Modeling the evolution of the US opioid crisis for national policy development.

The opioid crisis is a major public health challenge in the United States, killing about 70,000 people in 2020 alone. Long delays and feedbacks between policy actions and their effects on drug-use behavior create dynamic complexity, complicating policy decision-making. In 2017, the National Academies of Sciences, Engineering, and Medicine called for a quantitative systems model to help understand and address this complexity and guide policy decisions. Here, we present SOURCE (Simulation of Opioid Use, Response, Consequences, and Effects), a dynamic simulation model developed in response to that charge. SOURCE tracks the US population aged ≥12 y through the stages of prescription and illicit opioid (e.g., heroin, illicit fentanyl) misuse and use disorder, addiction treatment, remission, and overdose death. Using data spanning from 1999 to 2020, we highlight how risks of drug use initiation and overdose have evolved in response to essential endogenous feedback mechanisms, including: 1) social influence on drug use initiation and escalation among people who use opioids; 2) risk perception and response based on overdose mortality, influencing potential new initiates; and 3) capacity limits on treatment engagement; as well as other drivers, such as 4) supply-side changes in prescription opioid and heroin availability; and 5) the competing influences of illicit fentanyl and overdose death prevention efforts. Our estimates yield a more nuanced understanding of the historical trajectory of the crisis, providing a basis for projecting future scenarios and informing policy planning.

Female Cerebellum Seems Sociable; An iTBS Investigation.

The cerebellum has been shown to be engaged in tasks other than motor control, including cognitive and affective functions. Prior neuroimaging studies have documented the role of this area in social cognition and despite these findings, no studies have yet examined the causal relationship between the cerebellum and social cognition. This study aimed to investigate the role of the cerebellum in empathy and theory of mind (ToM) in a randomized, placebo-controlled, double-blind, parallel study. 32 healthy participants were assigned to either a sham or active group. For the active group, an intermittent theta-burst stimulation (iTBS) protocol at 100% of the motor threshold was applied to the cerebellum, while the control group received sham stimulation. An eyes-closed EEG session, the Empathy Quotient (EQ) test, and the Reading the Mind in the Eyes Test (RMET) were administered before and after the iTBS session. The results demonstrated differences in cognitive empathy, ToM, and a decrease in the activity of the default mode network (DMN) between the active and sham groups in females. Females also showed a decrease in the activity of the affective empathy network and connectivity in the DMN. We conclude that cognitive empathy and ToM are associated with cerebellar activity, and due to sex-related differences in the cortical organization of this area which is modulated by sex hormones, the stimulation of the cerebellum in males and females yields different results.

Brain stimulation for patients with multiple sclerosis: an umbrella review of therapeutic efficacy.

Multiple sclerosis patients often experience various symptoms that can greatly impact their quality of life. There are various brain stimulation techniques that have been evaluated for their ability to reduce the symptoms of multiple sclerosis. However, there is inconsistency in the specific stimulation methods used and the symptoms targeted in the existing research. This umbrella review conducted in order to evaluate the effectiveness of brain stimulation and identify limitations and gaps for further research. In this umbrella review, we conducted a searched on Web of Knowledge, PubMed, and Scopus database. We specifically looked for reviews, with or without meta-analyses, that have investigated the effects of brain stimulation methods on symptoms of multiple sclerosis. All articles were examined by AMSTAR 2 (A Measure Tool to Assess Systematic Review 2). We identified 155 articles, of which 14 were eligible for inclusion. Of those, five were qualitative studies and nine were meta-analyses. Among the included studies, four examined the use of deep brain stimulation, while ten investigated the therapeutic potential of noninvasive brain stimulation. Considering the heterogeneity of studies, the current evidence suggests that repetitive transcranial magnetic stimulation may be effective in treating pain and improving motor function, while transcranial direct current stimulation may be useful in alleviating fatigue and enhancing certain aspects of cognitive performance. Deep brain stimulation, on the other hand, appears to be effective in reducing tremors. However, further research is warranted to validate these findings and address the existing limitations in the field.

Prevalence of acute kidney injury following percutaneous nephrolithotomy.

Background: The objective is to evaluate the prevalence of acute kidney injury (AKI) as an early complication of the percutaneous nephrolithotomy (PCNL) procedure. Materials and Methods: From May 2022 to October 2022, we conducted a retrospective study on patients undergoing PCNL procedures in two of the tertiary medical centers affiliated with Isfahan University of Medical Sciences. Patients' baseline characteristics, laboratory values, perioperative data, and stone features were documented. AKI was defined either as a ≥0.3 mg/dL increase in the serum creatinine level within 2 days, or a ≥1.5-fold increase in baseline serum creatinine level within 7 days after the operation. Laboratory values were measured 1 day before PCNL and daily thereafter until discharge. Patients were followed 1 week later to detect all of the possible cases of AKI. Results: The final analysis was performed on 347 individuals. AKI developed in 16 (4.61%) cases. The two groups were comparable regarding age (P = 0.887), gender (P = 0.566), and underlying comorbidities including diabetes mellitus (P = 0.577) and hypertension (P = 0.383). The mean body mass index (BMI) (P < 0.001) and both frequency and severity of hydronephrosis (P < 0.001) were significantly different. A higher mean PCNL duration (P < 0.001), period of hospitalization (P < 0.001), and blood loss volume (P < 0.001) were observed in those who developed AKI. Overall, 56.3% (9) of patients in the AKI group and 2.7% (9) in the non-AKI group required the establishment of more than one access tract, during the procedure (P < 0.001). A lower preoperative hemoglobin level was observed in the AKI group (P < 0.001). Those with AKI had significantly larger stones (3.08 ± 0.46 vs. 2.41 ± 0.23 cm, P < 0.001) and higher Hounsfield units (P < 0.001). In addition, in the AKI group, most of the calculi (81.3%, 13) were of staghorn type, whereas in the non-AKI group, calculi were most frequently located in the middle calyx (30.2%, 100), (P < 0.001). Conclusion: The prevalence of post-PCNL AKI is approximately 4.61%. The mean BMI, preoperative hemoglobin level, PCNL duration, intraoperative blood loss volume, and hospitalization period were significantly higher among patients who developed AKI. Those with AKI had significantly larger stones with higher Hounsfield units and more frequently of staghorn type. The two groups were not statistically different regarding age, gender, and presence of comorbidities (hypertension and diabetes mellitus).

Development and validation of a task load index for process control room operators (PCRO-TLX).

Process control room operators (PCRO) perform a range of complex cognitive safety-critical tasks. The aim of this exploratory sequential mixed methods study was to develop an occupation specific tool to measure the task load of PCRO using NASA Task Load Index (TLX) methodology. Participants were 30 human factors experts and 146 PCRO at two refinery complexes in Iran. Dimensions were developed via a cognitive task analysis, a research review, and three expert panels. Six dimensions were identified: perceptual demand, performance, mental demand, time pressure, effort, and stress. Data from 120 PCRO confirmed that the developed PCRO-TLX has acceptable psychometric properties, and a comparison with the NASA-TLX confirmed that perceptual, not physical, demand was relevant for measuring workload in PCRO. There was a positive convergence of scores of the Subjective Workload Assessment Technique and the PCRO-TLX. This reliable tool (α = 0.83) is recommended for risk assessing the task load of PCRO.Practitioner summary: There are benefits of having a specific tool to measure task load in safety critical roles. Thus, we developed and validated an easy-to-use targeted tool, the PCRO-TLX, for process control room operatives. Timely use and response will assure optimal production alongside health and safety in an organisation.Abbreviations: PCRO: process control room operator; TLX: task load index; PCRO-TLX: process control room operator task load index; NASA-TLX: National Aeronautics and Space Administration task load index; SWAT: subjective workload assessment technique; DALI: driving activity load index; SURG-TLX: surgery task load index; SIM-TLX: virtual reality simulation task load index; VACP: visual, auditory, cognitive and psychomotor; CVI: content validity index; CVR: content validity ratio; RMSEA: root mean square of error approximation; GFI: goodness of fit index; AGFI: adjusted goodness of fit index; CFI: comparative fit index; ANOVA: analysis of variance; CI: confidence interval.

Evaluation of the efficacy of oxidized cellulose (surgicel) in reducing blood loss in suprapubic simple open prostatectomy: A randomized clinical trial.

Background: Simple open prostatectomy is still the treatment of choice for removing large prostates; however, peri-surgical bleeding accompanied by this technique has always been a challenge for urologist surgeons. Therefore, the present study aimed to investigate the effect of surgicel on reducing bleeding in trans-vesical prostatectomy. Materials and Methods: The present double-blinded clinical trial included 54 patients with Benign Prostatic Hyperplasia (BPH), divided into two groups of 27, and underwent trans-vesical prostatectomy. After removing the prostate, the prostate adenoma was weighed in the first group. Then, two surgicel were inserted into the prostate loge for prostate adenomas weighing 75 g or less. For larger prostates, another surgicel was inserted for each 25 g weight higher than the limit of 75 g. However, no Surgicel was inserted in the control group. Other steps of the procedure were the same in both groups. Moreover, hemoglobin and hematocrit levels were assessed in both groups; preoperation, intra-operative, 24 h, and 48 h postoperative. In addition, all the fluid used for bladder irrigation was collected, and its hemoglobin level was assessed. Results: According to our results, no intergroup difference in hemoglobin level changes, hematocrit changes, International Prostate Symptom Score (IPSS), postoperative hospital stay, and number of packed cells received. However, the postoperative blood loss in bladder lavage fluid was significantly higher in the control group (120.83 ± 46.66 g) as compared to the surgicel group (72.56 ± 32.53 g) (P < 0.001). Conclusion: The present study concluded that using surgicel in trans-vesical prostatectomy could reduce postoperative bleeding without increasing the chance of postoperative complications.

Evaluating the effectiveness of tranexamic acid administration in reducing bleeding in benign prostate hyperplasia patients underwent open prostatectomy: A double-blind randomized clinical trial.

Background: Blood loss of postoperative after prostate surgery could be related with an increase in urinary fibrinolytic activity. Tranexamic acid (TXA) is both a potent inhibitor of plasminogen and urokinase activators and a low molecular weight substance that is excreted unchanged in the urinary tract and can be administered both orally and intravenously. This study aimed to evaluate the effectiveness TXA administration in reducing bleeding in benign prostatic hyperplasia (BPH) patients who underwent open prostatectomy. Materials and Methods: This double-blind randomized clinical trial was conducted on patients with BPH who underwent open prostatectomy. The first group received TXA (1 gr IV from during surgery to 48 h after surgery, 3 times/day). Twenty-four hours after surgery, the two groups were compared in terms of bleeding rate. Hemoglobin (Hb), hematocrit (HCT), and platelet (Plt) counts were also assessed before and after the intervention. Results: Intervention and control groups were comparable in terms of basic and baseline values of variables at the beginning of the study (P > 0.05). The mean bleeding volume in TXA group was significantly lower than the control group 112.11 ± 53.5 and 190.00 ± 97.5 CC; P ≤ 0.001). Mean hospitalization (3.28±0.46 vs. 4.38 ± 0.95 days P < 0.001) and surgery duration (98.11 ± 37.11 vs. 128.00 ± 39.12 h; P = 0.001) were significantly lower in TXA group compared to control intervention. Conclusion: According to the findings of the current study, the administration of TXA led to reduce bleeding in BPH patients who underwent open prostatectomy. Furthermore, the mean Hb, HCT, levels were significantly affected by TXA. TXA treatment approach also can reduce the surgery and hospitalization time effectively. TXA approach is recommended as effective procedure in BPH patients who underwent open prostatectomy.

A field study of mental workload: conventional bus drivers versus bus rapid transit drivers.

Road traffic accidents are increasing worldwide and cause a high number of fatalities and injuries. Mental Work Load (MWL) is a contributing factor in road safety. The primary aim of this work was to study important MWL factors and then compare conventional and BRT (Bus Rapid Transit) drivers' MWL. This study evaluated bus drivers' MWL using the Driving Activity Load Index (DALI) questionnaire conducted with 123 bus drivers in Tehran. The results revealed significant differences between conventional and BRT drivers' mental workload. Moreover, data modelling showed that some organisational and environmental factors such as bus type, working hours per day, road maze, and route traffic volume contribute to drivers' mental workload. These findings suggest some essential customised factors that may help measure and offer practical solutions for decreasing the level of bus drivers' MWL in real-world road driving. Practitioner summaryMental workload is affected by several contributing factors. Depending on the working context, some of these contributing factors have a more significant influence on the level of the experienced MWL. Therefore, the main factors influencing the MWL of BRT and conventional bus drivers were assessed in their real-life environment.Abbreviations: MWL: mental work load; BRT: bus rapid transit; CB: conventional bus; DALI: driving activity load index; NASA-TLX: NASA task load index; SWAT: subjective workload assessment technique; EEG: electroencephalography electrocardiogram; fNIRS: functional magnetic resonance imaging; ITS: intelligent transportation systems; AVL: automated vehicle location.

Subjective and objective survey of office lighting: effects on alertness, comfort, satisfaction, and safety.

BACKGROUND: Lighting is one of the workplace factors that can relevantly impact workers' health, performance, safety, and job satisfaction. Brightness, natural light and color temperature are the factors that affect the quality of lighting. This study involved subjective and objective evaluation of office lighting and its effects on workers' alertness, comfort, satisfaction, safety, and performance in a prominent government office. METHODS: Visual comfort, alertness, performance, safety and satisfaction were assessed subjectively using the questionnaires and rating scales. Moreover, illuminance, color temperature of light sources, and natural light availability were evaluated objectively. RESULTS:  The findings of this study indicated that the use of natural light in the workplace could increase the illuminance and color temperature of light in the workplace and improve alertness, visual comfort, satisfaction and worker's preference. Conclusions: To improve the quality of lighting in the workplace, factors affecting it, such as the color temperature and the availability of natural light, should be considered.

Renal function markers in single-kidney patients after percutaneous nephrolithotomy: A pilot study.

Background: The present study was performed to investigate and compare renal functions of single-kidney patients after 12 h of percutaneous nephrolithotomy (PCNL) surgery through assessing major markers of renal function with focus on serum level of cystatin that performs a consistent accuracy in various conditions. Materials and Methods: This pilot quasi-experimental study was done on 92 patients with single kidney having staghorn calculus who had undergone PCNL and were referred to the Al-Zahra Hospital, Isfahan, Iran, during 2019-2021. Serum levels of cystatin C, creatinine, estimated glomerular filtration rate (eGFR), and neutrophil gelatinase-associated lipocalin (NGAL) urine level were evaluated before and 12 h after surgery. Results: The mean cystatin C decreased significantly 1.58 ± 0.55 versus mg/L 1.46 ± 0.52 after 12 h after surgery (P < 0.001). Furthermore, the mean levels of creatinine (2.04 ± 0.71 vs. 1.89 ± 0.60 mg/dL) and NGAL (39.72 ± 12.87 vs. 24.05 ± 10.89 µg/ml) were decreased significantly after 12 h of procedure (P < 0.05) while the mean eGFR (57.62 ± 27.59 vs. 64.68 ± 31.88 ml/min/1.73 m2) was increased significantly after 12 h (P < 0.001). Conclusion: Due to significant improvement in all markers of renal after PCNL, this procedure can be considered a potentially effective and safe approach for treating large stone in single-kidney patients.

Development and validation of a Nurse Station Ergonomics Assessment (NSEA) tool.

BACKGROUND: Nurse stations are one of the primary units for supporting effective functioning of any hospital. They are important working environments that demand adherence to known ergonomic principles for the well-being of both staff and patients. The aim of this study was to develop a psychometrically tested tool for the assessment of the ergonomic conditions of nurse workstations in hospitals. METHODS: Ten hospitals, with a total of 133 nurse stations participated in this mixed-methods research. The domains and items of the tool were developed based on a literature review, an experts' panel, and interviews with nurses. RESULTS: The final nurse station ergonomic assessment (NSEA) tool has good psychometric properties. Validity was assessed by face validity and content validity. Reliability was evaluated using inter-rater agreement and test-retest reliability analyses with a four-week interval between assessments. The NSEA is comprised of 64 items across eight domains: layout and location (7 items), workspace (11 items), security-safety (5 items), environmental conditions (8 items), counter (8 items), chair (13 items), desk (9 items), and monitor (3 items). CONCLUSIONS: The NSEA adds to the literature a tool for managers to ensure they comply with legal requirements and support best practice for those working on hospital wards. The NSEA can be used to identify challenges for healthcare professionals who use nurse stations and support the execution of targeted interventions to improve human-environment interactions.

An investigation of the effects of different shift schedules on the fatigue and sleepiness of officers on oil tankers during cargo handling operations.

Cargo handling is an operation, which requires a high level of performance from the officer of the watch (OOW). This study aimed to investigate the effect of different shift schedules on sleep quality, cognitive performance, and sleepiness of 139 OOWs on oil tankers with 4on-8off shifts, during the first shift of cargo handling. Sleep quality (Pittsburgh Sleep Quality Index (PSQI)), level of sleepiness (the Karolinska Sleepiness Scale (KSS)), Psychomotor Vigilance Task (PVT), and Arrow Flanker task performance were examined. The results showed that OOWs with (00:00-04:00, 12:00-16:00) and (04:00-08:00, 16:00-20:00) shifts had impaired cognitive performance and higher sleepiness during the cargo handling operation, and they also experienced impaired sleep quality. The results demonstrated that the circadian rhythm and homeostatic sleep drive have a greater impact on cognitive performance and sleepiness than time on shifts. These results suggest that allocating rest hours immediately before the cargo handling operation may reduce the risk of fatigue. Practitioner Summary: To the best of our knowledge, this maritime field study shows for the first time the prevalence of seafarers' sleepiness and cognitive performance while on duty during cargo handling, using a pre-post shift comparison between three different shifts. The results show the negative effects of keeping watch at night on sleep quality, sleepiness, and the impaired cognitive performance both in the day and the night shifts.

Diagnostic utility of a-methylacyl COA racemase in prostate cancer of the Iranian population.

BACKGROUND: Considering the great variations in the reported prevalence of prostate cancer across the world possibly due to different genetic and environmental backgrounds, we aimed to determine the expression pattern and the diagnostic utility of α-methylacyl coenzyme A racemase (AMACR) among Iranian patients with prostate adenocarcinoma. MATERIALS AND METHODS: In this cross-sectional study, formalin-fixed paraffin-embedded tissues of 58 patients with a definitive pathologic diagnosis of prostatic adenocarcinoma were evaluated. The expression of AMACR, intensity, and extensity of its staining was determined in selected samples by immunohistochemical technique. RESULTS: AMACR expression was significantly higher in neoplastic compared to normal tissue (P < 0.05). The expression of AMACR was significantly associated with the age of the patients (P = 0.04). The intensity of the staining was associated with the grade of the prostate adenocarcinoma (P = 0.04). There was no significant relationship between AMACR expression and perineural invasion. The sensitivity, specificity, positive predictive value, and negative predictive value of AMACR were 90%, 96%, 96%, and 90%, respectively. CONCLUSION: Findings from our study indicate that AMACR could be used as a diagnostic tool for the diagnosis of prostate adenocarcinoma. However, due to false-positive staining in the mimicker of prostatic adenocarcinoma, it is recommended to use it in combination with basal cell markers.

Efficacy and clinical predictors of response to rTMS treatment in pharmacoresistant obsessive-compulsive disorder (OCD): a retrospective study.

BACKGROUND: Application of repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) has been promising and approved by the Food and Drug Administration in 2018, but effects differ between patients. Knowledge about clinical predictors of rTMS response may help to increase clinical efficacy but is not available so far. METHODS: In a retrospective study, we investigated the efficacy of rTMS over the dorsolateral prefrontal cortex (DLPFC) or supplementary motor area (SMA) in 65 pharmaco-resistant OCD outpatients recruited for rTMS treatment from July 2015 to May 2017. Patients received either SMA rTMS (n = 38) or bilateral DLPFC rTMS (n = 27) in case of reporting higher affective and depressive symptoms in addition to the primary OCD symptoms. OCD symptoms and depression/anxiety states were measured at baseline (before the 1st session) and after the 20th session of rTMS. Additionally, we performed a binary logistic regression analysis on the demographic and clinical variables based on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) 3-factor and 2-factor models and individual items to investigate potential predictors of rTMS response. RESULTS: Patients' scores in Y-BOCS and Beck anxiety/depression inventories were significantly decreased following rTMS treatment. 46.2% of all patients responded to rTMS, based on the criterion of at least a 30% reduction in Y-BOCS scores. There was no significant difference between response rates of patients in DLPFC and SMA groups. No significant demographic predictors of rTMS efficacy were identified. The factors "obsession severity", "resistance" and "disturbance" and the "interference due to obsessions" and "resistance against compulsions" items of the Y-BOCS significantly predicted response to rTMS. CONCLUSIONS: In patients with less intrusive/interfering thoughts, and low scores in the "obsession severity", "disturbance", and "resistance" factors, rTMS might have superior effects. Identifying clinical and non-clinical predictors of response is relevant to personalize and adapt rTMS protocols in pharmaco-resistant OCD patients. Interpretation of rTMS efficacy should be done with caution due to the lack of a sham intervention condition.

Multiple environmental and psychosocial work risk factors and sleep disturbances.

BACKGROUND: This study aimed to investigate the relationship between multiple psychosocial and environmental work risk factors and sleep disturbances. METHODS: This cross-sectional study was conducted among 90 workers in a brick factory in Iran. The health and safety executive (HSE) tool, Epworth Sleepiness Scale (ESS), and Stop-Bang questionnaire were used to determine psychosocial factors, subjective sleepiness, and obstructive sleep apnea (OSA), respectively. Standard objective methods were used to assess the environmental risk factors, including noise, light, heat stress, and respirable particles. RESULTS: Most psychosocial and all environmental work factors were moderately to highly correlated to the ESS score. There were also moderate correlations between the demands (including work load, work patterns, and work environment), role (including a clear understanding of the employees about their role in the organization), and lighting variables and the Stop-Bang score. The results of multivariate logistic regression analysis showed that job control, wet bulb globe temperature (WBGT), and respirable dust were predictive of an ESS score indicating abnormal sleep status and noise was predictive of a Stop-Bang score predictive of OSA. CONCLUSIONS: The results suggest that stressors, especially noise, heat stress, and respirable dust, are related to the employees' indices of sleep disturbance independent of other potential workplace confounding factors. These results can highlight the importance of considering multiple psychosocial and environment work risk factors for implementing occupational health and ergonomics interventional programs to prevent sleep disturbances in the workforce.

Comparison of Melatonin Profile and Alertness of Firefighters with Different Work Schedules.

INTRODUCTION: A two-shift work schedule with different rotations is common among firefighters in Iranian petrochemical companies. This study compared salivary melatonin and sleepiness on the last night before turning to day shift at 19:00, 23:00, 3:00, and 7:00 among petrochemical firefighters (PFFs) working seven and four consecutive night shifts. METHODS: Sixty four PFFs working in the petrochemical industry were selected. To measure melatonin, saliva samples were taken, whereas the KSS index was used to assess sleepiness. Chi-square and independent samples t-test were carried out to analyze the data, and generalized linear model (GLM) was employed to determine the effect of confounding factors such as lighting and caffeine. RESULTS: The levels of melatonin at 3:00 and 7:00, and the overall changes during the shift in the two shift patterns under the study were different (P < 0.05). Sleepiness was significantly different only at 3:00 in the two studied shift patterns, while the effects of lighting and caffeine on melatonin changes were not significant (P > 0.05). CONCLUSION: It seems that a slow shift rotation is better because it reduces the secretion of melatonin (hence reducing sleepiness during the night) and changes the peak of melatonin secretion to the daytime, which is a sign of adaptation.

Comparison of the effect of typical firefighting activities, live fire drills and rescue operations at height on firefighters' physiological responses and cognitive function.

This study examined the impact of various types of firefighting activities on firefighters' physiological responses and cognitive function. Each firefighter was engaged in three conditions: (1) Live-fire activities (LFA), (2) Typical firefighting activities (TFA), and (3) Rescue operations at height (ROH). The effects of various types of firefighting activities on the physiological responses and cognitive function were evaluated by heart rate (HR), temporal artery temperature (TT), and the correct response (CR) on a cognitive test. The results indicated that, compared to the baseline, physiological response increased, while information processing performance decreased after the activity. Furthermore, HR and TT were significantly lower at the end of the firefighting activity in the LFA (149.33 bpm; 38.08 °C) compared with the TFA (152.22 bpm; 38.17 °C) and ROH (159.28 bpm; 38.24 °C) conditions. Also, CR was significantly higher at the end of the activity in the LFA and TFA compared with the ROH condition. The results showed that rescue at height was more intensive than the other firefighting tasks in decreasing physiological and cognitive function capacity after the experiment. Practitioner Summary: We assumed that various types of firefighting activities would have different effects on physiological and cognitive functions during firefighting activities. The Findings suggest that rescue at height operations, performed without the use of special protective equipment, was more influential than other firefighting duties in changing firefighters' physiological and cognitive capacity. Abbreviations: CR: correct response; LFA: live-fire activities; TFA: typical firefighting activities; ROH: rescue operations at height; HR: heart rate; TT: temporal artery tempearture; PASAT: pased auditory serila addition teat; FPC: firefighting protective clothing.

A Hybrid Methodology for Modeling Risk of Adverse Events in Complex Health-Care Settings.

In spite of increased attention to quality and efforts to provide safe medical care, adverse events (AEs) are still frequent in clinical practice. Reports from various sources indicate that a substantial number of hospitalized patients suffer treatment-caused injuries while in the hospital. While risk cannot be entirely eliminated from health-care activities, an important goal is to develop effective and durable mitigation strategies to render the system "safer." In order to do this, though, we must develop models that comprehensively and realistically characterize the risk. In the health-care domain, this can be extremely challenging due to the wide variability in the way that health-care processes and interventions are executed and also due to the dynamic nature of risk in this particular domain. In this study, we have developed a generic methodology for evaluating dynamic changes in AE risk in acute care hospitals as a function of organizational and nonorganizational factors, using a combination of modeling formalisms. First, a system dynamics (SD) framework is used to demonstrate how organizational-level and policy-level contributions to risk evolve over time, and how policies and decisions may affect the general system-level contribution to AE risk. It also captures the feedback of organizational factors and decisions over time and the nonlinearities in these feedback effects. SD is a popular approach to understanding the behavior of complex social and economic systems. It is a simulation-based, differential equation modeling tool that is widely used in situations where the formal model is complex and an analytical solution is very difficult to obtain. Second, a Bayesian belief network (BBN) framework is used to represent patient-level factors and also physician-level decisions and factors in the management of an individual patient, which contribute to the risk of hospital-acquired AE. BBNs are networks of probabilities that can capture probabilistic relations between variables and contain historical information about their relationship, and are powerful tools for modeling causes and effects in many domains. The model is intended to support hospital decisions with regard to staffing, length of stay, and investments in safety, which evolve dynamically over time. The methodology has been applied in modeling the two types of common AEs: pressure ulcers and vascular-catheter-associated infection, and the models have been validated with eight years of clinical data and use of expert opinion.

Effects of Shift Work on Cognitive Performance, Sleep Quality, and Sleepiness among Petrochemical Control Room Operators.

Shift work is associated with both sleepiness and reduced performance. The aim of this study was to examine cognitive performance, sleepiness, and sleep quality among petrochemical control room shift workers. Sixty shift workers participated in this study. Cognitive performance was evaluated using a number of objective tests, including continuous performance test, n-back test, and simple reaction time test; sleepiness was measured using the subjective Karolinska Sleepiness Scale (KSS); and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. ANCOVA, t-test, and repeated-measures ANOVA were applied for statistical analyses, and the significance level was set at p < 0.05. All variables related to cognitive performance, except for omission error, significantly decreased at the end of both day and night shifts (p < 0.0001). There were also significant differences between the day and night shifts in terms of the variables of omission error (p < 0.027) and commission error (p < 0.036). A significant difference was also observed between daily and nightly trends of sleepiness (p < 0.0001) so that sleepiness was higher for the night shift. Participants had low sleep quality on both day and night shifts, and there were significant differences between the day and night shifts in terms of subjective sleep quality and quantity (p < 0.01). Long working hours per shift result in fatigue, irregularities in the circadian rhythm and the cycle of sleep, induced cognitive performance decline at the end of both day and night shifts, and increased sleepiness in night shift. It, thus, seems necessary to take ergonomic measures such as planning for more appropriate shift work and reducing working hours.

Long-lasting analgesic effect of transcranial direct current stimulation in treatment of chronic endometriosis pain.

Approximately 10-20% of women of reproductive age suffer from endometriosis, with 70-90% of these women reporting chronic pain symptoms that persist during their menstrual cycle. We are presenting a case in which a novel form of noninvasive brain stimulation called transcranial direct current stimulation was used as an intervention in a 32-year-old woman with persistent, chronic pain symptoms caused by endometriosis for 20 years. Ten daily, 20-min sessions of 2-mA anodal transcranial direct current stimulation were applied over the left primary motor cortex. Acutely, visual analog scale pain symptoms were reduced by 60%. There were also significant decreases in modules of the Endometriosis Health Profile. At the 4-month follow-up, the patient still expressed an overall decrease in pain symptoms of 30%.