Exonic trinucleotide repeat expansions in ZFHX3 cause spinocerebellar ataxia type 4: A poly-glycine disease.

Autosomal-dominant ataxia with sensory and autonomic neuropathy is a highly specific combined phenotype that we described in two Swedish kindreds in 2014; its genetic cause had remained unknown. Here, we report the discovery of exonic GGC trinucleotide repeat expansions, encoding poly-glycine, in zinc finger homeobox 3 (ZFHX3) in these families. The expansions were identified in whole-genome datasets within genomic segments that all affected family members shared. Non-expanded alleles carried one or more interruptions within the repeat. We also found ZFHX3 repeat expansions in three additional families, all from the region of Skåne in southern Sweden. Individuals with expanded repeats developed balance and gait disturbances at 15 to 60 years of age and had sensory neuropathy and slow saccades. Anticipation was observed in all families and correlated with different repeat lengths determined through long-read sequencing in two family members. The most severely affected individuals had marked autonomic dysfunction, with severe orthostatism as the most disabling clinical feature. Neuropathology revealed p62-positive intracytoplasmic and intranuclear inclusions in neurons of the central and enteric nervous system, as well as alpha-synuclein positivity. ZFHX3 is located within the 16q22 locus, to which spinocerebellar ataxia type 4 (SCA4) repeatedly had been mapped; the clinical phenotype in our families corresponded well with the unique phenotype described in SCA4, and the original SCA4 kindred originated from Sweden. ZFHX3 has known functions in neuronal development and differentiation n both the central and peripheral nervous system. Our findings demonstrate that SCA4 is caused by repeat expansions in ZFHX3.

Stability of Mosaic Divergent Repeat Interruptions in X-Linked Dystonia-Parkinsonism.

BACKGROUND: X-Linked dystonia-parkinsonism (XDP) is an adult-onset neurodegenerative disorder characterized by rapidly progressive dystonia and parkinsonism. Mosaic Divergent Repeat Interruptions affecting motif Length and Sequence (mDRILS) were recently found within the TAF1 SVA repeat tract and were shown to associate with repeat stability and age at onset in XDP, specifically the AGGG [5'-SINE-VNTR-Alu(AGAGGG)2AGGG(AGAGGG)n] mDRILS. OBJECTIVE: This study aimed to investigate the stability of mDRILS frequencies and stability of (AGAGGG)n repeat length during transmission in parent-offspring pairs. METHODS: Fifty-six families (n = 130) were investigated for generational transmission of repeat length and mDRILS. The mDRILS stability of 16 individuals was assessed at two sampling points 1 year apart. DNA was sequenced with long-read technologies after long-range polymerase chain reaction amplification of the TAF1 SVA. Repeat number and mDRILS were detected with Noise-Cancelling Repeat Finder (NCRF). RESULTS: When comparing the repeat domain, 51 of 65 children had either contractions or expansions of the repeat length. The AGGG frequency remained stable across generations at 0.074 (IQR: 0.069-0.078) (z = -0.526; P = 0.599). However, the median AGGG frequency in children with an expansion (0.072 [IQR: 0.066-0.076]) was lower compared with children with retention or contraction (0.080 [IQR: 0.073-0.083]) (z = -0.007; P = 0.003). In a logistic regression model, the AGGG frequency predicted the outcome of either expansion or retention/contraction when including repeat number and sex as covariates (ß = 80.7; z-score = 2.63; P = 0.0085). The AGGG frequency varied slightly over 1 year (0.070 [IQR: 0.063-0.080] to 0.073 [IQR: 0.069-0.078]). CONCLUSIONS: Our results show that a higher AGGG frequency may stabilize repeats across generations. This highlights the importance of further investigating mDRILS as a disease-modifying factor with generational differences. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Recall and Appraisal of the Risks, Benefits, and Objectives of Interrupting HIV Treatment in an HIV Cure-Related Study.

The goal of HIV cure research is to either eliminate HIV from the body or durably suppress it in the absence of antiretroviral therapy (ART). This research often requires participants to interrupt ART. However, there are numerous risks associated with ART interruptions and therefore it is critical to understand how people with HIV (PWH) who participate recall the elements of consent, to safeguard their rights and welfare. Participants were recruited from the SCOPE Analytic Treatment Interruption (SCOPE-ATI: NCT04359186) study at the University of California San Francisco. We interviewed 12 SCOPE-ATI participants to assess their recall of informed consent elements and therapeutic misconception, using the Brief Informed Consent Evaluation Protocol (BICEP). Interviewees were primarily older adults, male, White, and non-Hispanic/Latinx. Their responses indicated that they understood the primary purpose of the SCOPE-ATI study to be scientific research. Nearly all participants demonstrated high recall of key elements of consent and no therapeutic misconception. We also found that the role of study staff was a major factor in participants' appraisal of risks and that associated psychosocial risks of pausing ART were of minimal concern (e.g., anxiety off ART, possible forward HIV transmission to sex partners). As HIV cure research expands, it is important to reiterate the duty of the investigative team to clearly communicate with participants about the associated risks and to assess their understanding throughout these studies.

Assessing the Burden of Electrical, Elevator, Heat, Hot Water, and Water Service Interruptions in New York City Public Housing.

Reliable electricity, elevators, heat, hot water, and water are aspects of safe and accessible housing. Interruptions to these services represent a persistent challenge faced by public housing residents in the New York City Housing Authority (NYCHA). We compiled outage data spanning 2020-2022 from NYCHA's online service interruptions portal and paired these data with demographic and meteorological sources to understand the burden of these outages. To ease dissemination of these data-a spatiotemporally granular outage dataset that could fill gaps surrounding urban outage health impacts-we provide a public dashboard for visualization and download of the service interruption data in an analysis-ready format. We demonstrated that (1) outages often exceeded health-relevant restoration windows (e.g., 8 h for electrical interruptions); (2) senior developments (exclusively residents 62 +) had the longest duration of elevator, heat, and hot water outages; and (3) outages sometimes overlapped with temperature extremes-potentially increasing their health risk. Residents of NYCHA, who are predominately low-income, Black, and Hispanic face a disproportionate burden of service interruptions. Like all New Yorkers, NYCHA residents deserve to live in dignified housing that is safe and accessible. Addressing service interruptions are one way to make public housing safer and push toward climate and environmental justice.

Mosaic divergent repeat interruptions in XDP influence repeat stability and disease onset.

While many genetic causes of movement disorders have been identified, modifiers of disease expression are largely unknown. X-linked dystonia-parkinsonism (XDP) is a neurodegenerative disease caused by a SINE-VNTR-Alu(AGAGGG)n retrotransposon insertion in TAF1, with a polymorphic (AGAGGG)n repeat. Repeat length and variants in MSH3 and PMS2 explain ∼65% of the variance in age at onset (AAO) in XDP. However, additional genetic modifiers are conceivably at play in XDP, such as repeat interruptions. Long-read nanopore sequencing of PCR amplicons from XDP patients (n = 202) was performed to assess potential repeat interruption and instability. Repeat-primed PCR and Cas9-mediated targeted enrichment confirmed the presence of identified divergent repeat motifs. In addition to the canonical pure SINE-VNTR-Alu-5'-(AGAGGG)n, we observed a mosaic of divergent repeat motifs that polarized at the beginning of the tract, where the divergent repeat interruptions varied in motif length by having one, two, or three nucleotides fewer than the hexameric motif, distinct from interruptions in other disease-associated repeats, which match the lengths of the canonical motifs. All divergent configurations occurred mosaically and in two investigated brain regions (basal ganglia, cerebellum) and in blood-derived DNA from the same patient. The most common divergent interruption was AGG [5'-SINE-VNTR-Alu(AGAGGG)2AGG(AGAGGG)n], similar to the pure tract, followed by AGGG [5'-SINE-VNTR-Alu(AGAGGG)2AGGG(AGAGGG)n], at median frequencies of 0.425 (IQR: 0.42-0.43) and 0.128 (IQR: 0.12-0.13), respectively. The mosaic AGG motif was not associated with repeat number (estimate = -3.8342, P = 0.869). The mosaic pure tract frequency was associated with repeat number (estimate = 45.32, P = 0.0441) but not AAO (estimate = -41.486, P = 0.378). Importantly, the mosaic frequency of the AGGG negatively correlated with repeat number after adjusting for age at sampling (estimate = -161.09, P = 3.44 × 10-5). When including the XDP-relevant MSH3/PMS2 modifier single nucleotide polymorphisms into the model, the mosaic AGGG frequency was associated with AAO (estimate = 155.1063, P = 0.047); however, the association dissipated after including the repeat number (estimate = -92.46430, P = 0.079). We reveal novel mosaic divergent repeat interruptions affecting both motif length and sequence (DRILS) of the canonical motif polarized within the SINE-VNTR-Alu(AGAGGG)n repeat. Our study illustrates: (i) the importance of somatic mosaic genotypes; (ii) the biological plausibility of multiple modifiers (both germline and somatic) that can have additive effects on repeat instability; and (iii) that these variations may remain undetected without assessment of single molecules.

Model analysis and data validation of structured prevention and control interruptions of emerging infectious diseases.

The design of optimized non-pharmaceutical interventions (NPIs) is critical to the effective control of emergent outbreaks of infectious diseases such as SARS, A/H1N1 and COVID-19 and to ensure that numbers of hospitalized cases do not exceed the carrying capacity of medical resources. To address this issue, we formulated a classic SIR model to include a close contact tracing strategy and structured prevention and control interruptions (SPCIs). The impact of the timing of SPCIs on the maximum number of non-isolated infected individuals and on the duration of an infectious disease outside quarantined areas (i.e. implementing a dynamic zero-case policy) were analyzed numerically and theoretically. These analyses revealed that to minimize the maximum number of non-isolated infected individuals, the optimal time to initiate SPCIs is when they can control the peak value of a second rebound of the epidemic to be equal to the first peak value. More individuals may be infected at the peak of the second wave with a stronger intervention during SPCIs. The longer the duration of the intervention and the stronger the contact tracing intensity during SPCIs, the more effective they are in shortening the duration of an infectious disease outside quarantined areas. The dynamic evolution of the number of isolated and non-isolated individuals, including two peaks and long tail patterns, have been confirmed by various real data sets of multiple-wave COVID-19 epidemics in China. Our results provide important theoretical support for the adjustment of NPI strategies in relation to a given carrying capacity of medical resources.

Cross-sectional associations between temporal patterns and composition of upright and stepping events with physical function in midlife: Insights from the 1970 British Cohort Study.

INTRODUCTION: Age-related decline in physical functioning has significant implications for health in later life but declines begin earlier in midlife. Physical activity (PA) volume is associated with physical function, but the importance of the pattern in which PA is accumulated is unclear. This study investigates associations between patterns of PA accumulation, including the composition, variation, and temporal distribution of upright and stepping events, with physical function in midlife. METHODS: Participants (n = 4378) from the 1970 British Cohort Study wore an activPAL3 accelerometer on the thigh for 7 consecutive days. Exposure measures included a suite of metrics describing the frequency, duration, and composition of upright events, as well as the duration and volume (total steps) of stepping events. In addition, patterns of accumulation of upright and sedentary events were examined including how fragmented/transient they were (upright-to-sedentary transition probability [USTP]) and their burstiness (the tendency for events to be clustered together followed by longer interevent times). Physical function outcomes included grip strength (GS), balance, and SF-36 physical functioning subscale (SF-36pf). Cross-sectional analyses included multivariable linear regression models to assess associations, adjusting for covariates including overall PA volume (mean daily step count). RESULTS: Higher upright event burstiness was associated with higher GS, and higher USTP was associated with lower GS. Duration and step volume of stepping events were positively associated with SF-36pf in females. Step-weighted cadence was positively associated with SF-36pf and balance. Contradictory findings were also present (e.g., more transient stepping events were associated with better GS) particularly for GS in males. Inconsistencies between sexes were observed across some associations. CONCLUSION: Our study reveals that diverse patterns of PA accumulation exhibit distinct associations with various measures of physical function in midlife, irrespective of the overall volume. Contradictory findings and inconsistency between sexes warrant further investigation. Patterns of PA accumulation, in addition to volume, should be considered in future PA research. Longitudinal studies are required to determine whether a given volume of activity accumulated in different patterns, impacts associations between PA and health outcomes.

Unravelling upright events: a descriptive epidemiology of the behavioural composition and temporal distribution of upright events in participants from the 1970 British Cohort Study.

BACKGROUND: Continued proliferation of accelerometers in physical activity research has opened new avenues for understanding activity behaviours beyond simple aggregate measures of frequency and duration. This study explores the standing and stepping composition, and the temporal distribution, of upright events, and investigates their associations with sociodemographic and health factors. METHODS: Participants from the 1970 British Cohort Study wore activPAL3 accelerometers for seven days. Event-based analysis was used to extract a time series of upright, standing, and stepping events. Derived metrics included daily number of upright and stepping events, total upright and stepping time, the burstiness of upright events and burstiness of sedentary events (burstiness refers to the pattern of how physical activity and sedentary behaviour are distributed throughout a given time period), within-event stepping proportion, within-event step count, and stepping cadence. Generalized linear regression models, adjusted for total step count, were employed to explore associations between derived metrics and sociodemographic and health-related factors. RESULTS: A total of 4527 participants, provided 30992 valid days (≥ 10 h of waking wear) and 1.64 million upright events. Upright event composition and temporal distribution varied across a range of sociodemographic and health-related factors. Females had more upright events than males (4.39 [3.41,5.38] n), spent more time upright, and exhibited burstier patterns of upright events (0.05 [0.04,0.05] Bn). Individuals with higher BMI had fewer upright events and a lower daily step count, but their temporal distribution of upright events was less bursty (overweight -0.02 [-0.02,-0.01] Bn; obese -0.03 [-0.04,-0.02] Bn), and upright events had a higher step count. People in active occupations were upright for longer, displayed burstier patterns of upright events (standing 0.04 [0.03,0.05] Bn; physical work 0.05 [0.04,0.05] Bn; heavy manual 0.06 [0.04,0.07] Bn), with more variable durations and shorter, slower paced stepping events compared with sedentary occupations. CONCLUSIONS: This study has revealed novel phenotypes of standing and sitting that go beyond simple aggregate measures of total steps, step event duration or time between events. People with the same volume of stepping and frequency of gaps between upright events can accumulate their steps in very different ways. These differences and associations with population sub-groups, which persisted after adjustment for total stepping volume, may have important relations with functional and health outcomes. The findings lay the groundwork for future studies to investigate how different sitting and standing phenotypes can add to our understanding of the relationship between physical activity and health.

Examining the cognitive processes underlying resumption costs in task-interruption contexts: Decay or inhibition of suspended task goals?

To examine whether an ongoing primary task is inhibited when switching to an interruption task, we implemented the n - 2 backward inhibition paradigm into a task-interruption setting. In two experiments, subjects performed two primary tasks (block-wise manipulation) consisting of a predefined sequence of three subtasks. The primary tasks differed regarding whether the last subtask switched or repeated relative to the penultimate subtask, resulting in n - 1 switch subtasks (e.g., ABC) and n - 1 repetition subtasks (e.g., ACC) as the last subtask of the primary task. Occasionally, an interruption task was introduced before the last subtask of a primary task, changing the last subtask of the primary task from a n - 1 switch subtask to a n - 2 switch subtask (e.g., AB → secondary task → C) and from a n - 1 repetition subtask to a n - 2 repetition subtask (e.g., AC → secondary task → C). In two experiments with different degrees of response-set overlap between the interruption task and the subtasks of the primary task, we observed that switching back from the interruption task to the primary task resulted in n - 2 switch costs in the first subtask after the interruption (i.e., worse performance in n - 2 switch subtasks than in n - 2 repetition subtasks). This n - 2 switch cost was replicated in a third experiment in which we used a predefined sequence of four subtasks instead of three subtasks. Our finding of n - 2 switch costs suggest that the last subtask performed before the interruption remains activated when switching to the interruption task.

Exploring Metaphorical Transformations of a Safety Boundary Wall in Virtual Reality.

Current virtual reality (VR) devices enable users to visually immerse themselves in the virtual world, contributing to their limited awareness of bystanders' presence. To prevent collisions when bystanders intrude into VR users' activity area, it is necessary to intuitively alert VR users to the intrusion event and the intruder's position, especially in cases where bystanders intrude from the side or behind the VR user. Existing intruder awareness cues fail to intuitively present the intrusion event in such cases. We propose a novel intruder awareness cue called "BrokenWall" by applying a metaphor of "a wall breached by invading soldiers" to the VR user's safety boundary wall. Specifically, BrokenWall refers to a safety boundary wall with a gap appearing in front of a VR user and rotating, guiding the user's attention toward an intruder coming from the side or behind the VR user. We conducted an empirical study (N = 30) comparing BrokenWall with existing awareness cue techniques, Halo and Radar. Halo employs a sphere to represent the intruder, with the size indicating proximity and the position reflecting the direction. Radar employs a radar map to visualize the intruder's position. The results showed that the BrokenWall awareness cue not only significantly reduces the time needed for users to detect an intruder but also has superior performance in subjective ratings. Based on our findings, we have established a design space for an interactive safety boundary wall to facilitate interactions between VR users and bystanders.

A Hybrid Algorithm of LSTM and Factor Graph for Improving Combined GNSS/INS Positioning Accuracy during GNSS Interruptions.

In urban road environments, global navigation satellite system (GNSS) signals may be interrupted due to occlusion by buildings and obstacles, resulting in reduced accuracy and discontinuity of combined GNSS/inertial navigation system (INS) positioning. Improving the accuracy and robustness of combined GNSS/INS positioning systems for land vehicles in the presence of GNSS interruptions is a challenging task. The main objective of this paper is to develop a method for predicting GNSS information during GNSS outages based on a long short-term memory (LSTM) neural network to assist in factor graph-based combined GNSS/INS localization, which can provide a reliable combined localization solution during GNSS signal outages. In an environment with good GNSS signals, a factor graph fusion algorithm is used for data fusion of the combined positioning system, and an LSTM neural network prediction model is trained, and model parameters are determined using the INS velocity, inertial measurement unit (IMU) output, and GNSS position incremental data. In an environment with interrupted GNSS signals, the LSTM model is used to predict the GNSS positional increments and generate the pseudo-GNSS information and the solved results of INS for combined localization. In order to verify the performance and effectiveness of the proposed method, we conducted real-world road test experiments on land vehicles installed with GNSS receivers and inertial sensors. The experimental results show that, compared with the traditional combined GNSS/INS factor graph localization method, the proposed method can provide more accurate and robust localization results even in environments with frequent GNSS signal loss.

Exploring the Timing of Disengagement From Nondriving Related Tasks in Scheduled Takeovers With Pre-Alerts: An Analysis of Takeover-Related Measures.

OBJECTIVES: This study aimed to investigate drivers' disengagement from nondriving related tasks (NDRT) during scheduled takeovers and to evaluate its impact on takeover performance. BACKGROUND: During scheduled takeovers, drivers typically have sufficient time to prepare. However, inadequate disengagement from NDRTs can introduce safety risks. METHOD: Participants experienced scheduled takeovers using a driving simulator, undergoing two conditions, with and without an NDRT. We assessed their takeover performance and monitored their NDRT disengagement from visual, cognitive, and physical perspectives. RESULTS: The study examined three NDRT disengagement timings (DTs): DT1 (disengaged before the takeover request), DT2 (disengaged after the request but before taking over), and DT3 (not disengaged). The impact of NDRT on takeover performance varied depending on DTs. Specifically, DT1 demonstrated no adverse effects; DT2 impaired takeover time, while DT3 impaired both takeover time and quality. Additionally, participants who displayed DT1 exhibited longer eye-off-NDRT duration and a higher eye-off-NDRT count during the prewarning stage compared to those with DT2 and DT3. CONCLUSION: Drivers can benefit from earlier disengagement from NDRTs, demonstrating resilience to the adverse effects of NDRTs on takeover performance. The disengagement of cognition is often delayed compared to that of eyes and hands, potentially leading to DT3. Moreover, visual disengagement from NDRTs during the prewarning stage could distinguish DT1 from the other two. APPLICATION: Our study emphasizes considering NDRT disengagement in designing systems for scheduled takeovers. Measures should be taken to promote early disengagement, facilitate cognitive disengagement, and employ visual disengagement during the prewarning period as predictive indicators of DTs.

[Analysis of the interruptions generated by the use of smartphones among Primary Care Health professionals]. / Análisis de las interrupciones generadas por el uso de los smartphones entre los profesionales sanitarios de Atención Primaria.

OBJECTIVE: To analyze the particular use of smartphones among Primary Care Health professionals during the care act and its consequences. DESIGN: Multicenter, cross-sectional study in a primary care setting, carried out in 3phases: survey of professionals, checklist of professionals and survey of patients. PARTICIPANTS: Primary Care Health professionals from the Territorial Primary Care Management of Barcelona (online survey) and health professionals (checklist) and patients (patient survey) from 2primary care teams in Barcelona city. MAIN MEASUREMENTS: Bivariate descriptive analysis of the variables from the different surveys. Use of the mobile phone in the consultation, time, reason, type of use and perception of appropriateness. Characteristics of interruptions. RESULTS: In relation to patients, 31% consider that the health professional should only consult the mobile phone if it is to resolve some aspect of their reason for consultation and 10% consider it a lack of respect. Eighteen percent of patients describe interruptions, the majority lasting between 10 and 30s and considering them mostly avoidable. In relation to professionals, the majority (96%) claim to have their mobile phone in the consultation and on mute (77%), with only 2% recognizing its use in the presence of the patient, which is in line with what the patients describe. Furthermore, 80% of professionals say they ask permission to use it, contrasting with what patients report (50%). Eighty-five percent of professionals consider its use appropriate. CONCLUSIONS: The use of mobile phones is perceived by patients as an interruption that can affect the care act, generating dissatisfaction, which must be taken into account by health professionals. Healthcare organizations should establish recommendations regarding the use of mobile phones in consultations.

Don't interrupt me! development of a handoff education bundle to simulate the real world.

OBJECTIVES: Ineffective nurse-to-nurse handoff communication is associated with information omissions, diagnostic errors, treatment errors, and delays. New nurses report a lack of confidence and ability in handoff communication, which may stem from inadequate training in prelicensure nursing programs. Our objective was to introduce prelicensure nursing students to a standardized, theory-based method for handoff, including behavioral strategies employed by nurses during interrupted handoff. METHODS: A handoff education bundle (HEB) was developed. Kern's six-step curriculum model was utilized to design, implement, and evaluate the handoff curriculum. RESULTS: Student feedback highlighted the importance of integrating multiple, varying distractors during learning cycles and recognition of the impact of distractors on handoff. CONCLUSIONS: Implementing a HEB at the prelicensure nursing level could promote competency in handoff communication for new graduate nurses. IMPLICATIONS FOR INTERNATIONAL AUDIENCE: Handoff is an international patient safety priority, as inadequate communication has been linked to adverse patient events.

Impacts of early therapy response, interval to therapy interruption, and cumulative therapy interruption duration on outcome of ibrutinib therapy in relapsed/refractory chronic lymphocytic leukemia.

To investigate the impact of early response and treatment interruption on the survival of patients with relapsed/refractory chronic lymphocytic leukemia or small lymphocytic lymphoma (r/r CLL/SLL) treated with ibrutinib. This post hoc analysis used data of patients received ibrutinib treatment from an open-label, multicenter phase 3 study comparing ibrutinib with rituximab in patients with r/r CLL/SLL. The association of complete or partial response at 6 months, interruption within the first 6 months, cumulative interruption durations during the ibrutinib-treated period with progression-free survival (PFS) and overall survival (OS) were evaluated using the adjusted Cox hazard proportional model. The study included 87 patients treated with ibrutinib, of which 74 patients had at least 6 months of ibrutinib treatment and were analyzed. The response at 6 months did not affect PFS (HR = 0.58, 95%CI: 0.22-1.49) or OS (HR = 0.86, 95%CI: 0.22-3.31). The onset of interruption before or after 6 months was not associated with PFS (HR = 0.88, 95%CI: 0.34-2.30) or OS (HR = 0.75, 95%CI: 0.23-2.52). However, a cumulative interruption of more than 35 days was independently associated with worse PFS (HR = 2.4, 95%CI: 0.99-5.74) and OS (HR = 2.6, 95%CI: 0.88-7.44). Continuous interruption for more than 14 days was associated with a numerically lower 3-year PFS rate (> 14 vs. ≤ 14 days: 42% vs. 73%) and 3-year OS rate (> 14 vs. ≤ 14 days: 58% vs. 84%, both P > 0.05). Response status at 6 months or early therapy interruptions did not affect survival in patients with r/r CLL/SLL treated with ibrutinib. However, a cumulative temporary interruption of more than 35 days could potentially impact patient outcomes.

Facilitators of Organizational Resilience Within South Carolina AIDS Service Organizations: Lessons Learned from the COVID-19 Pandemic.

HIV care services have been interrupted by the COVID-19 pandemic in many states in the U.S. including South Carolina (SC). However, many HIV care facilities demonstrated organizational resilience (i.e., the ability to maintain needed health services amid rapidly changing circumstances) by addressing challenges to maintaining care during the pandemic. This study, therefore, aims to identify key facilitators for organizational resilience among AIDS Services Organizations (ASOs) in SC. In-depth interviews were conducted among 11 leaders, from 8 ASOs, across SC during the summer of 2020. The interviews were recorded after receiving proper consent and then transcribed. Utilizing a codebook based upon the interview guide, a thematic analysis approach was utilized to analyze the data. All data management and analysis were conducted in NVivo 11.0. Our findings demonstrate several facilitators of organizational resilience, including (1) accurate and timely crisis information dissemination; (2) clear and preemptive protocols; (3) effective healthcare system policies, management, and leadership; (4) prioritization of staff psychological wellbeing; (5) stable access to personal protective equipment (PPE); (6) adequate and flexible funding; and (7) infrastructure that supports telehealth. Given the facilitators of organizational resilience among ASOs in SC during the COVID-19 pandemic, it is recommended that organizations implement and maintain coordinated and informed responses based upon preemptive protocols and emerging needs. ASO funders are encouraged to allow a flexibility in spending. The lessons learned from the participating leaders enable ASOs to develop and strengthen their organizational resilience and experience fewer disruptions in the future.

Intraoperative active and passive breaks during minimally invasive surgery influence upper extremity physical strain and physical stress response-A controlled, randomized cross-over, laboratory trial.

OBJECTIVE: Investigate the effect of passive, active or no intra-operative work breaks on static, median and peak muscular activity, muscular fatigue, upper body postures, heart rate, and heart rate variability. BACKGROUND: Although laparoscopic surgery is preferred over open surgery for the benefit of the patient, it puts the surgeons at higher risk for developing musculoskeletal disorders especially due to the less dynamic and awkward working posture. The organizational intervention intraoperative work break is a workplace strategy that has previously demonstrated positive effects in small-scale intervention studies. METHODS: Twenty-one surgeons were exposed to three 90-min conditions: no breaks, 2.5-min passive (standing rest) or active (targeted stretching and mobilization exercises) breaks after 30-min work blocks. Muscular activity and fatigue of back, shoulder and forearm muscles were assessed by surface electromyography; upper body posture, i.e., spinal curvature, by inclination sensors; and heart rate and variability (HRV) by electrocardiography. Generalized estimating equations were used for statistical analyses. This study (NCT03715816) was conducted from March 2019 to October 2020. RESULTS: The HRV-metric SDNN tended to be higher, but not statistically significantly, in the intervention conditions compared to the control condition. No statistically significant effects of both interventions were detected for muscular activity, joint angles or heart rate. CONCLUSION: Intraoperative work breaks, whether passive or active, may counteract shoulder muscular fatigue and increase heart rate variability. This tendency may play a role in a reduced risk for developing work-related musculoskeletal disorders and acute physical stress responses.

Simple changes to the reporting environment produce a large reduction in the frequency of interruptions to the reporting radiologist: an observational study.

BACKGROUND: Interruptions are a cause of discrepancy, errors, and potential safety incidents in radiology. The sources of radiological error are multifactorial and strategies to reduce error should include measures to reduce interruptions. PURPOSE: To evaluate the effect of simple changes in the reporting environment on the frequency of interruptions to the reporting radiologist of a hospital radiology department. MATERIAL AND METHODS: A prospective observational study was carried out. The number and type of potentially disruptive events (PDEs) to the radiologist reporting inpatient computed tomography (CT) scans were recorded during 20 separate 1-h observation periods during both pre- and post-intervention phases. The interventions were (i) relocation of the radiologist to a private, quiet room, and (ii) initial vetting of clinician enquiries via a separate duty radiologist. RESULTS: After the intervention there was an 82% reduction in the number of frank interruptions (PDEs that require the radiologist to abandon the reporting task) from a median 6 events per hour to 1 (95% confidence interval [CI] = 4-6; P < 0.00001). The overall number of PDEs was reduced by 56% from a median 11 events per hour to 5 (95% CI = 4.5-11: P < 0.00001). CONCLUSION: Relocation of inpatient CT reporting to a private, quiet room, coupled with vetting of clinician enquiries via the duty radiologist, resulted in a large reduction in the frequency of interruptions, a frequently cited avoidable source of radiological error.

Effect of improvement measures in reducing interruptions in a Japanese hospital pharmacy using a synthetic approach based on resilience engineering and systems thinking.

BACKGROUND: Workflow interruptions in pharmacies contribute to dispensing errors, a high-priority issue in patient safety, but have rarely been studied from a systemic perspective partly because of the limitations of the conventional reductionistic approach. This study aims to identify a mechanism for the occurrence of interruptions in a hospital pharmacy and find interventional points using a synthetic approach based on resilience engineering and systems thinking, and assess implemented measures for reducing them. METHODS: At a Japanese university hospital, we gathered information about performance adjustments of pharmacists in the inpatient medication dispensing unit for oral and topical medicines (IMDU-OT) and nurses in the inpatient wards (IPWs) in the medication dispensing and delivery process. Data about the workload and workforce of pharmacists were collected from hospital information systems. Telephone inquiries and counter services in the IMDU-OT, the primary sources of interruptions to pharmacists' work, were documented. The feedback structure between the IMDU-OT and the IPWs was analyzed using a causal loop diagram to identify interventional points. The numbers of telephone calls and counter services were measured cross-sectionally before (February 2017) and four months after implementing measures (July 2020). RESULTS: This study found that interruptions are a systemic problem emerging from the adaptive behavior of pharmacists and nurses to their work constraints, such as short staffing of pharmacists, which limited the frequency of medication deliveries to IPWs, and lack of information about the medication dispensing status for nurses. Measures for mitigating cross-system performance adjustments-a medication dispensing tracking system for nurses, request-based extra medication delivery, and pass boxes for earlier pick-up of medicines-were introduced. Following their implementation, the daily median number of telephone calls and counter services was significantly reduced (43 to 18 and 55 to 15, respectively), resulting in a 60% reduction in the total number of interruptions. CONCLUSION: This study found interruptions in the hospital pharmacy as a systemic problem that can be reduced by mitigating difficulties being compensated for by clinicians' cross-system performance adjustments. Our findings suggest that a synthetic approach can be effective for solving complex problems and have implications for methodological guidance for Safety-II in practice.

Association of external interruptions with increased medication administration duration and self-interruptions: A direct observational study: Empirical research quantitative.

AIMS: To examine task duration and frequency of self-interruptions among study participants during externally interrupted compared with externally uninterrupted simulated medication administration. BACKGROUND: Interruptions are prevalent during nursing medication administration and can lead to inefficient, delayed, omitted and unsafe patient care. Interrupted nursing tasks are shown to take longer to complete compared to uninterrupted tasks; however, studies seldom indicate if the time spent in the interruption was included or excluded in the reported task duration. It is unknown if the time spent in the interruption leads to longer task completion times or if other factors, such as the time needed to re-engage in the primary task and/or self-interruptions, are involved. Little is known about associations between external interruptions and self-interruptions during nursing tasks. Self-interruptions are caused by an individual's own decision to stop an activity to attend to something else. DESIGN: Cross-sectional within-subjects design. METHODS: This two-site study investigated task duration and frequencies of self-interruptions during externally interrupted and externally uninterrupted simulated medication administration. Data on medication administration duration, external interruption duration and self-interruptions were collected via direct observation from November 2019-February 2020. The time spent in the external interruption was deducted from the medication administration duration. RESULTS: Thirty-five participants were included in the study. The externally interrupted task had a significantly longer duration and significantly more frequent self-interruptions within-subjects compared to the externally uninterrupted task. Self-interruptions were most often due to forgotten supplies. CONCLUSIONS: The findings suggest that the time needed to re-engage with an externally interrupted task and/or self-interruptions may lead to longer task completion times. IMPACT: Researchers are encouraged to investigate mediators of interruptions that lead to longer task completion times and errors. Findings can be used to develop and implement interruption management strategies that aim to improve the safety and quality of patient care. REPORTING METHOD: Equator guidelines were followed using the STROBE reporting method. PATIENT/PUBLIC CONTRIBUTION: No patient or public involvement in this study. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Educators and researchers can use the study findings to guide teaching methods and direct future studies. By gaining a better understanding of the mediators of interruptions that create longer task completion times and increase the risk for errors, tailored interruption management strategies that aim to improve the safety and quality of healthcare can be developed and implemented.