reviews the current state of the prevention and management of child and adolescent aggressive behavior in psychiatric institutions, with particular reference to the indications and use of seclusion and restraint. It also presents guidelines that have been developed in response to professional, regulatory, and public concern about the use of restrictive interventions with aggressive patients with regard to personal safety and patient rights. The literature on the use of seclusion, physical restraint, mechanical restraint, and chemical restraint is reviewed, and procedures for carrying out each of these interventions are described. Clinical and regulatory agency perspectives on these interventions are presented. Effectiveness, indications, contraindications, complications, and adverse effects of seclusion and restraint procedures are addressed. Interventions are presented to provide more opportunities to promote patient independence and satisfaction with treatment while diminishing the necessity of using restrictive procedures.

  17. Summary of the practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions with special reference to seclusion and restraint.

    PubMed

    Masters, K J; Bellonci, C; Bernet, W; Arnold, V; Beitchman, J; Benson, S; Bukstein, O; Kinlan, J; McClellan, J; Rue, D; Shaw, J A; Stock, S; Kroeger, K

    2001-11-01

    This parameter reviews the current state of the prevention and management of child and adolescent aggressive behavior in psychiatric institutions, with particular reference to the indications and use of seclusion and restraint. It also presents guidelines that have been developed in response to professional, regulatory, and public concern about the use of restrictive interventions with aggressive patients with regard to personal safety and patient rights. The literature on the use of seclusion, physical restraint, mechanical restraint, and chemical restraint is reviewed, and procedures for carrying out each of these interventions are described. Clinical and regulatory agency perspectives on these interventions are presented. Effectiveness, indications, contraindications, complications, and adverse effects of seclusion and restraint procedures are addressed. Interventions are presented to provide more opportunities to promote patient independence and satisfaction with treatment while diminishing the necessity of using restrictive procedures.

  18. [Restraint variables in a regional mental health hospital in Turkey].

    PubMed

    Sercan, Mustafa; Bilici, Rabia

    2009-01-01

    To obtain a database to be used in the effort to reduce the use of restraint in mental health hospitals in Turkey, and to compare the data with results of similar studies. The sociodemographic characteristics, history of violent or suicidal behavior, and BPRS scores of patients restrained during a 1-month period, and data concerning the number of beds and staff working during day and night shifts were collected. The restraint variables, number of restraints used and duration of restraint use, in all wards were determined and adult psychosis wards were compared according to these variables. Approximately 25% (194) of 810 hospitalized patients were restrained for a total of 1524.25 h (mean: 3.25 h) during 1 month. In all, 182 restrained patients were analyzed and most were male, elementary school graduates, never married, and living with first-degree relatives. There were no correlations between these variables, and the number of restraints used and the duration of their use. Mean age of the females (36.27 years) was higher than that of the males (32.46 years); the difference was significant. In all, 66.6% of restraint use was because of violent behavior or the probability of violent behavior. The rate of restraint use was lower during day shifts (43.82%). Patients on adult wards were not different in terms of diagnosis, BPRS score, rate of violent behavior, and reasons for using restraint, but were markedly different in terms of the number of restraints used and the duration of restraint. The number of restraints used and the duration of restraint was on average level. Restraint was associated with being female and older, and having more severe symptoms. Night and weekend shifts were more risky for amount and duration of restraint. Non-clinical institutional factors were a determining factor in the use of restraint.

  19. Reenactment of circumstances in deaths related to restraint.

    PubMed

    O'Halloran, Ronald L

    2004-09-01

    Reenactment of the circumstances in deaths associated with restraint, utilizing participants and witnesses while memories are fresh, may help death investigators more accurately determine the cause of death. Two recent deaths in Ventura County that occurred during restraint are discussed. Within a day of the autopsies the restrainers agreed to participate in reenactments of the restraint process, utilizing live volunteers as subjects. They allowed videotaping. Deaths associated with restraint often have nonspecific autopsy findings. Timely reenactment of the circumstances of deaths associated with restraint can help death investigators more accurately determine the probable cause of death in these difficult cases.

  20. Administration of exogenous acylated ghrelin or rikkunshito, an endogenous ghrelin enhancer, improves the decrease in postprandial gastric motility in an acute restraint stress mouse model

    PubMed Central

    Nahata, M; Saegusa, Y; Sadakane, C; Yamada, C; Nakagawa, K; Okubo, N; Ohnishi, S; Hattori, T; Sakamoto, N; Takeda, H

    2014-01-01

    Background Physical or psychological stress causes functional disorders in the upper gastrointestinal tract. This study aims to elucidate the ameliorating effect of exogenous acylated ghrelin or rikkunshito, a Kampo medicine which acts as a ghrelin enhancer, on gastric dysfunction during acute restraint stress in mice. Methods Fasted and postprandial motor function of the gastric antrum was wirelessly measured using a strain gauge force transducer and solid gastric emptying was detected in mice exposed to restraint stress. Plasma corticosterone and ghrelin levels were also measured. To clarify the role of ghrelin on gastrointestinal dysfunction in mice exposed to stress, exogenous acylated ghrelin or rikkunshito was administered, then the mice were subjected to restraint stress. Key Results Mice exposed to restraint stress for 60 min exhibited delayed gastric emptying and increased plasma corticosterone levels. Gastric motility was decreased in mice exposed to restraint stress in both fasting and postprandial states. Restraint stress did not cause any change in plasma acylated ghrelin levels, but it significantly increased the plasma des-acyl ghrelin levels. Administration of acylated ghrelin or rikkunshito improved the restraint stress-induced delayed gastric emptying and decreased antral motility. Ameliorating effects of rikkunshito on stress-induced gastric dysfunction were abolished by simultaneous administration of a ghrelin receptor antagonist. Conclusions & Inferences Plasma acylated/des-acyl ghrelin imbalance was observed in acute restraint stress. Supplementation of exogenous acylated ghrelin or enhancement of endogenous ghrelin signaling may be useful in the treatment of decreased gastric function caused by stress. PMID:24684160

  1. Feasibility of an anticipatory noncontact precrash restraint actuation system

    SciTech Connect

    Kercel, S.W.; Dress, W.B.

    1995-12-31

    The problem of providing an electronic warning of an impending crash to a precrash restraint system a fraction of a second before physical contact differs from more widely explored problems, such as providing several seconds of crash warning to a driver. One approach to precrash restraint sensing is to apply anticipatory system theory. This consists of nested simplified models of the system to be controlled and of the system`s environment. It requires sensory information to describe the ``current state`` of the system and the environment. The models use the sensory data to make a faster-than-real-time prediction about the near future. Anticipation theory is well founded but rarely used. A major problem is to extract real-time current-state information from inexpensive sensors. Providing current-state information to the nested models is the weakest element of the system. Therefore, sensors and real-time processing of sensor signals command the most attention in an assessment of system feasibility. This paper describes problem definition, potential ``showstoppers,`` and ways to overcome them. It includes experiments showing that inexpensive radar is a practical sensing element. It considers fast and inexpensive algorithms to extract information from sensor data.

  2. Toward development of effective custom child restraint systems in motor vehicles.

    PubMed

    Ryan, Stephen; Rigby, Patricia

    2007-01-01

    Traveling safely in motor vehicles can be challenging for many families who have young children with physical disabilities. Harnesses, simple adaptations, and special child restraint systems are available, but sometimes these devices do not adequately meet the unique postural support requirements of children with complex seating needs. Faced with no alternative, parents may choose to use the custom seating system from a wheeled mobility device to support their children in the family car. Transporting children in this way can increase the risk of motor vehicle-related injury because custom seating systems are not designed to meet the requirements of federal motor vehicle safety regulations. We studied whether assistive technology suppliers could build custom child restraint systems that met the crashworthiness requirements of a safety standard for production child restraint systems. We provided technical instructions to 10 suppliers from different parts of North America so they could each build a custom restraint system using a transit frame that we designed. This approach allowed suppliers to make custom seats that could be attached to the transit frame using special connection hardware. We crash tested the 10 custom child restraint systems to evaluate the effectiveness of our transit frame design and fabrication instructions. Six custom restraint systems met the dynamic performance requirements of the stringent Canada Motor Vehicle Safety Standard 213.3. The remaining four systems did not meet the compliance criteria due to the failure of postural belt assemblies or seat securement hardware. We recommend that future research include similar effectiveness studies to support the introduction of technical requirements for adaptive seating systems that improve occupant safety and are practical for wheelchair users, their families, and assistive technology professionals to implement.

  3. Applying sensory modulation to mental health inpatient care to reduce seclusion and restraint: a case control study.

    PubMed

    Andersen, Charlotte; Kolmos, Anne; Andersen, Kjeld; Sippel, Volkmar; Stenager, Elsebeth

    2017-10-01

    Clinical training in managing conflicts and preventing violence seldom contains sensory modulation (SM) as a method to de-escalate and prevent restraint and seclusion. Sensory-based interventions promote adaptive regulation of arousal and emotion. SM is a complementary approach that is associated with reduced rates of seclusion and restraint in mental healthcare, but there is need for more research in this area. Using SM to reduce restraint and seclusion in inpatient mental health care. The study included two similar psychiatric units where one unit implemented SM and one unit served as the control group. In the very beginning of the study, a staff-training program in the use of SM including assessment tools and intervention strategies was established. Data on restraint and forced medicine were sampled post the course of the year of implementation and compared with the control group. The use of belts decreased with 38% compared to the control group. The use of forced medication decreased with 46% compared to the control group. Altogether the use of physical restraint and forced medication decreased significantly with 42% (p < .05). Implementing a SM approach in mental healthcare facilities has a significant effect on the reduction of restraint and seclusion. As a part of the implementation, staff training and education in SM are crucial.

  4. Weight control and restraint of laboratory rats

    NASA Technical Reports Server (NTRS)

    Hilado, C. J.; Van Breda Kolff, K.

    1979-01-01

    The use of restrained and confined rats in some procedures used in combustion toxicology introduces the problems of obtaining rats of the appropriate size for the apparatus, and of identifying any artifacts resulting from the use of restraint alone. Feeding studies indicate that controlled feeding of fast-growing strains such as the Sprague-Dawley can hold rat size essentially constant for significant periods of time. The undesirable aspects are the need to cage the animals individually, with resultant psychological as well as metabolic effects. Restraint studies of slow-growing strains such as the Fischer 344 indicate that denying access to food and water for periods of several hours at a time interrupts normal gain only temporarily.

  5. Observed child restraint use in automobiles

    PubMed Central

    Williams, A.

    1998-01-01

    Visual observations were made on restraint use in occupants of 5050 automobiles containing at least one passenger less than 10 years of age, and short interviews were conducted with the drivers. Ninety three per cent of passengers less than 10 years old were not restrained. Eighty nine per cent of passengers 10 or older and 78% of the drivers were not restrained. Sixteen per cent of child motor vehicle restraint devices observed were not used, and 73% of those in use were not used correctly. Use of such devices declined sharply after age one. Although child passengers were more likely to be restrained if the driver was restrained, more than 75% of the children were not restrained when the driver was, even if the driver was the child's parent. PMID:9666374

  6. Restraint stress in biobehavioral research: Recent developments.

    PubMed

    Buynitsky, Tatyana; Mostofsky, David I

    2009-07-01

    In the 15 years since the publication of two previous reviews on restraint stress much advancement has been made in the field. However, while previous reviews have focused mainly on drug effects, recent research has focused on broader implications in the health fields. This research has placed an increased emphasis on stress effects in physiological, immunological, endocrine and developmental processes as well as the impact of stress on numerous disorders. A major problem with our review was the inability to identify a large number of articles focusing on restraint and immobilization, since those keywords were often omitted from the title or not referred to within the body of the article. It seems likely that additional reviews with extended literature research of this field are required.

  7. Weight control and restraint of laboratory rats

    NASA Technical Reports Server (NTRS)

    Hilado, C. J.; Van Breda Kolff, K.

    1979-01-01

    The use of restrained and confined rats in some procedures used in combustion toxicology introduces the problems of obtaining rats of the appropriate size for the apparatus, and of identifying any artifacts resulting from the use of restraint alone. Feeding studies indicate that controlled feeding of fast-growing strains such as the Sprague-Dawley can hold rat size essentially constant for significant periods of time. The undesirable aspects are the need to cage the animals individually, with resultant psychological as well as metabolic effects. Restraint studies of slow-growing strains such as the Fischer 344 indicate that denying access to food and water for periods of several hours at a time interrupts normal gain only temporarily.

  8. Measurement of Dietary Restraint: Validity Tests of Four Questionnaires

    PubMed Central

    Williamson, Donald A.; Martin, Corby K.; York-Crowe, Emily; Anton, Stephen D.; Redman, Leanne M.; Han, Hongmei; Ravussin, Eric

    2007-01-01

    This study tested the validity of four measures of dietary restraint: Dutch Eating Behavior Questionnaire, Eating Inventory (EI), Revised Restraint Scale (RS), and the Current Dieting Questionnaire. Dietary restraint has been implicated as a determinant of overeating and binge eating. Conflicting findings have been attributed to different methods for measuring dietary restraint. The validity of four self-report measures of dietary restraint and dieting behavior was tested using: 1) factor analysis, 2) changes in dietary restraint in a randomized controlled trial of different methods to achieve calorie restriction, and 3) correlation of changes in dietary restraint with an objective measure of energy balance, calculated from the changes in fat mass and fat-free mass over a six-month dietary intervention. Scores from all four questionnaires, measured at baseline, formed a dietary restraint factor, but the RS also loaded on a binge eating factor. Based on change scores, the EI Restraint scale was the only measure that correlated significantly with energy balance expressed as a percentage of energy require d for weight maintenance. These findings suggest that that, of the four questionnaires tested, the EI Restraint scale was the most valid measure of the intent to diet and actual caloric restriction. PMID:17101191

  9. View of foot restraint strayed from Challenger

    NASA Image and Video Library

    1984-02-11

    S84-27024 (7 Feb 1984) --- This 70mm frame centers on a foot restraint that strayed from the Earth-orbiting Space Shuttle Challenger during the February 9, 1984 extravehicular activity (EVA) session of astronauts Bruce McCandless II and Robert Stewart. As seen in JSC photograph frame number S84-27025, McCandless goes after the piece. Not pictured is Vance D. Brand, crew commander, who moved the spacecraft nearer the object.

  10. Lateral restraint assembly for reactor core

    DOEpatents

    Gorholt, Wilhelm; Luci, Raymond K.

    1986-01-01

    A restraint assembly for use in restraining lateral movement of a reactor core relative to a reactor vessel wherein a plurality of restraint assemblies are interposed between the reactor core and the reactor vessel in circumferentially spaced relation about the core. Each lateral restraint assembly includes a face plate urged against the outer periphery of the core by a plurality of compression springs which enable radial preloading of outer reflector blocks about the core and resist low-level lateral motion of the core. A fixed radial key member cooperates with each face plate in a manner enabling vertical movement of the face plate relative to the key member but restraining movement of the face plate transverse to the key member in a plane transverse to the center axis of the core. In this manner, the key members which have their axes transverse to or subtending acute angles with the direction of a high energy force tending to move the core laterally relative to the reactor vessel restrain such lateral movement.

  11. End effector with astronaut foot restraint

    NASA Technical Reports Server (NTRS)

    Monford, Leo G., Jr. (Inventor)

    1991-01-01

    The combination of a foot restraint platform designed primarily for use by an astronaut being rigidly and permanently attached to an end effector which is suitable for attachment to the manipulator arm of a remote manipulating system is described. The foot restraint platform is attached by a brace to the end effector at a location away from the grappling interface of the end effector. The platform comprises a support plate provided with a pair of stirrups for receiving the toe portion of an astronaut's boots when standing on the platform and a pair of heel retainers in the form of raised members which are fixed to the surface of the platform and located to provide abutment surfaces for abutting engagement with the heels of the astronaut's boots when his toes are in the stirrups. The heel retainers preclude a backward sliding movement of the feet on the platform and instead require a lifting of the heels in order to extract the feet. The brace for attaching the foot restraint platform to the end effector may include a pivot or swivel joint to permit various orientations of the platform with respect to the end effector.

  12. Reference governors for controlled belt restraint systems

    NASA Astrophysics Data System (ADS)

    van der Laan, E. P.; Heemels, W. P. M. H.; Luijten, H.; Veldpaus, F. E.; Steinbuch, M.

    2010-07-01

    Today's restraint systems typically include a number of airbags, and a three-point seat belt with load limiter and pretensioner. For the class of real-time controlled restraint systems, the restraint actuator settings are continuously manipulated during the crash. This paper presents a novel control strategy for these systems. The control strategy developed here is based on a combination of model predictive control and reference management, in which a non-linear device - a reference governor (RG) - is added to a primal closed-loop controlled system. This RG determines an optimal setpoint in terms of injury reduction and constraint satisfaction by solving a constrained optimisation problem. Prediction of the vehicle motion, required to predict future constraint violation, is included in the design and is based on past crash data, using linear regression techniques. Simulation results with MADYMO models show that, with ideal sensors and actuators, a significant reduction (45%) of the peak chest acceleration can be achieved, without prior knowledge of the crash. Furthermore, it is shown that the algorithms are sufficiently fast to be implemented online.

  13. Chronic Restraint Stress Upregulates Erythropoiesis through Glucocorticoid Stimulation

    PubMed Central

    Voorhees, Jeffrey L.; Powell, Nicole D.; Moldovan, Leni; Mo, Xiaokui; Eubank, Timothy D.; Marsh, Clay B.

    2013-01-01

    In response to elevated glucocorticoid levels, erythroid progenitors rapidly expand to produce large numbers of young erythrocytes. Previous work demonstrates hematopoietic changes in rodents exposed to various physical and psychological stressors, however, the effects of chronic psychological stress on erythropoiesis has not be delineated. We employed laboratory, clinical and genomic analyses of a murine model of chronic restraint stress (RST) to examine the influence of psychological stress on erythropoiesis. Mice exposed to RST demonstrated markers of early erythroid expansion involving the glucocorticoid receptor. In addition, these RST-exposed mice had increased numbers of circulating reticulocytes and increased erythropoiesis in primary and secondary erythroid tissues. Mice also showed increases in erythroid progenitor populations and elevated expression of the erythroid transcription factor KLF1 in these cells. Together this work reports some of the first evidence of psychological stress affecting erythroid homeostasis through glucocorticoid stimulation. PMID:24205034

  14. Evaluation of response to restraint stress by salivary corticosterone levels in adult male mice.

    PubMed

    Nohara, Masakatsu; Tohei, Atsushi; Sato, Takumi; Amao, Hiromi

    2016-06-01

    Saliva as a sampling method is a low invasive technique for the detection of physiologically active substances, as opposed to sampling the plasma or serum. In this study, we obtained glucocorticoids transferred from the blood to the saliva from mice treated with 2.0 mg/kg via an intraperitoneal injection of cortisol. Next, to evaluate the effect of restraint stress using mouse saliva-collected under anesthesia by mixed anesthetic agents-we measured plasma and salivary corticosterone levels at 60 min after restraint stress. Moreover, to evaluate salivary corticosterone response to stress in the same individual mouse, an adequate recovery period (1, 3 and 7 days) after anesthesia was examined. The results demonstrate that exogenous cortisol was detected in the saliva and the plasma, in mice treated with cortisol. Restraint stress significantly increased corticosterone levels in both the plasma and saliva (P<0.001). Monitoring the results of individual mice showed that restraint stress significantly increased salivary corticosterone levels in all three groups (1-, 3- and 7-day recovery). However, the statistical evidence of corticosterone increase is stronger in the 7-day recovery group (P<0.001) than in the others (P<0.05). These results suggest that the corticosterone levels in saliva reflect its levels in the plasma, and salivary corticosterone is a useful, less-invasive biomarker of physical stress in mice. The present study may contribute to concepts of Reduction and Refinement of the three Rs in small animal experiments.

  15. An assessment of injury to European badgers (meles meles) due to capture in stopped restraints.

    PubMed

    Murphy, Denise; O'Keeffe, James J; Martin, S Wayne; Gormley, Eamonn; Corner, Leigh A L

    2009-04-01

    As part of ongoing culling operations, European badgers (Meles meles) were captured using stopped restraints in winter (October to December 2005) and summer (May to June 2006) in the Republic of Ireland. A subset of these badgers, those caught during four consecutive nights, was examined postmortem to determine the frequency and severity of physical injuries resulting from capture in the restraints. The skin and the tissues underlying the restraint of 343 badgers were assessed for injury by visual examination. There was an absence of skin damage or only minor skin abrasions in 88% of badgers; an absence of subcutaneous tissue injury or only localized subcutaneous tissue injury in 69%; and an absence of muscle injury or only slight muscle bruising in 99% of badgers. Only 2% of badgers had cuts to the skin and 5.5% had extensive subcutaneous edema, whereas 1.2% had areas of hemorrhage and tearing of the underlying muscle. Our results show that the majority of badgers examined sustained minimal injuries attributable to capture in stopped restraints.

  16. Staff resistance to restraint reduction: identifying & overcoming barriers.

    PubMed

    Curran, Staci Silver

    2007-05-01

    Professional organizations, regulating agencies, and hospital administrators have taken a strong stance on restraint reduction policies. When implementing a restraint reduction initiative, it is important to identify the barriers to restraint reduction, such as concern for personal safety, lack of knowledge about and practice using alternate de-escalation skills, and fear of disrupting the therapeutic milieu by using a variety of de-escalation methods. Education aimed to reduce the use of restraints needs to do more than simply provide information. It is important to acknowledge the emotional response of the nursing staff and the culture of the current practice. A variety of educational strategies, including role-playing, and case studies will help identify attitudes, beliefs, and behaviors that are congruent with reducing the use of restraints. If the ultimate goal of restraint reduction is philosophical change, it will eventually lead to a new culture of practice.

  17. Achieving restraint-free on an inpatient behavioral health unit.

    PubMed

    Barton, Sandra A; Johnson, M Rebecca; Price, Lydia V

    2009-01-01

    Restraint use in the treatment of mental illness has long been a controversial practice. Regulatory agencies, licensing organizations, and professional and advocacy groups have called for reduction of restraint use. Responding to this call for action, the leadership team of a behavioral health unit in a private, nonprofit community hospital evaluated reducing restraint use. Following training through the National Executive Training Institute of the National Association of State Mental Health Program Directors, a restraint-reduction project team was formed. Instead of reducing restraint use, it was decided to eliminate restraint use. Vision guided, the team developed an action plan. Culture change focused on the Mental Health Recovery Model and principles of trauma-informed care. Emphasizing person-centered care, this unit has now been restraint free for nearly 2 years. A surprise finding was that restraint elimination accompanied a decrease in use of "as needed" sedative-hypnotic medications. Person-centered care delivered by frontline staff led to culture change, a restraint-free environment, and less medication.

  18. Human Modeling Evaluations in Microgravity Workstation and Restraint Development

    NASA Technical Reports Server (NTRS)

    Whitmore, Mihriban; Chmielewski, Cynthia; Wheaton, Aneice; Hancock, Lorraine; Beierle, Jason; Bond, Robert L. (Technical Monitor)

    1999-01-01

    The International Space Station (ISS) will provide long-term missions which will enable the astronauts to live and work, as well as, conduct research in a microgravity environment. The dominant factor in space affecting the crew is "weightlessness" which creates a challenge for establishing workstation microgravity design requirements. The crewmembers will work at various workstations such as Human Research Facility (HRF), Microgravity Sciences Glovebox (MSG) and Life Sciences Glovebox (LSG). Since the crew will spend considerable amount of time at these workstations, it is critical that ergonomic design requirements are integral part of design and development effort. In order to achieve this goal, the Space Human Factors Laboratory in the Johnson Space Center Flight Crew Support Division has been tasked to conduct integrated evaluations of workstations and associated crew restraints. Thus, a two-phase approach was used: 1) ground and microgravity evaluations of the physical dimensions and layout of the workstation components, and 2) human modeling analyses of the user interface. Computer-based human modeling evaluations were an important part of the approach throughout the design and development process. Human modeling during the conceptual design phase included crew reach and accessibility of individual equipment, as well as, crew restraint needs. During later design phases, human modeling has been used in conjunction with ground reviews and microgravity evaluations of the mock-ups in order to verify the human factors requirements. (Specific examples will be discussed.) This two-phase approach was the most efficient method to determine ergonomic design characteristics for workstations and restraints. The real-time evaluations provided a hands-on implementation in a microgravity environment. On the other hand, only a limited number of participants could be tested. The human modeling evaluations provided a more detailed analysis of the setup. The issues identified

  19. Human Modeling Evaluations in Microgravity Workstation and Restraint Development

    NASA Technical Reports Server (NTRS)

    Whitmore, Mihriban; Chmielewski, Cynthia; Wheaton, Aneice; Hancock, Lorraine; Beierle, Jason; Bond, Robert L. (Technical Monitor)

    1999-01-01

    The International Space Station (ISS) will provide long-term missions which will enable the astronauts to live and work, as well as, conduct research in a microgravity environment. The dominant factor in space affecting the crew is "weightlessness" which creates a challenge for establishing workstation microgravity design requirements. The crewmembers will work at various workstations such as Human Research Facility (HRF), Microgravity Sciences Glovebox (MSG) and Life Sciences Glovebox (LSG). Since the crew will spend considerable amount of time at these workstations, it is critical that ergonomic design requirements are integral part of design and development effort. In order to achieve this goal, the Space Human Factors Laboratory in the Johnson Space Center Flight Crew Support Division has been tasked to conduct integrated evaluations of workstations and associated crew restraints. Thus, a two-phase approach was used: 1) ground and microgravity evaluations of the physical dimensions and layout of the workstation components, and 2) human modeling analyses of the user interface. Computer-based human modeling evaluations were an important part of the approach throughout the design and development process. Human modeling during the conceptual design phase included crew reach and accessibility of individual equipment, as well as, crew restraint needs. During later design phases, human modeling has been used in conjunction with ground reviews and microgravity evaluations of the mock-ups in order to verify the human factors requirements. (Specific examples will be discussed.) This two-phase approach was the most efficient method to determine ergonomic design characteristics for workstations and restraints. The real-time evaluations provided a hands-on implementation in a microgravity environment. On the other hand, only a limited number of participants could be tested. The human modeling evaluations provided a more detailed analysis of the setup. The issues identified

  20. [End of a psychiatric era? : Impact on the use of mechanical restraints after prohibition of psychiatric cage beds in a regional psychiatric department in Vienna, Austria].

    PubMed

    Sulyok, Christoph; Weiland-Fiedler, Petra; Schwehla, Sarah; Pfersmann, Vera

    2016-09-01

    Since June 1st, 2014 the use of cage beds, a physical coercive measure in psychiatric wards, is forbidden by Austrian law. The 3rd Psychiatric Department at the Otto Wagner Hospital in Vienna carried out a pilot-study prior to the application of this law and compared 6 months with and 6 months without the use of cage beds in psychiatric acute treatment. The investigation focused on the use of mechanical restraints, especially of 4-point-restraints at admission time. The study collected clinical and epidemiological data from the patients and analyzed interviews taken with patients and staff-members after the use of coercive measures. The prohibition of cage beds was associated with a relative increase of the use of 4-point-restraints. Time spent in 4-point-restraints is less than time spent in the cage beds. A trend could also be observed by a decrease of time spent in 4-point-restraints. Data from the interviews showed that there was no preference by patients of either kind of physical restraint. They strongly urged for more personal talks and non-physical and non-pharmacological therapies during admission. Team members required more human resources for the treatment of these acute psychiatric patients.

  1. Measuring Dietary Restraint Status: Comparisons between the Dietary Intent Scale and the Restraint Scale

    PubMed Central

    Boyce, Jessica A.; Gleaves, David H.; Kuijer, Roeline G.

    2015-01-01

    The measurement of young women’s self-reported dietary restraint status is complex. Compared to Herman and Polivy’s commonly utilized Restraint Scale (RS), Stice’s Dietary Intent Scale (DIS) is less understood. Because the DIS is becoming a popular research tool, it is important to understand how this scale compares to more traditional measures of restraint. We conducted two correlational studies (Study 1 N = 110; Study 2 N = 216) to ascertain the similarities and the differences between the DIS and – as a comparison measure – the well-researched RS. We explored how the two scales were related to several body image variables (e.g., thin-ideal internalization); with a range of self-regulatory variables (e.g., dispositional self-control); with observed food intake during a taste test; and with 18-month weight change (Study 2 only). Participants were female University students and were not selected for dieting or disordered eating. Unlike RS scores, DIS scores were not significantly correlated with the majority of variables tapping into unsuccessful self-regulation. However, our data also highlighted similarities between the two restraint scales (e.g., association with 18-month weight-loss) and demonstrated that not only were participants’ DIS scores un-related to unsuccessful self-regulatory variables, neither were they related to the variables tapping into successful self-regulation. PMID:25988136

  2. CETA truck and EVA restraint system

    NASA Technical Reports Server (NTRS)

    Beals, David C.; Merson, Wayne R.

    1991-01-01

    The Crew Equipment Translation Aid (CETA) experiment is an extravehicular activity (EVA) Space Transportation System (STS) based flight experiment which will explore various modes of transporting astronauts and light equipment for Space Station Freedom (SSF). The basic elements of CETA are: (1) two 25 foot long sections of monorail, which will be EVA assembled in the STS cargo bay to become a single 50 ft. rail called the track; (2) a wheeled baseplate called the truck which rolls along the track and can accept three cart concepts; and (3) the three carts which are designated manual, electric, and mechanical. The three carts serve as the astronaut restraint and locomotive interfaces with the track. The manual cart is powered by the astronaut grasping the track's handrail and pulling himself along. The electric cart is operated by an astronaut turning a generator which powers the electric motor and drives the cart. The mechanical cart is driven by a Bendix type transmission and is similar in concept to a man-propelled railroad cart. During launch and landing, the truck is attached to the deployable track by means of EVA removable restraint bolts and held in position by a system of retractable shims. These shims are positioned on the exterior of the rail for launch and landing and rotate out of the way for the duration of the experiment. The shims are held in position by strips of Velcro nap, which rub against the sides of the shim and exert a tailored force. The amount of force required to rotate the shims was a major EVA concern, along with operational repeatability and extreme temperature effects. The restraint system was tested in a thermal-vac and vibration environment and was shown to meet all of the initial design requirements. Using design inputs from the astronauts who will perform the EVA, CETA evolved through an iterative design process and represented a cooperative effort.

  3. Restraint system design and evaluation for military specific applications

    NASA Astrophysics Data System (ADS)

    Karwaczynski, Sebastian

    This research focuses on designing an optimal restraint system for usage in a military vehicle applications. The designed restraint system must accommodate a wide range of DHM's and ATD's with and without PPE such as: helmet, boots, and body armor. The evaluation of the restraint systems were conducted in a simulated vehicle environment, which was utilized to downselect the ideal restraint system for this program. In December of 2011 the OCP TECD program was formulated to increase occupant protection. To do this, 3D computer models were created to accommodate the entire Soldier population in the Army. These models included the entire PPE, which were later utilized for space claim activities and for designing new seats and restraints, which would accommodate them. Additionally, guidelines to increase protection levels while providing optimal comfort to the Soldier were created. The current and emerging threats were evaluated and focused on at the time of the program inception. Throughout this program various activities were conducted for restraint downselection including Soldier evaluations of various restraint system configurations. The Soldiers were given an opportunity to evaluate each system in a representative seat, which allowed them to position themselves in a manner consistent with the mission requirements. Systems ranged from fully automated to manual adjustment type systems. An evaluation of each particular system was conducted and analyzed against the other systems. It was discovered that the restraint systems, which utilize retractors allowed for automatic webbing stowage and allowed for easier access and repeatability when donning and doffing the restraint. It was also found that when an aid was introduced to help the Soldier don the restraint, it was more likely that such system would be utilized. Restraints were evaluated in drop tower experiments in addition to actual blast tests. An evaluation with this amount of detail had not been attempted

  4. Mechanical restraint in adolescent psychiatry: a Finnish Register study.

    PubMed

    Hottinen, Anja; Välimäki, Maritta; Sailas, Eila; Putkonen, Hanna; Joffe, Grigori; Puukka, Pauli; Noda, Toshie; Lindberg, Nina

    2013-04-01

    Little is known of the use of mechanical restraint in adolescent psychiatry. To investigate the frequency and features of mechanical restraint in the field of Finnish adolescent psychiatry. The data were collected in the metropolitan area of Helsinki, Finland, with seven closed and eight open wards for Finnish-speaking 13-17-year-old adolescents. The official restraint reports and the hospital files of the restraint patients from January 2009 to December 2009 were collected and analyzed. Among adolescents hospitalized in closed wards, the 1-year prevalence of mechanical restraint was 9.5%. Among all hospitalized adolescents, the prevalence was 6.9%. The number of mechanically restrained individuals per 100,000 13 to 17-year -old Finnish-speaking inhabitants was 57.1. The median duration of the restraint episode was 4 h and 50 min, but almost half of the mechanical restraint episodes lasted 8 h or more. A quarter of restraint episodes were not based on reasons mentioned in the Finnish Mental Health Act. The most frequent diagnostic categories of mechanically restrained adolescents were mood disorders followed by schizophrenia-related as well as behavioral and emotional disorders. Suicidality preceded 40% and violence 61% of restraint episodes. Boys were restrained during the first days of hospital treatment significantly more often than were girls, whereas one in four girls experienced her first episode of restraint after 1 month of hospitalization. Reducing the number and shortening the length of mechanical restraint episodes requires education of staff as well as projects focusing on reducing coercion. The clinical guidelines must be followed at grassroots level.

  5. Restraint Use in Older Adults Receiving Home Care.

    PubMed

    Scheepmans, Kristien; Dierckx de Casterlé, Bernadette; Paquay, Louis; Van Gansbeke, Hendrik; Milisen, Koen

    2017-08-01

    To determine the prevalence, types, frequency, and duration of restraint use in older adults receiving home nursing care and to determine factors involved in the decision-making process for restraint use and application. Cross-sectional survey of restraint use in older adults receiving home care completed by primary care nurses. Homes of older adults receiving care from a home nursing organization in Belgium. Randomized sample of older adults receiving home care (N = 6,397; mean age 80.6; 66.8% female). For each participant, nurses completed an investigator-constructed and -validated questionnaire collecting information demographic, clinical, and behavioral characteristics and aspects of restraint use. A broad definition of restraint was used that includes a range of restrictive actions. Restraints were used in 24.7% of the participants, mostly on a daily basis (85%) and often for a long period (54.5%, 24 h/d). The most common reason for restraint use was safety (50.2%). Other reasons were that the individual wanted to remain at home longer, which necessitated the use of restraints (18.2%) and to provide respite for the informal caregiver (8.6%). The latter played an important role in the decision and application process. The physician was less involved in the process. In 64.5% of cases, there was no evaluation after restraint use was initiated. Use of restraints is common in older adults receiving home care nursing in Belgium. These results contribute to a better understanding of the complexity of use of restraints in home care, a situation that may be even more complex than in nursing homes and acute hospital settings. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  6. Time-Out Training without Put-Backs, Spanks, or Restraint: A Brief Report of Deferred Time-Out

    ERIC Educational Resources Information Center

    Warzak, William J.; Floress, Margaret T.

    2009-01-01

    We demonstrate the effectiveness of a procedure to increase compliance in young children who are resistant to Time-out (TO). Parents of two boys, 3 and 4 years of age, were unable to enforce TO without resorting to physical guidance and restraint. With deferred TO (DTO), if a child resists TO, caregivers no longer interact with the child or…

  7. Restraint Use in Residential Programs: Why Are Best Practices Ignored?

    ERIC Educational Resources Information Center

    LeBel, Janice; Huckshorn, Kevin Ann; Caldwell, Beth

    2010-01-01

    Several states and providers have embarked on initiatives to reduce using restraint and seclusion in residential programs. Restraint and seclusion are associated with harm to youth and staff, significant costs, reduced quality of care, and less engagement of youth and families. Successful reduction/prevention strategies have been identified,…

  8. Astronauts Sullivan and Ride show sleep restraint equipment

    NASA Technical Reports Server (NTRS)

    1984-01-01

    Astronauts Kathryn D. Sullivan, left, and Sally K. Ride display a 'bag of worms'. The 'bag' is a sleep restraint and the majority of the 'worms' are springs and clips used with the sleep restraint in its normal application. Clamps, a bungee cord and velcro strips are other recognizable items in the 'bag'.

  9. 49 CFR 179.14 - Coupler vertical restraint system.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... section shall be achieved by verification testing of the coupler vertical restraint system in accordance... be equipped with couplers having this vertical restraint capability. (b) Test verification. Except as... section; (2) The testing apparatus shall simulate the vertical coupler performance at the mating...

  10. 49 CFR 179.14 - Coupler vertical restraint system.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... section shall be achieved by verification testing of the coupler vertical restraint system in accordance... be equipped with couplers having this vertical restraint capability. (b) Test verification. Except as... section; (2) The testing apparatus shall simulate the vertical coupler performance at the mating...

  11. 75 FR 67233 - Federal Motor Vehicle Safety Standards; Head Restraints

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-02

    ... Positions b. Leadtime for Small Vehicle Manufacturers c. Static Lockout of Active Head Restraints During.... Petitions for Rulemaking a. Discomfort Metric for Non-Use Position and Relaxation Requirement for Gap b... of Active Head Restraints During Backset Retention Testing 1. NHTSA Agrees To Specify the Fixation...

  12. Restraint Use in Residential Programs: Why Are Best Practices Ignored?

    ERIC Educational Resources Information Center

    LeBel, Janice; Huckshorn, Kevin Ann; Caldwell, Beth

    2010-01-01

    Several states and providers have embarked on initiatives to reduce using restraint and seclusion in residential programs. Restraint and seclusion are associated with harm to youth and staff, significant costs, reduced quality of care, and less engagement of youth and families. Successful reduction/prevention strategies have been identified,…

  13. 28 CFR 570.44 - Supervision and restraint requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... PROGRAMS AND RELEASE COMMUNITY PROGRAMS Escorted Trips § 570.44 Supervision and restraint requirements... all times. Restraints may be applied to an inmate going on an escorted trip, after considering the purpose of the escorted trip and the degree of supervision required by the inmate. Except for escorted...

  14. Astronauts Sullivan and Ride show sleep restraint equipment

    NASA Technical Reports Server (NTRS)

    1984-01-01

    Astronauts Kathryn D. Sullivan, left, and Sally K. Ride display a 'bag of worms'. The 'bag' is a sleep restraint and the majority of the 'worms' are springs and clips used with the sleep restraint in its normal application. Clamps, a bungee cord and velcro strips are other recognizable items in the 'bag'.

  15. Dietary Restraint Moderates Genetic Risk for Binge Eating

    PubMed Central

    Racine, Sarah E.; Burt, S. Alexandra; Iacono, William G.; McGue, Matt; Klump, Kelly L.

    2010-01-01

    Dietary restraint is a prospective risk factor for the development of binge eating and bulimia nervosa. Although many women engage in dietary restraint, relatively few develop binge eating. Dietary restraint may only increase susceptibility for binge eating in individuals who are at genetic risk. Specifically, dietary restraint may be a behavioral “exposure” factor that activates genetic predispositions for binge eating. We investigated this possibility in 1,678 young adolescent and adult same-sex female twins from the Minnesota Twin Family Study and the Michigan State University Twin Registry. Twin moderation models were used to examine whether levels of dietary restraint moderate genetic and environmental influences on binge eating. Results indicated that genetic and non-shared environmental factors for binge eating increased at higher levels of dietary restraint. Importantly, these effects were present after controlling for age, body mass index, and genetic and environmental overlap among dietary restraint and binge eating. Results suggest that dietary restraint may be most important for individuals at genetic risk for binge eating, and the combination of these factors could enhance individual differences in risk for binge eating. PMID:21171725

  16. Dietary restraint moderates genetic risk for binge eating.

    PubMed

    Racine, Sarah E; Burt, S Alexandra; Iacono, William G; McGue, Matt; Klump, Kelly L

    2011-02-01

    Dietary restraint is a prospective risk factor for the development of binge eating and bulimia nervosa. Although many women engage in dietary restraint, relatively few develop binge eating. Dietary restraint may increase susceptibility for binge eating only in individuals who are at genetic risk. Specifically, dietary restraint may be a behavioral exposure factor that activates genetic predispositions for binge eating. We investigated this possibility in 1,678 young adolescent and adult same-sex female twins from the Minnesota Twin Family Study and the Michigan State University Twin Registry. Twin moderation models were used to examine whether levels of dietary restraint moderate genetic and environmental influences on binge eating. Results indicated that genetic and nonshared environmental factors for binge eating increased at higher levels of dietary restraint. These effects were present after controlling for age, body mass index, and genetic and environmental overlap among dietary restraint and binge eating. Results suggest that dietary restraint may be most important for individuals at genetic risk for binge eating and that the combination of these factors could enhance individual differences in risk for binge eating.

  17. Restraint, Detainment, and Seclusion of Students in Public Schools

    ERIC Educational Resources Information Center

    Tidwell, Deidra Michelle

    2013-01-01

    This study examines how the courts have addressed the restraint, detainment, and seclusion of students in public schools. The study includes an analysis of 100 court cases on the topic of restraint, detainment, and seclusion of students in public schools, which occurred in state and federal jurisdictions, from 1977 to 2012. Cases were examined…

  18. Is Restraint a Model of Binge Eating and Obesity?

    ERIC Educational Resources Information Center

    Lowe, Michael R.; And Others

    Restraint theory assumes that restrained eating is functionally equivalent to dieting and that "restraint" accounts for the eating behavior of overweight individuals. This study evaluated both of these assumptions. In the first part of the study, normal weight women were divided into groups of unrestrained nondieters, restrained…

  19. Restraint, Detainment, and Seclusion of Students in Public Schools

    ERIC Educational Resources Information Center

    Tidwell, Deidra Michelle

    2013-01-01

    This study examines how the courts have addressed the restraint, detainment, and seclusion of students in public schools. The study includes an analysis of 100 court cases on the topic of restraint, detainment, and seclusion of students in public schools, which occurred in state and federal jurisdictions, from 1977 to 2012. Cases were examined…

  20. Effects of restraint on expansion due to delayed ettringite formation

    SciTech Connect

    Bouzabata, Hassina; Multon, Stephane; Sellier, Alain; Houari, Hacene

    2012-07-15

    Delayed ettringite formation (DEF) is a chemical reaction that causes expansion in civil engineering structures. The safety level of such damaged structures has to be reassessed. To do this, the mechanical conditions acting on DEF expansions have to be analysed and, in particular, the variation of strength with expansion and the effect of restraint on the DEF expansion. This paper highlights several points: DEF expansion is isotropic in stress-free conditions, compressive stresses decrease DEF expansion in the direction subjected to restraint and lead to cracks parallel to the restraint, and expansion measured in the stress-free direction of restrained specimens is not modified. Thus restraint causes a decrease of the volumetric expansion and DEF expansion under restraint is anisotropic. Moreover, the paper examines the correlation between DEF expansion and concrete damage, providing data that can be used for the quantification of the effect of stresses on DEF induced expansion.

  1. Parents’ experience with child safety restraint in China

    PubMed Central

    2014-01-01

    Background Child safety restraints are effective measures in protecting children from an injury while traveling in a car. However, the rate of child restraint use is extremely low in Chinese cities. Parent drivers could play an important role in promoting child safety restraint use, but not all of them take active responsibility. Methods This study used a qualitative approach and included 14 in-depth interviews among parents with a child, under the age of 6, living in Shantou City (7 child safety restraint users and 7 non-users). Purposive sampling was used to recruit eligible parent drivers who participated in a previous observation study. Interview data were collected from March to April 2013. The audio taped and transcribed data were coded and analyzed to identify key themes. Results Four key themes on child safety restraint emerged from the in-depth interviews with parents. These included 1) Having a child safety restraint installed in the rear seat with an adult sitting next to the restrained child is ideal, and child safety restraint is seen as an alternative when adult accompaniment is not available; 2) Having effective parental education strategies could help make a difference in child safety restraint use; 3) Inadequate promotion and parents’ poor safety awareness contribute to the low rate of child safety restraint in China; 4) Mandatory legislation on child safety restraint use could be an effective approach. Conclusion Inadequate promotion and low awareness of safe traveling by parents were closely linked to low child safety seat usage under the circumstance of no mandatory legislation. Future intervention efforts need to focus on increasing parents’ safe travel awareness combined with CSS product promotion before the laws are enacted. PMID:24708776

  2. Acute restraint stress produces behavioral despair in weanling rats in the forced swim test.

    PubMed

    Bernal-Morales, Blandina; Contreras, Carlos M; Cueto-Escobedo, Jonathan

    2009-10-01

    Stressful experiences in the rat during early life increase the vulnerability to later signs of behavioral despair in adulthood, reflected in increased immobility in the forced swim test (FST). However, the possible immediate effects of stress in weanling rats have only been partially described. The present study tested whether a single session of mild restraint stress modifies immobility in the FST in 21-day-old Wistar rats. After evaluating any possible changes in locomotion using the open field test (OFT), the latency and total duration of immobility were assessed in a single FST session. Regardless of gender, mild restraint stress significantly reduced crossings in the OFT, shortened the latency to the first period of immobility, and increased immobility in the FST compared with a control group devoid of stress. We conclude that a single mild physical stress session, as early as postnatal day 21, produces signs of behavioral despair.

  3. Designing and evaluating a persuasive child restraint television commercial.

    PubMed

    Lewis, Ioni; Ho, Bonnie; Lennon, Alexia

    2016-01-01

    Relatively high rates of child restraint inappropriate use and misuse and faults in the installation of restraints have suggested a crucial need for public education messages to raise parental awareness of the need to use restraints correctly. This project involved the devising and pilot testing of message concepts, filming of a television advertisement (the TVC), and the evaluation of the TVC. This article focuses specifically upon the evaluation of the TVC. The development and evaluation of the TVC were guided by an extended theory of planned behavior that included the standard constructs of attitudes, subjective norms, and perceived behavioral control as well as the additional constructs of group norms and descriptive norms. The study also explored the extent to which parents with low and high intentions to self-check restraints differed on salient beliefs regarding the behavior. An online survey of parents (N = 384) was conducted where parents were randomly assigned to either the intervention group (n = 161), and therefore viewed the advertisement within the survey, or the control group (n = 223), and therefore did not view the advertisement. Following a one-off exposure to the TVC, the results indicated that, although not a significant difference, parents in the intervention group reported stronger intentions (M = 4.43, SD = 0.74) to self-check restraints than parents in the control group (M = 4.18, SD = 0.86). In addition, parents in the intervention group (M = 4.59, SD = 0.47) reported significantly higher levels of perceived behavioral control than parents in the control group (M = 4.40, SD = 0.73). The regression results revealed that, for parents in the intervention group, attitudes and group norms were significant predictors of parental intentions to self-check their child restraint. Finally, the exploratory analyses of parental beliefs suggested that those parents with low intentions to self-check child restraints were significantly more likely than

  4. Magnetic nuclear core restraint and control

    DOEpatents

    Cooper, Martin H.

    1979-01-01

    A lateral restraint and control system for a nuclear reactor core adaptable to provide an inherent decrease of core reactivity in response to abnormally high reactor coolant fluid temperatures. An electromagnet is associated with structure for radially compressing the core during normal reactor conditions. A portion of the structures forming a magnetic circuit are composed of ferromagnetic material having a curie temperature corresponding to a selected coolant fluid temperature. Upon a selected signal, or inherently upon a preselected rise in coolant temperature, the magnetic force is decreased a given amount sufficient to relieve the compression force so as to allow core radial expansion. The expanded core configuration provides a decreased reactivity, tending to shut down the nuclear reaction.

  5. Magnetic nuclear core restraint and control

    DOEpatents

    Cooper, Martin H.

    1978-01-01

    A lateral restraint and control system for a nuclear reactor core adaptable to provide an inherent decrease of core reactivity in response to abnormally high reactor coolant fluid temperatures. An electromagnet is associated with structure for radially compressing the core during normal reactor conditions. A portion of the structures forming a magnetic circuit are composed of ferromagnetic material having a curie temperature corresponding to a selected coolant fluid temperature. Upon a selected signal, or inherently upon a preselected rise in coolant temperature, the magnetic force is decreased a given amount sufficient to relieve the compression force so as to allow core radial expansion. The expanded core configuration provides a decreased reactivity, tending to shut down the nuclear reaction.

  6. An editor for the generation and customization of geometry restraints

    DOE PAGES

    Moriarty, Nigel W.; Draizen, Eli J.; Adams, Paul D.

    2017-02-01

    Chemical restraints for use in macromolecular structure refinement are produced by a variety of methods, including a number of programs that use chemical information to generate the required bond, angle, dihedral, chiral and planar restraints. These programs help to automate the process and therefore minimize the errors that could otherwise occur if it were performed manually. Furthermore, restraint-dictionary generation programs can incorporate chemical and other prior knowledge to provide reasonable choices of types and values. However, the use of restraints to define the geometry of a molecule is an approximation introduced with efficiency in mind. The representation of a bondmore » as a parabolic function is a convenience and does not reflect the true variability in even the simplest of molecules. Another complicating factor is the interplay of the molecule with other parts of the macromolecular model. Finally, difficult situations arise from molecules with rare or unusual moieties that may not have their conformational space fully explored. These factors give rise to the need for an interactive editor for WYSIWYG interactions with the restraints and molecule. Restraints Editor, Especially Ligands (REEL) is a graphical user interface for simple and error-free editing along with additional features to provide greater control of the restraint dictionaries in macromolecular refinement.« less

  7. An editor for the generation and customization of geometry restraints

    PubMed Central

    Moriarty, Nigel W.; Adams, Paul D.

    2017-01-01

    Chemical restraints for use in macromolecular structure refinement are produced by a variety of methods, including a number of programs that use chemical information to generate the required bond, angle, dihedral, chiral and planar restraints. These programs help to automate the process and therefore minimize the errors that could otherwise occur if it were performed manually. Furthermore, restraint-dictionary generation programs can incorporate chemical and other prior knowledge to provide reasonable choices of types and values. However, the use of restraints to define the geometry of a molecule is an approximation introduced with efficiency in mind. The representation of a bond as a parabolic function is a convenience and does not reflect the true variability in even the simplest of molecules. Another complicating factor is the interplay of the molecule with other parts of the macromolecular model. Finally, difficult situations arise from molecules with rare or unusual moieties that may not have their conformational space fully explored. These factors give rise to the need for an interactive editor for WYSIWYG interactions with the restraints and molecule. Restraints Editor, Especially Ligands (REEL) is a graphical user interface for simple and error-free editing along with additional features to provide greater control of the restraint dictionaries in macromolecular refinement. PMID:28177308

  8. Exposure of pregnant rats to uranium and restraint stress: effects on postnatal development and behavior of the offspring.

    PubMed

    Sánchez, Domènec J; Bellés, Montserrat; Albina, Maria L; Gómez, Mercedes; Linares, Victoria; Domingo, José L

    2006-12-07

    The effects on postnatal development and behavior were assessed in the offspring of female rats concurrently exposed to uranium (U) and restraint stress. Adult female rats were administered uranyl acetate dihydrate (UAD) in the drinking water at doses of 0, 40 and 80 mg/(kg day) for 4 weeks before mating with untreated males, as well as during pregnancy and lactation. One-half of female rats in each group were concurrently subjected to restraint (2h/day). On gestation day 14, one-half of restrained and unrestrained rats were sacrificed in order to evaluate maternal toxicity and gestational parameters. Pups were evaluated for physical development, neuromotor maturation, and behavior. Uranium concentrations were also determined in various tissues of dams and fetuses. In all uranium-treated groups, the highest concentrations of this element were found in kidney and bone, being considerably higher than those in brain. Uranium levels in tissues of dam or fetuses were not significantly affected by restraint. No significant interactions between uranium and restraint could be observed in maternal toxicity. Moreover, no relevant effects of uranium, maternal restraint, or their combination were noted on developmental landmarks in the offspring. In the passive avoidance test, at 40 and 80 mg UAD/(kg day) restraint significantly modified passive avoidance acquisition (T1) and retention time (T2) 24h later. However, no significant differences were observed on the Morris water maze test. The results of the present study indicate that, in general terms, exposure of female rats to UAD before mating with untreated males, as well as during gestation and lactation, did not cause relevant dose-related adverse effects on postnatal development and behavior of the offspring. The influence of stress was very limited.

  9. Psychiatric Nurses' Emotional and Ethical Experiences Regarding Seclusion and Restraint.

    PubMed

    Korkeila, Heikki; Koivisto, Anna-Maija; Paavilainen, Eija; Kylmä, Jari

    2016-07-01

    The purpose of this study was to describe psychiatric nurses' emotional and ethical experiences regarding seclusion and restraint, and factors associated with these experiences. The data (n = 165) was collected in southern Finland, using the electronic version of the Seclusion and Restraint Experience Questionnaire (SREQ) and analyzed with statistical methods. We found that the experiences of control and duty were strongly emphasized in responses, especially among nurses with short work experience or temporary employment. These results offer new information about psychiatric nurses' experiences regarding seclusion and restraint. These results can be utilized both in the teaching and in management of the nursing.

  10. Coupling constants again: Experimental restraints in structure refinement

    NASA Astrophysics Data System (ADS)

    Mierke, Dale F.; Huber, Thomas; Kessler, Horst

    1994-02-01

    Utilization of coupling constants as restraints in computational structure refinement is reviewed. In addition, we address the effect of conformational averaging and examine different approaches to apply the restraints when the experimental observable is obviously a result of averaging. Here, two different computational methods are compared. The simulation of a single structure with time-dependent restraints produces results very similar to those obtained with the calculation of numerous copies of the molecule (an ensemble of structures) and ensemble averaging. The advantages and disadvantages of the two methods are illustrated with simulations of cyclosporin A, for which 117 NOEs and 62 homo- and heteronuclear coupling constants have been measured.

  11. On the Function of Self-Restraint and Its Relationship to Self-Injury.

    ERIC Educational Resources Information Center

    Fisher, Wayne W.; Iwata, Brian A.

    1996-01-01

    Discussion of the functional relationship between self-injurious behavior (SIB) and self-restraint in people with severe disabilities considers SIB and self-restraint as members of the same functional response class, SIB and self-restraint as functionally independent responses, access to self-restraint as positive reinforcement of SIB, termination…

  12. Characteristics of psychiatric hospitalizations with multiple mechanical restraint episodes versus hospitalization with a single mechanical restraint episode.

    PubMed

    Guzman-Parra, Jose; Guzik, Justyna; Garcia-Sanchez, Juan A; Pino-Benitez, Isabel; Aguilera-Serrano, Carlos; Mayoral-Cleries, Fermin

    2016-10-30

    We investigated the characteristics of multiple episodes of mechanical restraint versus a single episode in a psychiatric ward of a public general hospital. The following characteristics were associated with multiple restraints: young age, length of hospital stay, not being readmitted within 30 days from previous discharge, and admission in the previous year before the implementation of an intervention program to reduce mechanical restraint. The study suggests that both organizational factors and patients' disturbed behaviour are associated with the risk of being mechanically restrained several times. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Self-restraint as positive reinforcement for self-injurious behavior.

    PubMed

    Smith, R G; Lerman, D C; Iwata, B A

    1996-01-01

    Many individuals who engage in self-injurious behavior (SIB) also exhibit self-restraint. We compared rates of SIB exhibited by a 32-year-old woman diagnosed with profound retardation across conditions in which access to restraint was (a) continuously available, (b) presented as a consequence for SIB, or (c) unavailable. Rates of SIB increased when access to restraint was contingent upon SIB and decreased when restraint was unavailable, suggesting that self-restraint functioned as positive reinforcement for SIB.

  14. View of Astronaut Owen Garriott in sleep restraints

    NASA Image and Video Library

    1973-08-08

    SL3-111-1505 (July-September 1973) --- View of scientist-astronaut Owen K. Garriott, Skylab 3 science pilot, in his sleep restraints in the crew quarters of the Orbital Workshop (OWS). Photo credit: NASA

  15. Mission Specialist (MS) Gardner sleeps in middeck sleep restraint

    NASA Image and Video Library

    1983-09-05

    STS008-05-145 (5 Sept 1983) --- On middeck (MDK), Mission Specialist (MS) Gardner sleeps in sleep restraint attached to starboard wall. Open airlock hatch, airlock hatch hinge, and free-floating footwear appear in view.

  16. 76 FR 10637 - Consumer Information; Program for Child Restraint Systems

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-25

    ... Proposed Fit Criteria A. Vehicle Seat Belts B. Top Tether Anchorages C. Lower Anchorages D. Head Restraints... latter three dummies are instrumented and must meet HIC (Head Injury Criterion), head excursion, and...

  17. Pilot Hartsfield in sleep restraint tethered to forward middeck lockers

    NASA Technical Reports Server (NTRS)

    1982-01-01

    Pilot Hartsfield demonstrates the sleeping accomodations onboard the Earth-orbiting Columbia, Orbiter Vehicle (OV) 102. The sleep restraint is located in the middeck area of the spacecraft and is tethered to forward middeck lockers.

  18. Pilot Overmyer completes hygiene activities / demostrates IVA foot restraint

    NASA Technical Reports Server (NTRS)

    1982-01-01

    On middeck, Pilot Overmyer, drying his face with a towel from forward single tray personal item stowage locker, completes personal hygiene activities (shaving) and demostrates use of intravehicular activity (IVA) foot restraint on floor.

  19. Programming new geometry restraints: Parallelity of atomic groups

    DOE PAGES

    Sobolev, Oleg V.; Afonine, Pavel V.; Adams, Paul D.; ...

    2015-08-01

    Improvements in structural biology methods, in particular crystallography and cryo-electron microscopy, have created an increased demand for the refinement of atomic models against low-resolution experimental data. One way to compensate for the lack of high-resolution experimental data is to use a priori information about model geometry that can be utilized in refinement in the form of stereochemical restraints or constraints. Here, the definition and calculation of the restraints that can be imposed on planar atomic groups, in particular the angle between such groups, are described. Detailed derivations of the restraint targets and their gradients are provided so that they canmore » be readily implemented in other contexts. Practical implementations of the restraints, and of associated data structures, in the Computational Crystallography Toolbox(cctbx) are presented.« less

  20. Programming new geometry restraints: Parallelity of atomic groups

    SciTech Connect

    Sobolev, Oleg V.; Afonine, Pavel V.; Adams, Paul D.; Urzhumtsev, Alexandre

    2015-08-01

    Improvements in structural biology methods, in particular crystallography and cryo-electron microscopy, have created an increased demand for the refinement of atomic models against low-resolution experimental data. One way to compensate for the lack of high-resolution experimental data is to use a priori information about model geometry that can be utilized in refinement in the form of stereochemical restraints or constraints. Here, the definition and calculation of the restraints that can be imposed on planar atomic groups, in particular the angle between such groups, are described. Detailed derivations of the restraint targets and their gradients are provided so that they can be readily implemented in other contexts. Practical implementations of the restraints, and of associated data structures, in the Computational Crystallography Toolbox(cctbx) are presented.

  1. A Case Study: Seclusion and Restraint in Psychiatric Care.

    PubMed

    Goulet, Marie-Hélène; Larue, Caroline

    2017-06-01

    A wide breadth of research has recognized that seclusion and restraint affects patients, staff, and organizations alike. Therefore, it is essential to understand the viewpoints of all stakeholders to improve practices. The study aimed to understand the context in which seclusion and restraint practices are employed based on the perceptions of staff and inpatients in a psychiatric ward. A case study was performed using a participatory approach. Methods included a 56-hr immersion in the practice setting and individual interviews with staff and patients ( n = 17). The main themes discussed were patient characteristics (etiology of the violence, difficult experience), staff characteristics (feelings of safety, rationalization of seclusion use), and environmental characteristics. Both explicit (e.g., hospital protocol) and implicit (e.g., ward rules) standards seem to influence seclusion and restraint management. Our results point toward the potential for developing post-seclusion and restraint review in which both patient and staff perspectives are taken into account.

  2. Pilot Overmyer completes hygiene activities / demostrates IVA foot restraint

    NASA Technical Reports Server (NTRS)

    1982-01-01

    On middeck, Pilot Overmyer, drying his face with a towel from forward single tray personal item stowage locker, completes personal hygiene activities (shaving) and demostrates use of intravehicular activity (IVA) foot restraint on floor.

  3. Justifying a presumption of restraint in animal biotechnology research.

    PubMed

    Fiester, Autumn

    2008-06-01

    Articulating the public's widespread unease about animal biotechnology has not been easy, and the first attempts have not been able to provide an effective tool for navigating the moral permissibility of this research. Because these moral intuitions have been difficult to cash out, they have been belittled as representing nothing more than fear or confusion. But there are sound philosophical reasons supporting the public's opposition to animal biotechnology and these arguments justify a default position of resistance I call the Presumption of Restraint. The Presumption of Restraint constitutes a justificatory process that sets out the criteria for permitting or rejecting individual biotechnology projects. This Presumption of Restraint can be overridden by compelling arguments that speak to a project's moral and scientific merit. This strategy creates a middle-of-the-road stance that can embrace particular projects, while rejecting others. The Presumption of Restraint can also serve as a model for assessing moral permissibility in other areas of technological innovation.

  4. Astronauts Sullivan and Ride show sleep restraint equipment

    NASA Image and Video Library

    1984-10-06

    41G-07-021 (5-13 October 1984) --- Astronauts Kathryn D. Sullivan, left, and Sally K. Ride show off what appears to be a "bag of worms", a product of their creativity. The "bag" is a sleep restraint and the majority of the "worms" are springs and clips used with the sleep restraint in its normal application. Clamps, a bungee cord and Velcro strips are other recognizable items in the "creation".

  5. Wheelchair integrated occupant restraints: feasibility in frontal impact.

    PubMed

    VanRoosmalen, L; Bertocci, G E; Ha, D; Karg, P

    2001-12-01

    Individuals often use their wheelchair as a motor vehicle seat when traveling in motor vehicles. The current use of fixed vehicle-mounted wheelchair occupant restraint systems (FWORSs) often results in poor belt fit and discomfort. Additionally, satisfaction, usability and usage rate of FWORSs during transit use are often low. The automotive industry has shown improved occupant restraint usage, belt fit and injury protection when integrating the upper torso and pelvic restraint in a motor vehicle seat. This study compared occupant injury measures of a FWORS to a concept wheelchair integrated restraint system (WIRS) using a 20g frontal sled impact test with a 30 mph change in velocity. Neck loads, neck moments, head, pelvis and chest acceleration, sternum compression and knee and head excursion data were recorded from the wheelchair seated 50th percentile male hybrid III anthropomorphic test dummy (ATD). The WIRS resulted in a lower head injury criteria (HIC) value, lower sternum compression and a lower upper-torso restraint load than the FWORS. Compared with the FWORS, increased head, knee and wheelchair excursions and higher neck loads and moments were measured in the WIRS test. Both restraint scenario injury parameters were complied with occupant injury criteria based on General Motors Injury Assessment Reference Values (GM-IARVs) and occupant kinematic requirements defined by the Society of Automotive Engineers (SAE) voluntary standard, J2249. A higher motion criteria index was calculated for the WIRS scenario and a comparable combined injury criteria index was calculated for both restraint scenarios. The sled impact test showed WIRS concept feasibility, facilitating further development by industrial manufacturers who might further want to pursue this restraint principle to increase wheelchair occupant safety and comfort during transport in motor vehicles.

  6. Restraint use law enforcement intervention in Latino communities.

    PubMed

    Schaechter, Judy; Uhlhorn, Susan B

    2011-11-01

    Motor vehicle crashes are the leading cause of death for U.S. Latinos aged 1 to 35 years. Restraint use is an effective means of prevention of motor vehicle crash injury. Effective interventions to raise restraint use include the following: legislation, law enforcement, education, and equipment distribution. The effects of law enforcement interventions in Latino immigrant communities are understudied. We measured the community-level effect of a combined intervention that included warnings and citations phase enforcement in Latino communities. We designed and implemented in two of three Latino-majority communities a multicomponent intervention consisting of a community awareness campaign, restraint use education with equipment distribution, and a two-staged law enforcement intervention. Restraint use observations were conducted in all three communities at baseline, after the warnings phase and again after the citations phase of the intervention were completed. The combined intervention of community awareness, education, child passenger restraint distribution, and law enforcement focused on educational traffic stops with incentives and warnings was associated with a significant increase in both driver and child passenger restraint use in one intervention community, but only driver restraint increased to a level of significance in the other intervention community; significant increase was also noted among nonintervention drivers. The citations phase of the intervention did not result in a significant increase in restraint use and was complicated by interruptions due to unlicensed drivers. The combined effort of community awareness, education, equipment distribution and law enforcement intervention that included incentives and warnings may be effective at increasing seat belt use in Latino communities without the need for citations.

  7. ACES (Advanced Concept Ejection Seat) II Negative Gz Restraint Investigation.

    DTIC Science & Technology

    1983-10-01

    used to establish the safety of the selected test conditions. Details of the testing process , and results and analysis are described in Chapters V...simplify the data reduction process , an attempt was made to deal primarily with a relatively small number of discrete measurements made during each test For...After the three inversions the restraint configuration was changed (by the subject), and the process repeated. The final restraint system was tested

  8. Airbags & children: making correct choices in child passenger restraints.

    PubMed

    Kamerling, Susan Nudelman

    2002-01-01

    Countless numbers of young lives are lost each year due to motor vehicle crashes. One of the most effective means of reducing the number of children killed and injured as occupants in motor vehicles is through the use of child passenger restraints. Seat belts and child safety seats save lives and reduce the severity of injuries sustained by occupants in motor vehicle crashes. Nurses are in a unique position to educate and influence families on the proper way to safely transport all motor vehicle passengers. Therefore, nurses working with infants, children, and families have a moral and professional obligation to understand the basics of child passenger safety. At the very least, nurses should be able to direct families appropriately for specifics related to child passenger restraints. The intent of this article is to provide an overview of child passenger safety through a historical, theoretical, and clinical approach. Proper child restraint use is reviewed based on current recommendations for age and size. The potential hazards of child restraint misuse, with an in-depth discussion on airbags, is presented. The discussion on airbags serves to dispel any misconceptions that may be held about airbags. The article includes two case studies that illustrate the injury potential of relatively common misuse patterns. The clinical implications for maternal-child nurses include the recognition that child passenger deaths are primarily due to child restraint nonuse and misuse and the realization of nursing's role in the promotion of proper child passenger restraint.

  9. Ergonomic Evaluation of the Foot Restraint Equipment Device (FRED)

    NASA Technical Reports Server (NTRS)

    Whitmore, Mihriban; Chmielewski, Cindy; Qazi, A. S.; Mount, Francis

    1999-01-01

    Within the scope of the Microgravity Workstation and Restraint Evaluation project, funded by the NASA Headquarters Life Sciences Division, evaluations were proposed to be conducted in ground, KC-135, and/or Shuttle environments to investigate the human factors engineering (HFE) issues concerning confined/unique workstations, including crew restraint requirements. As part of these evaluations, KC-135 flights were conducted to investigate user/ workstation/ restraint integration for microgravity use of the FRED with the RMS workstation. This evaluation was a pre-cursor to Detailed Supplementary Objective (DSO) - 904 on STS-88. On that mission, a small-statured astronaut will be using the FRED restraint while working at the Aft RMS workstation. The DSO will collect video for later posture analyses, as well as subjective data in the form of an electronic questionnaire. This report describes the current FRED KC-135 evaluations. The primary objectives were to evaluate the usability of the FRED and to verify the DSO in-flight setup. The restraint interface evaluation consisted of four basic areas of restraint use: 1) adjustability; 2) general usability and comfort; 3) usability at the RMS workstation; and 4) assembly and disassembly.

  10. Perceptions of supported and unsupported prone-restraint positions.

    PubMed

    Barnett, R; Stirling, C; Hall, J; Davies, A; Orme, P

    2016-04-01

    WHAT IS KNOWN ON THE SUBJECT?: Although the use of prone restraint should be avoided, it may remain a last resort emergency intervention for violent behaviour in psychiatric settings. However, when used as a last resort, concerns remain about the ability of staff to maintain the dignity, welfare and safety of the patient and minimize the potential adverse outcomes associated with restraint. This study builds on existing research regarding the risks of prone restraint by focusing on the psychological perceptions of individuals held in this position. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Individuals, who were asked to rate the psychological impact of two different prone-restraint positions (Supported and Unsupported Prone Positions) reported that the Supported Prone Position was more comfortable, less anxiety inducing and less limiting to breathing. Although no individual found prone restraint a positive experience, it shows that individuals found the psychological impact of the Supported Prone Position was less than the Unsupported Prone Position. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health professionals have a clear responsibility to maintain the dignity, safety and wellbeing of individuals subject to prone restraint as a short-term emergency procedure for the management of violent behaviour. Reducing both the physiological and psychological impact of prone restraint will help to reduce any adverse impact on individuals subject to such interventions. The findings will help influence current practice and promote the removal of the USPP as a specific prone-restraint intervention. Aim Restraint-related deaths are multi-factorial with prone restraint remaining a concern due to the physiological and psychological risks. This study builds on evidence presented by (Barnett et al. Medicine, Science and the Law (2012b): 1) that the Supported Prone Position (SPP) reduces physiological risks, by examining if the SPP also reduces the psychological impact of

  11. Restraints and occupant kinematics in vehicular rollovers.

    PubMed

    Meyer, Steven E; Herbst, Brian; Forrest, Stephen; Syson, Stephen R; Sances, Anthony; Kumaresan, Srirangam

    2002-01-01

    Occupant kinematics and the potential for injury in vehicular rollover crashes are dramatically affected by various restraint system characteristics. This study reviews previous research that utilized various methodologies and test fixtures to evaluate restrained occupant motions, primarily in the vertical direction, during both inverted and quasi-static simulated rollover environments. Additional laboratory tests were conducted in order to understand the static and dynamic excursion of restrained humans and surrogates in typical production motor vehicles under inverted circumstances. These tests indicated that volunteer occupants restrained within a complete vehicle by typical production 3 point seat belts will move vertically towards the vehicle roof structure by approximately 50-150 mm in production vehicles, depending on occupant size and belt configuration, when inverted and subjected to a static 1 g acceleration. Dynamic inverted vehicle drop testing in 3-point belt production vehicles, resulting in 4 to 11 g impacts, resulted in surrogates moving only about an additional 23 to 55 mm beyond the static inverted 1 g excursions.

  12. Restraint stress delays endometrial adaptive remodeling during mouse embryo implantation.

    PubMed

    Liu, Guanhui; Dong, Yulan; Wang, Zixu; Cao, Jing; Chen, Yaoxing

    2015-01-01

    In mice, previously, we showed that restraint stress reduces the number of embryo implantation sites in the endometrium. Here, we hypothesized that the uterine microenvironment is altered by restraint stress and consequently is suboptimal for embryo implantation. On embryonic day 1 (E1), 60 of 154 pregnant CD1 mice underwent restraint stress (4 h), repeated daily to E3, E5 or E7 (n = 10 mice per group). Restraint stress decreased food intake and suppressed body weight gain on E3, E5 and E7. Restraint stress decreased the actual and relative weight (percent body weight) of uterus and ovary on E5 (by 14.9%, p = 0.03; 16.1%, p = 0.004) and E7 (by 16.8%, p = 0.03; 20.0%, p = 0.01). Morphologically, restraint stress decreased relative endometrial area (by 8.94-18.8%, p = 0.003-0.021) and uterine gland area (by 30.6%, p < 0.01 on E3 and 44.5%, p < 0.01 on E5). Immunohistochemistry showed that restraint stress decreased microvessel density (by 12.9-70.5%, p < 0.01) and vascular endothelial growth factor expression (by 14.6-45.9%, p = 0.007-0.02). Restraint stress decreased by 32.4-39.8% (p = 0.002-0.01) the mean optical density ratio for proliferating cell nuclear antigen/terminal deoxynucleotidyl transferase dUTP nick end labeling. Methyl thiazolyl tetrazolium assay showed a dose-dependent decrease in proliferative activity of endometrial stromal cells (from 52 of 154 pregnant E5 control mice) incubated with H2O2 (100-1000 μM) in vitro. These findings supported the hypothesis that restraint stress negatively influences endometrial adaptive remodeling via an oxidative stress pathway, which resulted in fewer implantation sites.

  13. Exhaustive enumeration of protein conformations using experimental restraints.

    PubMed Central

    DeWitte, R. S.; Michnick, S. W.; Shakhnovich, E. I.

    1995-01-01

    We present an efficient new algorithm that enumerates all possible conformations of a protein that satisfy a given set of distance restraints. Rapid growth of all possible self-avoiding conformations on the diamond lattice provides construction of alpha-carbon representations of a protein fold. We investigated the dependence of the number of conformations on pairwise distance restraints for the proteins crambin, pancreatic trypsin inhibitor, and ubiquitin. Knowledge of between one and two contacts per monomer is shown to be sufficient to restrict the number of candidate structures to approximately 1,000 conformations. Pairwise RMS deviations of atomic position comparisons between pairs of these 1,000 structures revealed that these conformations can be grouped into about 25 families of structures. These results suggest a new approach to assessing alternative protein folds given a very limited number of distance restraints. Such restraints are available from several experimental techniques such as NMR, NOESY, energy transfer fluorescence spectroscopy, and crosslinking experiments. This work focuses on exhaustive enumeration of protein structures with emphasis on the possible use of NOESY-determined distance restraints. PMID:8528076

  14. A multifaceted approach to improving motor vehicle restraint compliance

    PubMed Central

    Hanfling, M.; Mangus, L.; Gill, A.; Bailey, R.

    2000-01-01

    Objectives—To increase proper use of seat belts and car seats, thereby reducing morbidity and mortality from motor vehicle collisions. Setting—The Vehicle Injury Prevention program community intervention was implemented in Houston, Texas. Effectiveness data are limited to "target area one", an impoverished neighborhood in northeast Harris County. Methods—This multifaceted public health education campaign brought together six segments of the community: education, health, government, law enforcement, private industry, and the media, to improve restraint use. It was evaluated by observation of proper restraint use before and nine months after implementation. Trained, independent observers made observations of occupants in the target area and at two comparison sites. Pre-post differences in restraint compliance were calculated by a standard binomial proportion test. Results—Motorists in target area one significantly improved their restraint use by 15% (p<0.05) from 39% pre-intervention to 54% post-intervention, whereas use in the comparison neighborhoods remained unchanged. Conclusions—Implementation of a public health education program, combined with economic incentives to increase vehicle restraint use, can be successful with multifaceted community support. PMID:10875669

  15. Restriction on Restraints in the Care for People with Intellectual Disabilities in the Netherlands: Lessons Learned from Australia, UK, and United States

    ERIC Educational Resources Information Center

    Romijn, Anita; Frederiks, Brenda J. M.

    2012-01-01

    In the Netherlands, physical/mechanical restraints in the care provided to people with intellectual disabilities are still in use, with the case of "Brandon" being a recent and illustrative example. The public debate that this case triggered raised questions concerning the policy proposal in the Care and Coercion Bill ("Wetsvoorstel…

  16. Restriction on Restraints in the Care for People with Intellectual Disabilities in the Netherlands: Lessons Learned from Australia, UK, and United States

    ERIC Educational Resources Information Center

    Romijn, Anita; Frederiks, Brenda J. M.

    2012-01-01

    In the Netherlands, physical/mechanical restraints in the care provided to people with intellectual disabilities are still in use, with the case of "Brandon" being a recent and illustrative example. The public debate that this case triggered raised questions concerning the policy proposal in the Care and Coercion Bill ("Wetsvoorstel…

  17. Mental health: use and abuse of control and restraint.

    PubMed

    Tarbuck, P

    The recent report of the inquiry into complaints at Ashworth Hospital (1) recommended that control and restraint techniques, used to contain violent conduct, should be used as a last resort, 'and should be subject to careful scrutiny to determine system failures'. This article, which points out that nurses in many areas are victims of increased levels of violence, defines control and restraint techniques, who should use them and in which situations their use may be sanctioned. The author concludes that although preservation of the patient's rights and dignity is paramount, nurses who have undergone control and restraint training are more confident practitioners when they are confronted with violent situations. In a second article next month, Tarbuck will look at issues of ethics and the human rights of patients.

  18. Comparative modelling by restraint-based conformational sampling.

    PubMed

    Furnham, Nicholas; de Bakker, Paul Iw; Gore, Swanand; Burke, David F; Blundell, Tom L

    2008-01-31

    Although comparative modelling is routinely used to produce three-dimensional models of proteins, very few automated approaches are formulated in a way that allows inclusion of restraints derived from experimental data as well as those from the structures of homologues. Furthermore, proteins are usually described as a single conformer, rather than an ensemble that represents the heterogeneity and inaccuracy of experimentally determined protein structures. Here we address these issues by exploring the application of the restraint-based conformational space search engine, RAPPER, which has previously been developed for rebuilding experimentally defined protein structures and for fitting models to electron density derived from X-ray diffraction analyses. A new application of RAPPER for comparative modelling uses positional restraints and knowledge-based sampling to generate models with accuracies comparable to other leading modelling tools. Knowledge-based predictions are based on geometrical features of the homologous templates and rules concerning main-chain and side-chain conformations. By directly changing the restraints derived from available templates we estimate the accuracy limits of the method in comparative modelling. The application of RAPPER to comparative modelling provides an effective means of exploring the conformational space available to a target sequence. Enhanced methods for generating positional restraints can greatly improve structure prediction. Generation of an ensemble of solutions that are consistent with both target sequence and knowledge derived from the template structures provides a more appropriate representation of a structural prediction than a single model. By formulating homologous structural information as sets of restraints we can begin to consider how comparative models might be used to inform conformer generation from sparse experimental data.

  19. Reducing Self-Injury and Corresponding Self-Restraint through the Strategic Use of Protective Clothing.

    ERIC Educational Resources Information Center

    Silverman, Kenneth; And Others

    1984-01-01

    The use of protective clothing (padded helmet and slippers) was found to reduce a severely retarded 13-year-old's kicking and two corresponding forms of self-restraint--arm and leg self-restraints. (Author/CL)

  20. Effect of habituation on the susceptibility of the rat to restraint ulcers

    NASA Technical Reports Server (NTRS)

    Martin, M. S.; Martin, F.; Lambert, R.

    1980-01-01

    The frequency and gravity of restraint ulcers were found to significantly diminish in rats previously exposed to brief periods of immobilization. The rats' becoming habituated to restraint conditions probably explains this phenomenon.

  1. Nurses' and physicians' educational needs in seclusion and restraint practices.

    PubMed

    Kontio, Raija; Välimäki, Maritta; Putkonen, Hanna; Cocoman, Angela; Turpeinen, Saija; Kuosmanen, Lauri; Joffe, Grigori

    2009-07-01

    This study aimed to explore nurses' (N= 22) and physicians' (N= 5) educational needs in the context of their perceived seclusion and restraint-related mode of action and need for support. The data were collected by focus group (N= 4) interviews and analyzed with inductive content analysis. Participants recognized a need for on-ward and problem-based education and infrastructural and managerial support. The declared high ethical principles were not in accordance with the participants' reliance on manpower and the high seclusion and restraint rates. Future educational programs should bring together written clinical guidelines, education on ethical and legal issues, and the staff's support aspect.

  2. Commentary: seclusion and restraint in corrections a time for change.

    PubMed

    Champion, Michael K

    2007-01-01

    Seclusion and restraint are essential interventions in the acute psychiatric care of patients in correctional environments. When administered and monitored properly, they are safe and effective in reducing the risk of harm. However, correctional systems have not developed uniform practices that are consistent with current community standards. There has been no clear national standard of care for the use of seclusion and restraint in correctional mental health care. The need for a national standard of care is discussed, and sources for developing a standard of care are reviewed. The Resource Document produced by the American Psychiatric Association is presented as a significant step toward establishing a national standard of care.

  3. Analgesia and chemical restraint for the emergent veterinary patient.

    PubMed

    Dyson, Doris H

    2008-11-01

    Frequently, analgesics are withheld in the emergent patient based on common misconceptions. Concerns expressed are that analgesics "mask" physiologic indicators of patient deterioration or that potential toxicity and adverse reactions associated with drug administration outweigh the benefits gained. Appropriate selection of drugs and doses as described in this article allow the veterinarian to achieve analgesia, in addition to sedation or restraint when needed, without unwarranted fears. Guidelines are provided for typical situations encountered in trauma patients to provide a safe starting point for providing analgesia. Caution required in these cases is also discussed, with emphasis on individualization of the approach to analgesia and chemical restraint.

  4. Dynamics of column stability with partial end restraints

    NASA Technical Reports Server (NTRS)

    Gregory, Peyton B.

    1990-01-01

    The dynamic behavior of columns with partial end restraints and loads consisting of a dead load and a pulsating load are investigated. The differential equation is solved using a lumped impulse recurrence formula relative to time coupled with a finite difference discretization along the member length. A computer program is written from which the first critical frequencies are found as a function of end stiffness. The case of a pinned ended column compares very well with the exact solution. Also, the natural frequency and buckling load formulas are derived for equal and unequal end restraints.

  5. Fast Flux Test Facility core restraint system performance

    SciTech Connect

    Hecht, S.L.; Trenchard, R.G.

    1990-02-01

    Characterizing Fast Flux Test Facility (FFTF) core restraint system performance has been ongoing since the first operating cycle. Characterization consists of prerun analysis for each core load, in-reactor and postirradiation measurements of subassembly withdrawal loads and deformations, and using measurement data to fine tune predictive models. Monitoring FFTF operations and performing trend analysis has made it possible to gain insight into core restraint system performance and head off refueling difficulties while maximizing component lifetimes. Additionally, valuable information for improved designs and operating methods has been obtained. Focus is on past operating experience, emphasizing performance improvements and avoidance of potential problems. 4 refs., 12 figs., 2 tabs.

  6. Investigation of Child Restraint System (CRS) Compatibility in the Vehicle Seat Environment.

    PubMed

    Bing, Julie A; Bolte, John H; Agnew, Amanda M

    2015-01-01

    Child restraint system (CRS) misuse is common and can have serious consequences to child safety. Physical incompatibilities between CRS and vehicles can complicate the installation process and may worsen CRS misuse rates. This study aims to identify the most common sources of incompatibility between representative groups of CRS and vehicles. Detailed dimensional data were collected from 59 currently marketed CRS and 61 late model vehicles. Key dimensions were compared across all 3,599 theoretical CRS/vehicle combinations and the most common predicted incompatibilities were determined. A subset of 34 physical installations was analyzed to validate the results. Only 58.2% of rear-facing (RF) CRS/vehicle combinations were predicted to have proper agreement between the vehicle's seat pan angle and the CRS manufacturers' required base angle. The width of the base of the CRS was predicted to fit snugly between the vehicle's seat pan bolsters in 63.3% of RF CRS/vehicle combinations and 62.2% of forward-facing (FF) CRS/vehicle combinations. FF CRS were predicted to be free of interaction with the vehicle's head restraint in 66.4% of combinations. Roughly 90.0% of RF CRS/vehicle combinations were predicted to have enough horizontal clearance space to set the front seat in the middle its fore/aft slider track. Compatibility rates were above 98% regarding the length of the CRS base compared to the length of the vehicle seat pan and the ability of the top tether to reach the tether anchor. Validation studies revealed that the predictions of RF CRS base angle range vs. seat pan angle compatibility were accurate within 6%, and head restraint interference and front row clearance incompatibilities may be more common than the dimensional analysis approach has predicted. The results of this study indicate that RF CRS base angles and front row clearance space, as well as FF CRS head restraint interference, are frequent compatibility concerns. These results enable manufacturers

  7. Effects of prenatal exposure to WIFI Signal (2.45GHz) on postnatal development and behavior in rat: Influence of maternal restraint.

    PubMed

    Othman, Haifa; Ammari, Mohamed; Sakly, Mohsen; Abdelmelek, Hafedh

    2017-03-10

    The present study was carried out to investigate the potential combined influence of maternal restraint stress (and 2.45GHz WiFi signal exposure on postnatal development and behavior in the offspring of exposed rats. 24 pregnant albino Wistar rats were randomly assigned to four groups: Control, WiFi-exposed, restrained and both WiFi-exposed and restrained groups. Each of WiFi exposure and restraint occurred 2h/day along gestation till parturition. The pups were evaluated for physical development and neuromotor maturation. Moreover, elevated plus maze test, open field activity and stationary beam test were also determined on postnatal days 28, 30 and 31, respectively. After behavioral tests, the rats were anesthetized and their brains were removed for biochemical analysis. Our main findings showed no detrimental effects on gestation progress and outcomes at delivery in all groups. Subsequently, WiFi and restraint, per se and mainly in concert altered physical development of pups with slight differences between genders. Behaviorally, the gestational WiFi irradiation, restraint and especially the associated treatment affected the neuromotor maturation mainly in male progeny. At adult age, we noticed anxiety, motor deficit and exploratory behavior impairment in male offspring co-exposed to WiFi radiation and restraint, and in female progeny subjected to three treatments. The biochemical investigation showed that, all three treatments produced global oxidative stress in brain of both sexes. As for serum biochemistry, phosphorus, magnesium, glucose, triglycerides and calcium levels were disrupted. Taken together, prenatal WiFi radiation and restraint, alone and combined, provoked several behavioral and biochemical impairments at both juvenile and adult age of the offspring.

  8. A Theoretical Analysis of Potential Extinction Properties of Behavior-Specific Manual Restraint

    ERIC Educational Resources Information Center

    Cipani, Ennio; Thomas, Melvin; Martin, Daniel

    2007-01-01

    This paper will examine possible extinction properties of behavior-specific manual restraint. It will analyze the possibility of extinction being produced via restraint with respect to the target behavior's possible environmental functions. The theoretical analysis will involve the analysis of behavioral properties of restraint during two temporal…

  9. Functional Analysis of Self-Injurious Behavior and Its Relation to Self-Restraint

    ERIC Educational Resources Information Center

    Rooker, Griffin W.; Roscoe, Eileen M.

    2005-01-01

    Some individuals who engage in self-injurious behavior (SIB) also exhibit self-restraint. In the present study, a series of three functional analyses were conducted to determine the variables that maintained a participant's SIB, one without restraint items available, one with a preferred and effective form of self-restraint (an airplane pillow)…

  10. Restraint Use Legislation: Its Prospects for Increasing the Protection of Children in Cars.

    ERIC Educational Resources Information Center

    Williams, Allan F.

    Young children and infants are especially vulnerable to serious injury in auto collisions because so few of them are protected by restraints or because legally required restraint devices are improperly used. Seat belt use laws tend to exclude children and child restraint legislation which exists includes gaps and shortcomings that limit its…

  11. The Effects of Non-Contingent Self-Restraint on Self-Injury

    ERIC Educational Resources Information Center

    Kerth, Denise Marzullo; Progar, Patrick R.; Morales, Sabrina

    2009-01-01

    Background: Self-restraint is a pervasive phenomenon among individuals who engage in self-injurious behaviour (SIB). Materials and Methods: The present study examined the use of clothing as a socially acceptable alternative to self-restraint to reduce SIB and other topographies of self-restraint in an adolescent diagnosed with autism. Two separate…

  12. The Effects of Non-Contingent Self-Restraint on Self-Injury

    ERIC Educational Resources Information Center

    Kerth, Denise Marzullo; Progar, Patrick R.; Morales, Sabrina

    2009-01-01

    Background: Self-restraint is a pervasive phenomenon among individuals who engage in self-injurious behaviour (SIB). Materials and Methods: The present study examined the use of clothing as a socially acceptable alternative to self-restraint to reduce SIB and other topographies of self-restraint in an adolescent diagnosed with autism. Two separate…

  13. 76 FR 16472 - Consumer Information; Program for Child Restraint Systems; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-23

    ... National Highway Traffic Safety Administration Consumer Information; Program for Child Restraint Systems... Car Assessment Program, to help caregivers find a child restraint system (``child safety seat'') that... FURTHER INFORMATION CONTACT: For non-legal issues related to the Vehicle-Child Restraint System (CRS)...

  14. Dominance status alters restraint-induced neural activity in brain regions controlling stress vulnerability.

    PubMed

    Cooper, Matthew A; Seddighi, Sahba; Barnes, Abigail K; Grizzell, J Alex; Dulka, Brooke N; Clinard, Catherine T

    2017-10-01

    Understanding the cellular mechanisms that control resistance and vulnerability to stress is an important step toward identifying novel targets for the prevention and treatment of stress-related mental illness. In Syrian hamsters, dominant and subordinate animals exhibit different behavioral and physiological responses to social defeat stress, with dominants showing stress resistance and subordinates showing stress vulnerability. We previously found that dominant and subordinate hamsters show different levels of defeat-induced neural activity in brain regions that modulate coping with stress, although the extent to which status-dependent differences in stress vulnerability generalize to non-social stressors is unknown. In this study, dominant, subordinate, and control male Syrian hamsters were exposed to acute physical restraint for 30min and restraint-induced c-Fos immunoreactivity was quantified in select brain regions. Subordinate animals showed less restraint-induced c-Fos immunoreactivity in the infralimbic (IL), prelimbic (PL), and ventral medial amygdala (vMeA) compared to dominants, which is consistent with the status-dependent effects of social defeat stress. Subordinate animals did not show increased c-Fos immunoreactivity in the rostroventral dorsal raphe nucleus (rvDRN), which is in contrast to the effects of social defeat stress. These findings indicate that status-dependent changes in neural activity generalize from one stressor to another in a brain region-dependent manner. These findings further suggest that while some neural circuits may support a generalized form of stress resistance, others may provide resistance to specific stressors. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Impact of eLearning course on nurses' professional competence in seclusion and restraint practices: a randomized controlled study (ISRCTN32869544).

    PubMed

    Kontio, R; Lahti, M; Pitkänen, A; Joffe, G; Putkonen, H; Hätönen, H; Katajisto, J; Välimäki, M

    2011-11-01

    Education on the care of aggressive and disturbed patients is fragmentary. eLearning could ensure the quality of such education, but data on its impact on professional competence in psychiatry are lacking. The aim of this study was to explore the impact of ePsychNurse.Net, an eLearning course, on psychiatric nurses' professional competence in seclusion and restraint and on their job satisfaction and general self-efficacy. In a randomized controlled study, 12 wards were randomly assigned to ePsychNurse.Net (intervention) or education as usual (control). Baseline and 3-month follow-up data on nurses' knowledge of coercion-related legislation, physical restraint and seclusion, their attitudes towards physical restraint and seclusion, job satisfaction and general self-efficacy were analysed for 158 completers. Knowledge (primary outcome) of coercion-related legislation improved in the intervention group, while knowledge of physical restraint improved and knowledge of seclusion remained unchanged in both groups. General self-efficacy improved in the intervention group also attitude to seclusion in the control group. In between-group comparison, attitudes to seclusion (one of secondary outcomes) favoured the control group. Although the ePsychNurse.Net demonstrated only slight advantages over conventional learning, it may be worth further development with, e.g. flexible time schedule and individualized content.

  16. Mission Specialist (MS) Fabian in middeck sleep restraint

    NASA Image and Video Library

    1983-06-24

    STS007-06-0314 (18-24 June 1983) --- Astronaut John M. Fabian, STS-7 mission specialist, sleeps in a zip-up blue sleep restraint device in the locker area of the Earth-orbiting space shuttle Challenger's middeck. The frame was exposed with a 35mm camera. Photo credit: NASA

  17. Kregel sleeping in middeck sleep restraints wearing mask

    NASA Image and Video Library

    1995-07-31

    STS070-334-031 (13-22 JULY 1995) --- Astronaut Kevin R. Kregel demonstrates the new shuttle sleep restraints on the space shuttle Discovery?s middeck. During an August 11, 1995, post flight presentation to fellow employees at the Johnson Space Center (JSC), the STS-70 pilot discussed features of the device and lauded its ability to add comfort for crew members.

  18. The Influence of Restraint Systems on Panel Behavior

    NASA Technical Reports Server (NTRS)

    Jegley, Dawn C.

    2011-01-01

    When a panel is tested in uniaxial compression in a test machine, the boundary conditions are not quite the same as they would be if it were part of a complete structure. A restraint system may be used to simulate conditions found in a complete vehicle. Quantifying the quality of the restraint with only point-measurement devices can leave an inadequate characterization of the out-of-plane behavior. However, today s full-field displacement monitoring techniques allow for much more accurate views of the global panel deformation and strain, and therefore allow for a better understanding of panel behavior. In the current study, the behavior of a hat-stiffened and two rod-stiffened carbon-epoxy panels is considered. Panels were approximately 2 meters tall and 0.76 to 1.06 m wide. Unloaded edges were supported by knife edges and stiffeners were attached to a support structure at selected locations to restrain out-of-plane motion. A comparison is made between test results based on full-field measurements and analyses based on assumptions of boundary conditions of a completely rigid edge restraint and the absence of any edge restraint. Results indicate that motion at the restrained edges must be considered to obtain accurate test-analysis correlation.

  19. Pilot Overmyer completes hygiene activities / demostrates IVA foot restraint

    NASA Image and Video Library

    1982-11-16

    STS005-06-230 (11-16 Nov. 1982) --- On middeck, astronaut Robert F. Overmyer, STS-5 pilot, drying his face with a towel from forward single tray personal item stowage locker, completes personal hygiene activities (shaving) and demonstrates use of intravehicular activity (IVA) foot restraint on floor. Photo credit: NASA

  20. Dietary Restraint and Fatness in Early Adolescent Girls and Boys.

    ERIC Educational Resources Information Center

    Fox, K. R.; And Others

    1994-01-01

    Investigated degree to which actual fatness and/or greater body dimensions might provide stimulus for dietary restraint (DR) in children (n=126). High DR boys were heavier, fatter, and had larger waists and hips resulting from fat deposition than low DR boys. High DR girls were heavier and fatter that low DR girls, with larger waists and hips.…

  1. The Cost of Prior Restraint: "U. S. v. The Progressive."

    ERIC Educational Resources Information Center

    Soloski, John; Dyer, Carolyn Stewart

    Increased litigation and rising litigation costs threaten the future of newspapers and magazines. A case study was conducted to determine the costs and effects of "United States v. 'The Progressive,'" a prior restraint case over the publication in 1979 of an article on the hydrogen bomb. "The Progressive," which operates at a…

  2. Correlates of Restraint Use in an Institutional Population: A Replication

    ERIC Educational Resources Information Center

    Sturmey, P.; Lott, J. D.; Laud, R.; Matson, J. L.

    2005-01-01

    Reducing inappropriate restraint is an important mission of services for people with intellectual disabilities (IDs). In this study, 52 clients who had been restrained were compared with 52 other clients, individually matched on age, gender and level of IDs. Participants were mostly adults with severe and profound IDs in an institutional setting.…

  3. Adult Education Between Past and Present Restraints and Future Prospects.

    ERIC Educational Resources Information Center

    Lavrnja, Ilija; Klapan, Anita

    Analysis of the theoretical and methodological basis for adult education is always somewhere between history, the present, and an orientation toward the future. The key questions that must be addressed when predicting the future of education are related to the following areas: determining how to overcome the restraints that are imminent to past…

  4. 45 CFR 1310.11 - Child Restraint Systems.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 4 2012-10-01 2012-10-01 false Child Restraint Systems. 1310.11 Section 1310.11 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, HEAD...

  5. 45 CFR 1310.11 - Child Restraint Systems.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Child Restraint Systems. 1310.11 Section 1310.11 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, HEAD...

  6. 45 CFR 1310.11 - Child Restraint Systems.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 4 2013-10-01 2013-10-01 false Child Restraint Systems. 1310.11 Section 1310.11 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, HEAD...

  7. 45 CFR 1310.11 - Child Restraint Systems.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 4 2014-10-01 2014-10-01 false Child Restraint Systems. 1310.11 Section 1310.11 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, HEAD...

  8. 45 CFR 1310.11 - Child Restraint Systems.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Child Restraint Systems. 1310.11 Section 1310.11 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, HEAD...

  9. 49 CFR 179.14 - Coupler vertical restraint system.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 3 2011-10-01 2011-10-01 false Coupler vertical restraint system. 179.14 Section 179.14 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) SPECIFICATIONS FOR TANK...

  10. The effect of obesity on the restraint of automobile occupants.

    PubMed

    Forman, Jason; Lopez-Valdes, Francisco J; Lessley, David; Kindig, Matthew; Kent, Richard; Bostrom, Ola

    2009-10-01

    As obesity rates increase, the protection of obese occupants will become increasingly important in vehicle and restraint design. As a first step in this effort, this study seeks to compare the kinematics, dynamics, and injuries of obese post mortem human surrogates (PMHS) to (approximately) 50(th) percentile adult male PMHS in frontal impact sled tests with a force-limiting, pre-tensioning restraint system. Forty-eight km/h, frontal impact sled tests were performed with a sled buck representing the rear seat occupant compartment of a 2004 mid-sized sedan. The restraint system consisted of a 3-point belt with a pretensioner and a progressive force-limiter at the retractor. The test subjects were either obese PMHS or approximately 50(th) percentile adult male PMHS. Instrumentation included accelerometer packages on the spine. Deformation of the subjects' chests were measured using chestbands placed nominally at the superior-inferior locations of the 4(th) and 8(th) ribs. Tension in the restraint system was measured at the upper shoulder belt, lower shoulder belt, and the lap belt. Motion of the head, shoulder, pelvis, and knee were recorded using high-speed video. Two obese PMHS (average mass 137 kg, average stature 186 cm) and three approximately mid-sized male PMHS (average mass 68 kg, average stature 176 cm) were tested. The obese PMHS exhibited significantly greater forward motion of the head and the pelvis compared to the mid-sized PMHS. The obese PMHS also exhibited backwards torso rotation at the time of maximum forward excursion, whereas the mid-sized PMHS did not. The obese PMHS exhibited average maximum chest compressions of approximately 44% (+/- 9% standard deviation) of their initial chest depths, and exhibited 26 g (+/- 2 g) average 3 ms clip maximum chest resultant acceleration. In comparison, the mid-sized PMHS exhibited averages of 29% (+/- 9%) maximum chest compression and 35 g (+/- 4 g) maximum 3 ms clip chest acceleration. The obese PMHS exhibited

  11. The Effect of Obesity on the Restraint of Automobile Occupants

    PubMed Central

    Forman, Jason; Lopez-Valdes, Francisco J.; Lessley, David; Kindig, Matthew; Kent, Richard; Bostrom, Ola

    2009-01-01

    As obesity rates increase, the protection of obese occupants will become increasingly important in vehicle and restraint design. As a first step in this effort, this study seeks to compare the kinematics, dynamics, and injuries of obese post mortem human surrogates (PMHS) to (approximately) 50th percentile adult male PMHS in frontal impact sled tests with a force-limiting, pre-tensioning restraint system. Forty-eight km/h, frontal impact sled tests were performed with a sled buck representing the rear seat occupant compartment of a 2004 mid-sized sedan. The restraint system consisted of a 3-point belt with a pretensioner and a progressive force-limiter at the retractor. The test subjects were either obese PMHS or approximately 50th percentile adult male PMHS. Instrumentation included accelerometer packages on the spine. Deformation of the subjects' chests were measured using chestbands placed nominally at the superior-inferior locations of the 4th and 8th ribs. Tension in the restraint system was measured at the upper shoulder belt, lower shoulder belt, and the lap belt. Motion of the head, shoulder, pelvis, and knee were recorded using high-speed video. Two obese PMHS (average mass 137 kg, average stature 186 cm) and three approximately mid-sized male PMHS (average mass 68 kg, average stature 176 cm) were tested. The obese PMHS exhibited significantly greater forward motion of the head and the pelvis compared to the mid-sized PMHS. The obese PMHS also exhibited backwards torso rotation at the time of maximum forward excursion, whereas the mid-sized PMHS did not. The obese PMHS exhibited average maximum chest compressions of approximately 44% (± 9% standard deviation) of their initial chest depths, and exhibited 26 g (± 2 g) average 3 ms clip maximum chest resultant acceleration. In comparison, the mid-sized PMHS exhibited averages of 29% (± 9%) maximum chest compression and 35 g (± 4 g) maximum 3 ms clip chest acceleration. The obese PMHS exhibited 7 and 2 rib

  12. Mechanical restraint in psychiatry: preventive factors in theory and practice. A Danish-Norwegian association study.

    PubMed

    Bak, Jesper; Zoffmann, Vibeke; Sestoft, Dorte Maria; Almvik, Roger; Brandt-Christensen, Mette

    2014-07-01

    To examine how potential mechanical restraint preventive factors in hospitals are associated with the frequency of mechanical restraint episodes. This study employed a retrospective association design, and linear regression was used to assess the associations. Three mechanical restraint preventive factors were significantly associated with low rates of mechanical restraint use: mandatory review (exp[B] = .36, p < .01), patient involvement (exp[B] = .42, p < .01), and no crowding (exp[B] = .54, p < .01). None of the three mechanical restraint preventive factors presented any adverse effects; therefore, units should seriously consider implementing these measures. © 2013 Wiley Periodicals, Inc.

  13. Assessment of self-restraint using a functional analysis of self-injury.

    PubMed

    Scheithauer, Mindy; O'Connor, Julia; Toby, Lauryn M

    2015-12-01

    When self-restraint and self-injurious behavior (SIB) co-occur, self-restraint might be maintained by negative reinforcement through the removal of SIB. The current study evaluated this possibility with an individual who exhibited hand-to-head SIB. Three functional analyses of SIB were conducted: (a) no consequences for self-restraint, (b) self-restraint blocked, and (c) hypothesized aversive effects of SIB blocked. The outcomes of the 3 analyses suggested that self-restraint was maintained by negative reinforcement.

  14. Choosing Staff Members Reduces Time in Mechanical Restraint Due to Self-Injurious Behaviour and Requesting Restraint

    ERIC Educational Resources Information Center

    Jensen, Craig C.; Lydersen, Tore; Johnson, Paul R.; Weiss, Shannon R.; Marconi, Michael R.; Cleave, Mary L.; Weber, Patricia

    2012-01-01

    Background: Using mechanical restraints to protect a person who engaged in dangerous self-injury was decreased by manipulation of an establishing operation involving the client choosing the staff person who would work with her. Materials and Methods: The client was a 28-year-old woman diagnosed with autism, bipolar disorder, static cerebral…

  15. Choosing Staff Members Reduces Time in Mechanical Restraint Due to Self-Injurious Behaviour and Requesting Restraint

    ERIC Educational Resources Information Center

    Jensen, Craig C.; Lydersen, Tore; Johnson, Paul R.; Weiss, Shannon R.; Marconi, Michael R.; Cleave, Mary L.; Weber, Patricia

    2012-01-01

    Background: Using mechanical restraints to protect a person who engaged in dangerous self-injury was decreased by manipulation of an establishing operation involving the client choosing the staff person who would work with her. Materials and Methods: The client was a 28-year-old woman diagnosed with autism, bipolar disorder, static cerebral…

  16. JLigand: a graphical tool for the CCP4 template-restraint library

    SciTech Connect

    Lebedev, Andrey A.; Young, Paul; Isupov, Michail N.; Moroz, Olga V.; Vagin, Alexey A.; Murshudov, Garib N.

    2012-04-01

    The CCP4 template-restraint library defines restraints for biopolymers, their modifications and ligands that are used in macromolecular structure refinement. JLigand is a graphical editor for generating descriptions of new ligands and covalent linkages. Biological macromolecules are polymers and therefore the restraints for macromolecular refinement can be subdivided into two sets: restraints that are applied to atoms that all belong to the same monomer and restraints that are associated with the covalent bonds between monomers. The CCP4 template-restraint library contains three types of data entries defining template restraints: descriptions of monomers and their modifications, both used for intramonomer restraints, and descriptions of links for intermonomer restraints. The library provides generic descriptions of modifications and links for protein, DNA and RNA chains, and for some post-translational modifications including glycosylation. Structure-specific template restraints can be defined in a user’s additional restraint library. Here, JLigand, a new CCP4 graphical interface to LibCheck and REFMAC that has been developed to manage the user’s library and generate new monomer entries is described, as well as new entries for links and associated modifications.

  17. Sensitization of restraint-induced corticosterone secretion after chronic restraint in rats: Involvement of 5-HT7 receptors

    PubMed Central

    García-Iglesias, Brenda B.; Mendoza-Garrido, María E.; Gutiérrez-Ospina, Gabriel; Rangel-Barajas, Claudia; Noyola-Díaz, Martha; Terrón, José A.

    2013-01-01

    Serotonin (5-HT) modulates the hypothalamic-pituitary-adrenal (HPA) axis response to stress. We examined the effect of chronic restraint stress (CRS; 20 min/day) as compared to control (CTRL) conditions for 14 days, on: 1) restraint-induced ACTH and corticosterone (CORT) secretion in rats pretreated with vehicle or SB-656104 (a 5-HT7 receptor antagonist); 2) 5-HT7 receptor-like immunoreactivity (5-HT7-LI) and protein in the hypothalamic paraventricular nucleus (PVN) and adrenal glands (AG); 3) baseline levels of 5-HT and 5-hydroxyindolacetic acid (5-HIAA), and 5-HIAA/5-HT ratio in PVN and AG; and 4) 5-HT-like immunoreactivity (5-HT-LI) in AG and tryptophan hydroxylase (TPH) protein in PVN and AG. On day 15, animals were subdivided into Treatment and No treatment groups. Treatment animals received an i.p. injection of vehicle or SB-656104; No Treatment animals received no injection. Sixty min later, Treatment animals were either decapitated with no further stress (0 min) or submitted to acute restraint (10, 30, 60 or 120 min); hormone serum levels were measured. No Treatment animals were employed for the rest of measurements. CRS decreased body weight gain and increased adrenal weight. In CTRL animals, acute restraint increased ACTH and CORT secretion in a time of restraint-dependent manner; both responses were inhibited by SB-656104. Exposure to CRS abolished ACTH but magnified CORT responses to restraint as compared to CTRL conditions; SB-656104 had no effect on ACTH levels but significantly inhibited sensitized CORT responses. In CTRL animals, 5-HT7-LI was detected in magnocellular and parvocellular subdivisions of PVN and sparsely in adrenal cortex. Exposure to CRS decreased 5-HT7-LI and protein in the PVN, but increased 5-HT7-LI in the adrenal cortex and protein in whole AG. Higher 5-HT and 5-HIAA levels were detected in PVN and AG from CRS animals but 5-HIAA/5-HT ratio increased in AG only. Finally, whereas 5-HT-LI was sparsely observed in the adrenal cortex

  18. Girls at Risk for Overweight at Age 5 Are at Risk for Dietary Restraint, Disinhibited Overeating, Weight Concerns, and Greater Weight Gain from 5 to 9 Years

    PubMed Central

    SHUNK, JENNIFER A.; BIRCH, LEANN L.

    2008-01-01

    Objective The goal of this study was to investigate the emergence of dietary restraint, disinhibited eating, weight concerns, and body dissatisfaction among girls from 5 to 9 years old, and to assess whether girls at risk for overweight at age 5 were at greater risk for the emergence of restraint, disinhibited overeating, weight concerns, and body dissatisfaction. Design Longitudinal data were used to assess the relationship between weight status and the development of dietary restraint, aspects of disinhibited overeating, weight concern, and body dissatisfaction at ages 5, 7, and 9 years. Subjects Participants were 153 girls from predominately middle class and exclusively non-Hispanic white families living in central Pennsylvania. Statistical Analyses Differences in weight status, dietary restraint, disinhibition, weight concern, and body dissatisfaction between girls at risk (>85th percentile body mass index) or not at risk for overweight at age 5 were assessed using repeated measures analysis of variance at ages 5, 7, and 9 years. Results Girls who were at risk for overweight at age 5 reported significantly higher levels of restraint, disinhibition, weight concern, and body dissatisfaction by age 9. Girls at risk for overweight at age 5 also showed greater increases in weight status from 5 to 9 years of age. Conclusions Higher levels of dietary restraint, weight concern, and body dissatisfaction among young girls at risk for overweight were accompanied by greater weight gain from 5 to 9 years of age, consistent with other recent findings suggesting that youths’ attempts at weight control may promote weight gain. Positive alternatives to attempts at dietary restriction are essential to promoting healthful weight status among children, and should include encouraging physical activity, promoting children’s acceptance of a variety of low–energy-density foods, and providing guides to appropriate portion sizes. PMID:15215771

  19. Effects of dietary restraint and body mass index on the relative reinforcing value of snack food.

    PubMed

    Goldfield, Gary S; Lumb, Andrew

    2009-01-01

    The present study examined the independent and interactive association between dietary restraint, body mass index (BMI) and the relative reinforcing value of food. Four hundred and three introductory psychology students completed questionnaires assessing age, gender, BMI, hunger, smoking status, nicotine dependence, dietary restraint, hedonic ratings for snack food and fruits and vegetables and the relative reinforcing value of snack food and fruits and vegetables. In the overall sample, results indicated a dietary restraint x BMI interaction after controlling for age, hunger, nicotine dependence, and hedonics. However, when regression models were separated by gender, the BMI x restraint interaction emerged only for females and not for males. Findings suggest that BMI moderates the relationship between dietary restraint and snack food reinforcement in females only, such that restraint and snack food reinforcement are inversely correlated in females with lower BMI, but restraint is positively correlated with snack food reinforcement in females with higher BMI. Theoretical and clinical implications of these findings are discussed.

  20. Dangerous Use of Seclusion and Restraints in Schools Remains Widespread and Difficult to Remedy: A Review of Ten Cases. United States Senate Health, Education, Labor, and Pensions Committee. Majority Committee Staff Report

    ERIC Educational Resources Information Center

    US Senate (NJ1), 2014

    2014-01-01

    There is no evidence that physically restraining or putting children in unsupervised seclusion in the K-12 school system provides any educational or therapeutic benefit to a child. In fact, use of either seclusion or restraints in non-emergency situations poses significant physical and psychological danger to students. Yet the first round of data…

  1. Contribution of Social Isolation, Restraint, and Hindlimb Unloading to Changes in Hemodynamic Parameters and Motion Activity in Rats

    PubMed Central

    Tsvirkun, Darya; Bourreau, Jennifer; Mieuset, Aurélie; Garo, Florian; Vinogradova, Olga; Larina, Irina; Navasiolava, Nastassia; Gauquelin-Koch, Guillemette; Gharib, Claude; Custaud, Marc-Antoine

    2012-01-01

    The most accepted animal model for simulation of the physiological and morphological consequences of microgravity on the cardiovascular system is one of head-down hindlimb unloading. Experimental conditions surrounding this model include not only head-down tilting of rats, but also social and restraint stresses that have their own influences on cardiovascular system function. Here, we studied levels of spontaneous locomotor activity, blood pressure, and heart rate during 14 days under the following experimental conditions: cage control, social isolation in standard rat housing, social isolation in special cages for hindlimb unloading, horizontal attachment (restraint), and head-down hindlimb unloading. General activity and hemodynamic parameters were continuously monitored in conscious rats by telemetry. Heart rate and blood pressure were both evaluated during treadmill running to reveal cardiovascular deconditioning development as a result of unloading. The main findings of our work are that: social isolation and restraint induced persistent physical inactivity, while unloading in rats resulted in initial inactivity followed by normalization and increased locomotion after one week. Moreover, 14 days of hindlimb unloading showed significant elevation of blood pressure and slight elevation of heart rate. Hemodynamic changes in isolated and restrained rats largely reproduced the trends observed during unloading. Finally, we detected no augmentation of tachycardia during moderate exercise in rats after 14 days of unloading. Thus, we concluded that both social isolation and restraint, as an integral part of the model conditions, contribute essentially to cardiovascular reactions during head-down hindlimb unloading, compared to the little changes in the hydrostatic gradient. PMID:22768322

  2. Effects of edge restraint on slab behavior. Final report

    SciTech Connect

    Guice, L.K.

    1986-02-01

    This study was performed in conjunction with a Federal Emergency Management Agency program to plan, design, and construct keyworker blast shelters which would be used in high-risk areas of the country during and after a nuclear attack. The shelters considered in this study were box-type structures in which damage is much more likely to occur in the roof slab than in the walls or floor. In this part of the program, the effect of edge restraint on slab behavior was investigated. The primary objective was to determine the effects of partial rotational restraint on slab strength, ductility, and mechanism of failure. Sixteen one-way, reinforced concrete plate elements were tested in a reaction structure under uniform static water pressure.

  3. Validity of dietary restraint among 5- to 9-year old girls.

    PubMed

    Shunk, Jennifer A; Birch, Leann L

    2004-06-01

    Dietary restraint is defined as the cognitive tendency to restrict intake and is often accompanied by the breakdown of restraint, referred to as disinhibition, leading to overeating and overweight in adults. Given recent evidence suggesting that dietary restraint and disinhibition are emerging as early as middle childhood, this study examined the validity of the restraint construct as measured in girls between the ages of 5 and 9. Dietary restraint was assessed longitudinally by questionnaire and validity was established by correlating restraint with measures previously reported to be related to restraint including weight concerns, body esteem, self-reported dieting, and measures of dietary intake when girls were ages 5, 7, and 9. Participants were 153 girls from predominately middle class, and exclusively non-Hispanic white families living in central Pennsylvania. Correlational data were used to assess relationships between dietary restraint and weight concerns, body esteem, dietary intake, and dieting. Results from this study indicate that there is evidence for the validity of the dietary restraint construct among girls by age 9. Specifically, dietary restraint was highly and positively associated with body mass index, weight concerns and body dissatisfaction and negatively correlated with dietary intake, findings similar to those reported in the adult literature.

  4. Effects of child restraint system features on installation errors.

    PubMed

    Klinich, Kathleen D; Manary, Miriam A; Flannagan, Carol A C; Ebert, Sheila M; Malik, Laura A; Green, Paul A; Reed, Matthew P

    2014-03-01

    This study examined how child restraint system (CRS) features contribute to CRS installation errors. Sixteen convertible CRS, selected to include a wide range of features, were used in volunteer testing with 32 subjects. Subjects were recruited based on their education level (high or low) and experience with installing CRS (none or experienced). Each subject was asked to perform four child restraint installations in the right-rear passenger seat of a 2006 Pontiac G6 sedan using a crash dummy as a child surrogate. Each subject installed two CRS forward-facing (FF), one with LATCH and one with the vehicle seatbelt, and two CRS rear-facing (RF), one with LATCH and one with the seatbelt. After each installation, the experimenter evaluated 42 factors for each installation, such as choice of belt routing path, tightness of installation, and harness snugness. Analyses used linear mixed models to identify CRS installation outcomes associated with CRS features. LATCH connector type, LATCH strap adjustor type, and the presence of belt lockoffs were associated with the tightness of the CRS installation. The type of harness shoulder height adjuster was associated with the rate of achieving a snug harness. Correct tether use was associated with the tether storage method. In general, subject assessments of the ease-of-use of CRS features were not highly correlated with the quality of their installation, suggesting a need for feedback with incorrect installations. The data from this study provide quantitative assessments of some CRS features that were associated with reductions in CRS installation errors. These results provide child restraint designers with design guidelines for developing easier-to-use products. Research on providing effective feedback during the child restraint installation process is recommended.

  5. Restraint stress alters neutrophil and macrophage phenotypes during wound healing

    PubMed Central

    Tymen, Stéphanie D.; Rojas, Isolde G.; Zhou, Xiaofeng; Fang, Zong Juan; Zhao, Yan; Marucha, Phillip T.

    2013-01-01

    Previous studies reported that stress delays wound healing, impairs bacterial clearance, and elevates the risk for opportunistic infection. Neutrophils and macrophages are responsible for the removal of bacteria present at the wound site. The appropriate recruitment and functions of these cells are necessary for efficient bacterial clearance. In our current study we found that restraint stress induced an excessive recruitment of neutrophils extending the inflammatory phase of healing, and the gene expression of neutrophil attracting chemokines MIP-2 and KC. However, restraint stress did not affect macrophage infiltration. Stress decreased the phagocytic abilities of phagocytic cells ex vivo, yet it did not affect superoxide production. The cell surface expression of adhesion molecules CD11b and TLR4 were decreased in peripheral blood monocytes in stressed mice. The phenotype of macrophages present at the wound site was also altered. Gene expression of markers of pro-inflammatory classically activated macrophages, CXCL10 and CCL5, were down-regulated; as were markers associated with wound healing macrophages, CCL22, IGF-1, RELMα; and the regulatory macrophage marker, chemokine CCL1. Restraint stress also induced up-regulation of IL10 gene expression. In summary, our study has shown that restraint stress suppresses the phenotype shift of the macrophage population, as compared to the changes observed during normal wound healing, while the number of macrophages remains constant. We also observed a general suppression of chemokine gene expression. Modulation of the macrophage phenotype could provide a new therapeutic approach in the treatment of wounds under stress conditions in the clinical setting. PMID:22884902

  6. Astronaut Joseph Kerwin strapped into sleep restraint in crew quarters

    NASA Image and Video Library

    1973-06-01

    Scientist-Astronaut Joseph P. Kerwin, Skylab 2 science pilot, is photographed strapped into the sleep restraint in the crew quarters of the Orbital Workshop of the Skylab 1 and 2 space station cluster in Earth orbit. Kerwin is wearing the special cap which contains biomedical instrumentation for the M133 Sleep Monitoring Experiment. The purpose of the M133 experiment is to evaluate quantity and quality of sleep during prolonged space flight by the analysis of electroencephalographic (EEG) and electrooculographic (EOG) activity.

  7. Astronaut William Fisher anchored to foot restraint on Discovery

    NASA Image and Video Library

    1985-09-01

    51I-102-048 (4-5 Sept 1985) --- A 35mm frame showing astronaut William F. Fisher standing on the edge of Discovery's cargo bay (in foot restraint) during the second day of a two-day effort to capture, repair and re-release the Syncom IV-3 communications satellite. Astronaut James D. van Hoften, standing on the Discovery's RMS arm, exposed the frame.

  8. Restraint stress alters neutrophil and macrophage phenotypes during wound healing.

    PubMed

    Tymen, Stéphanie D; Rojas, Isolde G; Zhou, Xiaofeng; Fang, Zong Juan; Zhao, Yan; Marucha, Phillip T

    2013-02-01

    Previous studies reported that stress delays wound healing, impairs bacterial clearance, and elevates the risk for opportunistic infection. Neutrophils and macrophages are responsible for the removal of bacteria present at the wound site. The appropriate recruitment and functions of these cells are necessary for efficient bacterial clearance. In our current study we found that restraint stress induced an excessive recruitment of neutrophils extending the inflammatory phase of healing, and the gene expression of neutrophil attracting chemokines MIP-2 and KC. However, restraint stress did not affect macrophage infiltration. Stress decreased the phagocytic abilities of phagocytic cells ex vivo, yet it did not affect superoxide production. The cell surface expression of adhesion molecules CD11b and TLR4 were decreased in peripheral blood monocytes in stressed mice. The phenotype of macrophages present at the wound site was also altered. Gene expression of markers of pro-inflammatory classically activated macrophages, CXCL10 and CCL5, were down-regulated; as were markers associated with wound healing macrophages, CCL22, IGF-1, RELMα; and the regulatory macrophage marker, chemokine CCL1. Restraint stress also induced up-regulation of IL10 gene expression. In summary, our study has shown that restraint stress suppresses the phenotype shift of the macrophage population, as compared to the changes observed during normal wound healing, while the number of macrophages remains constant. We also observed a general suppression of chemokine gene expression. Modulation of the macrophage phenotype could provide a new therapeutic approach in the treatment of wounds under stress conditions in the clinical setting.

  9. Astronaut Joseph Kerwin strapped into sleep restraint in crew quarters

    NASA Technical Reports Server (NTRS)

    1973-01-01

    Scientist-Astronaut Joseph P. Kerwin, Skylab 2 science pilot, is photographed strapped into the sleep restraint in the crew quarters of the Orbital Workshop of the Skylab 1 and 2 space station cluster in Earth orbit. Kerwin is wearing the special cap which contains biomedical instrumentation for the M133 Sleep Monitoring Experiment. The purpose of the M133 experiment is to evaluate quantity and quality of sleep during prolonged space flight by the analysis of electroencephalographic (EEG) and electrooculographic (EOG) activity.

  10. Development of restraint material and tucked fabric joints

    NASA Technical Reports Server (NTRS)

    Mcmullen, J. M.

    1975-01-01

    A study was conducted to evaluate and select a suitable restraint material for the exterior of space suits pressurized to 4.0 PSID for normal operations, and to develop and improve tucked fabric joints for motions associated with the human shoulder, elbow, knee, waist, hip, ankle, and wrist. The many attributes of the end items are summarized to include structural integrity, simplicity, low maintenance, lightweight, high durability, low elongation, full range mobility, long life, and resistance to degradation in the operational environment.

  11. Payload specialist Wubbo Ockels in new sleeping restraint

    NASA Image and Video Library

    1985-10-30

    61A-08-018 (30 Oct.-6 Nov. 1985) --- Wubbo J. Ockels, a Dutch scientists representing the European Space Agency (ESA), crawls from an unique sleeping restraint in D-1 science module. Unlike the other crewmembers on STS 61A, Ockels did not sleep in the middeck of the Challenger. Ockels proposed this concept of sleeping facility and the actual hardware was developed by the Technisch Natur Wetenschappelyk Onderzoek (TNO), a Dutch government organization.

  12. STS-102 Onboard Photograph-The Payload Equipment Restraint System

    NASA Technical Reports Server (NTRS)

    2001-01-01

    In this Space Shuttle STS-102 mission image, the Payload Equipment Restraint System H-Strap is shown at the left side of the U.S. Laboratory hatch and behind Astronaut James D. Weatherbee, mission specialist. PERS is an integrated modular system of components designed to assist the crew of the International Space Station (ISS) in restraining and carrying necessary payload equipment and tools in a microgravity environment. The Operations Development Group, Flight Projects Directorate at the Marshall Space Flight Center (MSFC), while providing operation support to the ISS Materials Science Research Facility (MSRF), recognized the need for an on-orbit restraint system to facilitate control of lose objects, payloads, and tools. The PERS is the offspring of that need and it helps the ISS crew manage tools and rack components that would otherwise float away in the near-zero gravity environment aboard the Space Station. The system combines Kevlar straps, mesh pockets, Velcro and a variety of cornecting devices into a portable, adjustable system. The system includes the Single Strap, the H-Strap, the Belly Pack, the Laptop Restraint Belt, and the Tool Page Case. The Single Strap and the H-Strap were flown on this mission. The PERS concept was developed by industrial design students at Auburn University and the MSFC Flight Projects Directorate.

  13. STS-102 Onboard Photograph-The Payload Equipment Restraint System

    NASA Technical Reports Server (NTRS)

    2001-01-01

    In this Space Shuttle STS-102 mission image, the Payload Equipment Restraint System (PERS) Single-Strap and H-Strap are shown behind astronaut James S. Voss (left) and cosmonaut Yury V. Usachev in the U.S. Laboratory. PERS is an integrated modular system of components designed to assist the crew of the International Space Station (ISS) in restraining and carrying necessary payload equipment and tools in a microgravity environment. The Operations Development Group, Flight Projects Directorate at the Marshall Space Flight Center (MSFC), while providing operation support to the ISS Materials Science Research Facility (MSRF), recognized the need for an on-orbit restraint system to facilitate control of lose objects, payloads, and tools. The PERS is the offspring of that need and it helps the ISS crew manage tools and rack components that would otherwise float away in the near-zero gravity environment aboard the Space Station. The system combines Kevlar straps, mesh pockets, Velcro, and a variety of cornecting devices into a portable, adjustable system. The system includes the Single Strap, the H-Strap, the Belly Pack, the Laptop Restraint Belt, and the Tool Page Case. The Single Strap and the H-Strap were flown on this mission. The PERS concept was developed by industrial design students at Auburn University and the MSFC Flight Projects Directorate.

  14. STS-102 Onboard Photograph-The Payload Equipment Restraint System

    NASA Technical Reports Server (NTRS)

    2001-01-01

    In this Space Shuttle STS-102 mission image, the Payload Equipment Restraint System (PERS) H-Strap is shown at the left side of the U.S. laboratory's hatch. PERS is an integrated modular system of components designed to assist the crew of the International Space Station (ISS) in restraining and carrying necessary payload equipment and tools in a microgravity environment. The Operations Development Group, Flight Projects Directorate at the Marshall Space Flight Center (MSFC), while providing operation support to the ISS Materials Science Research Facility (MSRF), recognized the need for an on-orbit restraint system to facilitate control of lose objects, payloads, and tools. The PERS is the offspring of that need and it helps the ISS crew manage tools and rack components that would otherwise float away in the near-zero gravity environment aboard the Space Station. The system combines Kevlar straps, mesh pockets, Velcro, and a variety of cornecting devices into a portable, adjustable system. The system includes the Single Strap, the H-Strap, the Belly Pack, the Laptop Restraint Belt, and the Tool Page Case. The Single Strap and the H-Strap were flown on this mission. The PERS concept was developed by industrial design students at Auburn University and the MSFC Flight Projects Directorate. Cosmonauts Yury V. Usachev (left), Expedition Two commander and Sergei K. Krikalev, Expedition One flight engineer, are shown inside the U.S. Laboratory in this photograph.

  15. Exploring RNA conformational space under sparse distance restraints.

    PubMed

    Taylor, William R; Hamilton, Russell S

    2017-03-10

    We show that the application of a small number of restraints predicted by coevolution analysis can provide a powerful restriction on the conformational freedom of an RNA molecule. The greatest degree of restriction occurs when a contact is predicted between the distal ends of a pair of adjacent stemloops but even with this location additional flexibilities in the molecule can mask the contribution. Multiple cross-links, especially those including a pseudoknot provided the strongest restraint on conformational freedom with the effect being most apparent in topologically simple folds and less so if the fold is more topologically entwined. Little was expected for large structures (over 300 bases) and although a few strong localised restrictions were observed, they contributed little to the restraint of the overall fold. Although contacts predicted using a correlated mutation analysis can provide some powerful restrictions on the conformational freedom of RNA molecules, they are too erratic in their occurrence and distribution to provide a general approach to the problem of RNA 3D structure prediction from sequence.

  16. Expectancies, dietary restraint, and test meal intake among undergraduate women.

    PubMed

    Sysko, Robyn; Timothy Walsh, B; Terence Wilson, G

    2007-07-01

    This study investigated the relationship between self-reported dietary restraint and expectancies about caloric content on test meal consumption among undergraduate women. Participants completed two test meal sessions during which they were asked to consume as much milkshake from a covered opaque container as they wished. In one session, participants were instructed that the milkshake was made with high-calorie ingredients, and in the other that the milkshake was made with low-calorie ingredients. The milkshakes in both sessions were actually made with the same ingredients. Participants' mean consumption was less on the low-calorie instruction day (402 g) than on the high-calorie instruction day (382 g), but the difference was not statistically significant. In addition, few significant relationships were observed between dietary restraint measures and total intake on either the low- or high-calorie instruction days. Thus, this study supports a growing body of literature indicating that scores on measures of dietary restraint are not related to the actual restriction of food intake.

  17. Drinking motives, drinking restraint and drinking behaviour among young adults.

    PubMed

    Lyvers, Michael; Hasking, Penelope; Hani, Riana; Rhodes, Madolyn; Trew, Emily

    2010-02-01

    Motives to drink alcohol are widely thought to be the proximal cognitive factors involved in the decision to consume alcohol beverages. However it has also been argued that the ability to restrain drinking may be a more proximal predictor of drinking behaviour. The current study aimed to examine the relationships between drinking motives, drinking restraint and both alcohol consumption and alcohol-related problems in a sample of young adults. A sample of 221 young adults (aged 17-34 years) completed self-report measures assessing drinking behaviour, motives for drinking and drinking restraint. Multiple regression analyses revealed that coping, enhancement and social motives were related to alcohol consumption and alcohol-related problems, while Cognitive and Emotional Preoccupation with drinking was related to all criterion variables. Further, the relationship between coping motives and drinking behaviour was mediated by preoccupation with drinking. The results are discussed in light of the roles of drinking motives and drinking restraint in risky drinking among young people, and implications for prevention and early intervention are presented.

  18. Tethered-restraint system for blood collection from ferrets

    SciTech Connect

    Jackson, R.K.; Kieffer, V.A.; Sauber, J.S.; King, G.L.

    1988-10-01

    The laboratory ferret, Mustela putorius furo, recently has come into prominence as a laboratory animal for use in biomedical research. This laboratory has adopted the use of this species because the ferret's emetic response to radiation occurs at a lower dose and has a more rapid onset than that of dogs. One approach for determining the physiological basis of this response is to measure serum levels of various circulating substances before and after irradiation. However, blood collection from the ferret can be difficult because the lack of easily accessible veins and seasonal accumulation of subcutaneous body fat. This report describes a method of tethered-restraint for the ferret in which an in-dwelling venous jugular catheter is implanted for withdrawing blood samples. No interference with the animal's normal activities occurs during the sampling procedure. Each animal is conditioned to the tethered-restraint prior to surgical placement of the catheter. The technique provides a minimally stressful method of restraint. A similar tethering system has been used successfully on several other animal species, such as non-human primates and rats.

  19. Effects of maternal restraint stress and sodium arsenate in mice.

    PubMed

    Rasco, J F; Hood, R D

    1994-01-01

    Either maternal restraint stress or sodium arsenate treatment during pregnancy can cause adverse effects on the mouse conceptus. The current study assessed the effects of both factors administered concurrently. Five treatment groups were used initially: (1) vehicle (H2O) control [C], (2) feed/water deprived [FWD], (3) sodium arsenate [SA], (4) restraint only [R], and (5) sodium arsenate plus restraint [SA+R]. A sixth group, arsenate plus feed/water deprived [SA+FWD], was added later, along with (7) a concurrent arsenate-only control [SAC]. Mated female CD-1 mice in Groups 3, 5, 6, and 7 were injected ip with sodium arsenate (20 mg/kg) on gestation day (GD) 9 (plug = day 1). Group 5 mice were restrained for 12 h beginning immediately after dosing. Groups 4 and 5 were restrained in the supine position from 9:00 a.m. to 9:00 p.m. on GD 9; FWD mice were deprived during that time. All females were killed on GD 18 and subjected to teratologic examination. Significantly increased exencephaly and decreased fetal weight were seen in SA+R Group fetuses. The incidence of supernumerary ribs was significantly higher in the SA+R Group than in the SA Group but did not differ from the R Group. These results add to the evidence that maternal stress combined with a chemical teratogen may have a greater effect on the conceptus than would exposure to either agent alone.

  20. The evolution of reproductive restraint through social communication.

    PubMed

    Werfel, Justin; Bar-Yam, Yaneer

    2004-07-27

    The evolution of altruistic behavior through group selection is generally viewed as possible in theory but unlikely in reality, because individual selection favoring selfish strategies should act more rapidly than group selection favoring cooperation. Here we demonstrate the evolution of altruism, in the form of conditional reproductive restraint based on an explicitly social mechanism, modulated by intrapopulation communication comprising signal and evolved response, in a spatially distributed predatory/parasitic/pathogenic model system. The predatory species consistently comes to exploit a signal implying overcrowding, individuals constraining their reproduction in response, with a corresponding increase in equilibrium reproduction rate in the absence of signal. This signaled restraint arises in a robust way for a range of model spatial systems; it outcompetes non-signal-based restraint and is not vulnerable to subversion by noncooperating variants. In these systems, communication is used to evaluate population density and regulate reproduction accordingly, consistent with central ideas of Wynne-Edwards [Wynne-Edwards, V. C. (1962) Animal Dispersion in Relation to Social Behavior (Hafner, New York)], whose claims about the evolutionary importance of group selection helped ignite decades of controversy. This quantitative simulation model shows how the key evolutionary transition from solitary living to sociality can occur. The process described here of cooperation evolving through communication may also help to explain other major evolutionary transitions such as intercellular communication leading to multicellular organisms.

  1. Exploring RNA conformational space under sparse distance restraints

    PubMed Central

    Taylor, William R.; Hamilton, Russell S.

    2017-01-01

    We show that the application of a small number of restraints predicted by coevolution analysis can provide a powerful restriction on the conformational freedom of an RNA molecule. The greatest degree of restriction occurs when a contact is predicted between the distal ends of a pair of adjacent stemloops but even with this location additional flexibilities in the molecule can mask the contribution. Multiple cross-links, especially those including a pseudoknot provided the strongest restraint on conformational freedom with the effect being most apparent in topologically simple folds and less so if the fold is more topologically entwined. Little was expected for large structures (over 300 bases) and although a few strong localised restrictions were observed, they contributed little to the restraint of the overall fold. Although contacts predicted using a correlated mutation analysis can provide some powerful restrictions on the conformational freedom of RNA molecules, they are too erratic in their occurrence and distribution to provide a general approach to the problem of RNA 3D structure prediction from sequence. PMID:28281575

  2. Controlled impact demonstration seat/cabin restraint systems: FAA

    NASA Technical Reports Server (NTRS)

    Johnson, R. A.

    1986-01-01

    The FAA restraint system experiments consisted of 24 standard and modified seats, 2 standard galleys and 2 standard overhead compartments. Under the controlled impact demonstration (CID) program, the experimental objective was to demonstrate the effectiveness of individual restraint system designs when exposed to a survivable air-to-ground impact condition. What researchers were looking for was the performance exhibited by standard and modified designs, performance differences resulting from their installed cabin location, and interrelating performance demonstrated by test article and attaching floor and/or fuselage structure. The other restraint system experiment consisted of 2 standard overhead stowage compartments and 2 galley modules. Again, researchers were concerned with the retention of stowed equipment and carry-on articles. The overhead compartments were loaded with test weights up to their maximum capacity, and each of the galleys was filled with test articles: aft with normal galley equipment, forward with hazardous material test packages. A breakdown of instrumentation and distribution is given beginning with 11 instrumented type anthropomorphic dummies and 185 sensors which provided for acceleration and load measurements at the various experiment and associated structure locations. The onboard cameras provided additional coverage of these experiments, including the areas of cabin which were not instrumented. Test results showing the window-side leg forces versus pulse duration are given.

  3. Exercising restraint: clinical, legal and ethical considerations for the patient with Alzheimer's disease.

    PubMed

    McBrien, Barry

    2007-04-01

    The number of older people using emergency care is increasing steadily and older people account for over half of all emergency admissions. In the emergency setting, nurses caring for older people with Alzheimer's disease can be faced with many complex ethical and legal challenges. Moreover, challenges such as the use of physical restraint can precipitate conflict when the nurse is placed in the precarious position of doing good, respecting autonomy and avoiding paternalism. Although, there is no complete set of "rules" that can provide nurses with an answer to each dilemma, it is of significant value for nurses to have sound knowledge of ethical and legal positions in order to analyse the many complex situations that they may encounter.

  4. Physics.

    ERIC Educational Resources Information Center

    Bromley, D. Allan

    1980-01-01

    The author presents the argument that the past few years, in terms of new discoveries, insights, and questions raised, have been among the most productive in the history of physics. Selected for discussion are some of the most important new developments in physics research. (Author/SA)

  5. Physics.

    ERIC Educational Resources Information Center

    Bromley, D. Allan

    1980-01-01

    The author presents the argument that the past few years, in terms of new discoveries, insights, and questions raised, have been among the most productive in the history of physics. Selected for discussion are some of the most important new developments in physics research. (Author/SA)

  6. The use of restraint in four general hospital emergency departments in Australia.

    PubMed

    Gerace, Adam; Pamungkas, Dewi R; Oster, Candice; Thomson, Del; Muir-Cochrane, Eimear

    2014-08-01

    The purpose of this study was to investigate restraint use in Australian emergency departments (EDs). A retrospective audit of restraint incidents in four EDs (from 1 January 2010 to 31 December 2011). The restraint rate was 0.04% of total ED presentations. Males and females were involved in similar numbers of incidents. Over 90% of restrained patients had a mental illness diagnosis and were compulsorily hospitalised. Mechanical restraint with the use of soft shackles was the main method used. Restraint was enacted to prevent harm to self and/or others. Median incident duration was 2 hours 5 minutes. In order to better integrate the needs of mental health clients, consideration is needed as to what improvements to procedures and the ED environment can be made. EDs should particularly focus on reducing restraint duration and the use of hard shackles. © The Royal Australian and New Zealand College of Psychiatrists 2014.

  7. Effect of restraint stress on nociceptive responses in rats: role of the histaminergic system.

    PubMed

    Ibironke, G F; Mordi, N E

    2011-12-20

    Stress induced analgesia (SIA) is well known, but the reverse phenomenon, hyperalgesia is poorly documented. This study investigated the role of the histaminergic system in restraint stress hyperalgesia in rats, using thermal stimulation method (hot plate and tail flick tests). Paw licking and tail withdrawal latencies were taken before and after restraint for about one hour. Significant decreases (p<0.05) were obtained in these latencies after the restraint in both tests. Administration of H1 and H2 receptor blockers, chlorpheniramine and cimetidine respectively 30 mins before the restraint still resulted in significant reductions (p<0.05) in these latencies, connoting the persistence of hyperalgesia, showing that histamine H1 and H2 receptors did not participate in the mechanism of restraint stress hyperalgesia. We therefore suggest a histaminergic independent mechanism for restraint stress induced hyperalgesia.

  8. Behavioral Effects of Acclimatization To Restraint Protocol Used for Awake Animal Imaging

    PubMed Central

    Reed, Michael D.; Pira, Ashley S.; Febo, Marcelo

    2013-01-01

    Functional MRI of awake rats involves acclimatization to restraint to minimize motion. We designed a study to examine the effects of an acclimatization protocol (5 days of restraint, 60 minutes per day) on the emission of 22-kHz ultrasonic vocalizations and performance on a forced swim test (FST). Our results show that USV calls are reduced significantly by day 3, 4 and 5 of acclimatization. Although rats show less climbing activity (and more immobility) in FST on day 5 compared to the 1st day of restraint acclimatization, the difference is gone once animals are given a 2 week hiatus. Overall, we show that animals adapt to the restraint over the five day period, however, restraint may introduce confounding behavioral outcomes that may hinder the interpretation of results derived from awake rat imaging. The present data warrant further testing of the effects of MRI restraint on behavior. PMID:23562621

  9. Behavioral effects of acclimatization to restraint protocol used for awake animal imaging.

    PubMed

    Reed, Michael D; Pira, Ashley S; Febo, Marcelo

    2013-07-15

    Functional MRI in awake rats involves acclimatization to restraint to minimize motion. We designed a study to examine the effects of an acclimatization protocol (5 days of restraint, 60 min per day) on the emission of 22-kHz ultrasonic vocalizations and performance in a forced swim test (FST). Our results showed that USV calls are reduced significantly by days 3, 4 and 5 of acclimatization. Although the rats showed less climbing activity (and more immobility) in FST on day 5 compared to the 1st day of restraint acclimatization, the difference was not detected once the animals were given a 2-week hiatus. Overall, we showed that animals adapt to the restraint over a five-day period; however, restraint may introduce confounding behavioral outcomes that may hinder the interpretation of results derived from awake rat imaging. The present data warrants further testing of the effects of MRI restraint on behavior. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. Ensemble models of proteins and protein domains based on distance distribution restraints.

    PubMed

    Jeschke, Gunnar

    2016-04-01

    Conformational ensembles of intrinsically disordered peptide chains are not fully determined by experimental observations. Uncertainty due to lack of experimental restraints and due to intrinsic disorder can be distinguished if distance distributions restraints are available. Such restraints can be obtained from pulsed dipolar electron paramagnetic resonance (EPR) spectroscopy applied to pairs of spin labels. Here, we introduce a Monte Carlo approach for generating conformational ensembles that are consistent with a set of distance distribution restraints, backbone dihedral angle statistics in known protein structures, and optionally, secondary structure propensities or membrane immersion depths. The approach is tested with simulated restraints for a terminal and an internal loop and for a protein with 69 residues by using sets of sparse restraints for underlying well-defined conformations and for published ensembles of a premolten globule-like and a coil-like intrinsically disordered protein. © 2016 Wiley Periodicals, Inc.

  11. Whole body vibration and dynamic restraint.

    PubMed

    Hopkins, T; Pak, J O; Robertshaw, A E; Feland, J B; Hunter, I; Gage, M

    2008-05-01

    The purpose of this study was to identify changes due to whole body vibration in peroneus longus (PL) activation following ankle inversion perturbation. Participants were 22 (age 22.1 +/- 1.8 yrs, ht 168.8 +/- 8.2 cm, mass 65.5 +/- 11.2 kg) physically active male and female students with no recent history of lower extremity injury. Measurements of PL electromechanical delay (EMD), reaction time, and muscle activation were collected from two groups (WBV and control) over 3 time intervals (pretreatment, posttreatment, and 30 min posttreatment). Two-way ANOVAs were used to compare groups over time for all dependent variables. No group x time interactions were detected (p < 0.05) for any of the dependent variables. Whole body vibration did not alter PL EMD, reaction time, peak EMG, or average EMG. The use of WBV for enhancing ankle dynamic stability was not supported by this study. However, more data are needed to determine if WBV is an effective intervention in other areas of injury prevention or rehabilitation. These data were not consistent with the hypothesis that WBV enhances muscle spindle sensitivity.

  12. Biomechanics of seat belt restraint system.

    PubMed

    Sances, Anthony; Kumaresan, Srirangam; Herbst, Brian; Meyer, Steve; Hock, Davis

    2004-01-01

    Seat belt system restrains and protects occupants in motor vehicle crashes and any slack in seat belt system induces additional loading on occupant. Signs of belt loading are more obvious in high-speed frontal collisions with heavy occupants. However subtle changes may occur at low speeds or with low forces from occupants during rollovers. In certain cases, the seat belt webbing is twisted and loaded by the occupant. The loading of webbing induces an observable fold/crimp on the seat belt. The purpose of the study is to biomechanically evaluate the force required to produce such marks using an anthropometric physical test dummy. Two tests were conducted to determine the amount of force required to put an observable fold/crimp in a shoulder belt. A head form designed by Voight Hodgson was used to represent the neck which interacted with the belt. The force was applied with a pneumatic pull ram (central hydraulic 89182 N) and the force was measured with a 44,000 N transducer load cell (DSM-10K). Results indicate that the force of over 1,000 N produced a fold or crimp in the belt.

  13. Accounting for pairwise distance restraints in FFT-based protein-protein docking.

    PubMed

    Xia, Bing; Vajda, Sandor; Kozakov, Dima

    2016-11-01

    ClusPro is a heavily used protein-protein docking server based on the fast Fourier transform (FFT) correlation approach. While FFT enables global docking, accounting for pairwise distance restraints using penalty terms in the scoring function is computationally expensive. We use a different approach and directly select low energy solutions that also satisfy the given restraints. As expected, accounting for restraints generally improves the rank of near native predictions, while retaining or even improving the numerical efficiency of FFT based docking.

  14. Dietary restraint, anxiety, and the relative reinforcing value of snack food in non-obese women.

    PubMed

    Goldfield, Gary S; Legg, Christine

    2006-11-01

    This study tested the independent and interactive effects of anxiety and dietary restraint on the relative reinforcing value of snack food. Thirty non-obese, female university students were assigned to one of four groups based on median split scores on measures of dietary restraint and state-anxiety: low-restraint/low-anxiety (n=7), low-restraint/high-anxiety (n=7), high-restraint/low-anxiety (n=9), and high-restraint/high-anxiety (n=7). Participants were provided the choice to earn points for palatable snack foods or fruits and vegetables using a computerized concurrent schedules choice task. The behavioural cost to gain access to snack foods increased across trials, whereas the cost to gain access to fruits and vegetables was held constant across trials. The relative reinforcing value of palatable snack food in relation to fruits and vegetables was defined as the total amount of points earned for snack food. Two-way analysis of covariance, with hunger and hedonic snack food ratings as covariates, showed that dietary restraint and anxiety had a significant interactive effect on the relative reinforcing value of snack food, indicating that the effect of anxiety on snack food reinforcement is moderated by dietary restraint. Specifically, the high-anxiety/low-restraint women found snack food significantly less reinforcing than low-anxiety/low-restraint women, but no differences emerged between high- and low-anxiety women with high-restraint. Neither restraint nor anxiety had an independent effect on the relative reinforcing value of snack food. These findings indicate that anxiety may have a suppressive effect on the relative reinforcing value of snack food in low-restrained eaters, but not an enhancing effect on snack food reinforcement in high-restrained eaters. Clinical implications of these findings are discussed.

  15. Patterns of Restraint Utilization in a Community Hospital's Psychiatric Inpatient Units.

    PubMed

    Jacob, Theresa; Sahu, Geetanjali; Frankel, Violina; Homel, Peter; Berman, Bonnie; McAfee, Scot

    2016-03-01

    Restraint use in psychiatry has been a topic of clinical and ethical debate for years. As much as the medical community desires to attain the goal of a restraint-free environment, there are not many alternatives available when it comes to protecting the safety of violent patients and those around them. Our objective was to examine patterns of restraint use and analyze the factors leading to its use in adult psychiatric inpatient units. We conducted a retrospective review of restraint orders from January 2007 to December 2012, for inpatient units at a community mental health hospital, examining-unit, patient gender, number and duration of restraint episodes, time of day, and whether medications and/or verbal redirection were used. For the 6-year period studied, a total of 1753 restraint order-sheets were filed for 455 patients. Mixed-model regression found significant differences in duration of restraint episodes depending on: patient gender, unit, medication use, verbal redirection and AM/PM shifts. These differences were consistent over time with no significant interactions with years and remained significant when included together in an overall multivariate model. We elucidate variable patterns of restraint utilization correlating with elements such as patient gender, time of day and staff shift, medication use, and attempts at verbally redirecting the patient. Besides providing much needed data on the intricate dynamics influencing restraint use, we suggest steps to implement hospital-wide restraint-reduction initiatives including cultural changes related to restraint usage, enhanced staff-training in conflict de-escalation techniques and personalized treatment plans for foreseeable restraint episodes.

  16. Keep it together: restraints in crystallographic refinement of macromolecule–ligand complexes

    PubMed Central

    Steiner, Roberto A.; Tucker, Julie A.

    2017-01-01

    A short introduction is provided to the concept of restraints in macromolecular crystallographic refinement. A typical ligand restraint-generation process is then described, covering types of input, the methodology and the mechanics behind the software in general terms, how this has evolved over recent years and what to look for in the output. Finally, the currently available restraint-generation software is compared, concluding with some thoughts for the future. PMID:28177305

  17. Keep it together: restraints in crystallographic refinement of macromolecule-ligand complexes.

    PubMed

    Steiner, Roberto A; Tucker, Julie A

    2017-02-01

    A short introduction is provided to the concept of restraints in macromolecular crystallographic refinement. A typical ligand restraint-generation process is then described, covering types of input, the methodology and the mechanics behind the software in general terms, how this has evolved over recent years and what to look for in the output. Finally, the currently available restraint-generation software is compared, concluding with some thoughts for the future.

  18. Using interactive virtual presence to support accurate installation of child restraints: Efficacy and parental perceptions.

    PubMed

    Schwebel, David C; Tillman, M Alison; Crew, Marie; Muller, Matthew; Johnston, Anna

    2017-09-01

    Child restraint systems (car seats) reduce injury risk for young children involved in motor-vehicle crashes, but parents experience significant difficulty installing child restraints correctly. Installation by certified child passenger safety (CPS) technicians yields more accurate installation, but is impractical for broad distribution. A potential solution is use of interactive virtual presence via smartphone application (app), which permits "hands on" teaching through simultaneous and remote joint exposure to 3-dimensional images. In two studies, we examined the efficacy of remote communication via interactive virtual presence to help parents install child restraints. Study 1 was conducted at existing car seat checkpoints and Study 2 at preschools/daycare centers. In both cases, existing installations were assessed by certified CPS technicians using an objective coding scheme. Participants then communicated with remotely-located certified CPS technicians via a smartphone app offering interactive virtual presence. Technicians instructed participants to install child restraints and then the installation was inspected by on-site technicians. Both before and after the remote interaction, participants completed questionnaires concerning perception of child restraints and child restraint installation, self-efficacy to install child restraints, and perceived risk of injury to children if they were in a crash. In both studies, accuracy of child restraint installations improved following the remote interaction between participants and certified CPS technicians. Together, the two samples achieved a weighted average of 90% correct installations across a multi-point inspection. Both samples reported increased self-efficacy to install child restraints and altered perceptions about the accuracy of the child restraint installations in their vehicles. Findings support use of interactive virtual presence as a strategy to realize accurate installation of child restraints

  19. Occupant Restraint in the Rear Seat: ATD Responses to Standard and Pre-tensioning, Force-Limiting Belt Restraints

    PubMed Central

    Forman, Jason; Michaelson, Jarett; Kent, Richard; Kuppa, Shashi; Bostrom, Ola

    2008-01-01

    Recent studies have shown that restrained occupants over the age of 50 in frontal crashes have a higher risk of injury in the rear seat than in the front, and have hypothesized that the incorporation of technology such as belt pre-tensioning and force limiting preferentially in the front seat is at least partially responsible for this trend. This study investigates the potential benefits and trade-offs of seat belt pretensioners and force-limiters in the rear seat using a series of frontal impact sled tests at two speeds (48 km/h and 29 km/h ΔV) with a buck representing the interior of the reat seat occupant compartment of a contemporary mid-sized sedan. Four different dummies were tested: the Hybrid III six year old (in a booster seat, H3 6YO), the Hybrid III 5th percentile female (H3 AF05), the Hybrid III 50th percentile male (H3 AM50), and the THOR-NT. The restraints consisted of either a standard three point belt, or a 3-point belt with a retractor pretensioner and a progressive force-limiter (FL+PT). Each test condition was repeated in triplicate. The FL+PT restraints (compared to the standard restraints) resulted in a significant (p≤0.05) decrease in peak internal chest deflection for each of the Hybrid III dummies at both test speeds (48 km/h: 29% decrease for H3 6YO, 38% decrease for H3 AF05, 30% decrease for H3 AM50), and for the THOR-NT at a ΔV of 29 km/h. At 48 km/h, the FL+PT restraint qualitatively decreased the average peak internal chest deflection of the THOR-NT, however this decrease was not statistically significant (p=0.06). Furthermore, the FL+PT system allowed little or no increase in forward head excursion, and improved whole-body kinematics for all dummies by restricting pelvic excursion and slightly increasing torso pitch. The results suggest that the FL+PT system studied here may provide injury-reducing benefit to rear seat occupants in moderate to high severity frontal crashes, although more study is needed to evaluate these restraints

  20. Occupant restraint in the rear seat: ATD responses to standard and pre-tensioning, force-limiting belt restraints.

    PubMed

    Forman, Jason; Michaelson, Jarett; Kent, Richard; Kuppa, Shashi; Bostrom, Ola

    2008-10-01

    Recent studies have shown that restrained occupants over the age of 50 in frontal crashes have a higher risk of injury in the rear seat than in the front, and have hypothesized that the incorporation of technology such as belt pre-tensioning and force limiting preferentially in the front seat is at least partially responsible for this trend. This study investigates the potential benefits and trade-offs of seat belt pretensioners and force-limiters in the rear seat using a series of frontal impact sled tests at two speeds (48 km/h and 29 km/h DeltaV) with a buck representing the interior of the reat seat occupant compartment of a contemporary mid-sized sedan. Four different dummies were tested: the Hybrid III six year old (in a booster seat, H3 6YO), the Hybrid III 5(th) percentile female (H3 AF05), the Hybrid III 50(th) percentile male (H3 AM50), and the THOR-NT. The restraints consisted of either a standard three point belt, or a 3-point belt with a retractor pretensioner and a progressive force-limiter (FL+PT). Each test condition was repeated in triplicate. The FL+PT restraints (compared to the standard restraints) resulted in a significant (p < or = 0.05) decrease in peak internal chest deflection for each of the Hybrid III dummies at both test speeds (48 km/h: 29% decrease for H3 6YO, 38% decrease for H3 AF05, 30% decrease for H3 AM50), and for the THOR-NT at a DeltaV of 29 km/h. At 48 km/h, the FL+PT restraint qualitatively decreased the average peak internal chest deflection of the THOR-NT, however this decrease was not statistically significant (p=0.06). Furthermore, the FL+PT system allowed little or no increase in forward head excursion, and improved whole-body kinematics for all dummies by restricting pelvic excursion and slightly increasing torso pitch. The results suggest that the FL+PT system studied here may provide injury-reducing benefit to rear seat occupants in moderate to high severity frontal crashes, although more study is needed to evaluate

  1. The use of mechanical restraint in mental health: a catalyst for change?

    PubMed

    Carr, P G

    2012-09-01

    The Care Quality Commission recently acknowledged the use of mechanical restraint/s as an intervention for the management of self-harm. I implemented the use of mechanical restraint for a female patient in life-threatening circumstances. This involved an exploration of the defining characteristics as well as the history and ethics of mechanical restraint. Informed consent and examining the legal, ethical and organizational frameworks supporting the use of this intervention in the clinical setting were critical to implementation. Ultimately the outcome not only proved to be life saving, but also a 'catalyst for change'. © 2012 Blackwell Publishing.

  2. Quantifying the Relationship Between Vehicle Interior Geometry and Child Restraint Systems

    PubMed Central

    Sherwood, C. P.; Abdelilah, Y.; Crandall, J. R.

    2006-01-01

    The prevention of interactions of children or child restraints with other vehicle structures is critical to child passenger safety. Fifteen current vehicles and seven rear and forward facing child restraint systems were measured in an attempt to quantify the available distance between child restraints and these vehicle structures. Rear facing child restraints exhibited such small amounts of clearance that contact would be expected in the majority of frontal crashes. Upper tethers are critical in the prevention of head contact, while head contact is likely when the upper tether is not used. PMID:16968649

  3. Repeated restraint stress increases seizure susceptibility by activation of hippocampal endoplasmic reticulum stress.

    PubMed

    Zhu, Xinjian; Dong, Jingde; Xia, Zhengrong; Zhang, Aifeng; Chao, Jie; Yao, Honghong

    2017-09-05

    A growing body of evidence suggests that stress triggers a variety of pathophysiological responses. Recent studies show that stress produces enduring effects on structure and function of hippocampus, which is one of the most important structures involved in epilepsy. In the present study, we determined the effect of repeated restraint stress exposure on the susceptibility of pentylenetetrazole (PTZ)-induced seizures and the possible mechanisms involved using a rodent model. Our results show that mice subjected to repeated restraint stress exhibited shorter latency to PTZ-induced tonic-clonic seizures and higher seizure severity, suggesting chronic restraint stress increases seizure susceptibility. Following repeated restraint stress, we observed an increased level of endoplasmic reticulum (ER) stress as well as oxidative stress in the hippocampus. Moreover, our results show that chronic restraint stress exposure causes neuron loss in the hippocampus. Inhibition of ER stress with chemical chaperone, tauroursodeoxycholic acid (TUDCA), however, protects against chronic restraint stress-induced neuron loss, suggesting repeated restraint stress-induced neuronal degeneration is dependent on ER stress activation. On the other hand, inhibition of ER stress with TUDCA suppresses restraint stress-induced seizure susceptibility. Taken together, these results indicate that repeated restraint stress increases seizure susceptibility by activation of hippocampal ER stress and ER stress mediated oxidative stress and neurodegeneration. Thus, attenuating ER stress may serve as a potential therapeutic strategy targeted to block stress-induced seizure activities. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Increase in best practice child car restraint use for children aged 2-5 years in low socioeconomic areas after introduction of mandatory child restraint laws.

    PubMed

    Brown, Julie; Keay, Lisa; Hunter, Kate; Bilston, Lynne E; Simpson, Judy M; Ivers, Rebecca

    2013-06-01

    To examine changes in child car restraint practices in low socioeconomic areas following the introduction of mandatory child car restraint legislation in New South Wales (NSW), Australia. Data from two cross-sectional studies of child car restraint use at pre-schools, early childhood centres and primary schools before and after the introduction of legislating mandatory age-appropriate car restraint use for children up to the age of seven years was used in this analysis. All included observations were from local government areas with socioeconomic status in the lowest 30% of urban Sydney. Children aged 2-5 years were observed in their vehicles as they arrived at observation sites (107 pre-legislation, 360 post-legislation). Multilevel logistic regression was used to examine changes in observed age-appropriate and correct use of car restraints. Age-appropriate car restraint use was higher post-legislation than pre-legislation. After controlling for child's age, parental income, language spoken at home and adjusting for clustering, the odds of children being appropriately restrained post-legislation were 2.3 times higher than in the pre-legislation sample, and the odds of them being correctly restrained were 1.6 times greater. Results indicate an improvement in car restraint practices among children aged 2-5 in low socioeconomic areas after introduction of child restraint laws. Implications : Despite improvements observed with enhanced legislation, further efforts are required to increase optimal child car restraint use. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

  5. Consumers and Carer perspectives on poor practice and the use of seclusion and restraint in mental health settings: results from Australian focus groups.

    PubMed

    Brophy, Lisa M; Roper, Catherine E; Hamilton, Bridget E; Tellez, Juan José; McSherry, Bernadette M

    2016-01-01

    Seclusion and restraint are interventions currently permitted for use in mental health services to control or manage a person's behaviour. In Australia, serious concerns about the use of such seclusion and restraint have been raised at least since 1993. Consumers and their supporters have also expressed strong views about the harm of these practices. This paper presents the results of ten focus group discussions with people with lived experience of mental health issues and also carers, family members and support persons in relation to the use of seclusion and restraint. The 30 consumers and 36 supporters participating in the focus groups convened in four Australian cities and one regional centre discussed their understandings of the use of seclusion and restraint and its impact on the people involved. Participants also presented their observations about poor practice and what contributes to it as well as providing ideas and recommendations regarding strategies to reduce or eliminate seclusion and restraint. Focus group discussions were recorded and transcribed, then analysed using the NVivo 10 qualitative data analysis software with a general inductive approach used to analyse data. This analysis enabled consideration of the responses to key questions in the focus groups as well as the identification of emerging themes. Six themes emerged from the analysis, these being: human rights, trauma, control, isolation, dehumanisation and 'othering', and anti-recovery. Examples of poor practice identified by focus groups included the use of excessive force, lack of empathy/paternalistic attitudes, lack of communication and interaction and a lack of alternative strategies to the use of seclusion and restraint. There was a confluence of factors identified by participants as contributing to poor practice, with the main factors being organisational culture, the physical environment, under-resourced mental health services and fear and stigma. Focus group participants in the main

  6. Evaluation of Multi Canister Overpack (MCO) Handling Machine Uplift Restraint for a Seismic Event During Repositioning Operations

    SciTech Connect

    SWENSON, C.E.

    2000-05-15

    Insertion of the Multi-Canister Overpack (MCO) assemblies into the Canister Storage Building (CSB) storage tubes involves the use of the MCO Handling Machine (MHM). During MCO storage tube insertion operations, inadvertent movement of the MHM is prevented by engaging seismic restraints (''active restraints'') located adjacent to both the bridge and trolley wheels. During MHM repositioning operations, the active restraints are not engaged. When the active seismic restraints are not engaged, the only functioning seismic restraints are non-engageable (''passive'') wheel uplift restraints which function only if the wheel uplift is sufficient to close the nominal 0.5-inch gap at the uplift restraint interface. The MHM was designed and analyzed in accordance with ASME NOG-1-1995. The ALSTHOM seismic analysis reported seismic loads on the MHM uplift restraints and EDERER performed corresponding structural calculations to demonstrate structural adequacy of the seismic uplift restraint hardware. The ALSTHOM and EDERER calculations were performed for a parked MHM with the active seismic restraints engaged, resulting in uplift restraint loading only in the vertical direction. In support of development of the CSB Safety Analysis Report (SAR), an evaluation of the MHM seismic response was requested for the case where the active seismic restraints are not engaged. If a seismic event occurs during MHM repositioning operations, a moving contact at a seismic uplift restraint would introduce a friction load on the restraint in the direction of the movement. These potential horizontal friction loads on the uplift restraints were not included in the existing restraint hardware design calculations. One of the purposes of the current evaluation is to address the structural adequacy of the MHM seismic uplift restraints with the addition of the horizontal friction associated with MHM repositioning movements.

  7. An unexpected increase in restraint duration alters the expression of stress response habituation

    PubMed Central

    Kearns, Rachael R.; Spencer, Robert L.

    2013-01-01

    While habituation develops to a repeated psychological stressor, manipulating certain parameters of the stress challenge experience may lead to dishabituation of the stress response. In this experiment, we investigated whether the behavioral, endocrine, and neural responses (c-fos mRNA immediate early gene expression) to a psychological stressor (restraint) differ when the duration of the stressor given on the test day violates expectations based on prior stress experience. Rats experienced 10 min of daily restraint on Days 1-4 followed by challenge with either the same duration (10 min) or a longer duration (30 min) of restraint on Day 5. Rats’ behavior was video recorded during the Day 5 restraint episode, and trunk blood and brain tissue were collected 30 min following restraint onset. Struggling behavior was manually scored as active attempts to escape the restraint device. Rats who experienced the same duration of repeated restraint showed a significant decrease of plasma corticosterone (CORT) compared to the 10 min acute restraint group (habituation). In addition, these rats showed decreased active struggling over repeated restraint trials. Conversely, the rats showed an increased CORT response (dishabituation) when they experienced a longer duration of restraint on Day 5 than they had previously. These rats showed a habituated behavioral response during the first 10 min of restraint, however struggling behavior increased once the duration of restraint exceeded the expected duration (with a peak at 12 min). This peak in struggling behavior did not occur during 30 min acute restraint, indicating that the effect was related to memory of previous restraint experience and not due to a longer duration of restraint. In contrast, these animals showed habituated c-fos mRNA expression in the paraventricular nucleus (PVN), lateral septum (LS), and medial prefrontal cortex (mPFC) in response to the increased stressor duration. Thus, there was dissociation between c

  8. [Therapeutic restraint and freedom of movement, changing practices].

    PubMed

    Perrin-Niquet, Annick

    From confinement to the philosophy of care in the community, the history of psychiatry testifies to the evolution of practices in the matter of the restriction of freedom. The French National Health Authority still too often recommends practices based on restraint. Caregivers, in relation to the clinical aspect of the patients, need clearly identified therapeutic projects. While training can be vital for them, risk management policies can prove to be a hindrance to patients' freedom. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  9. Crew Restraint Design for the International Space Station

    NASA Technical Reports Server (NTRS)

    Norris, Lena; Holden, Kritina; Whitmore, Mihriban

    2006-01-01

    With permanent human presence onboard the International Space Station (ISS), crews will be living and working in microgravity, dealing with the challenges of a weightless environment. In addition, the confined nature of the spacecraft environment results in ergonomic challenges such as limited visibility and access to the activity areas, as well as prolonged periods of unnatural postures. Without optimum restraints, crewmembers may be handicapped for performing some of the on-orbit tasks. Currently, many of the tasks on ISS are performed with the crew restrained merely by hooking their arms or toes around handrails to steady themselves. This is adequate for some tasks, but not all. There have been some reports of discomfort/calluses on the top of the toes. In addition, this type of restraint is simply insufficient for tasks that require a large degree of stability. Glovebox design is a good example of a confined workstation concept requiring stability for successful use. They are widely used in industry, university, and government laboratories, as well as in the space environment, and are known to cause postural limitations and visual restrictions. Although there are numerous guidelines pertaining to ventilation, seals, and glove attachment, most of the data have been gathered in a 1-g environment, or are from studies that were conducted prior to the early 1980 s. Little is known about how best to restrain a crewmember using a glovebox in microgravity. Another ISS task that requires special consideration with respect to restraints is robotic teleoperation. The Robot Systems Technology Branch at the NASA Johnson Space Center is developing a humanoid robot astronaut, or Robonaut. It is being designed to perform extravehicular activities (EVAs) in the hazardous environment of space. An astronaut located inside the ISS will remotely operate Robonaut through a telepresence control system. Essentially, the robot mimics every move the operator makes. This requires the

  10. Crew Restraint Design for the International Space Station

    NASA Technical Reports Server (NTRS)

    Norris, Lena; Holden, Kritina; Whitmore, Mihriban

    2006-01-01

    With permanent human presence onboard the International Space Station (ISS), crews will be living and working in microgravity, dealing with the challenges of a weightless environment. In addition, the confined nature of the spacecraft environment results in ergonomic challenges such as limited visibility and access to the activity areas, as well as prolonged periods of unnatural postures. Without optimum restraints, crewmembers may be handicapped for performing some of the on-orbit tasks. Currently, many of the tasks on ISS are performed with the crew restrained merely by hooking their arms or toes around handrails to steady themselves. This is adequate for some tasks, but not all. There have been some reports of discomfort/calluses on the top of the toes. In addition, this type of restraint is simply insufficient for tasks that require a large degree of stability. Glovebox design is a good example of a confined workstation concept requiring stability for successful use. They are widely used in industry, university, and government laboratories, as well as in the space environment, and are known to cause postural limitations and visual restrictions. Although there are numerous guidelines pertaining to ventilation, seals, and glove attachment, most of the data have been gathered in a 1-g environment, or are from studies that were conducted prior to the early 1980 s. Little is known about how best to restrain a crewmember using a glovebox in microgravity. Another ISS task that requires special consideration with respect to restraints is robotic teleoperation. The Robot Systems Technology Branch at the NASA Johnson Space Center is developing a humanoid robot astronaut, or Robonaut. It is being designed to perform extravehicular activities (EVAs) in the hazardous environment of space. An astronaut located inside the ISS will remotely operate Robonaut through a telepresence control system. Essentially, the robot mimics every move the operator makes. This requires the

  11. Biomechanical analysis of pediatric injuries and child restraint system.

    PubMed

    Kumar, Sri; Harcourt, John; Herbst, Brian; Strickland, Daniel

    2012-01-01

    Airbag related injuries to infants in rear facing child seats are common in frontal crashes. Several vehicular modifications such as deactivated passenger airbags, manual cut-off switches, depowered airbags and smart airbags have been advanced to mitigate the effect of airbag deployment on child seats. However, there is limited research effort to address the biomechanics of airbag injuries due to modification in child restraint systems. The purpose of this research is to evaluate the biomechanical effects of a protective barrier between the rear facing child restraint and the frontal passenger airbag of the vehicle. An experimental study was conducted using an Anthropometric Test Dummy (ATD) in a vehicular partial structure (buck). The rear facing child seat was placed in the right front passenger seat of the vehicle. The child seat was restrained using the three-point restraint in the vehicle. The six-month-old instrumented ATD was restrained in the child seat. The ATD was instrumented with the head tri-axial and two uni-axial linear accelerometers. The uni-axial linear acceleration was used to calculate the angular acceleration. Two different rear facing child seats, the standard rear facing infant seat and the rear facing infant seat inside the protective barrier structure were tested. In each test, the Head Injury Criteria (HIC) and angular head acceleration were measured. Results show that the HIC was reduced by 95% and the angular head acceleration was reduced by 85% by the protective barrier. The head injury values were well below the tolerance limit for the child with the barrier. The protective barrier deflected the airbag away from the ATD’s head and also acted as a shield to minimize airbag force on the child seat. In the typical infant seat, the airbag contacted the ATD’s head and exerted significant force on the child seat which rotated the seat rearward. These kinematic responses may explain the clinical observation of severe head injuries by

  12. Anxiolytic-like effects of restraint during the dark cycle in adolescent mice.

    PubMed

    Ota, Yuki; Ago, Yukio; Tanaka, Tatsunori; Hasebe, Shigeru; Toratani, Yui; Onaka, Yusuke; Hashimoto, Hitoshi; Takuma, Kazuhiro; Matsuda, Toshio

    2015-05-01

    Stress during developmental stage may cause psychological morbidities, and then the studies on stress are important in adolescent rodents. Restraint is used as a common stressor in rodents and the effects of restraint during the light cycle have been studied, but those of restraint during the dark cycle have not. The present study examined the effects of restraint during the light and dark cycles on anxiety behaviors in adolescent mice. Restraint for 3h during either the light or dark cycle impaired memory function in the fear conditioning test, but did not affect locomotor activity. In the elevated plus-maze test, restraint during the dark cycle reduced anxiety-like behaviors in mice. Repeated exposure to a 3-h period dark cycle restraint for 2 weeks had a similar anxiolytic-like effect. In contrast, restraint for 3h during the light cycle produced anxiety behavior in adolescent, but not adult, mice. The light cycle stress increased plasma corticosterone levels, and elevated c-Fos expression in the prefrontal cortex, paraventricular hypothalamic nucleus, basolateral amygdala and dentate gyrus, and enhanced serotonin turnover in the hippocampus and striatum, while the dark cycle stress did not. There was no difference in the stress-mediated reduction in pentobarbital-induced sleeping time between dark and light cycle restraint. These findings suggest that the anxiolytic effect of dark cycle restraint is mediated by corticosterone, serotonin or γ-aminobutyric acid-independent mechanisms, although the anxiogenic effect of light cycle restraint is associated with changes in plasma corticosterone levels and serotonin turnover in specific brain regions. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. Repeated restraint stress produces acute and chronic changes in hemodynamic parameters in rats.

    PubMed

    Sikora, Mariusz; Konopelski, Piotr; Pham, Kinga; Wyczalkowska-Tomasik, Aleksandra; Ufnal, Marcin

    2016-11-01

    Noninvasive hemodynamic measurements in rats require placing animals in restrainers. To minimize restraint stress-induced artifacts several habituation protocols have been proposed, however, the results are inconclusive. Here, we evaluated if a four-week habituation is superior to a shorter habituation, or no habituation. This is the first study comparing different habituation protocols with the use of four-week continuous telemetry measurements. We did the experiments on male, 16-week old, Sprague-Dawley rats. Continuous recordings of mean arterial blood pressure (MABP) and heart rate (HR) were made before and during habituation protocols. Rats were subjected either to control (four weeks of restraint-free recordings, n = 5) or two-week (seven restraints, n = 6) or four-week (14 restraints, n = 6) restraint sessions. The restraint protocols included placement of rats in the middle of the dark phase into plastic restrainers as used for tail-cuff measurements. Restraint lasted for 60 min, and was repeated every second day. Each restraint significantly increased MABP (by 15-25 mmHg) and HR (by 40-120 beats/min). Exposure to the restraint protocols decreased diurnal variation in MABP. There was no hemodynamic adaptation to repeated restraint, and no significant difference in hemodynamic response to restraint among controls, the two-week and the four-week groups. In conclusion, our study indicates that measurements in restrained rats are not likely being made without stress-induced changes in MABP. Moreover, in hemodynamic studies in repeatedly restrained rats longer habituation is not superior to shorter habituation.

  14. Analysis of Seating and Restraint Limitations Restricting Total Body Weight for Aircrew and Passengers on U.S. Army Helicopters

    DTIC Science & Technology

    1993-07-01

    largest available flight suit (size 48L), SRU-21/P survival vest, and webbing restraints accommodate a 47-inch waist circumference . Aviation Life Support Equipment, Restraint, Aircrew, Helicopters, Aircraft seats, Survival vest

  15. Factors Associated with the Use of Restraints in the Public Schools

    ERIC Educational Resources Information Center

    Barnard-Brak, Lucy; Xiao, Feiya; Liu, Xiaoya

    2014-01-01

    The improper use of reported restraints has been associated with serious injury and death in both mental health and school settings. However, there is currently no federal legislation that regulates the use of reported restraints in the schools in contrast to health care facilities (e.g., Children's Health Act of 2000). As children with…

  16. 49 CFR 571.225 - Standard No. 225; Child restraint anchorage systems.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... van-type vehicles, vehicles manufactured to be sold exclusively to the U.S. Postal Service, shuttle..., other than Type I or Type II seat belts, that is involved in transferring loads generated by a child restraint system to the vehicle structure. Child restraint anchorage system means a vehicle system that...

  17. Treatment of Self-Restraint Associated with the Application of Protective Equipment

    ERIC Educational Resources Information Center

    Powers, Katherine V.; Roane, Henry S.; Kelley, Michael E.

    2007-01-01

    The current investigation assessed the effectiveness of protective equipment, specifically arm splints, in reducing the occurrence of severe self-injurious behavior (SIB). Although the protective equipment reduced rates of SIB to near-zero levels, self-restraint subsequently emerged. In an attempt to reduce self-restraint while maintaining…

  18. 32 CFR 884.3 - Placing member under restraint pending delivery.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Placing member under restraint pending delivery. 884.3 Section 884.3 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE MILITARY PERSONNEL DELIVERY OF PERSONNEL TO UNITED STATES CIVILIAN AUTHORITIES FOR TRIAL § 884.3 Placing member under restraint pending...

  19. The Association for Behavior Analysis International Position Statement on Restraint and Seclusion

    ERIC Educational Resources Information Center

    Vollmer, Timothy R.; Hagopian, Louis P.; Bailey, Jon S.; Dorsey, Michael F.; Hanley, Gregory P.; Lennox, David; Riordan, Mary M.; Spreat, Scott

    2011-01-01

    A task force authorized by the Executive Council of the Association for Behavior Analysis International (ABAI) generated the statement below concerning the techniques called "restraint" and "seclusion." Members of the task force independently reviewed the scientific literature concerning restraint and seclusion and agreed unanimously to the…

  20. Weight gain, dietary restraint, and disordered eating in the freshman year of college.

    PubMed

    Delinsky, Sherrie S; Wilson, G Terence

    2008-01-01

    The aims of the study were to assess whether women during the first year of college experience (1) significant weight gain; (2) a prospective relation between dietary restraint and weight gain; (3) an increase in disordered eating; and (4) a prospective relation between dietary restraint or concern about the Freshmen 15 (i.e., weight gain of 15 lbs during the freshman year of college) and disordered eating. Participants were 336 female students in their first year of college who completed questionnaire measures of Body Mass Index (BMI), eating disorder pathology, dietary restraint, body image, and self-esteem. Participants' mean weight gain was approximately 3 lbs (1.5 kg), and among those who gained weight, the mean gain was 7.32 lbs (3.3 kg). Dietary restraint in September did not predict weight change in April, but participants who lost weight reported significantly greater dietary restraint than those participants who gained weight. Eating disorder symptoms increased significantly from September to April. Dietary restraint, concern about the "Freshman 15", and self-esteem in September uniquely predicted EDE-Q Weight and Shape Concern subscale scores in April. Female students in their first year of college gain a small but significant amount of weight, and weight gain was mostly unrelated to dietary restraint. Disordered eating increases during the first year of college and, is predicted by prospective dietary restraint and concerns about weight gain.

  1. 28 CFR 552.24 - Use of four-point restraints.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-point restraints, qualified health personnel shall initially assess the inmate to ensure appropriate... beyond eight hours requires the supervision of qualified health personnel. Mental health and qualified health personnel may be asked for advice regarding the appropriate time for removal of the restraints. (g...

  2. 28 CFR 552.24 - Use of four-point restraints.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...-point restraints, qualified health personnel shall initially assess the inmate to ensure appropriate... beyond eight hours requires the supervision of qualified health personnel. Mental health and qualified health personnel may be asked for advice regarding the appropriate time for removal of the restraints. (g...

  3. 28 CFR 552.24 - Use of four-point restraints.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-point restraints, qualified health personnel shall initially assess the inmate to ensure appropriate... beyond eight hours requires the supervision of qualified health personnel. Mental health and qualified health personnel may be asked for advice regarding the appropriate time for removal of the restraints. (g...

  4. As time goes by: reasons and characteristics of prolonged episodes of mechanical restraint in forensic psychiatry.

    PubMed

    Gildberg, Frederik A; Fristed, Peter; Makransky, Guido; Moeller, Elsebeth H; Nielsen, Lea D; Bradley, Stephen K

    2015-01-01

    Evidence suggests the prevalence and duration of mechanical restraint are particularly high among forensic psychiatric inpatients. However, only sparse knowledge exists regarding the reasons for, and characteristics of, prolonged use of mechanical restraint in forensic psychiatry. This study therefore aimed to investigate prolonged episodes of mechanical restraint on forensic psychiatric inpatients. Documentary data from medical records were thematically analyzed. Results show that the reasons for prolonged episodes of mechanical restraint on forensic psychiatric inpatients can be characterized by multiple factors: "confounding" (behaviors associated with psychiatric conditions, substance abuse, medical noncompliance, etc.), "risk" (behaviors posing a risk for violence), and "alliance parameters" (qualities of the staff-patient alliance and the patients' openness to alliance with staff), altogether woven into a mechanical restraint spiral that in itself becomes a reason for prolonged mechanical restraint. The study also shows lack of consistent clinical assessment during periods of restraint. Further investigation is indicated to develop an assessment tool with the capability to reduce time spent in mechanical restraint.

  5. 28 CFR 552.24 - Use of four-point restraints.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...-point restraints, qualified health personnel shall initially assess the inmate to ensure appropriate... beyond eight hours requires the supervision of qualified health personnel. Mental health and qualified health personnel may be asked for advice regarding the appropriate time for removal of the restraints. (g...

  6. 28 CFR 552.24 - Use of four-point restraints.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-point restraints, qualified health personnel shall initially assess the inmate to ensure appropriate... beyond eight hours requires the supervision of qualified health personnel. Mental health and qualified health personnel may be asked for advice regarding the appropriate time for removal of the restraints. (g...

  7. Factors Associated with the Use of Restraints in the Public Schools

    ERIC Educational Resources Information Center

    Barnard-Brak, Lucy; Xiao, Feiya; Liu, Xiaoya

    2014-01-01

    The improper use of reported restraints has been associated with serious injury and death in both mental health and school settings. However, there is currently no federal legislation that regulates the use of reported restraints in the schools in contrast to health care facilities (e.g., Children's Health Act of 2000). As children with…

  8. Dieting, Dietary Restraint, and Binge Eating Disorder among Overweight Adolescents in Turkey

    ERIC Educational Resources Information Center

    Bas, Murat; Bozan, Nuray; Cigerim, Nevin

    2008-01-01

    The purpose of this study was to determine the relationship among dieting, dietary restraint, disinhibition, hunger, and binge eating among overweight adolescent girls. Participants were 743 overweight adolescent girls between 16 and 19 years of age. The mean BMI was 24.9 [+ or -] 0.8 kg/[m[superscript 2] in the low-restraint group and 25.1 [+ or…

  9. Use of a pitch adjustable foot restraint system: Operator strength capability and load requirements

    NASA Technical Reports Server (NTRS)

    Wilmington, Robert P.; Poliner, Jeffrey; Klute, Glenn K.

    1994-01-01

    The zero-gravity environment creates a need for a proper human body restraint system to maintain a comfortable posture with less fatigue and to maximize productivity. In addition, restraint systems must be able to meet the loading demands of maintenance and assembly tasks performed on orbit. The shuttle's primary intravehicular astronaut restraint system is currently a foot loop design that attaches to flat surfaces on the shuttle, allowing for varying mounting locations and easy egress and ingress. However, this design does not allow for elevation, pitch, or foot loop length adjustment. Several prototype foot restraint systems are being evaluated for use aboard the space station and the space shuttle. The JSC Anthropometry and Biomechanics Laboratory initiated this study to quantify the maximum axial forces and moments that would be induced on a foot loop type of restraint while operators performed a torque wrench task, also allowing for angling the restraint pitch angle to study yet another effect. Results indicate that the greatest forces into the torque wrench and into the foot restraint system occur while the operator performs an upward effort. This study did not see any significant difference in the operators' force due to pitch orientation. Thus, in a work environment in which hand holds are available, no significant influence of the pitch angle on forces imparted to the restraint system existed.

  10. 75 FR 44284 - Notice of Draft NIJ Criminal Justice Restraints Selection and Application Guide

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-28

    ... of Justice Programs Notice of Draft NIJ Criminal Justice Restraints Selection and Application Guide... of Draft NIJ Criminal Justice Restraints Selection and Application Guide. SUMMARY: In an effort to..., National Institute of Justice (NIJ) will make available to the general public the draft ``NIJ...

  11. Treatment of Self-Restraint Associated with the Application of Protective Equipment

    ERIC Educational Resources Information Center

    Powers, Katherine V.; Roane, Henry S.; Kelley, Michael E.

    2007-01-01

    The current investigation assessed the effectiveness of protective equipment, specifically arm splints, in reducing the occurrence of severe self-injurious behavior (SIB). Although the protective equipment reduced rates of SIB to near-zero levels, self-restraint subsequently emerged. In an attempt to reduce self-restraint while maintaining…

  12. Recent Changes in State Policies and Legislation Regarding Restraint or Seclusion

    ERIC Educational Resources Information Center

    Freeman, Jennifer; Sugai, George

    2013-01-01

    In this article, we describe and evaluate the extent to which recent changes to state-level policy are related to seclusion and restraint in schools and detail what components of comprehensive restraint and seclusion policy are indicated. We examined state policy documents and coded them for the presence of specific characteristics related to…

  13. Are Dietary Restraint Scales Valid Measures of Acute Dietary Restriction? Unobtrusive Observational Data Suggest Not

    ERIC Educational Resources Information Center

    Stice, Eric; Fisher, Melissa; Lowe, Michael R.

    2004-01-01

    The finding that dietary restraint scales predict onset of bulimic pathology has been interpreted as suggesting that dieting causes this eating disturbance, despite the dearth of evidence that these scales are valid measures of dietary restriction. The authors conducted 4 studies that tested whether dietary restraint scales were inversely…

  14. The Association for Behavior Analysis International Position Statement on Restraint and Seclusion

    ERIC Educational Resources Information Center

    Vollmer, Timothy R.; Hagopian, Louis P.; Bailey, Jon S.; Dorsey, Michael F.; Hanley, Gregory P.; Lennox, David; Riordan, Mary M.; Spreat, Scott

    2011-01-01

    A task force authorized by the Executive Council of the Association for Behavior Analysis International (ABAI) generated the statement below concerning the techniques called "restraint" and "seclusion." Members of the task force independently reviewed the scientific literature concerning restraint and seclusion and agreed unanimously to the…

  15. 28 CFR 552.22 - Principles governing the use of force and application of restraints.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Principles governing the use of force and... JUSTICE INSTITUTIONAL MANAGEMENT CUSTODY Use of Force and Application of Restraints on Inmates § 552.22 Principles governing the use of force and application of restraints. (a) Staff ordinarily shall first attempt...

  16. 28 CFR 552.27 - Documentation of use of force and application of restraints incidents.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Documentation of use of force and..., DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CUSTODY Use of Force and Application of Restraints on Inmates § 552.27 Documentation of use of force and application of restraints incidents. Staff shall...

  17. 28 CFR 552.27 - Documentation of use of force and application of restraints incidents.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Documentation of use of force and..., DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CUSTODY Use of Force and Application of Restraints on Inmates § 552.27 Documentation of use of force and application of restraints incidents. Staff shall...

  18. 28 CFR 552.22 - Principles governing the use of force and application of restraints.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Principles governing the use of force and... JUSTICE INSTITUTIONAL MANAGEMENT CUSTODY Use of Force and Application of Restraints on Inmates § 552.22 Principles governing the use of force and application of restraints. (a) Staff ordinarily shall first attempt...

  19. 28 CFR 552.27 - Documentation of use of force and application of restraints incidents.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Documentation of use of force and..., DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CUSTODY Use of Force and Application of Restraints on Inmates § 552.27 Documentation of use of force and application of restraints incidents. Staff shall...

  20. 28 CFR 552.27 - Documentation of use of force and application of restraints incidents.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Documentation of use of force and..., DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CUSTODY Use of Force and Application of Restraints on Inmates § 552.27 Documentation of use of force and application of restraints incidents. Staff shall...

  1. Prior Restraint in High School: Does It Violate Students' First Amendment Rights?

    ERIC Educational Resources Information Center

    Trager, Robert E.

    The Supreme Court of the United States has issued three significant rulings on the question of prior restraint by government officials of material to be published in print media. Each time it ruled that only in exceptional circumstances will prior restraint be permitted. Lower federal courst have not taken the same view regarding prior restraint…

  2. 28 CFR 552.27 - Documentation of use of force and application of restraints incidents.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Documentation of use of force and..., DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CUSTODY Use of Force and Application of Restraints on Inmates § 552.27 Documentation of use of force and application of restraints incidents. Staff...

  3. Recent Changes in State Policies and Legislation Regarding Restraint or Seclusion

    ERIC Educational Resources Information Center

    Freeman, Jennifer; Sugai, George

    2013-01-01

    In this article, we describe and evaluate the extent to which recent changes to state-level policy are related to seclusion and restraint in schools and detail what components of comprehensive restraint and seclusion policy are indicated. We examined state policy documents and coded them for the presence of specific characteristics related to…

  4. Are Dietary Restraint Scales Valid Measures of Acute Dietary Restriction? Unobtrusive Observational Data Suggest Not

    ERIC Educational Resources Information Center

    Stice, Eric; Fisher, Melissa; Lowe, Michael R.

    2004-01-01

    The finding that dietary restraint scales predict onset of bulimic pathology has been interpreted as suggesting that dieting causes this eating disturbance, despite the dearth of evidence that these scales are valid measures of dietary restriction. The authors conducted 4 studies that tested whether dietary restraint scales were inversely…

  5. Dieting, Dietary Restraint, and Binge Eating Disorder among Overweight Adolescents in Turkey

    ERIC Educational Resources Information Center

    Bas, Murat; Bozan, Nuray; Cigerim, Nevin

    2008-01-01

    The purpose of this study was to determine the relationship among dieting, dietary restraint, disinhibition, hunger, and binge eating among overweight adolescent girls. Participants were 743 overweight adolescent girls between 16 and 19 years of age. The mean BMI was 24.9 [+ or -] 0.8 kg/[m[superscript 2] in the low-restraint group and 25.1 [+ or…

  6. 49 CFR 571.213 - Standard No. 213; Child restraint systems.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... vehicle shell means the actual vehicle model part into which the built-in child restraint system is or is... capitalization. (a) The model name or number of the system. (b) The manufacturer's name. A distributor's name may... words are optional) and the restraint's model number and manufacturing date to (insert address) or...

  7. 49 CFR 579.25 - Reporting requirements for manufacturers of child restraint systems.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) REPORTING OF INFORMATION AND COMMUNICATIONS ABOUT POTENTIAL DEFECTS Reporting of Early Warning Information § 579.25 Reporting requirements for manufacturers of child restraint systems. For each reporting period... restraint systems. 579.25 Section 579.25 Transportation Other Regulations Relating to Transportation...

  8. 49 CFR 579.25 - Reporting requirements for manufacturers of child restraint systems.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) REPORTING OF INFORMATION AND COMMUNICATIONS ABOUT POTENTIAL DEFECTS Reporting of Early Warning Information § 579.25 Reporting requirements for manufacturers of child restraint systems. For each reporting period... restraint systems. 579.25 Section 579.25 Transportation Other Regulations Relating to Transportation...

  9. 49 CFR 579.25 - Reporting requirements for manufacturers of child restraint systems.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) REPORTING OF INFORMATION AND COMMUNICATIONS ABOUT POTENTIAL DEFECTS Reporting of Early Warning Information § 579.25 Reporting requirements for manufacturers of child restraint systems. For each reporting period... restraint systems. 579.25 Section 579.25 Transportation Other Regulations Relating to Transportation...

  10. 49 CFR 579.25 - Reporting requirements for manufacturers of child restraint systems.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) REPORTING OF INFORMATION AND COMMUNICATIONS ABOUT POTENTIAL DEFECTS Reporting of Early Warning Information § 579.25 Reporting requirements for manufacturers of child restraint systems. For each reporting period... restraint systems. 579.25 Section 579.25 Transportation Other Regulations Relating to Transportation...

  11. 49 CFR 579.25 - Reporting requirements for manufacturers of child restraint systems.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) REPORTING OF INFORMATION AND COMMUNICATIONS ABOUT POTENTIAL DEFECTS Reporting of Early Warning Information § 579.25 Reporting requirements for manufacturers of child restraint systems. For each reporting period... restraint systems. 579.25 Section 579.25 Transportation Other Regulations Relating to Transportation...

  12. Non-invasive primate head restraint using thermoplastic masks.

    PubMed

    Drucker, Caroline B; Carlson, Monica L; Toda, Koji; DeWind, Nicholas K; Platt, Michael L

    2015-09-30

    The success of many neuroscientific studies depends upon adequate head fixation of awake, behaving animals. Typically, this is achieved by surgically affixing a head-restraint prosthesis to the skull. Here we report the use of thermoplastic masks to non-invasively restrain monkeys' heads. Mesh thermoplastic sheets become pliable when heated and can then be molded to an individual monkey's head. After cooling, the custom mask retains this shape indefinitely for day-to-day use. We successfully trained rhesus macaques (Macaca mulatta) to perform cognitive tasks while wearing thermoplastic masks. Using these masks, we achieved a level of head stability sufficient for high-resolution eye-tracking and intracranial electrophysiology. Compared with traditional head-posts, we find that thermoplastic masks perform at least as well during infrared eye-tracking and single-neuron recordings, allow for clearer magnetic resonance image acquisition, enable freer placement of a transcranial magnetic stimulation coil, and impose lower financial and time costs on the lab. We conclude that thermoplastic masks are a viable non-invasive form of primate head restraint that enable a wide range of neuroscientific experiments. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. Robustness Improvement of ARA Kevlar Holddown Restraint Cables

    NASA Astrophysics Data System (ADS)

    Bongers, E.; Koning, J.; Konink, T.

    2013-09-01

    Dutch Space has developed a Hold Down and Release System based on Kevlar Restraint cables and Thermal Knife release in the early nineties of the previous century. The system has been qualified for application in the company's solar array families ARA and FRED for GEO, LEO, MEO and scientific deep space missions comprising solar panel stacks ranging from 2 to 6 panels. Beside solar arrays, derivatives of the HDRS have been used for antenna, cooler and experiment cover hold down and release. Over 500 HDRS units have performed with 100% success in space.Today's missions do not differ much in nominal conditions but more extreme failure modes are specified resulting in more extreme temperatures. The restraint cables, which are exposed directly to these limits of the thermal environment, have been upgraded to cope with the new requirements. An extended life time acceleration test program has been defined and executed to demonstrate their robustness.The qualified upper temperature of the system, the most critical one concerning loads, has been increased from 105°C to 125°C.The paper will describe problems experienced at high temperatures, the new design, supporting engineering tests, the measurement of tension distribution in the cables with Raman spectroscopy, and the accelerated test program and its results.Kevlar cables according to this new design are now baseline for solar arrays of the ESA programs Sentinel- 1, Sentinel-2, Galileo FOC, EarthCARE and Aeolus.

  14. Responding with Restraint: What Are the Neurocognitive Mechanisms?

    PubMed Central

    Jahfari, Sara; Stinear, Cathy M.; Claffey, Mike; Verbruggen, Frederick; Aron, Adam R.

    2010-01-01

    ■ An important aspect of cognitive control is the ability to respond with restraint. Here, we modeled this experimentally by measuring the degree of response slowing that occurs when people respond to an imperative stimulus in a context where they might suddenly need to stop the initiated response compared with a context in which they do not need to stop. We refer to the RT slowing that occurs as the “response delay effect.” We conjectured that this response delay effect could relate to one or more neurocognitive mechanism(s): partial response suppression (i.e., “active braking”), prolonged decision time, and slower response facilitation. These accounts make different predictions about motor system excitability and brain activation. To test which neurocognitive mechanisms underlie the response delay effect, we performed two studies with TMS and we reanalyzed fMRI data. The results suggest that the response delay effect is at least partly explained by active braking, possibly involving a mechanism that is similar to that used to stop responses completely. These results further our understanding of how people respond with restraint by pointing to proactive recruitment of a neurocognitive mechanism heretofore associated with outright stopping. ■ PMID:19583473

  15. Non-invasive primate head restraint using thermoplastic masks

    PubMed Central

    Drucker, Caroline B.; Carlson, Monica L.; Toda, Koji; DeWind, Nicholas K.; Platt, Michael L.

    2015-01-01

    Background The success of many neuroscientific studies depends upon adequate head fixation of awake, behaving animals. Typically, this is achieved by surgically affixing a head-restraint prosthesis to the skull. New Method Here we report the use of thermoplastic masks to non-invasively restrain monkeys’ heads. Mesh thermoplastic sheets become pliable when heated and can then be molded to an individual monkey’s head. After cooling, the custom mask retains this shape indefinitely for day-to-day use. Results We successfully trained rhesus macaques (Macaca mulatta) to perform cognitive tasks while wearing thermoplastic masks. Using these masks, we achieved a level of head stability sufficient for high-resolution eye-tracking and intracranial electrophysiology. Comparison with Existing Method Compared with traditional head-posts, we find that thermoplastic masks perform at least as well during infrared eye-tracking and single-neuron recordings, allow for clearer magnetic resonance image acquisition, enable freer placement of a transcranial magnetic stimulation coil, and impose lower financial and time costs on the lab. Conclusions We conclude that thermoplastic masks are a viable non-invasive form of primate head restraint that enable a wide range of neuroscientific experiments. PMID:26112334

  16. Automated Design of Restraint Layer of an Inflatable Vessel

    NASA Technical Reports Server (NTRS)

    Spexarth, Gary

    2007-01-01

    A Mathcad computer program largely automates the design and analysis of the restraint layer (the primary load-bearing layer) of an inflatable vessel that consists of one or more sections having cylindrical, toroidal, and/or spherical shape(s). A restraint layer typically comprises webbing in the form of multiple straps. The design task includes choosing indexing locations along the straps, computing the load at every location in each strap, computing the resulting stretch at each location, and computing the amount of undersizing required of each strap so that, once the vessel is inflated and the straps thus stretched, the vessel can be expected to assume the desired shape. Prior to the development of this program, the design task was performed by use of a difficult-to-use spreadsheet program that required manual addition of rows and columns depending on the numbers of strap rows and columns of a given design. In contrast, this program is completely parametric and includes logic that automatically adds or deletes rows and columns as needed. With minimal input from the user, this program automatically computes indexing locations, strap lengths, undersizing requirements, and all design data required to produce detailed drawings and assembly procedures. It also generates textual comments that help the user understand the calculations.

  17. Different subtypes of impulsivity differentiate uncontrolled eating and dietary restraint.

    PubMed

    Leitch, Margaret A; Morgan, Michael J; Yeomans, Martin R

    2013-10-01

    The current study explored the relationship between three subtypes of impulsivity (Reflection Impulsivity, Impulsive Choice, and Impulsive Action) and measures of uncontrolled eating (TFEQ-D) and restraint (TFEQ-R). Eighty women classified as scoring higher or lower on TFEQ-D and TFEQ-R completed the Matching Familiar Figures Test (MFFT20), Delay Discounting Task (DDT), a Go No Go task, Balloon Analogue Risk Task (BART), and the Barrett Impulsivity Scale-11 (BIS-11). To test whether these relationships were affected by enforced controls overeating, half of the participants fasted the night before and ate breakfast in the laboratory before testing and half had no such control. Women scoring higher on the TFEQ-D were significantly more impulsive on the MFFT20 and BIS-11 overall but not on DDT, Go No Go or BART. Women scoring higher on TFEQ-R were significantly less impulsive on the Go No Go task but did not differ on other measures. The eating manipulation modulated responses on the BART and BIS-11 non-planning scale depending on TFEQ-D classification. These results confirm recent data that high scores on TFEQ-D are related to impulsivity, but imply this relates more to Reflection Impulsivity rather than Impulsive Choice or Action. In contrast restrained eating was associated with better inhibitory control. Taken together, these results suggest that subtypes of impulsivity further differentiate uncontrolled eating and restraint, and suggest that a poor ability to reflect on decisions may underlie some aspects of overeating.

  18. Comparative protein modelling by satisfaction of spatial restraints.

    PubMed

    Sali, A; Blundell, T L

    1993-12-05

    We describe a comparative protein modelling method designed to find the most probable structure for a sequence given its alignment with related structures. The three-dimensional (3D) model is obtained by optimally satisfying spatial restraints derived from the alignment and expressed as probability density functions (pdfs) for the features restrained. For example, the probabilities for main-chain conformations of a modelled residue may be restrained by its residue type, main-chain conformation of an equivalent residue in a related protein, and the local similarity between the two sequences. Several such pdfs are obtained from the correlations between structural features in 17 families of homologous proteins which have been aligned on the basis of their 3D structures. The pdfs restrain C alpha-C alpha distances, main-chain N-O distances, main-chain and side-chain dihedral angles. A smoothing procedure is used in the derivation of these relationships to minimize the problem of a sparse database. The 3D model of a protein is obtained by optimization of the molecular pdf such that the model violates the input restraints as little as possible. The molecular pdf is derived as a combination of pdfs restraining individual spatial features of the whole molecule. The optimization procedure is a variable target function method that applies the conjugate gradients algorithm to positions of all non-hydrogen atoms. The method is automated and is illustrated by the modelling of trypsin from two other serine proteinases.

  19. Association of empathy of nursing staff with reduction of seclusion and restraint in psychiatric inpatient care.

    PubMed

    Yang, Chin-Po Paul; Hargreaves, William A; Bostrom, Alan

    2014-02-01

    Disruptive behavior leading to seclusion or restraint increases with patients in a high-acuity stage of mental illness who have histories of aggressive behavior. The study examined whether greater nursing staff empathy skills and motivation reduced use of seclusion and restraint and whether empathy training can further this effect. In 1,098 nursing shifts in 2 six-month periods one year apart, hierarchical analyses examined the effects of nursing shift and patient characteristics, the effect for each shift of nurses' skill and motivation to use empathy, and whether empathy training reduced use of seclusion and restraint. With controls for shift, patient, and other staffing variables, analyses showed that the presence of more nursing staff with above-average empathy ratings was strongly associated with reduced use of seclusion and restraint but empathy training showed no further benefit. Recruiting and retaining empathic nursing staff may be the best way to reduce the use of seclusion and restraint.

  20. Exploring the use of seclusion and restraint with deaf psychiatric patients: comparisons with hearing patients.

    PubMed

    Diaz, David R; Landsberger, Sarah A

    2010-12-01

    Archival data of seclusion and restraint events in a group of deaf adults (n = 30) was compared with a random sample of hearing adults with intellectual disabilities (ID) (n = 30) and a random sample of hearing adults without ID (n = 51) admitted to a state hospital from 1998 to 2008. Only 12% of the hearing non-ID group experienced a seclusion or restraint versus 43% of the deaf group. The ID group also showed significantly higher rates of seclusion and restraint than the hearing non-ID group (30 vs. 12%). Patients in the deaf and ID group were significantly more likely to be diagnosed with impulse control disorders (23 and 23%, respectively), which may have contributed to the higher utilization of seclusion and restraint procedures in these groups. Deafness-related cultural and linguistic variables that impact the use of seclusion and restraint are reviewed.