The perceptions and effects of sleep deprivation in anaesthetists

A research report submitted to the faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Medicine in Anaesthesiology Johannesburg, 2016Background: Sleep deprivation is known to have multiple pathophysiological, psychological and cognitive effects. The effects of sleep deprivation on anaesthetists have been recognised both within and outside of the workplace. Guidelines and strategies have been proposed to counteract some of the effects of sleep deprivation. This study investigated the perceived effects of sleep deprivation amongst anaesthetists. Method: A prospective, contextual, descriptive research design was followed for the study. Anaesthetists completed a questionnaire regarding perceptions and effects of sleep deprivation and the Epworth Sleepiness Scale (ESS). Results: A mean longest time spent without sleep due to work schedule of 31 (SD 9.1) hours. The mean score from the ESS was 11.5 (SD 4.4), indicating mild sleepiness. Sixty-one (57%) anaesthetists reported insufficient sleep due to work schedule 1 to 2 nights per week and the majority reported perceptions of the effects of sleep deprivation at work in the 1 to 2 times per week category. Sixtytwo (57.9%) anaesthetists have dozed off in theatre during the day and 85 (79.4%) have dozed off in theatre on a night call with varying degrees of regularity. Fifty-two (48.6%) anaesthetists perceived making mistakes related to sleepiness and 74 (69.2%) making mistakes unrelated to sleepiness. Due to sleepiness, 44 (41.1%) anaesthetists reported a percutaneous injury, 101 (94.4%) anaesthetists admitted to feeling at risk of a motor vehicle accident and 99 (92.5%) anaesthetists missed social or family activities because of sleepiness. Strategies to reduce sleepiness were assessed. Eighty-seven (81.3%) anaesthetists consumed at least one caffeinated beverage per day. Conclusion: Anaesthetists reported perceptions of inadequate sleep and the subsequent effects. The mean score from the ESS indicated a mild sleepiness level. Few anaesthetists used strategies to reduce the effects of sleep deprivation.MT201

Perioperative echocardiography for invasive thymoma with intracardiac invasion in a child: a case report

In the paediatric population, thymomas are rare mediastinal tumours. Surgical management is the main treatment for these tumours. A case of an aggressive thymoma with intracardiac invasion in a child is presented. The management plan involved either resection of the mass or de-bulking of the tumour followed by radiation therapy. Anaesthetic management for this procedure is reported and the use of transthoracic and transoesophageal echocardiography during the perioperative period is described. Echocardiography adds important haemodynamic and anatomical information not obtained from traditional imaging and it is recommended that it be considered routinely in these patients.Keywords: echocardiography, intracardiac invasion, paediatric, thymom

How Good are Our Measures? Investigating the Appropriate Use of Factor Analysis for Survey Instruments

Background: Evaluation work frequently utilizes factor analysis to establish the dimensionality, reliability, and stability of surveys. However, survey data is typically ordinal, violating the assumptions of most statistical methods, and thus is often factor-analyzed inappropriately. Purpose: This study illustrates the salient analytical decisions for factor-analyzing ordinal survey data appropriately and demonstrates the repercussions of inappropriate analyses. Setting: The data used for this study are drawn from an evaluation of the efficacy of a drama-based approach to teaching Shakespeare in elementary and middle school.  Intervention: Not applicable. Research Design: Survey research. Data Collection and Analysis: Four factor analytic methods were compared: a traditional exploratory factor analysis (EFA), a full-information EFA, and two EFAs within the confirmatory factor analysis framework (E/CFA) conducted according to the Jöreskog method and the Gugiu method. Findings: Methods appropriate for ordinal data produce better models, the E/CFAs outperform the EFAs, and the Gugiu method demonstrates greater model interpretability and stability than the Jöreskog method. These results suggest that the Gugiu E/CFA may be the preferable factor analytic method for use with ordinal data. Practical applications of these findings are discussed. Keywords: factor analysis; ordinal data; E/CFA; survey research

The Perceptions and Effects of Sleep Deprivation in a Department of Anesthesiology

Background and Objective Sleep deprivation has multiple pathophysiological, psychological and cognitive effects. The effects of sleep deprivation on anesthetists have been recognized both within and outside of the workplace. This study investigated the perceived effects of sleep deprivation on anesthetists. To document the longest time spent without sleep due to work schedule, to describe the perceptions of the effects of sleep deprivation and the degree of sleepiness and daytime fatigue symptoms using the Epworth Sleepiness Scale (ESS) and to describe measures taken by anesthetists to overcome sleepiness. Methods A prospective, contextual, descriptive research design was followed for the study. A convenience sample of anesthetists completed a questionnaire regarding perceptions and effects of sleep deprivation and the ESS. Data were descriptively analyzed. Results The mean [standard deviation (SD)] longest time spent without sleep due to work schedule was 31 (9.1) hours and all anesthetists felt that they had insufficient sleep due to work schedule, with 61 (57%) stating this occurred 1 to 2 nights per week. Effects of sleep deprivation included effects on academic development, feeling tired at work, difficulty in concentrating at work and feeling stressed or irritable. Dozing off in theatre both during a night call and a day shift at different frequencies were reported. Other effects on family and social life were described. The mean (SD) ESS score was 11.5 (4.4). Conclusions Anesthetists reported perceptions of inadequate sleep and the subsequent effects both at work and at home. Further research to determine the extent of sleep deprivation amongst anesthetists in South Africa is suggested

Predicting running away in girls who are victims of commercial sexual exploitation

Youth that are victims of commercial sexual exploitation of children (CSEC) have a host of clinical problems and often run away from home, residential care, and treatment, which complicates and limits treatment effectiveness. No research to date has attempted to predict running away in CSEC victims. The present study aimed to 1) characterize a clinically referred sample of girls who were victims of CSEC and compare them to other high-risk girls (i.e., girls who also have a history of trauma and running away, but deny CSEC); and 2) examine the utility of using the Youth Level of Service/Case Management Inventory (YLS/CMI) to predict future running away. Data were collected from de-identified charts of 80 girls (mean age = 15.38, SD = 1.3, 37.9% White, 52.5% CSEC victims) who were referred for psychological assessment by the Department of Child Services. Girls in the CSEC group were more likely to have experienced sexual abuse (χ2 = 6.85, p = .009), an STI (χ2 = 6.45, p = .01), a post-traumatic stress disorder diagnosis (χ2 = 11.84, p = .001), and a substance use disorder diagnosis (χ2 = 11.32, p = .001) than high-risk girls. Moderated regression results indicated that YLS/CMI scores significantly predicted future running away among the CSEC group (β = 0.23, SE = .06, p = .02), but not the high-risk group (β = -.008, SE = .11, p =.90). The YLS/CMI shows initial promise for predicting future running away in girls who are CSEC victims. Predicting running away can help identify those at risk for and prevent running away and improve treatment outcomes. We hope current findings stimulate future work in this area

Prospectus, February 26, 2014

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Siri Humphrey: Design Principles for an AI Policy Analyst

This workgroup considered whether the policy analysis function in government could be replaced by an artificial intelligence policy analyst (AIPA) that responds directly to requests for information and decision support from political and administrative leaders. We describe the current model for policy analysis, identify the design criteria for an AIPA, and consider its limitations should it be adopted. A core limitation is the essential human interaction between a decision maker and an analyst/advisor, which extends the meaning and purpose of policy analysis beyond a simple synthesis or technical analysis view (each of which is nonetheless a complex task in its own right). Rather than propose a wholesale replacement of policy analysts with AIPA, we reframe the question focussing on the use of AI by human policy analysts for augmenting their current work, what we term intelligence-amplified policy analysis (IAPA). We conclude by considering how policy analysts, schools of public affairs, and institutions of government will need to adapt to the changing nature of policy analysis in an era of increasingly capable AI

Climate change influences foliar nutrition and metabolism of red maple (Acer rubrum) trees in a northern hardwood forest

© The Author(s), 2022. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Blagden, M., Harrison, J. L., Minocha, R., Sanders-DeMott, R., Long, S., & Templer, P. H. Climate change influences foliar nutrition and metabolism of red maple (Acer rubrum) trees in a northern hardwood forest. Ecosphere, 13(2), (2022): e03859. https://doi.org/10.1002/ecs2.3859.Mean annual air temperatures are projected to increase, while the winter snowpack is expected to shrink in depth and duration for many mid- and high-latitude temperate forest ecosystems over the next several decades. Together, these changes will lead to warmer growing season soil temperatures and an increased frequency of soil freeze–thaw cycles (FTCs) in winter. We took advantage of the Climate Change Across Seasons Experiment (CCASE) at the Hubbard Brook Experimental Forest in the White Mountains of New Hampshire, USA, to determine how these changes in soil temperature affect foliar nitrogen (N) and carbon metabolism of red maple (Acer rubrum) trees in 2015 and 2017. Earlier work from this study revealed a similar increase in foliar N concentrations with growing season soil warming, with or without the occurrence of soil FTCs in winter. However, these changes in soil warming could differentially affect the availability of cellular nutrients, concentrations of primary and secondary metabolites, and the rates of photosynthesis that are all responsive to climate change. We found that foliar concentrations of phosphorus (P), potassium (K), N, spermine (a polyamine), amino acids (alanine, histidine, and phenylalanine), chlorophyll, carotenoids, sucrose, and rates of photosynthesis increased with growing season soil warming. Despite similar concentrations of foliar N with soil warming with and without soil FTCs in winter, winter soil FTCs affected other foliar metabolic responses. The combination of growing season soil warming and winter soil FTCs led to increased concentrations of two polyamines (putrescine and spermine) and amino acids (alanine, proline, aspartic acid, γ-aminobutyric acid, valine, leucine, and isoleucine). Treatment-specific metabolic changes indicated that while responses to growing season warming were more connected to their role as growth modulators, soil warming + FTC treatment-related effects revealed their dual role in growth and stress tolerance. Together, the results of this study demonstrate that growing season soil warming has multiple positive effects on foliar N and cellular metabolism in trees and that some of these foliar responses are further modified by the addition of stress from winter soil FTCs.This research was supported by an NSF Long Term Ecological Research (LTER) Grant to Hubbard Brook (NSF 1114804 and 1637685) and an NSF CAREER grant to PHT (NSF DEB1149929). RSD was supported by NSF DGE0947950, a Boston University (BU) Dean's Fellowship, and the BU Program in Biogeoscience. Jamie Harrison was supported by a BU Dean's Fellowship. Megan Blagden was supported by a BU Undergraduate Research Opportunity Program fellowship. This manuscript is a contribution to the Hubbard Brook Ecosystem Study. Hubbard Brook is part of the LTER network, which is supported by the NSF

The Physiologic and Behavioral Implications of Playing Active and Sedentary Video Games in a Seated and Standing Position

International Journal of Exercise Science 7(3) : 194-201, 2014. Previous studies have assessed physiologic response while playing video games per manufacturer instructions with participants standing during active video game play and seated during sedentary game play. It is not known whether an assigned seated or standing position affects positional preference and oxygen consumption (VO2) while gaming. The purpose of the study was to assess VO2 and preference of playing active and sedentary video games in a seated and standing position. VO2 was assessed in 25 participants during four, 20-minute conditions; resting, PlayStation 2 Madden NFL Football 2011, Nintendo Wii-Sports Boxing and Nintendo Wii Madden NFL Football 2011. Each condition was divided into two positional conditions (10 minutes seated, 10 minutes standing) and each participant indicated their positional preference after each 20-minute condition. Standing VO2 (4.4 ± 0.2 ml•kg-1•min-1 PS2, 4.6 ± 0.1 ml•kg-1•min-1 Wii Madden, 6.8 ± 0.3 ml•kg-1•min-1Wii Boxing) was significantly (p ≤ 0.001) greater than seated VO2 (4.0 ± 0.1 ml•kg-1•min-1 PS2, 4.2 ± 0.1 ml•kg-1•min-1 Wii Madden, 6.1 ± 0.3 ml•kg-1•min-1Wii Boxing) for each gaming condition. Participants preferred (p ≤ 0.001) to sit for all gaming conditions except Wii Boxing. Playing video games while standing increases VO2 to a greater extent than playing the same games in a seated position. Standing was only preferred for the most physiologically challenging game, Wii Boxing. Gaming position should be considered when assessing the physiologic and behavioral outcomes of playing video games

Physiologic Responses, Liking and Motivation for Playing the Same Video Game on an Active Versus a Traditional, Non-Active Gaming System.

Int J Exerc Sci 5(2) : 160-169, 2012. Evidence suggests that individuals playing certain video games on the Nintendo Wii® (Wii) exhibit increased energy expenditure versus traditional video games, although little research examines non-Wii Sports/Fit games. The purpose of this study is to assess physiologic responses, liking, and the relative reinforcing value (RRV) of a popular, non-Wii sports video game for the Wii relative to the same game played on a traditional, non-active system. Twenty-four college-aged students participated. Heart rate and oxygen consumption (O2) was assessed during rest and when playing the following games: Madden NFL 2011® for Playstation 2 (PS2 Madden) and the Wii (Wii Madden), and Wii Sports Boxing. The RRV was assessed for Wii Madden versus PS2 Madden. Analysis of variance demonstrated a main effect for condition (p ≤ 0.01) as O2 (5.2 ± 0.2 ml·kg-1·min-1 Wii, 4.1 ± 0.1 ml·kg-1·min-1 PS2, 3.7 ± 0.1 ml·kg-1·min-1, rest) and heart rate (89.2 ± 2.7 bpm Wii, 79.7 ± 2.5 bpm PS2, 79.1 ± 2.5 bpm, rest) was greater for Wii Madden than PS2 Madden and rest. Heart Rate (105.4 ± 5.3 bpm) and O2 (10.4 ml·kg-1·min-1) for Wii Sports Boxing was significantly greater than all other conditions (p ≤ 0.003). The RRV was not significantly different between Wii Madden and PS2 Madden (p = 0.50). Compared to the same game on a traditional system, Wii Madden is more physiologically challenging and equally reinforcing. However, Wii Madden would not be categorized as moderate-intensity physical activity