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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Generalizability of a biomathematical model of fatigue's sleep predictions.

Introduction: Biomathematical models of fatigue (BMMF) predict fatigue during a work-rest schedule on the basis of sleep-wake histories. In the absence of actual sleep-wake histories, sleep-wake histories are predicted directly from work-rest schedules. The predicted sleep-wake histories are then used to predict fatigue. It remains to be determined whether workers organize their sleep similarly across operations and thus whether sleep predictions generalize.Methods: Officers (n = 173) enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress study were studied. Officers' sleep-wake behaviors were measured using wrist-actigraphy and predicted using a BMMF (FAID Quantum) parameterized in aviation and rail. Sleepiness (i.e. Karolinska Sleepiness Scale (KSS) ratings) was predicted using actual and predicted sleep-wake data. Data were analyzed using sensitivity analyses.Results: During officers' 16.0 ± 1.9 days of study participation, they worked 8.6 ± 3.1 shifts and primarily worked day shifts and afternoon shifts. Across shifts, 7.0 h ± 1.9 h of actual sleep were obtained in the prior 24 h and associated peak KSS ratings were 5.7 ± 1.3. Across shifts, 7.2 h ± 1.1 h of sleep were predicted in the prior 24 h and associated peak KSS ratings were 5.5 ± 1.2. The minute-by-minute predicted and actual sleep-wake data demonstrated high sensitivity (80.4%). However, sleep was observed at all hours-of-the-day, but sleep was rarely predicted during the daytime hours.Discussion: The sleep-wake behaviors predicted by a BMMF parameterized in aviation and rail demonstrated high sensitivity with police officers' actual sleep-wake behaviors. Additional night shift data are needed to conclude whether BMMF sleep predictions generalize across operations.

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

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

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

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

Fatigue and short-term unplanned absences among police officers.

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

Working Time Society consensus statements: Prescriptive rule sets and risk management-based approaches for the management of fatigue-related risk in working time arrangements.

Traditionally, working time arrangements to limit fatigue-related risk have taken a prescriptive approach, which sets maximum shift durations in order to prevent excessive buildup of fatigue (and the associated increased risk) within shifts and sets minimum break durations to allow adequate time for rest and recovery within and/or between shifts. Prescriptive rule sets can be successful when, from a fatigue-related risk standpoint, they classify safe work hours as permitted and unsafe work hours as not permitted. However, prescriptive rule sets ignore important aspects of the biological factors (such as the interaction between circadian and homeostatic processes) that drive fatigue, which are critical modulators of the relationship between work hours and fatigue-related risk. As such, in around-the-clock operations when people must work outside of normal daytime hours, the relationship between regulatory compliance and safety tends to break down, and thus these rule sets become less effective. To address this issue, risk management-based approaches have been designed to regulate the procedures associated with managing fatigue-related risk. These risk management-based approaches are suitable for nighttime operations and a variety of other non-standard work schedules, and can be tailored to the particular job or industry. Although the purpose of these fatigue risk management approaches is to curb fatigue risk, fatigue risk cannot be measured directly. Thus, the goal is not on regulating fatigue risk per se, but rather to put in place procedures that serve to address fatigue before, during, and after potential fatigue-related incidents. Examples include predictive mathematical modeling of fatigue for work scheduling, proactive fatigue monitoring in the workplace, and reactive post-incident follow-up. With different risks and different needs across industries, there is no "one size fits all" approach to managing fatigue-related risk. However, hybrid strategies combining prescriptive rule sets and risk management-based approaches can create the flexibility necessary to reduce fatigue-related risk based on the specific needs of different work environments while maintaining appropriate regulatory oversight.

U.S. police rosters: Fatigue and public complaints.

STUDY OBJECTIVES: Recent experimental research indicates a substantial impact of shift work related fatigue on police officers' encounters with the public. In recent years, biomathematical models of fatigue have provided a new way to identify potential relationships between working time arrangements and job performance. This study focused on public complaints against police officers and determined whether the odds of a public complaint were associated with work schedules and/or a biomathematical model's predictions of fatigue and sleepiness. METHODS: N = 144 police officers from two municipal police departments in the United States reported shift start times, shift hours, court hours, and public complaints each duty day during study participation. A biomathematical model of fatigue (FAID Quantum) predicted sleep duration and sleep timing and inferred fatigue and sleepiness for 15 744 shifts. Fatigue, sleepiness, 24 hr sleep estimates, and work schedule were tested as predictors of public complaints. RESULTS: Greater fatigue, greater sleepiness, and less sleep in the 24 hr prior to a shift increased the odds of a public complaint (F ≥ 9.14, p < 0.01). Working back-to-back night shifts increased the odds of a public complaint (OR = 4.27, p < 0.01), particularly when off-duty court hours were worked between the night shifts (OR = 4.73, p < 0.01). CONCLUSIONS: On-duty fatigue and sleepiness, sleep obtained prior to a shift, and working night shifts were strongly associated with public complaints. Off-duty court appearances reduced sleep between night shifts and further increased the odds of a public complaint. The results suggest that off-duty court hours should be limited between night shifts and duty schedules should be considered when scheduling court appearances.