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Long sitting hours and fatigue are common in call centre work. Call centre work is associated with mental exhaustion and physical repercussions such as musculo-skeletal disorders, cardiac problems and hindrances in circadian cycles. The demanding nature of work reduces the autonomy to have flexible working which may lead to physical and mental stress for the employees. While there is some research on adding physical exercises to work routines, there is limited research on utilizing mental games to enhance wellbeing and productivity in the workplace for call centre employees. To address the issue of long sitting hours and the associated health problems in call centres in UK, this research was aimed at bringing flexible work changes, such as introducing mental games in the work breaks to observe outcome on factors such as objective productivity and perceived workload of call centre employees. Three studies were conducted to achieve this goal. As a part of the first study, an online questionnaire survey was sent to call centre employees (n=84) to explore their perception of mental fatigue at work and the extent of their willingness to take breaks and play mental games in those breaks. It was found that the employees were taking adequate breaks but found their work to be tiring and repetitive. Those employees with higher seated time (42%) had a greater urge to take a break as compared to those with shorter hours (37%). Employees who were willing to take breaks also had a greater urge to take a longer break (33% compared to 29% of those not willing to take additional breaks). Similarly, those employees who were seated longer (61% compared to 47%) and willing to take breaks (61% compared to 47%) thought that game playing could help increase productivity. They reported the thought that game playing contributed to mental alertness. As a follow up to the online survey study, employees (n=10) were interviewed to explore the factors contributing to fatigue/monotony in the workplace and the effect that mental game playing might have on perceived workload and objective productivity. Employees were not happy with the structured scheduled breaks. Games were thought to bring a change in scenery and a positive distraction to relieve stress regardless of their role in productivity increase. The main study included a game playing intervention (n=32). This study was conducted to observe the differences in perceived workload and objective productivity in relation to mental game playing during breaks at work. The results showed that perceived workload decreased in the middle of the intervention period for the game playing group, while it decreased in the end of the intervention period for the non-playing group. Similarly, objective productivity increased at the end of the intervention period for the playing group while it increased in the beginning of intervention period for the non-playing group. Both perceived workload and objective productivity scores of the intervention group was less across all weeks (average perceived workload= 41, average objective productivity = 37.7) compared to the comparison group (average perceived workload = 46.25, average objective productivity = 55.62) The final study attempted to understand the results of the game playing intervention study from the participant's perspective and explore other work factors that could affect working conditions. This was achieved through conducting focus group discussions (n=15). Participants reported the increase in playing group productivity in week 4 because of the focus on improving their performance just before completion of the intervention. They reported the decrease in perceived workload in week 2 and week 3, as game playing being mentally accepted in these weeks. Employees also highlighted that working conditions, such as having to play games in the break schedules may help to improve working conditions for call centre employees. The findings of this PhD suggest the use of cognitive break activities as a possible strategy for organizations and professional bodies to improve objective productivity and perceived workload in the workplace. Further research in game playing in the workplace can help improve job design to bring improvement in objective productivity and perceived workload in call centres.

Impaired attention has been found in approximately 1 out of 4 patients with heart failure (HF). Mechanisms of attention impairment are lowered cerebral oxygen supply due to cardiac dysfunction and increased mental effort from dealing with the fatal disease, HF. Although there is evidence that attention impairment is common in these patients and can affect their HF self-care activities, no interventions to date have directly targeted attention in HF patients. To improve attention, natural restorative environment (NRE) interventions have been conducted and found to be efficacious in diverse populations. NRE interventions are based on Attention Restoration Theory, which asserts that when directed attention is rested, it can be restored. Whether NRE intervention is efficacious for HF patients is not known. Thus, the primary aim of this study was to examine the efficacy of a NRE intervention for patients with HF on attention. The secondary aim was to examine its efficacy on mood. A randomized crossover design was used in 20 HF patients and 20 age- and education-matched healthy adults. The NRE intervention involved viewing 50 photographs of nature on a computer and the control condition involved viewing 50 photographs of urban environments. Pre and post intervention, attention was measured by four neuropsychological tests: the Multi-source Interference Task, Trail Making Test, Stroop Test, and Digit Span Test. Mood was measured by the Positive and Negative Affect Schedule. Intervention order was randomly assigned and delivered one week apart. At baseline, poorer attention was found correlated with lower oxygen saturation and greater mental effort in HF patients compared to healthy adults. Linear mixed models in a pooled sample (n = 40) showed that NRE intervention was efficacious in improving attention, specifically sustained attention compared to the control condition. Attention switching, however, was preserved only in healthy participants after the control condition, but decreased in HF patients. Mood did not differ after interventions. The NRE intervention is safe and has the potential to be widely disseminated. Future studies are needed on a larger sample with different intervention doses and a longer period of observations, providing knowledge about optimal quality of the intervention.

The multilevel model (MLM) is easily parameterized to handle partially clustered data (see, for example, Baldwin, Bauer, Stice, & Rohde, 2011). The current study evaluated the performance of this model under various departures from underlying assumptions, including assumptions of normally distributed and homoscedastic Level 1 residuals. Two estimating models – one assuming homoscedasticity, the other allowing for the estimation of unique Level 1 variance components – were compared. Results from a Monte Carlo simulation suggest that the MLM for partially clustered data yields consistently unbiased parameter estimates, except for an underestimation of the Level 2 variance component under heteroscedastic generating conditions. However, this negative parameter bias desisted when the MLM allowed for Level 1 heteroscedasticity. Standard errors for variance component estimates at both levels were underestimated in the presence of nonnormally distributed Level 1 residuals. A discussion of results, as well as suggestions for future research, is provided.

Objective: Cardiotrophin-1 (CT-1) shares some similarities with other cytokines, and participates in the control of energy metabolism. Higher circulating levels are observed in obese humans, but little information is gathered in weight loss (WL) programs. Therefore, we aimed to investigate the association of serum CT-1 levels with metabolic variables and the risk of developing metabolic syndrome (MetS) after a WL program in overweight/obese children. Subjects and Methods: Forty-four overweight/obese children (mean age 11.5 yr; 50% males) undergoing a 10-week WL program were enrolled. Subjects were dichotomized at the median of Body Mass Index-Standard Deviation Score (BMI-SDS) change, as high and low responders after intervention. Results: CT-1 levels were significantly reduced (-48 fmol/mL, p=0.043) in the high responder group after the WL program. They had significantly lower body weight (-3.7 kg, p

In medicine and public health research, the randomized delayed-intervention controlled trial (RDICT), also known as a wait-listed or stepped wedge design, is commonly used to study overt, slow-acting treatments in comparison to a control condition over time. Ten RDICT designs are specified as generalizations of the motivating example, a longitudinal psychology study of a psychoeducational intervention for children with bipolar disorder. These designs vary according to number of observation occasions, time between observations, and length of delay before the control group receives treatment.Two estimators of fixed effects in separate linear mixed effects (LME) models, θ1 and θ2, are proposed to measure treatment effect based on data from an RDICT design. The LME models have a piecewise linear mean structure, allowing phases for treatment, placebo, and leveling-off effects. The treatment effect is traditionally conceptualized as the difference in slopes between the immediate treatment (IT) and pre-intervention control groups, which we call θ1.Alternately, in an RDICT design, the treatment effect can be the change in slope post-intervention in the delayed-treatment (DT) control group, called θ0. The full model, which allows these treatment effects to differ, produces the standard estimator, θ1. A reduced model, nested within the full one, forces the inter and intra treatment effects to be identical and produces the novel estimator, θ2.A simulation study was conducted to observe the relative efficiency of θ2 to θ1 as it varies over the 10 RDICT designs and 8 scenarios, which differ in size of treatment effect, intraclass correlation, and sample allocation to DT group.The best-performing and recommended RDICT design, called H2.5 with a DT:IT allocation ratio of 2:1, achieved a relative efficiency of 1.3 when the group-specific treatment effects are identical. The H2.5 design has the longest overall calendar duration of the 10 designs considered and is an extension of the design used in the motivating example study of childhood mood disorders.