A resonant sextuplet of sub-Neptunes transiting the bright star HD 110067.

Planets with radii between that of the Earth and Neptune (hereafter referred to as 'sub-Neptunes') are found in close-in orbits around more than half of all Sun-like stars1,2. However, their composition, formation and evolution remain poorly understood3. The study of multiplanetary systems offers an opportunity to investigate the outcomes of planet formation and evolution while controlling for initial conditions and environment. Those in resonance (with their orbital periods related by a ratio of small integers) are particularly valuable because they imply a system architecture practically unchanged since its birth. Here we present the observations of six transiting planets around the bright nearby star HD 110067. We find that the planets follow a chain of resonant orbits. A dynamical study of the innermost planet triplet allowed the prediction and later confirmation of the orbits of the rest of the planets in the system. The six planets are found to be sub-Neptunes with radii ranging from 1.94R⊕ to 2.85R⊕. Three of the planets have measured masses, yielding low bulk densities that suggest the presence of large hydrogen-dominated atmospheres.

Relevance of subclinical right ventricular dysfunction measured by feature-tracking cardiac magnetic resonance in non-ischemic dilated cardiomyopathy.

BACKGROUND: Right ventricular (RV) dysfunction in patients with non-ischemic dilated cardiomyopathy (NICM) is associated with cardiovascular events. To analyze the feasibility of assessing RV myocardial deformation by feature tracking (FT)-cardiac magnetic resonance (CMR), and its usefulness as a prognostic marker. METHODS: Retrospective study of NICM patients undergoing CMR. Longitudinal FT-RV free wall (LFT-RVFW) and fractional area change (FAC) were obtained. Correlation with standard RV parameters was studied. An association with combined event (heart failure (HF), ICD implantation or cardiovascular death) was assessed using a logistic regression model. RESULTS: 98 patients (64 ± 13 years) were included. Left ventricular (LV) systolic function (LVEF 29.5 ± 9.6%, 47% with LVEF ≥ 30%) and RV (RVEF 52.2 ± 14.6%, 72% with RVEF ≥ 45%). Follow-up of 38 ± 17 months, 26.5% presented at least one admission for HF. An excellent correlation of LFT-RVFW (r = 0.82) and FAC (r = 0.83) with RVEF was evident. No association of RV-FT parameters with prognosis entire study population was found. However, in patients with LVEF ≥ 30%, admissions for HF were associated with lower LFT-RVFW (-21.6 ± 6.6% vs -31.3 ± 10%; p = 0.006) and FAC (36.6 ± 9.6% vs 50.5 ± 13.4%; p < 0.001) values. Similar differences were observed when only patients with RVEF ≥ 45% were considered. An LFT-RVFW cut-off point of -19.5% and FAC of 36.5% showed good prognostic performance. Decreased LFT-RVFW or FAC represented an independent predictor of combined event in patients with LVEF ≥ 30%. CONCLUSIONS: In NICM patients without severe LV dysfunction, decreased values of LFT-RVFW and/or FAC were associated with HF admissions, independently of RVEF.

Biofilm Formation of Two Different Marine Bacteria on Modified PDMS Surfaces is Affected by Surface Roughness and Topography.

Different strategies were tested to reduce biofilm formation of the model marine bacteria Cobetia marina and Marinobacter hydrocarbonoclasticus on cross-linked polydimethylsiloxane (PDMS) coated aluminum and cellulose acetate surfaces modified by addition of multi-walled carbon nanotubes (MWCNT) or exposure of the surfaces to bromine vapors in the presence and absence of UV irradiation. The three surface modifications explored led to important reductions in biofilm formation for the two marine bacteria, up to 30% in the case of exposure to Br2(g). Biofouling reduction could be correlated to surface properties in all cases through the introduction of a quantitative theoretical model based on an effective roughness parameter, Raeff, that accounted for the different morphological changes observed. The model considers the possibility of bacterial inclusion into large surface wells, as observed by AFM in the case of Br2(g) + UV light treatment. In addition, a linear relationship was observed between biofouling reduction and the Raeff effective roughness parameter.

Minimization of measuring points for the electric field exposure map generation in indoor environments by means of Kriging interpolation and selective sampling.

In a world with increasing systems accessing to radio spectrum, the concern for exposure to electromagnetic fields is growing and therefore it is necessary to check limits in those areas where electromagnetic sources are working. Therefore, radio and exposure maps are continuously being generated, mainly in outdoor areas, by using many interpolation techniques. In this work, Surfer software and Kriging interpolation have been used for the first time to generate an indoor exposure map. A regular measuring mesh has been generated. Elimination of Less Significant Points (ELSP) and Geometrical Elimination of Neighbors (GEN) strategies to reduce the measuring points have been presented and evaluated. Both strategies have been compared to the map generated with all the measurements by calculating the root mean square and mean absolute errors. Results indicate that ELSP method can reduce up to 70% of the mesh measuring points while producing similar exposure maps to the one generated with all the measuring points. GEN, however, produces distorted maps and much higher error indicators even for 50% of eliminated measuring points. As a conclusion, a procedure for reducing the measuring points to generate radio and exposure maps is proposed based on the ELSP method and the Kriging interpolation.

Viral internet challenges scale in preadolescents: An exploratory study.

In recent years, viral challenges on the Internet have become a very frequent phenomenon. These allude to the actions that are proposed to Internet users to record themselves performing a challenge and disseminate it on different online platforms so that other users will also perform it. Despite its rapid expansion, there is no evidence of any validated assessment tool of this phenomenon. To meet this need, the Viral Internet Challenges Scale (VICH-S) was designed. The main objective of this study was to establish the psychometric properties of this scale, the prevalence of different types of challenges (social, solidary, and dangerous), as well as the single or conjoint performance of these types of challenges using the VICH-S. Furthermore, the construct validity of the scale was tested with these variables: Fear of Missing Out, Loss of Connection (nomophobia), Self-Online, and Emotional Attention Online. Participants were 417 preadolescents (41.2% boys) with age ranging from 10 to 14 years. Exploratory factor analysis of the VICH-S scale revealed the existence of two factors: Challenge Satisfaction and Social Motivation. Convergent validity indicators showed positive and significant correlations between these two dimensions and the Fear of Missing Out, Loss of Connection (nomophobia), Self-Online, and Emotional Attention Online. The most frequent challenges were social challenges (80.3%), followed by solidary (20.6%) and dangerous challenges (7.7%). This study has relevant implications, as the VICH-S presents adequate psychometric properties to evaluate this barely explored and growing phenomenon of viral challenges on the Internet in preadolescence.

Simplified biplanar (0-90°) fluoroscopic puncture technique for percutaneous nephrolithotomy: the learning curve.

PURPOSE: To evaluate the learning curve of the simplified fluoroscopic biplanar (0-90º) puncture technique for percutaneous nephrolithotomy. METHODS: We prospectively evaluated patients with renal stones treated with percutaneous nephrolithotomy by a single institution's fellows employing the simplified bi-planar (0-90º) fluoroscopic puncture technique for renal access. The learning curve was assessed with the fluoroscopic screening time and the percutaneous renal puncture time. Data obtained were compared to a subset of patients operated by a senior surgeon. RESULTS: Eighty-nine patients were included in the study. Forty patients were operated by fellow-1, 39 by fellow-2, and 10 patients by the senior surgeon. Demographic data of all patients between groups were homogeneous, with no difference in gender (p = 0.432), age (p = 0.92), stone volume (p = 0.78), puncture laterality (p = 0.755), and body mass index (p = 0.365). The mean puncture time was 7.5, 4, and 3.1 min for fellow-1, fellow-2, and expert, respectively. The mean fluoroscopic screening time for the puncture was 10, 11, and 5.1 s for fellow-1, fellow-2, and the expert, respectively. Stone cases, both fellows needed to complete 10 procedures to match the senior surgeon in the mean puncture time (p = 0.046); meanwhile, the fluoroscopic screening time was equal even before to complete 10 procedures. CONCLUSION: This study suggests that with the simplified biplanar (0-90º) puncture technique, the fluoroscopic screening time used in the learning process is brief. A novice fellow could require to complete ten cases to flatten the learning curve treating complex stone cases, and a flat learning curve is seen since the beginning when treating simple renal stones.

Recommendations for coastal planning and beach management in Caribbean insular states during and after the COVID-19 pandemic.

The COVID-19 pandemic has implications for coastal planning and management. Rules for isolation and physical distancing, among other measures for human life protection, have led to the closure of most beaches around the world. The present critical situation has raised the following question: How can some recommendations be designed in sun, sea, and sand tourism-dependent-insular countries to face "the COVID-19 new normality?" We used the content analysis technique to analyze representative publications on a global level to ascertain information on best management practices. A survey of 58 experts provided additional information. We used inferential statistics for sample selection and produced a list of 43 practices and beach planning and management actions to face the COVID-19 pandemic. This led to 27 new recommendations designed for beach planning and management within insular contexts, some of which were tested in the Republic of Cuba. Recommendations aim to guarantee a culture of safety and improvement within the field of beach or coastal planning and management. These recommendations should prove useful for other insular countries, during the COVID-19 period, in the new normality that follows, and in other post-pandemic scenarios.

Mutations in the voltage-gated sodium channel gene associated with deltamethrin resistance in commercially sourced Phytoseiulus persimilis.

The implementation of Integrated Pest Management in current agricultural practice is a convenient and very effective strategy to keep pest populations under control. The use of biological control agents, such as Phytoseiulus persimilis, is key for the success of such an approach. This predatory mite is widely used as it is very effective for controlling Tetranychus urticae, one of the most devastating crop pests. Here, we identify several mutations located in the voltage-gated sodium channel (VGSC) of commercially sourced P. persimilis that correlate with a reduced susceptibility to the pyrethroid deltamethrin. We found that the mites sourced from two different biocontrol product companies have intrinsic genotypic differences that correlate with their phenotype when tested with different concentrations of deltamethrin. Mites from Syngenta Bioline, carrying the mutations M918L and A1536T, were able to survive deltamethrin concentrations of up to 10 ppm, while the mites from Koppert Biological Systems, with the combination M918L, L925V and S1539T, survived treatment with 40 ppm. All of the point mutations identified in the predatory mite samples are located in a particular region of the VGSC, previously proposed as the binding site for this family of pesticides and identified as a 'hot spot' for resistance.

Feasibility of gas chromatography-atmospheric pressure photoionization-high-resolution mass spectrometry for the analysis of polychlorinated dibenzo-p-dioxins, dibenzofurans, and dioxin-like polychlorinated biphenyls in environmental and feed samples.

In this work, the suitability of atmospheric pressure photoionization (APPI) has been assessed for the determination of polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) and dioxin-like polychlorinated biphenyls (dl-PCBs) by gas chromatography-high-resolution mass spectrometry (GC-HRMS). The APPI of target compounds has been tested in both positive and negative ion modes. Under positive ion mode, the analytes generated the molecular ion, which was favoured using dopants that promote charge exchange gas-phase reactions (i.e., benzene), while in negative ion mode, the ion [M-Cl+O]- for PCDFs and dl-PCBs were mainly formed, providing the best results using benzene and diethyl ether as dopants, respectively. Concerning PCDDs, highly chlorinated congeners were mainly ionized by means of the [M-Cl]- ion, whereas [M-Cl+O2]- was the base peak for tetraCDD and [M-Cl+O]- for penta- and hexaCDDs. Method quality parameters, in accordance with the current EU Regulation guidelines for food and feed analysis, showed the good performance of the two GC-APPI-HRMS (Orbitrap) methods since they provided high detection capability (low fg levels), good linearity, and satisfactory precision (RSD% < 9%). In addition, the GC-APPI-HRMS (Orbitrap) methods were validated by analysing selected environmental and feed samples and the results were compared to those obtained using conventional GC-EI-HRMS, demonstrating the good performance in the analysis of the target compounds. Hence, the GC-APPI-HRMS technique can be proposed as alternative to the conventional methods for the determination of PCDD/Fs and dl-PCBs in environmental and feed matrices.

Profile of patients who visit medical internists for an osteoporosis assessment: The OSTEOMED registry. / Perfil de los pacientes que acuden al médico internista para valoración de osteoporosis: registro OSTEOMED.

BACKGROUND AND OBJECTIVES: Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients' care more effectively and efficiently. MATERIAL AND METHODS: Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. RESULTS: In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients' mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; P<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; P<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; P<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). CONCLUSIONS: These results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.

Relationship between cyberbullying and health-related quality of life in a sample of children and adolescents.

PURPOSE: Health-related quality of life (HRQoL) is a well-known construct that refers to a state of complete physical, mental, and social well-being. Its relationship with multiple forms of violence, including bullying, has been widely explored, but this is not the case for cyberbullying. The main objective is to analyze how HRQoL varies depending on the role played in cyberbullying, its temporal stability, and gender and age differences. METHOD: An analytical and longitudinal study was conducted at two temporal moments. At Time 1 (December 2015), 920 Spanish students aged between 11 and 18 years participated (Mage = 13.36, SD = 1.83: 48.9% boys and 51.1% girls). At Time 2 (April 2016), there were 313 participants (Mage 12.81 years, SD = 1.59: 53.4% boys and 46.6% girls). We used the Cyberbullying Test (technological scale) and the Spanish version of the KIDSCREEN-52. RESULTS: Cybervictims and cyberbully-victims present worse scores in all dimensions of the KIDSCREEN-52 (p < .001), compared to cyberbystanders or uninvolved individuals. There are gender differences only in cyberaggression and cyberbystanding. There are significant inverse correlations between all the dimensions of the KIDSCREEN-52 and cybervictimization, with Bullying (r = - .603, p < .001), Mood (r = - .329, p < .001), and School environment (r = - .327, p < .001) being particularly relevant. There were statistically significant differences between T1 and T2 for cyberbystanding (lower scores at T2). CONCLUSION: Cybervictims and cyberbully-victims have worse quality of life in all the dimensions than uninvolved individuals, especially in Psychological well-being, School environment, and Bullying.

Biological parameters of the triatomine, Meccus phyllosomus pallidipennis, fed on two bloodmeal sources under laboratory conditions.

Chagas disease is one of the most important vector-borne diseases in Latin America, including Mexico. Meccus phyllosomus pallidipennis (Stål), 1872 (Hemiptera: Reduviidae) is a Mexican triatomine vector that is commonly associated with hens and rabbits. The biological parameters of two cohorts fed on hens (H) and on rabbits (R) were evaluated. The median lifecycles of the two cohorts were 198 days (H) and 180 days (R). Moreover, mortality was around 30% in both cohorts. Time lapse for beginning of feeding was 0.5-1.9 (H) and 1.1-2.4 min (R). Feeding times of each instar in both cohorts were over 10 min. Most specimens fed on hens defecated immediately after feeding, whereas those that fed on rabbits defecated within 1-5 min post-feeding. Similar numbers of males and females (50%) were obtained in both cohorts. An average of 2.1-2.3 eggs per female per day was noted in both cohorts, with eclosion rates of 95.4 (H) and 88.8% (R). Thus, it can be concluded that M. phyllosomus pallidipennis may take advantage of feeding in hens, as in rabbits, which could imply a higher risk of Trypanosoma cruzi transmission to humans and animals in its distribution area.

Correction to: Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes.

The article "Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes", written by L. Trenti, S. Biondo, A. Galvez, A. Bravo, J. Cabrera, E. Kreisler, was originally published electronically on the publisher's internet portal (currently SpringerLink) on [27 April 2017] without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 7 June, 2018 to

Solar insolation in springtime influences age of onset of bipolar I disorder.

OBJECTIVE: To confirm prior findings that the larger the maximum monthly increase in solar insolation in springtime, the younger the age of onset of bipolar disorder. METHOD: Data were collected from 5536 patients at 50 sites in 32 countries on six continents. Onset occurred at 456 locations in 57 countries. Variables included solar insolation, birth-cohort, family history, polarity of first episode and country physician density. RESULTS: There was a significant, inverse association between the maximum monthly increase in solar insolation at the onset location, and the age of onset. This effect was reduced in those without a family history of mood disorders and with a first episode of mania rather than depression. The maximum monthly increase occurred in springtime. The youngest birth-cohort had the youngest age of onset. All prior relationships were confirmed using both the entire sample, and only the youngest birth-cohort (all estimated coefficients P < 0.001). CONCLUSION: A large increase in springtime solar insolation may impact the onset of bipolar disorder, especially with a family history of mood disorders. Recent societal changes that affect light exposure (LED lighting, mobile devices backlit with LEDs) may influence adaptability to a springtime circadian challenge.

Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes.

BACKGROUND: Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy (Doppler-guided THD) seems to be associated with better short-term outcomes than conventional hemorrhoidectomy, but there are little data about long-term recurrence. The aim of this study was to compare Doppler-guided THD for grade III-IV hemorrhoids with conventional hemorrhoidectomy with regard to long-term postoperative morbidity and recurrence. METHODS: This was a single-center longitudinal and comparative study of a cohort of patients who underwent either distal Doppler-guided THD with low ligation of the hemorrhoidal artery and mucopexy or conventional excisional hemorrhoidectomy (Milligan and Morgan or Ferguson) for grade III and IV hemorrhoids. Short- and long-term postoperative morbidity was recorded. Severity of hemorrhoid symptoms (bleeding, prolapse, manual reduction, discomfort or pain and impact on quality of life) and fecal continence status (Vaizey score) were evaluated before surgery and at minimum of 1 year after surgery. RESULTS: Eighty-three patients were included in the study. Forty-nine patients (59%) underwent Doppler-guided THD, and 34 (41%) patients underwent conventional hemorrhoidectomy. The 30-day postoperative surgical morbidity was 26.5% in the Doppler-guided THD group and 8.82% in the conventional hemorrhoidectomy group (p = 0.085). No significant differences between the groups were observed in terms of persistence of bleeding, prolapse, need for manual reduction in prolapse and pain. One (2%) patient in the THD group and 2 (5.4%) patients in the conventional hemorrhoidectomy group needed further surgical procedures. Minor fecal incontinence occurred only after conventional hemorrhoidectomy in 2 (5.4%) patients. CONCLUSIONS: Our results showed that Doppler-guided THD is not inferior to conventional excisional hemorrhoidectomy for advanced hemorrhoidal disease in terms of postoperative complications and long-term recurrence of symptoms.

Spontaneous photosensitization by Heterophyllaea pustulata Hook. f. (Rubiaceae), in sheep from Northwestern Argentina.

Heterophyllaea pustulata Hook. f. (Rubiaceae) is a phototoxic plant. It grows in the Andean area of northwest of Argentina, and it causes significant economic losses in the livestock. This plant induces dermal lesions by photosensitization probably due to its content of photosensitizing anthraquinones. This paper describes an outbreak of poisoning in Corriedale sheepfold, which had an incidence of 49%. Ear skin biopsies and blood samples were collected of six affected animals. Liver enzymes remained within the reference limits. Histopathologically, a deep necrotizing dermatitis was identified in all samples. H. pustulata was identified in the areas of grazing. Anthraquinone concentration in leaves was 0.84% p/p, expressed as rubiadin. All findings allow us to conclude that the diagnosis is a primary photosensitization. Huge regional economic losses could be attributed to H. pustulata poisoning, although its toxicity has been little studied.

Growth differentiation factor 11 (GDF11) - a promising anti-ageing factor - is highly concentrated in platelets.

Recent research suggests that growth differentiation factor 11 (GDF11) could reverse age-related diseases and that its blood concentration decreases with age. This poses plasma from young donors as a therapeutic GDF11 source to treat age-related diseases. In addition, the tissue source of circulating GDF11 remains unknown. We analysed GDF11 levels in paired samples of serum, plasma and platelet lysate (PL) from 23 volunteers. Plasma and PL were collected by plateletpheresis. Here, we show that GDF11 is highly concentrated in platelets and that the circulating levels reported in previous studies could be biased as a result of serum sample manipulation.

The International Mood Network (IMN) Nosology Project: differentiating borderline personality from bipolar illness.

OBJECTIVE: The differential diagnosis of bipolar illness vs. borderline personality is controversial. Both conditions manifest impulsive behavior, unstable interpersonal relationships, and mood symptoms. This study examines whether and which mood clinical features can differentiate between both conditions. METHOD: A total of 260 patients (mean ± standard deviation age 41 ± 13 years, 68% female) attending to a mood clinic were examined for diagnosis of bipolar illness and borderline personality disorder using SCID-I, SCID-II, and clinical mood criteria extracted from Mood Disorder Questionnaire (MDQ). They were analyzed using diagnoses as dependent variables. Predictors of bipolar and borderline diagnoses were identified by multivariable logistic regressions, and predictive validity of models was assessed using ROC curve analysis. RESULTS: Bipolar illness was strongly predicted by elevated mood (OR = 4.02, 95% CI: 1.80-9.15), increased goal-directed activities (OR = 3.90, 95% CI: 1.73-8.96), and episodicity of mood symptoms (OR = 3.48, 95% CI 1.49-8.39). This triad model predicted bipolar illness with 88.7% sensitivity, 81.4% specificity, and obtained an auROC of 0.91 (95% CI: 0.76-0.96) and a positive predictive value of 85.1%. For borderline personality disorder, only female gender was a statistically significant predictor (OR = 3.41, 95% CI: 1.29-13.7), and the predictive model obtained an auROC of 0.67 (95% CI: 0.53-0.74). CONCLUSION: In a mood disorder clinic setting, manic criteria and episodic mood course distinguished bipolar illness from borderline personality disorder.

A transiting giant planet with a temperature between 250 K and 430 K.

Of the over 400 known exoplanets, there are about 70 planets that transit their central star, a situation that permits the derivation of their basic parameters and facilitates investigations of their atmospheres. Some short-period planets, including the first terrestrial exoplanet (CoRoT-7b), have been discovered using a space mission designed to find smaller and more distant planets than can be seen from the ground. Here we report transit observations of CoRoT-9b, which orbits with a period of 95.274 days on a low eccentricity of 0.11 +/- 0.04 around a solar-like star. Its periastron distance of 0.36 astronomical units is by far the largest of all transiting planets, yielding a 'temperate' photospheric temperature estimated to be between 250 and 430 K. Unlike previously known transiting planets, the present size of CoRoT-9b should not have been affected by tidal heat dissipation processes. Indeed, the planet is found to be well described by standard evolution models with an inferred interior composition consistent with that of Jupiter and Saturn.

Identifying workflow disruptions in the cardiovascular operating room.

The objectives of this study were to identify the frequency and nature of flow disruptions in the operating room with respect to three cardiac surgical team members: anaesthetists; circulating nurses; and perfusionists. Data collected from 15 cases and coded using a human factors taxonomy identified 878 disruptions. Significant differences were identified in frequency relative to discipline type. Circulating nurses experienced more coordination disruptions (χ(2) (2, N = 110) = 7.136, p < 0.028) and interruptions (χ(2) (2, N = 427) = 29.743, p = 0.001) than anaesthetists and perfusionists, whereas anaesthetists and perfusionists experienced more layout issues than circulating nurses (χ(2) (2, N = 153) = 48.558, p = 0.001). Time to resolve disruptions also varied among disciplines (λ (12, 878) = 5.186, p = 0.000). Although most investigations take a one-size fits all approach in addressing disruptions to flow, this study demonstrates that targeted interventions must focus on differences with respect to individual role.