Assaults and Microaggressions Against Psychiatric Residents: Findings from a US Survey.

OBJECTIVES: Psychiatric physicians may experience higher rates of assault than those in other fields. For many reasons, residents may be especially vulnerable. This study updates rates of assaults among US psychiatry residents as well as the reporting rates and emotional effects of these incidents. Little data exists to examine rates of microaggressions against psychiatry residents. METHODS: A cross-sectional online survey was distributed through a national residency database via a snowball-sampling approach between June and September of 2021. The questionnaire asked about experiences of verbal, physical, and sexual assaults, as well as microaggressions and their impact. Descriptive analyses of the obtained data were conducted. RESULTS: The survey was completed by 275 psychiatry residents from 29 states (63.6% women). At least one form of assault was experienced by 78.9% of participants with 74.5% experiencing verbal, 22.2% experiencing physical, and 6.2% experiencing sexual assault. At least one type of microaggression was experienced by 86.9% of trainees. Elevations in PTSD scores were seen in residents who identified as women and non-White and those physically injured or sexually assaulted. While 92.7% of residents stated their program provided training about assault, 25% of residents indicated they had no training on recognizing and responding to microaggressions. CONCLUSIONS: Psychiatric residents experience widespread assault and microaggressions in the clinical setting but often do not report them. Due to the ubiquitous nature of these events, programs should provide training about early recognition and de-escalation techniques for agitation, responding effectively to microaggressions, and the importance of reporting events.

The human factors of mineworker fatigue: An overview on prevalence, mitigation, and what's next.

BACKGROUND: Though mining remains a vital shiftwork industry for U.S. commerce, problems of continued prevalence of mineworker fatigue and its mitigation persist. Publications and reports on fatigue in mining appear to be rich and diverse, yet variable and remote, much like the industry itself. METHODS: The authors engaged in a brief nonexhaustive overview of the literature on sleep and fatigue among mineworking populations. RESULTS: This overview covers: potential sources of fatigue unique to mine work (e.g., monotonous and disengaging Work Tasks, underground environments and light exposure, remote work operations); evaluation of mitigation strategies for mineworker fatigue or working hours (e.g., shift-scheduling and training); and areas for future research and practice (e.g., fatigue risk management systems in mining, mineworker sleep and fatigue surveillance, lighting interventions, and automation). CONCLUSIONS: Fatigue continues to be a critical challenge for the mining industry. While research on the problems and solutions of mineworker fatigue has been limited to date, the future of fatigue research in mining can expand these findings by exploring the origins, nature, and outcomes of fatigue using advancements in lighting, automation, and fatigue risk management.

The Utilization of a Rapid Agitation Scale and Treatment Protocol for Patient and Staff Safety in an Inpatient Psychiatric Setting.

Agitation is a common and potentially dangerous condition requiring rapid recognition and treatment in acute psychiatric units. Prompt intervention can prevent a patient with agitation from harming themselves, harming others, or needing restraints or seclusion. After the review of numerous guidelines, the Modified Agitation Severity Scale (MASS) agitation treatment protocol was developed to identify and manage agitation in an inpatient adult psychiatric setting. This protocol involved modifying an existing agitation scale and pairing scores with a treatment algorithm to indicate which behavioral and medication interventions would be most appropriate. All scoring and interventions were recorded in the electronic medical record (EMR). Three months of data were collected before and after the protocol was implemented. The new, modified scale had high reliability and correlated well with another validated agitation scale. Perceived patient safety was high during both study phases. Nurses' perceptions of safety trended upward after the protocol was implemented, though these differences were not significant, likely due to insufficient power. Although there was no decrease in seclusion events after implementation of the treatment protocol, there was a 44% decrease in restraint events and average restraint minutes per incident. Despite a potential increase in workload for nursing staff, implementation of the protocol did not increase burnout scores. Physicians continued to order the protocol for 55% of patients after the study period ended. These findings suggest that including a rapid agitation assessment and protocol within the EMR potentially improves nurses' perceptions of unit safety, helps assess treatment response, reduces time patients spend restrained, and supports decision making for nurses.

Behavioural sleep interventions in infants: Plan B - Combining models of responsiveness to increase parental choice.

In families with infants between the ages of 6 and 18 months, sleep disruption can be significant, often putting parents at risk of a range of negative psychological and psychosocial consequences. Commonly prescribed sleep interventions typically involve 'extinction' methods, which require parents to completely or periodically ignore their infant's overnight cries. These methods can be effective in many, but not all cases. For over 40 years 30-40% of parents have consistently reported difficulty ignoring their child. For this group, ignoring their child is behaviourally and/or ideologically difficult with attrition often leading to a perceived sense of failure. For these parents the treatment may be worse than the problem. On the other hand, there is emerging evidence to support the use of more responsive methods for those who find extinction approaches behaviourally or ideologically challenging. In this paper we propose an integrated, less polarised approach to infant behavioural sleep interventions that better caters to those who have difficulty with extinction methods - our so-called 'Plan B'. This approach potentially resolves the often opposing ideological and theoretical perspectives of extinction versus responsiveness into a practical, complementary and pragmatic treatment framework. Recommendations on how best to implement Plan B are also presented. In our view, Plan B could provide practitioners with a logically integrated well-targeted suite of clinical interventions that could potentially improve compliance, reduce attrition and ultimately benefit the sleep and well-being of all infants and their parents, especially those who struggle with traditional extinction methodologies.

Fatigue and short-term unplanned absences among police officers.

PURPOSE ­: The purpose of this paper is to assess whether shift work, sleep loss and fatigue are related to short-term unplanned absences in policing. DESIGN/METHODOLOGY/APPROACH ­: N = 367 police officers from the Buffalo Police Department were studied. Day-by-day work and sick leave data were obtained from the payroll. Absenteeism was defined as taking a single sick day on a regularly scheduled workday. Biomathematical models of fatigue (BMMF) predicted officers' sleep-wake behaviors and on-duty fatigue and sleepiness. Prior sleep, fatigue and sleepiness were tested as predictors of absenteeism during the next shift. FINDINGS ­: A total of 513,666 shifts and 4,868 cases of absenteeism were studied. The odds of absenteeism increased as on-duty fatigue and sleepiness increased and prior sleep decreased. This was particularly evident for swing shift officers and night shift officers who were predicted by BMMF to obtain less sleep and have greater fatigue and sleepiness than day shift officers. The odds of absenteeism were higher for female officers than male officers; this finding was not due to a differential response to sleep loss, fatigue or sleepiness. PRACTICAL IMPLICATIONS ­: Absenteeism may represent a self-management strategy for fatigue or compensatory behavior to reduced sleep opportunity. Long and irregular work hours that reduce sleep opportunity may be administratively controllable culprits of absenteeism. ORIGINALITY/VALUE ­: Police fatigue has consequences for police officers, departments and communities. BMMF provide a potential tool for predicting and mitigating police fatigue. BMMF were used to investigate the effects of sleep and fatigue on absenteeism.

Sleep Schedule Regularity Is Associated with Sleep Duration in Older Australian Adults: Implications for Improving the Sleep Health and Wellbeing of Our Aging Population.

OBJECTIVES: The National Sleep Foundation (NSF) recommends 7 to 9 hours of sleep per night for adults ≥ 65 years of age. Sleep duration below 7h per night has been associated with negative health consequences, so enabling older adults to obtain at least 7 hours per night is important for health and wellbeing. However, little is known about behavioral factors that support sleep duration (≥ 7h/24h) in this group. Our aim was to determine factors associated with sleep duration in older adults, and evaluate the utility of sleep schedule regularity in particular, given the relationship between lifestyle regularity (of which sleep is an important component) and health in this population. METHODS: A sample of 311 Australian adults (≥ 65 years old; 156 male, 155 female) completed a telephone survey assessing sleep history over the prior 24 hours, sleep schedule regularity, demographic and health factors as part of a larger study of the Australian population. RESULTS: Sleep schedules with variability in bed and rise times of > 60 minutes were associated with increased odds of reporting sleep duration below 7 hours per night (< 7h/24h; OR = 2.38, CI = 1.26-4.48, p = .007). No other behaviors were associated with meeting sleep duration recommendations. CONCLUSIONS: Sleep schedule regularity may be associated with sleep duration (≥ 7h/24h) in older adults. CLINICAL IMPLICATIONS: Empowering older adults to maintain sleep schedule regularity may be a practical and efficacious strategy to support sleep durations that are in line with recommendations (≥ 7h/24h).

Epidemiology of mass casualty incidents in the United States.

OBJECTIVE: We sought to characterize and estimate the frequency of mass casualty incidents (MCIs) occurring in the United States during the year 2010, as reported by emergency medical services (EMS) personnel. METHODS: Using the 2010 National EMS Database of the National Emergency Medical Services Information System (NEMSIS), containing data from 32 states and territories, we estimated and weighted the frequency of MCIs documented by EMS personnel based on their perception of the event to produce incidence rates of MCIs per 100,000 population and MCIs per 1,000 9-1-1 calls requesting EMS service. We conducted descriptive analyses to characterize the MCIs by geographic location, incident type, and time of day as well as the MCI patients by demographic and health information. We used chi-squared tests to compare response delays and two-tailed t-tests to compare system response times between EMS responses documented as MCIs and those not. RESULTS: Among the 9,776,094 EMS responses in the 2010 National EMS Database, 14,504 entries were documented as MCI. These entries represented an estimated 9,913 unique MCIs from the National EMS Database: 39.1% occurred in the South Atlantic region of the United States where only 19.1% of the population resides, 60.9% occurred in an urban setting, and 58.4% occurred on a street or highway. There were an estimated 13,677 MCI patients. The prehospital EMS personnel's primary impressions of the patients ranged from electrocution (0.01%) to traumatic injury (40.7%). Of the patients with a primary impression of injury (N = 7,960), motor vehicle traffic crash was the cause of injury for 62.7%. Among the MCI EMS responses, 47.6% documented experiencing a response delay compared to only 12.3% of non-MCI EMS responses. CONCLUSIONS: This study demonstrates the range of health conditions and characteristics of EMS responses that EMS personnel perceive as MCIs, suggests that response delays are common during MCIs, and indicates there may be underreporting of all persons involved in an MCI. The National EMS Database is useful for describing MCIs and may help guide national leadership in strengthening EMS system preparedness for MCIs.

An evidence-based prehospital guideline for external hemorrhage control: American College of Surgeons Committee on Trauma.

This report describes the development of an evidence-based guideline for external hemorrhage control in the prehospital setting. This project included a systematic review of the literature regarding the use of tourniquets and hemostatic agents for management of life-threatening extremity and junctional hemorrhage. Using the GRADE methodology to define the key clinical questions, an expert panel then reviewed the results of the literature review, established the quality of the evidence and made recommendations for EMS care. A clinical care guideline is proposed for adoption by EMS systems. Key words: tourniquet; hemostatic agents; external hemorrhage.

Estimating informal household food waste in developed countries: the case of Australia.

Food waste is a global problem. In Australia alone, it is estimated that households throw away AU$5.2 billion worth of food (AU$616 per household) each year. Developed countries have formal waste management systems that provide measures of food waste. However, much remains unknown about informal food waste disposal routes and volumes outside of the formal system. This article provides indicative metrics of informal food waste by identifying, in detail, five of the dominant informal food waste disposal routes used by Australian households: home composting, feeding scraps to pets, sewer disposal, giving to charity, and dumping or incineration. Informal waste generation rates are then calculated from three primary data sources, in addition to data from previous Australian and UK surveys, using a weighted average method in conjunction with a Monte-Carlo simulation. We find that the average Australian household disposes of 2.6 kgs of food waste per week through informal routes (1.7 kgs via household composting, 0.2 kgs via animals, and 0.6 kgs via sewage). This represents 20% of Australian household food waste flows. Our results highlight that informal food waste is a sizable food waste flow from Australian homes, deserving of greater research and government attention. Our examination of the full extent of food waste by disposal mode provides waste managers and policy makers with clear disposal routes to target for behaviour change and positive environmental outcomes.

How much advance notice do workers need? A review and theoretical framework for determining advance notice periods for unpredictable work.

Regulatory guidance materials for fatigue management typically advise that employees be provided with days or weeks of advance notice of schedules/rosters. However, the scientific evidence underpinning this advice is unclear. A systematic search was performed on current peer reviewed literature addressing advance notice periods, which found three relevant studies. A subsequent search of grey literature to determine the quality of evidence for the recommendation for advance notice periods returned 37 relevant documents. This review found that fatigue management guidance materials frequently advocated advance notice for work shifts but did not provide empirical evidence to underpin the advice. Although it is logical to suggest that longer notice periods may result in increased opportunities for pre-work preparations, improved sleep, and reduced worker fatigue, the current guidance appears to be premised on this reasoning rather than empirical evidence. Paradoxically, it is possible that advance notice could be counterproductive, as too much may result in frequent alterations to the schedule, particularly where adjustments to start and end times of the work period are not uncommon (e.g., road transport, rail). To assist organisations in determining the appropriate amount of advance notice to provide, we propose a novel theoretical framework to conceptualise advance notice.

The effects of kefir consumption on human health: a systematic review of randomized controlled trials.

CONTEXT: Kefir, a traditional, fermented-milk beverage, has increasingly been promoted for various health benefits. The evidence from systematic reviews, however, is limited. OBJECTIVE: Evidence from randomized controlled trials testing oral consumption of fermented-milk kefir on any outcome of human health or disease. DATA SOURCES: A systematic search of 4 electronic databases (PubMed, Scopus, Allied and Complementary Medicine Database, and Cochrane Trials) from inception to July 31, 2021, was conducted. DATA EXTRACTION: Data extraction and risk-of-bias assessments were conducted by 2 reviewers independently. DATA ANALYSIS: A total of 18 publications reporting the results of 16 studies were included. Per the narrative analysis, fermented-milk kefir may have potential as a complementary therapy in reducing oral Streptococcus mutans, thereby reducing dental caries risk, and in Helicobacter pylori eradication therapy. Kefir may further aid treatment of adult dyslipidemia and hypertension, although evidence was very limited. Safety was only assessed in 5 of the 18 included publications, and 12 of the studies had an overall high risk for bias. CONCLUSION: Kefir is a dairy product with a unique microbiological profile that appears to be a safe for generally healthy populations to consume. However, efficacy and safety data from high-quality human trials are essential before any recommendations may be made for conditions of the oral and gastric microbiota and metabolic health. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42020211494.

How Tired is Too Tired to Drive? A Systematic Review Assessing the Use of Prior Sleep Duration to Detect Driving Impairment.

Driver fatigue is a contributory factor in approximately 20% of vehicle crashes. While other causal factors (eg, drink-driving) have decreased in recent decades due to increased public education strategies and punitive measures, similar decreases have not been seen in fatigue-related crashes. Fatigued driving could be managed in a similar way to drink-driving, with an established point (ie, amount of prior sleep) after which drivers are "deemed impaired". This systematic review aimed to provide an evidence-base for the concept of deemed impairment and to identify how much prior sleep may be required to drive safely. Four online databases were searched (PubMed, Web of Science, Scopus, Embase). Eligibility requirements included a) measurement of prior sleep duration and b) driving performance indicators (eg, lane deviation) and/or outcomes (eg, crash likelihood). After screening 1940 unique records, a total of 61 studies were included. Included studies were categorised as having experimental/quasi-experimental (n = 21), naturalistic (n = 3), longitudinal (n = 1), case-control (n = 11), or cross-sectional (n = 25) designs. Findings suggest that after either 6 or 7 hours of prior sleep, a modest level of impairment is generally seen compared with after ≥ 8 hours of prior sleep (ie, well rested), depending on the test used. Crash likelihood appears to be ~30% greater after 6 or 7 hours of prior sleep, as compared to individuals who are well rested. After one night of either 4 or 5 hours of sleep, there are large decrements to driving performance and approximately double the likelihood of a crash when compared with well-rested individuals. When considering the scientific evidence, it appears that there is a notable decrease in driving performance (and associated increase in crash likelihood) when less than 5h prior sleep is obtained. This is a critical first step in establishing community standards regarding the amount of sleep required to drive safely.

How effective are Fatigue Risk Management Systems (FRMS)? A review.

OBJECTIVE: Fatigue Risk Management Systems (FRMS) are a data-driven set of management practices for identifying and managing fatigue-related safety risks. This approach also considers sleep and work time, and is based on ongoing risk assessment and monitoring. This narrative review addresses the effectiveness of FRMS, as well as barriers and enablers in the implementation of FRMS. Furthermore, this review draws on the literature to provide evidence-based policy guidance regarding FRMS implementation. METHODS: Seven databases were drawn on to identify relevant peer-reviewed literature. Relevant grey literature was also reviewed based on the authors' experience in the area. In total, 2129 records were screened based on the search strategy, with 231 included in the final review. RESULTS: Few studies provide an evidence-base for the effectiveness of FRMS as a whole. However, FRMS components (e.g., bio-mathematical models, self-report measures, performance monitoring) have improved key safety and fatigue metrics. This suggests FRMS as a whole are likely to have positive safety outcomes. Key enablers of successful implementation of FRMS include organisational and worker commitment, workplace culture, and training. CONCLUSIONS: While FRMS are likely to be effective, in organisations where safety cultures are insufficiently mature and resources are less available, these systems may be challenging to implement successfully. We propose regulatory bodies consider a hybrid model of FRMS, where organisations could choose to align with tight hours of work (compliance) controls. Alternatively, where organisational flexibility is desired, a risk-based approach to fatigue management could be implemented.

Safety implications of fatigue and sleep inertia for emergency services personnel.

Emergency services present a unique operational environment for the management of fatigue and sleep inertia. Communities request and often expect the provision of emergency services on a 24/7/365 basis. This can result in highly variable workloads and/or significant need for on-demand or on-call working time arrangements. In turn, the management of fatigue-related risk requires a different approach than in other more predictable shift working sectors (e.g., mining and manufacturing). The aim of this review is to provide a comprehensive overview of fatigue risk management that is accessible to regulators, policy makers and organisations in the emergency services sector. The review outlines the unique fatigue challenges in the emergency services sector, examines the current scientific and policy consensus around managing fatigue and sleep inertia, and finally discusses strategies that emergency services organisations can use to minimise the risks associated with fatigue and sleep inertia.

Guiding principles for determining work shift duration and addressing the effects of work shift duration on performance, safety, and health: guidance from the American Academy of Sleep Medicine and the Sleep Research Society.

Risks associated with fatigue that accumulates during work shifts have historically been managed through working time arrangements that specify fixed maximum durations of work shifts and minimum durations of time off. By themselves, such arrangements are not sufficient to curb risks to performance, safety, and health caused by misalignment between work schedules and the biological regulation of waking alertness and sleep. Science-based approaches for determining shift duration and mitigating associated risks, while addressing operational needs, require: (1) a recognition of the factors contributing to fatigue and fatigue-related risks; (2) an understanding of evidence-based countermeasures that may reduce fatigue and/or fatigue-related risks; and (3) an informed approach to selecting workplace-specific strategies for managing work hours. We propose a series of guiding principles to assist stakeholders with designing a shift duration decision-making process that effectively balances the need to meet operational demands with the need to manage fatigue-related risks.

Guiding principles for determining work shift duration and addressing the effects of work shift duration on performance, safety, and health: guidance from the American Academy of Sleep Medicine and the Sleep Research Society.

CITATION: Risks associated with fatigue that accumulates during work shifts have historically been managed through working time arrangements that specify fixed maximum durations of work shifts and minimum durations of time off. By themselves, such arrangements are not sufficient to curb risks to performance, safety, and health caused by misalignment between work schedules and the biological regulation of waking alertness and sleep. Science-based approaches for determining shift duration and mitigating associated risks, while addressing operational needs, require: (1) a recognition of the factors contributing to fatigue and fatigue-related risks; (2) an understanding of evidence-based countermeasures that may reduce fatigue and/or fatigue-related risks; and (3) an informed approach to selecting workplace-specific strategies for managing work hours. We propose a series of guiding principles to assist stakeholders with designing a shift duration decision-making process that effectively balances the need to meet operational demands with the need to manage fatigue-related risks.

Prediction of probabilistic sleep distributions following travel across multiple time zones.

STUDY OBJECTIVES: To parameterize and validate a model to estimate average sleep times for long-haul aviation pilots during layovers following travel across multiple time zones. The model equations were based on a weighted distribution of domicile- and local-time sleepers, and included algorithms to account for sleep loss and circadian re-synchronization. DESIGN: Sleep times were collected from participants under normal commercial operating conditions using diaries and wrist activity monitors. PARTICIPANTS: Participants included a total of 306 long-haul pilots (113 captains, 120 first officers, and 73 second officers). MEASUREMENT AND RESULTS: The model was parameterized based on the average sleep/wake times observed during international flight patterns from Australia to London and Los Angeles (global R2 = 0.72). The parameterized model was validated against the average sleep/wake times observed during flight patterns from Australia to London (r2 = 0.85), Los Angeles (r2 = 0.79), New York (r2 = 0.80), and Johannesburg (r2 = 0.73). Goodness-of-fit was poorer when the parameterized model equations were used to predict the variance across the sleep/wake cycles of individual pilots (R2 = 0.42, 0.35, 0.31, and 0.28 for the validation flight patterns, respectively), in part because of substantial inter-individual variability in sleep timing and duration. CONCLUSIONS: It is possible to estimate average sleep times during layovers in international patterns with a reasonable degree of accuracy. Models of this type could form the basis of a stand-alone application to estimate the likelihood that a given duty schedule provides pilots, on average, with an adequate opportunity to sleep.

How well do pilots sleep during long-haul flights?

It is imperative that shiftworkers in safety-critical workplaces obtain sufficient sleep to operate effectively. This presents a challenge to long-haul airline pilots who are required to supplement normal bed sleep with sleep on-board an aircraft during flight. In the current study, the sleep/wake behaviour of 301 airline pilots operating long-haul flight patterns was monitored for at least 2 weeks using self-report sleep diaries and wrist activity monitors. The data indicate that sleep opportunities in on-board rest facilities during long-haul flights result in a similar amount of sleep, but only 70% as much recovery, as duration-matched bed sleeps. STATEMENT OF RELEVANCE: This study indicates that in-flight sleep provides airline pilots with 70% as much restoration as duration-matched bed sleep. To increase the restoration provided by in-flight sleep, airlines could take measures to improve the quality, or increase the amount, of sleep obtained by pilots during flights.

Sleep-wake behaviors exhibited by shift workers in normal operations and predicted by a biomathematical model of fatigue.

STUDY OBJECTIVES: To compare rail workers' actual sleep-wake behaviors in normal operations to those predicted by a biomathematical model of fatigue (BMMF). To determine whether there are group-level residual sources of error in sleep predictions that could be modeled to improve group-level sleep predictions. METHODS: The sleep-wake behaviors of 354 rail workers were examined during 1,722 breaks that were 8-24 h in duration. Sleep-wake patterns were continuously monitored using wrist-actigraphy and predicted from the work-rest schedule using a BMMF. Rail workers' actual and predicted sleep-wake behaviors were defined as split-sleep (i.e. ≥2 sleep periods in a break) and consolidated-sleep (i.e. one sleep period in a break) behaviors. Sleepiness was predicted from the actual and predicted sleep-wake data. RESULTS: Consolidated-sleep behaviors were observed during 1,441 breaks and correctly predicted during 1,359 breaks. Split-sleep behaviors were observed during 280 breaks and correctly predicted during 182 breaks. Predicting the wrong type of sleep-wake behavior resulted in a misestimation of hours of sleep during a break. Relative to sleepiness predictions derived from actual sleep-wake data, predicting the wrong type of sleep-wake behavior resulted in a misestimation of sleepiness predictions during the subsequent shift. CONCLUSIONS: All workers with the same work-rest schedule have the same predicted sleep-wake behaviors; however, these workers do not all exhibit the same sleep-wake behaviors in real-world operations. Future models could account for this group-level residual variance with a new approach to modeling sleep, whereby sub-group(s) may be predicted to exhibit one of a number of sleep-wake behaviors.

The likelihood of crashing during a simulated post-work commute decreases across a week of consecutive night shifts.

The aim of this study was to assess the effect of working multiple, consecutive night shifts on crash risk during the morning commute. Participants (36 F, 36 M, aged 23.1 ± 3.6 y) completed a laboratory-based shiftwork protocol with seven consecutive night shifts (23:00-07:00 h) that each started and ended with a 20 min simulated commute. Compared to the corresponding pre-work commutes, the likelihood of crashing during the post-work commutes was 11.0-, 8.5-, and 5.6-fold higher at the start, middle, and end of the week, respectively. The results of this simulation study indicate that crash risk is relatively high during the morning commute but declines throughout a week of night work.