短效催眠药三唑仑、唑吡坦和佐匹克隆对人体认知能力的影响

目的 观察正常人服用短效催眠药三唑仑、唑吡坦和佐匹克隆对认知能力的副作用,为制定飞行人员的合理用药方案提供科学依据。方法 8名健康男性青年志愿者,在4次试验(每次间隔5d)中交叉服用三唑仑0．25mg、唑吡坦10mg、佐匹克隆7．5mg和安慰剂,采用随机双盲设计给药,分别在服药前4h、服药后1h、2h、3h、4h、6h、8h、10h各完成1次认知能力测试,同时观察用药不良反应。测试内容包括：(1)斯坦福嗜睡量表;(2)单双重任务(包括四数连加正确率、心理运动能力及两者复合的双重任务)能力;(3)声光刺激反应(包括声光反应时、声光运动时、临界闪光融合频率和注意分配)能力。用两因素重复测量的方差分析比较药物间与不同用药后时间认知能力的差别。结果与安慰剂组比较,唑吡坦和佐匹克隆在用药后能明显提高斯坦福嗜睡量表分值(安慰剂组最高2．O分,两药物组分别达到4．O和3．4分);唑吡坦、佐匹克隆可明显降低心理运动能力(分别为9．2％和11．0％);唑吡坦可明显降低双重任务保持率;佐匹克隆可明显降低四数连加正确率和双重任务正确率。三唑仑对各项指标的影响均不显著。结论 3种短效催眠药在用药约6h后,对认知能力的影响消失,其中三唑仑的副作用最小。     

解放军预防医学杂志2003年第21卷学科分类总题录索引

述　评加强预防医学学术交流全心全意为部队健康服务　　—纪念《解放军预防医学杂志》创刊 2 0周年　晁福寰 (1) :1………………………………………………高技术战争对军事预防医学训练的要求　及对策张晓丽等 (2 ) :79…………………………………我军恙虫病流行病学研究回顾与展望　陶开华等 (3) :15 7…………………………………………军事作业医学研究现状及展望刘洪涛等 (5 ) :313…………新时期军事医学研究所地位作用及发展　方向探讨王常有等 (6 ) :391………………………………劳动卫生学短效催眠药唑吡坦和三唑仑对人体前庭　功能…     

超生理浓度的软脂酸和瘦素对大鼠胰岛素影响的实验研究

目的研究高浓度长链游离脂肪酸(LC-FFA)即2mM软脂酸(Palmitate) 和/或15ng/ml瘦素(Leptin)对正常成年SD雄性大鼠胰岛培养液中胰岛素(Insulin,Ins)浓度的影响. 方法将经过2mM软脂酸、15ng/ml瘦素处理过的大鼠胰岛培养液用放射免疫分析法测定Ins浓度. 结果①培养第2日,2mM软脂酸组Ins浓度比对照组高,(156.37±9.26)vs(51.28±7.11)(单位mIU/L,以下同),差异有极显著意义(P<0.001); 第4日,(16.62±1.92)vs(19.83±9.27),差异不显著(P>0.05);②培养第2日,15ng/ml瘦素组Ins浓度比对照组高,(176.30±3.20)vs(51.28±7.11),差异有极显著意义(P<0.001);第4日,(18.73±1.72)vs(19.83±9.27),差异不显著 (P>0.05);③培养第2日,2mM软脂酸+15ng/ml瘦素组Ins浓度比对照组高,(166.86±15.87)vs(51.28±7.11),第4日,比对照组浓度低,(10.72±1.72 )vs(19.83±9.27),差异均有极显著意义(P<0.001);④培养第2日,2mM软脂酸组与2mM软脂酸+15ng/ml瘦素组相比,(156.37±9.26)vs(166.86±15.87),Ins浓度差异不显著(P>0.05);第4日,2mM软脂酸组Ins浓度高,(16.62±1.92)vs(10.72±1.72),差异有极显著意义(P<0.001);⑤培养第2日,15ng/ml瘦素组与2mM软脂酸+15ng/ml瘦素组相比,(176.30±3.20)vs(166.86±15.87),差异不显著(P>0.05);第4日,15ng/ml瘦素组Ins浓度高,(18.73±1.72)vs(10.72±1.72),差异有极显著意义(P<0.001);⑥2mM软脂酸组Ins浓度比15ng/ml瘦素组低,培养第2日,(156.37±9.26)vs(176.30±3.20),差异有极显著意义(P<0.001);第4日,(16.62±1.92)vs(18.73±1.72),差异显著 (P<0.05). 结论软脂酸和瘦素均刺激Ins释放; 15ng/ml瘦素在第4日继续对抗2mM软脂酸的脂毒性、脂凋亡作用.     

连续肾替代治疗在外科严重脓毒症并发毛细血管渗漏综合征中的治疗价值

Objective To investigate the clinical therapeutic value of CRRT on severe sepsis coincidence with capillary leak syndrome in surgical patients. Methods 38 patients suffering from severe sepsis coincidence with capillary leak syndrome were random divided into routine group ( n = 18 ) and CRRT group ( n =20). Both groups were given routine treatment, while the patients of CRRT group were given CRRT in addition. Red blood cell count (RBC), haematoglobin level, blood platelets count, leukocyte count, hematocrit (HCT), plasma-albumin level, central venous pressure ( CVP), arterial blood pressure ( ABP), urinary production change of every hour, oxygenation index condition ( PO2\FiO2 ) were measured at 0, 12, 24, 48,72 hour following routine treatment or CRRT. Additionally, serum levels of tumor necrosis factor- a (TNF-α), interleukin-6 (IL-6) and interleukin-8(IL-8) were determined at the same time. Results Blood platelets count, HCT, plasma-albumin level in CRRT group were significantly higher than those of routine group [72 h: (211. 75 ± 45. 23 ) × 109 vs ( 135.67 ± 41.45 ) × 109 ;0. 43 ± 0. 05 vs 0. 35 ±0. 04; (48. 60 ±4. 76) g/L vs (41.17 ±4. 64) g/L, P <0. 01 ]. WBC were significantly lower than those of routine group[72 h:(7.58 ±2.31) ×109 vs (13.77 ±2.67) × 109, P <0.01]. Change of ABP, PO2\FiO2, urinary production for every hour was notably increased than those of routine group [72 h: (94. 25 ±8.60) mmHg vs ( 84. 22 ± 7. 37 ) mmHg; 345. 25 ± 35. 21 vs 304. 22 ± 38. 74; ( 80. 15 ± 14. 54 ) ml vs (62. 72 ± 12. 33) ml, P <0. 01 ]. The serum levels of TNF-α, IL-6 and IL-8 of CRRT group were markedly decreased compared with those of routine group(72 h:249. 55 ±99. 60 vs 368. 83 ±97. 11 ;600. 75 ±98. 31 vs 718. 94 ± 92. 00 ;665. 35 ±138. 44 vs 843. 22 ±123. 95 , P <0. 01,P <0.05). Conclusions CRRT can significantly improve patient's condition, which may be an effective nechanism to treat the surgical patients with severe sepsis coincidence with capillary leak syndrome.     

口腔念珠菌病患者唾液硝酸根分泌能力升高

Objective To observe the alterations of saliva nitrate and nitrite level in patients with oral candidiasis. Methods Parotid saliva and whole saliva were collected from 33 patients and 34 healthy volunteers. Concentrations of nitrate and nitrite in saliva were determined by high-performance liquid chromatography. Follow-up observation was performed on 10 patients after treatment. The data were statistically analyzed with independent-samples t test or paired-samples t test at α=0. 05. Results There was significant increase of the concentrations and secretion rate of parotid saliva nitrate in patient group as compared with controls: (49. 70±0. 50) vs (21.51±0. 60) mg/L (t=2. 692,P=0. 009) and (27.71±0. 50) vs (12. 55±0. 60)μg/min (t=2. 554, P=0. 013), respectively. Significantly increased concentrations and secretion rate of nitrate and nitrite [nitrate: (6. 46±0. 94) vs (1.11±0. 70) mg/L (t=3.792,P=0.000); nitrite: (8.48±0.58) vs (3.39±0.53) mg/L (t=2.888,P=0.005); nitrate secretion rate: (10. 57±0. 91) vs (2. 10±0. 74)μg/min (t=3.464, P=0. 001) ; nitrite secretion rate:(13.91±0.55) vs (6.42±0.58)μg,/min (t=2.397,P=0.020)]were revealed in whole saliva of patients group. Significantly decreased nitrate and nitrite levels were also observed in patients after treatment, especially the changes of parotid saliva nitrate secretion rate [(37. 50±0. 50) vs (14. 34±0. 64)μg/min (t=3. 142, P=0. 012)], whole saliva nitrate [(14.29±1.01) vs (2. 59±1.03) mg/L (t=3.475, P=0. 007)]and whole saliva nitrate secretion rate [(25.97±0. 93) vs (4. 12±1.00)μg/min (t=3. 922,P=0. 003)]. Conclusion The present study revealed the significant increase of salivary nitrate and nitrite level in patients with oral candidiasis is considered to be associated with the host defense reaction.     

口腔念珠菌病患者唾液硝酸根分泌能力升高

Objective To observe the alterations of saliva nitrate and nitrite level in patients with oral candidiasis. Methods Parotid saliva and whole saliva were collected from 33 patients and 34 healthy volunteers. Concentrations of nitrate and nitrite in saliva were determined by high-performance liquid chromatography. Follow-up observation was performed on 10 patients after treatment. The data were statistically analyzed with independent-samples t test or paired-samples t test at α=0. 05. Results There was significant increase of the concentrations and secretion rate of parotid saliva nitrate in patient group as compared with controls: (49. 70±0. 50) vs (21.51±0. 60) mg/L (t=2. 692,P=0. 009) and (27.71±0. 50) vs (12. 55±0. 60)μg/min (t=2. 554, P=0. 013), respectively. Significantly increased concentrations and secretion rate of nitrate and nitrite [nitrate: (6. 46±0. 94) vs (1.11±0. 70) mg/L (t=3.792,P=0.000); nitrite: (8.48±0.58) vs (3.39±0.53) mg/L (t=2.888,P=0.005); nitrate secretion rate: (10. 57±0. 91) vs (2. 10±0. 74)μg/min (t=3.464, P=0. 001) ; nitrite secretion rate:(13.91±0.55) vs (6.42±0.58)μg,/min (t=2.397,P=0.020)]were revealed in whole saliva of patients group. Significantly decreased nitrate and nitrite levels were also observed in patients after treatment, especially the changes of parotid saliva nitrate secretion rate [(37. 50±0. 50) vs (14. 34±0. 64)μg/min (t=3. 142, P=0. 012)], whole saliva nitrate [(14.29±1.01) vs (2. 59±1.03) mg/L (t=3.475, P=0. 007)]and whole saliva nitrate secretion rate [(25.97±0. 93) vs (4. 12±1.00)μg/min (t=3. 922,P=0. 003)]. Conclusion The present study revealed the significant increase of salivary nitrate and nitrite level in patients with oral candidiasis is considered to be associated with the host defense reaction.     

睡眠剥夺对大鼠学习能力的影响及机制初步研究

目的 :探讨睡眠剥夺对大鼠学习能力的影响。方法 :采用小平台水环境法建立睡眠剥夺模型 ,以正常组和大平台组作为对照 ,检测大鼠海马一氧化氮 (NO)及一氧化氮合酶 (NOS)含量变化 ,并以Y型迷宫测量大鼠学习能力。结果 :(1)睡眠剥夺 1d、3d、5d组海马NO含量分别为(5 .2 6± 1.34)、(7.6 3± 1.86 )、(7.96± 2 .15 ) μmol·mgprot- 1,NOS含量分别为 (2 .4 6± 0 .6 8)、(2 .97± 0 .73)、(3.18± 0 .82 )U·mgprot- 1,分别高于正常对照组〔(3.4 9± 1.18) μmol·mgprot- 1、(1.32±0 .6 7)U·mgprot- 1〕和大平台组〔(4.35± 1.0 9) μmol·mgprot- 1、(1.89± 0 .6 2 )U·mgprot- 1(P <0 .0 1,0 .0 5 )〕 ;后两组比较无显著性差异。 (2 )睡眠剥夺 3d、5d组迷宫正确反应所需电击次数分别为 (2 8.1± 5 .2 )、(41.4± 7.9)次 ,所需时间为 (136 .4± 2 1.7)、(186 .7± 2 9.8)s ,高于正常对照组的 (2 2 .9± 4 .7)次 ,(10 9.6± 16 .5 )s和大平台组的 (16 .8± 3.5 )次 ,(82 .9± 13.2 )s(P <0 .0 1)。 (3)NO含量与迷宫正确反应所需电击次数及时间有显著正相关关系 (P <0 .0 1)。结论 :睡眠剥夺导致的大鼠学习能力下降可能与NO/NOS的神经毒性作用有关。     

不同价态锰对神经母细胞瘤细胞的氧化损伤作用

目的　探讨不同价态、不同浓度锰引起神经细胞的脂质过氧化对细胞的损伤作用。方法　分别用 0 ,0 2 5 ,0 5 0 ,0 75mmol/L二价锰、三价锰对神经母细胞瘤细胞 (SH SY5Y)染毒 2 4h ,观察测定细胞超氧化物歧化酶 (SOD)、谷胱甘肽过氧化物酶 (GSH Px)、丙二醛 (MDA)、GSH Px/MDA及细胞膜脂荧光各向异性的变化。结果　二价锰、三价锰染毒各低、中、高剂量组细胞SOD活力 [(5 2 2 1 2± 5 7 74 ) ,(4 98 38± 37 2 9) ,(4 6 4 86± 2 4 0 9)和 (4 99 79± 30 86 ) ,(4 77 2 3± 6 1 6 6 ) ,(4 35 95± 74 0 4 )NU/mg蛋白 ]与对照组[(86 1 2 4± 35 74 )NU/mg蛋白 ]比较明显降低 ,差异有显著性 (P <0 0 5 ) ;GSH Px活力 [(1 9 0 4± 5 1 6 ) ,(1 7 74± 5 91 ) ,(1 5 99± 5 6 2 )和 (1 6 5 8± 6 1 9) ,(1 5 79± 7 2 9) ,(1 4 2 3± 5 2 0 )活力单位 ]均较对照组[(2 9 2 3± 7 83)活力单位 ]降低 ,差异有非常显著性 (P <0 0 1 ) ;GSH Px/MDA较对照组降低 ,差异有显著性 (P <0 0 5 ) ,而MDA和细胞膜脂荧光各向异性有所升高 (P <0 0 5 ) ;相同染毒剂量情况下 ,三价锰组上述指标的变化比二价锰组明显。结论　锰通过抑制SOD、GSH Px活力 ,降低细胞抗氧化能力 ,造成细胞膜功能的损伤。三     

感染性脑水肿发生的机理研究

目的　观察实验性感染性脑水肿时β -内啡肽 (β -EP)的变化以探讨感染性脑水肿的发病机理。方法　采用兔百日咳菌液感染性脑水肿模型 ,观察生理盐水组 (NS ,n =7)、百日咳菌液组 (PB ,n =7)两组兔脑组织含水量、大脑皮层、海马、血浆及脑脊液中 β -EP含量变化。 结果　PB组脑组织含水量显著高于NS组 (P<0 0 1) ,大脑皮层、海马、血浆及脑脊液中 β -EP含量分别为 (5 6 2 8± 11 6 6 )pg/mg ,(85 97± 33 76 )pg/mg ,(10 6 33± 2 4 96 )ng/ml,(2 4 9± 0 6 6 )ng/ml,均显著高于NS组 (18 5 0± 2 0 1)pg/mg ,(2 2 5 2± 6 0 7)pg/mg ,(43 80± 19 6 3)ng/ml,(1 14± 0 39)ng/ml,P均小于 0 0 1)。结论　感染性脑水肿时 ,大脑皮层、海马、血浆及脑脊液中β -EP含量明显增加 ,引起脑水肿的发生和发展。     

肝细胞生长因子改善移植小肠的粘膜屏障功能

目的 :了解肝细胞生长因子 (HGF)对改善移植小肠粘膜屏障功能的作用。　方法 :以Wistar大鼠为供体 ,SD大鼠为受体 ,行异位全小肠移植 ,并以环孢素A(CsA) 6mg/(kg·d)肌注 ,抑制排斥反应 ;肝细胞生长因子组(HGF组 )用微量输液泵持续均匀输入HGF 15 0 μg/(kg·d) ;对照组输入等量等渗盐水。于第 7天以乳果糖及甘露醇对移植小肠进行灌注 ,第 8天采集移植肠系膜淋巴结及门静脉血行细菌培养。　结果 :对照组尿液中乳果糖含量 (0 .0 931± 0 .0 0 85vs 0 .0 15 0± 0 .0 0 2 0 ,P =0 .0 0 0 1)及乳果糖 /甘露醇比率 (0 .132± 0 .0 2 1vs0 .0 2 0± 0 .0 0 5 ,P=0 .0 0 0 1)明显高于正常标准。HGF组乳果糖含量 (0 .0 396± 0 .0 0 90vs 0 .0 15 0± 0 .0 0 2 0 ,P =0 .0 0 2 3)及乳果糖 /甘露醇比率 (0 .0 5 6± 0 .0 13vs 0 .0 2 0± 0 .0 0 5 ,P =0 .0 0 17)也较正常标准增加 ,且两项指标均显著低于对照组(P <0 .0 5 )。HGF组移植肠系膜淋巴结细菌培养阳性率为 10 % ,对照组为 6 0 % ,明显高于HGF组 (P =0 .0 2 8)。HGF组与对照组门静脉血培养细菌阳性率无显著差异。　结论 :HGF能够降低同种移植小肠粘膜的通透性及细菌移位率 ,改善肠粘膜屏障功能。     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.