Working hours, sleep, and fatigue in the public safety sector: A scoping review of the research.

BACKGROUND: The public safety sector includes law enforcement officers (LEO), corrections officers (CO), firefighter service (FF), wildland firefighting (WFF), and emergency medical services (EMS), as defined in the National Occupational Research Agenda (NORA) of the National Institute for Occupational Safety and Health (NIOSH). Across these occupations, shiftwork, long-duration shifts, and excessive overtime are common. Our objective was to identify research gaps related to working hours, sleep, and fatigue among these workers. METHODS: We used a scoping review study design that included searches of MEDLINE, Embase, CAB Abstracts, Global Health, PsychInfo, CINAHL, Scopus, Academic Search Complete, Agricultural and Environmental Science Collection, ProQuest Central, Cochrane Library, Safety Lit, Homeland Security Digital Library, and Sociological Abstracts using a range of occupational search terms and terms related to working hours, sleep, and fatigue. RESULTS: Out of 3415 articles returned from our database search, 202 met all inclusion criteria. Six common outcomes related to working hours, sleep, and fatigue emerged: sleep, fatigue, work performance, injury, psychosocial stress, and chronic disease. Nearly two-thirds (59%, n = 120) of the studies were observational, of which 64% (n = 77) were cross sectional and 9% were (n = 11) longitudinal; 14% (n = 30) of the studies were reviews; and 19% (n = 39) were experimental or quasi-experimental studies. Only 25 of the 202 articles described mitigation strategies or interventions. FFs, LEOs, EMS, and WFFs were the most studied, followed by COs. CONCLUSIONS: In general, more longitudinal and experimental studies are needed to enrich the knowledge base on the consequences of long working hours, poor sleep, and fatigue in the public safety sector. Few experimental studies have tested novel approaches to fatigue mitigation in diverse sectors of public safety. This gap in research limits the decisions that may be made by employers to address fatigue as a threat to public-safety worker health and safety.

Sensitivity and specificity of pupillary light reflex measures for ASD using monocular pupillometry.

INTRODUCTION: Automated hand-held pupillometry demonstrates precision accuracy, offering promise for augmenting ASD screening. METHODS: Monocular pupillometry was examined in children and adolescents (36 ASD; 24 TD). Multiple logistic regression and receiver operating characteristic analysis assessed PLR metrics and diagnostic status. RESULTS: Constriction time (Ct1) (ASD: M = 0.69, SD = 0.21; TD: M = 0.82, SD = 0.18; t(58 = 2.37; p = 0.02) and return to baseline (RTB T75) (ASD: M = 2.93, SD = 1.21; TD: M = 2.32, SD = 1.08; t(58) = - 2.03; p = 0.04) predicted ASD (ß = - 1.31, OR = 0.27; RTB T75, ß = 0.156, OR = 1.162). Sensitivity = 74.8%, when RTB ≥ 1.83 s and 69.4% when Ct1 = 0.785 s. CONCLUSION: Findings suggest monocular pupillometry captures differences detecting ASD.

Psychometric Evaluation of the Creighton Competency Evaluation Instrument in a Population of Working Nurses.

BACKGROUND AND PURPOSE: This study explored the psychometric properties of the Creighton Competency Evaluation Instrument (C-CEI), previously validated for use with nursing students, to assess simulation performance among registered nurses working 12-hour shifts. Valid and reliable measurements are needed to test clinical and simulation competencies and characterize the effects of fatigue on nursing performance. METHODS: Trained raters scored nurses' patient care performance in simulation scenarios using the C-CEI. We analyzed the instrument's principal components, internal reliability, and construct validity. RESULTS: Internal reliability of the C-CEI aggregate score and the Clinical Decision-making component were high (>.70). The latter robustly correlated with predicted cognitive effectiveness, a measure of fatigue. CONCLUSIONS: The C-CEI is a reliable measure for use among registered nurses and its further development will be important for testing performance of working nurses and fatigue-mitigation innovations.

The effects of three consecutive 12-hour shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study.

BACKGROUND: Healthcare systems have widely adopted consecutive 12 h day and night shifts for nurses, but the effects of these shifts on cognition, sleepiness, and nursing performance remains understudied. OBJECTIVE: To determine the extent of changes in cognition and sleepiness in nurses working three consecutive 12 h shifts, quantify the respective impacts of these changes on different aspects of nursing performance, and investigate individual differences in all measures. DESIGN: A quasi-experimental, between-within design collected data from nurses between November 2018 and March 2020. The between-groups component was comprised of day shift nurses vs. night shift nurses, while the within-groups component was comprised of two separate test sessions for each nurse: one immediately following a third consecutive shift (fatigued) and one after three consecutive days off work (rested). SETTING: Participants were tested in a northwestern US university's nursing simulation laboratory. PARTICIPANTS: A volunteer sample of 94 registered nurses involved in direct patient care working 12 h shifts were recruited from two local hospitals. METHODS: Simulated nursing performance was measured in seven separate domains and an aggregate score from the Creighton Competence and Evaluation Inventory, covering both lower- and higher-level constructs like procedural skills, assessment, decision-making, etc. Cognition and sleepiness were assessed through measures of sustained attention, predicted cognitive effectiveness, and subjective sleepiness. RESULTS: In our 94 nurses, individual differences in all our measures varied from trivial to extensive. For six domains of performance and the aggregate score there were no significant differences in means across groups or conditions. For the seventh, Communication skills were lower for night nurses than day nurses, but this effect was small. After three consecutive shifts, sustained attention and predicted cognitive effectiveness decreased, and subjective sleepiness increased. Predicted cognitive effectiveness was particularly low for fatigued night nurses relative to other conditions and was positively correlated with Communication while controlling for other predictors. CONCLUSIONS AND RELEVANCE: Nurses maintained their levels of performance for all domains after three consecutive shifts. Individual differences in predicted cognitive effectiveness could account for variation in performance by shift type for Communication skills but for no other domain of performance. Communication skills and predicted cognitive effectiveness may interest researchers in the development of fatigue-mitigation strategies for night nurses, but our findings also suggest that more sensitive measures of performance may be necessary to capture other meaningful effects of long, consecutive shifts-if any-on patient care. Tweetable abstract: The effects of three consecutive 12 h shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study.

Sleep health and predicted cognitive effectiveness of nurses working 12-hour shifts: an observational study.

BACKGROUND: Due to the 24hr nature of society, shift work has become an integral part of many industries. Within the literature there exists an abundance of evidence linking shift work-related sleep restriction and fatigue with errors, accidents, and adverse long-term health outcomes. OBJECTIVE: The study goal was to physiologically measure sleep patterns and predicted cognitive decline of nurses working both 12hr day and night shifts to address the growing concern about sleep restriction among healthcare workers. DESIGN: This study presents the results of a quasi-experimental, mixed between-within design where the sleep of 12hr day and night shift nurses was measured using ReadiBand wrist actigraphs. The between groups component was comprised of day v. night shift nurses. The within groups component was comprised of two separate measurement periods for each nurse-once for three consecutive days while they were working shifts (on duty) and once for three consecutive days off work (off duty). SETTING: Participants wore the wrist actigraph at home and in the hospital, and were instructed to adhere to their regular sleep schedule. PARTICIPANTS: Participants were recruited from two hospitals in Washington State (n=90). Participants were 48 night- and 42 day-shift nurses. All participants worked 12-hour shifts. METHODS: Sleep was measured using ReadiBand wrist actigraphs, which are licensed with the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTEtm) Alertness Score model, a biomathematical model that predicts cognitive effectiveness based on sleep/wake schedule. ReadiBands also calculate sleep quantity, sleep efficiency, and sleep latency. Results were analysed in SPSS (v26) through multilevel modelling. RESULTS: Differences were observed in sleep quantity, efficiency, and latency based on shift type (day vs. night) and shift duty (on vs. off). The most extreme differences, however, were noted in cognitive effectiveness (SAFTEtm), whereby night shift nurses experienced substantial decline-frequently into the "high risk" zone-throughout their shifts compared to day shift nurses. CONCLUSIONS: The present study identifies sleep characteristics that differ between day and night nurses working 12-hour shifts using objective measurements of sleep. Biomathematical modelling can offer a novel method to estimate hours of greatest cognitive decline, and have implications for policy around shift duration, timing, and overtime allocation.

Pupillary Response and Phenotype in ASD: Latency to Constriction Discriminates ASD from Typically Developing Adolescents.

Brain imaging data describe differences in the ASD brain, including amygdala overgrowth, neural interconnectivity, and a three-phase model of neuroanatomical changes from early post-natal development through late adolescence. The pupil reflex test (PRT), a noninvasive measure of brain function, may help improve early diagnosis and elucidate underlying physiology in expression of ASD endophenotype. Commonly observed characteristics of ASD include normal visual acuity but difficulty with eye gaze and photosensitivity, suggesting deficient neuromodulation of cranial nerves. Aims of this study were to confirm sensitivity of the PRT for identifying adolescents with ASD, determine if a phenotype for a subtype of ASD marked by pupil response is present in adolescence, and determine whether differences could be observed on a neurologic exam testing cranial nerves II and III (CNII; CNIII). Using pupillometry, constriction latency was measured serving as a proxy for recording neuromodulation of cranial nerves underlying the pupillary reflex. The swinging flashlight method, used to perform the PRT for measuring constriction latency and return to baseline, discriminated ASD participants from typically developing adolescents on 72.2% of trials. Results further confirmed this measure's sensitivity within a subtype of ASD in later stages of development, serving as a correlate of neural activity within the locus-coeruleus norepinephrine (LC-NE) system. A brainstem model of atypical PRT in ASD is examined in relation to modulation of cranial nerves and atypical arousal levels subserving the atypical pupillary reflex. Autism Res 2018, 11: 364-375. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Milder forms of autism spectrum disorder (ASD) can be difficult to diagnose based on behavioral testing alone. This study used eye-tracking equipment and a hand-held penlight to measure the pupil reflex in adolescents with "high functioning" ASD and in adolescents without ASD. The ASD group showed a delay in pupil response. This is the first eye-tracking study to conduct this test as typically performed by a clinical provider, demonstrating differences in older individuals with a subtype of ASD.

Shift Work: Disrupted Circadian Rhythms and Sleep-Implications for Health and Well-Being.

PURPOSE OF REVIEW: Our 24/7 society is dependent on shift work, despite mounting evidence for negative health outcomes from sleep displacement due to shift work. This paper reviews short- and long-term health consequences of sleep displacement and circadian misalignment due to shift work. RECENT FINDINGS: We focus on four broad health domains: metabolic health; risk of cancer; cardiovascular health; and mental health. Circadian misalignment affects these domains by inducing sleep deficiency, sympathovagal and hormonal imbalance, inflammation, impaired glucose metabolism, and dysregulated cell cycles. This leads to a range of medical conditions, including obesity, metabolic syndrome, type II diabetes, gastrointestinal dysfunction, compromised immune function, cardiovascular disease, excessive sleepiness, mood and social disorders, and increased cancer risk. SUMMARY: Interactions of biological disturbances with behavioral and societal factors shape the effects of shift work on health and well-being. Research is needed to better understand the underlying mechanisms and drive the development of countermeasures.

Identifying psychophysiological indices of expert vs. novice performance in deadly force judgment and decision making.

OBJECTIVE: To demonstrate that psychophysiology may have applications for objective assessment of expertise development in deadly force judgment and decision making (DFJDM). BACKGROUND: Modern training techniques focus on improving decision-making skills with participative assessment between trainees and subject matter experts primarily through subjective observation. OBJECTIVE metrics need to be developed. The current proof of concept study explored the potential for psychophysiological metrics in deadly force judgment contexts. METHOD: Twenty-four participants (novice, expert) were recruited. All wore a wireless Electroencephalography (EEG) device to collect psychophysiological data during high-fidelity simulated deadly force judgment and decision-making simulations using a modified Glock firearm. Participants were exposed to 27 video scenarios, one-third of which would have justified use of deadly force. Pass/fail was determined by whether the participant used deadly force appropriately. RESULTS: Experts had a significantly higher pass rate compared to novices (p < 0.05). Multiple metrics were shown to distinguish novices from experts. Hierarchical regression analyses indicate that psychophysiological variables are able to explain 72% of the variability in expert performance, but only 37% in novices. Discriminant function analysis (DFA) using psychophysiological metrics was able to discern between experts and novices with 72.6% accuracy. CONCLUSION: While limited due to small sample size, the results suggest that psychophysiology may be developed for use as an objective measure of expertise in DFDJM. Specifically, discriminant function measures may have the potential to objectively identify expert skill acquisition. APPLICATION: Psychophysiological metrics may create a performance model with the potential to optimize simulator-based DFJDM training. These performance models could be used for trainee feedback, and/or by the instructor to assess performance objectively.