Effect of wrist restraint on maximal exercise capacity in healthy volunteers

Each year, reports occur of deaths in individuals, while struggling against physical restraint. The mechanism of these deaths remains unclear. This study aimed to determine the effect of wrist restraint on cardiorespiratory function during maximal exercise. Twelve healthy volunteers underwent 3 incremental maximal exercise tests on a cycle ergometer. In a randomized order, they exercised while unrestrained, with the wrists tied in front of the body or wrists tied behind the back. The primary outcome measures were the number of minutes exercised in each position and heart rate and whole blood lactate level for each stage and on reaching maximum exercise capacity. The mean exercise duration was 19 minutes 6 seconds unrestrained (95% confidence interval [CI] 16 minutes 52 seconds to 20 minutes 57 seconds), 18 minutes 51 seconds (95% CI 17 minutes 51 seconds to 20 minutes 50 seconds) with arms restrained in front and 16 minutes 51 seconds (95% CI 14 minutes 6 seconds to 19 minutes 20 seconds) with the arms restrained behind the body (P = 0.16). There was no significant difference in heart rate or lactate measurements. It is probable that other factors make a more important contribution than wrist restraint behind the body to cardiorespiratory compromise in a struggling and fatigued individual.     

Community‐Based Participatory Research as a Tool for Policy Change: A Case Study of the Southern California Environmental Justice Collaborative

In 2000, a regional rule governing maximum individual cancer risk from stationary facilities in Southern California was dramatically altered, reducing allowable risk levels by 75%. This article uses a case study approach to explore the role of a community‐based participatory research (CBPR) partnership, the Southern California Environmental Justice Collaborative, in producing research and helping spearhead policy advocacy leading to this policy change. It also highlights the role of the collaborative in helping to change the framing of the issue from individual to cumulative risk assessment, so that the regulatory agencies began to reflect this broader thinking in their policymaking. The collaborative's structure and methodology, regional focus, relationships with key decision makers, and its reputation as an important source of both credible science and “people power” were seen as contributing to its effectiveness. The role of contextual factors including a recovering and more regulation‐friendly economy also is highlighted, as are key barriers faced. Implications for other community–academic partnerships working to address regional and statewide public policy are discussed.     

Incorporating Equity into International Water Agreements

River basins have provided resources for the advancement of human civilization from the earliest historic times. With river basin development has also come conflict, particularly in the past century. In response, the international community has developed generalized, global principles for the equitable allocation of water resources between nation-states, most notably through the 1997 United Nations Convention on the Law of the Non-Navigational Uses of International Watercourses. These principles, however, have rarely been explicitly put into practice. To resolve or avert conflict in the world's 261 international river basins, riparian nations have instead relied upon treaties that incorporate basin-specific needs and conditions and define equity at the most local level. An examination of the progression of geographic thought on river basin development reveals a spatial focus that has not evolved beyond the basin and landscape scales. The absence of theoretical underpinnings for global frameworks may explain why riparian nations have not widely adopted general principles for the equitable allocation of water resources in actual treaty practice.