Non-traditional Schedules Research Articles

An Analysis of Safe Parking Programs: Identifying Program Features and Outcomes of an Emerging Homelessness Intervention

As vehicular homelessness increases in the United States, safe parking programs have proliferated. Yet little research exists on this emerging homelessness intervention. This three-year, mixed-methods study analyzed one of the largest safe parking programs in operation: the Jewish Family Service of San Diego Safe Parking Program (JFS SPP). Through analysis of quantitative data and interviews with 349 clients and 15 staff, this study yielded three major findings. First, JFS SPP has a 40% positive exit rate, with younger clients, women, veterans, and families more likely to exit into housing. Second, JFS SPP is preferred over shelters by persons who have used both services. This preference is especially important for older clients and clients with disabilities for whom safe parking is a safety net. Finally, increasing access to lots and services would benefit all clients, including families, seniors, and individuals with nontraditional schedules. Findings support policy recommendations for safe parking programs.

Assessing the Adequacy of Small Solute Clearance for Various Dialysis Modalities, with Inclusion of Residual Native Kidney Function.

Measurement of small molecule clearance remains important in the clinical care of patients requiring long-term dialysis. Many patients maintain a significant degree of residual native kidney function and may have nontraditional schedules with or without combined dialysis modalities. In this review, we examine and outline methods for comparing small molecule clearances among various dialysis prescriptions and modalities, with inclusion of residual kidney urea clearance.

The Night Relative Value Unit: A Weighted Relative Value Unit to Equate Day and Night Interpretations

Increasing emergency department patient volumes and the centrality of diagnostic imaging to patient care have contributed to the growing demand for contemporaneous radiology interpretations [1,2]. This demand has accelerated the rise of emergency radiology as a subspecialty and has increased the number of radiologists providing exclusively (or predominantly) evening or overnight interpretations [2-4]. Academic and private practices increasingly seek to hire, deploy, and retain radiologists willing to work these hours. Nontraditional schedules, including evening or overnight shifts, are usually compensated by extra time off. As a result, the annual clinical production of off-hour radiologists, which is often tracked by existing traditional measures, may unfairly discount their efforts relative to colleagues working routine schedules. Despite its shortcomings, the relative value unit (RVU) remains a useful standard for comparing clinical production among radiologists in a single group, division, or department. At a basic level, Current Procedural Terminology (CPT) codes have assigned RVUs consisting of components related to physician work, practice expense, and malpractice expense [5]. TheRVUwork specifically addresses the interpretative component of diagnostic imaging. This

How the Circadian Rhythm Affects Sleep, Wakefulness, and Overall Health

It is estimated that 15 to 25% of the U.S. labor force works night, evening, or rotating shifts. These non-traditional schedules can affect the circadian rhythm, a self-sustained rhythm of biological processes that plays an important role in modulating sleep/wake function, resulting in circadian rhythm sleep disorder, shift work type, usually referred to as shift work disorder. The disorder consists of a constant or recurrent pattern of sleep interruption that results in insomnia when sleep is needed and excessive sleepiness during waking hours. Clinicians need more information about the role of the circadian rhythm in human functioning as well as the pathophysiology, prevalence, and consequences of shift work disorder, so that they can recognize and diagnose this problem in clinical practice.

Visualizing jet lag in the mouse suprachiasmatic nucleus and peripheral circadian timing system

Circadian rhythms regulate most physiological processes. Adjustments to circadian time, called phase shifts, are necessary following international travel and on a more frequent basis for individuals who work non-traditional schedules such as rotating shifts. As the disruption that results from frequent phase shifts is deleterious to both animals and humans, we sought to better understand the kinetics of resynchronization of the mouse circadian system to one of the most disruptive phase shifts, a 6-h phase advance. Mice bearing a luciferase reporter gene for mPer2 were subjected to a 6-h advance of the light cycle and molecular rhythms in suprachiasmatic nuclei (SCN), thymus, spleen, lung and esophagus were measured periodically for 2 weeks following the shift. For the SCN, the master pacemaker in the brain, we employed high-resolution imaging of the brain slice to describe the resynchronization of rhythms in single SCN neurons during adjustment to the new light cycle. We observed significant differences in shifting kinetics among mice, among organs such as the spleen and lung, and importantly among neurons in the SCN. The phase distribution among all Period2-expressing SCN neurons widened on the day following a shift of the light cycle, which was partially due to cells in the ventral SCN exhibiting a larger initial phase shift than cells in the dorsal SCN. There was no clear delineation of ventral and dorsal regions, however, as the SCN appear to have a population of fast-shifting cells whose anatomical distribution is organized in a ventral-dorsal gradient. Full resynchronization of the SCN and peripheral timing system, as measured by a circadian reporter gene, did not occur until after 8 days in the advanced light cycle.