Medical residency is characterized by sleep deprivation, stress, and heavy workload. The impact of these pressures on physician-patient communication has not been fully explored. The aim of the current study was to investigate how contextual demands, stress, and burnout impact empathy and provision of patient-centered communication among internal medicine residents in two hospitals. The long-call shift was studied, as it is known to be particularly taxing and is a primary feature of medical residency. Assessments were obtained both prior to and at the conclusion of residents' shifts. Cognitive complexity was examined as a potential mediator of the relationship between stress and burnout, and burnout and empathy. Results revealed that there was a significant decline in physician empathy from the beginning to the end of the long-call shift and that this decline in empathy predicted less patient-centered communication from physicians. Stress, burnout, and decline in empathy were all positively associated, indicating that resident physicians who were more stressed and burned out were at increased risk for declines in empathy over the course of their shift. Cognitive complexity was not found to be a significant mediator of any associations between study variables, though it was associated with several key variables in unexpected ways. These findings highlight the importance of identifying and addressing barriers to patient-centered communication, as a number of these barriers may be routinely present in the demanding environment of medical residency.

Organizations are increasingly devoting interest towards understanding the causes of workplace deviance behaviors, which include interpersonal aggression, theft, violence, vandalism and sabotage. These behaviors are particularly relevant to organizations, in that the yearly losses due to theft are estimated at over 40 billion dollars for U.S. businesses (Coffin, 2003), and acts of workplace deviance could cost as much as 200 billion dollars annually (Murphy, 1993).In this research, I integrated theoretical perspectives from psychology and organizational behavior with neurocognitive evidence in order to examine the effects of sleep deprivation on workplace deviance behavior. In particular, I argue that cognitive resource theories offer explanatory power for the proposed linkage between sleep loss and deviant behaviors. Specifically, sleep deprivation was expected to reduce cognitive capacity and self-regulatory ability, and as a result decrease individuals' self-control, increase hostility, and impair moral decisions, which would in turn increase workplace deviance. Finally, proposed methods are presented for two studies. The first study utilized a field sample of shiftworkers with irregular sleep schedules (i.e., nurses). The second study utilized a lab sample of university students who were subjected to sleep deprivation conditions in a controlled environment.Results largely supported the model in both samples, with the exception of moral reasoning, which was unrelated to sleep deprivation. Sleep deprivation affected self-control and hostility, which were in turn related to deviance, with the exception of self-control and interpersonal deviance in Study 2.

A descriptive study was conducted to examine the relationship between social support and adaptation to sleep by Southern Taiwan hospitalized adults. The conceptual framework for this study was based on Roy's adaptation model and social support as a beneficial factor in health and well-being. Sixty-one hospitalized adults, ages 20 to 71 years, participated in this study. Sixteen subjects (26.2%) had a supportive person stay with them. Data analysis showed that only daytime sleep items of the supplementation factor were significantly different between the supported and unsupported groups. However, all the mean values of effectiveness items in the supported group were higher than those in the unsupported group. It is recommended that a larger sample size from diverse hospitals in Taiwan be used to repeat the study.

Approved for public release; distribution is unlimited / This study compares the effects of a visual and a 3-dimensional auditory display on primary and secondary task performance, mood, and mental workload at incremental levels of sleep deprivation. It is based on a study conducted by the Army Research Laboratory, Cognitive Science Branch, Aberdeen, Maryland, from 12 Marines performing land navigational tasks in two helmet-mounted display (HMD) modes; visual and 3-dimensional auditory, for a 48 hour period. The results indicate that performance under sleep deprivation is significantly impacted in both modalities; however, performance in the primary task was more degraded in the 3-D auditory modality. Additionally, Marines were more likely to experience degraded performance in the secondary task with increased sleep deprivation. The recommendations address the need to design HMDs that will not overburden sensory channels and the concern for military leaders to understand the additional demands imposed on solders in a HMD environment. / Captain, Signal Corps, United States Army

A common reason why athletes retire from their sport is burnout. Athletic burnout often occurs when athletes are over-trained and do not get enough rest. The present study examines the question: why is it that some athletes are able to perform at a high level for many years while others fizzle out? The purpose of the proposed study is to investigate the effects of perfectionism and anxiety on sleep disturbances and athletic burnout in high school students. The proposed method will be a correlational within-participants design and participants will be high school-age female gymnasts. The gymnasts will complete measures of perfectionism surrounding academics and athletics, anxiety, and burnout. Additionally, the gymnasts’ parents will complete measures of perfectionism and their perceptions of their child’s burnout. Athletes will then be given a sleep tracker to wear each night for a week to measure the athlete’s sleep per night. It is predicted that academic perfectionism and amount of sleep will interact to result in higher burnout levels. Additionally, it is predicted that there will be an interaction between anxiety levels and amount of sleep resulting in higher levels of burnout. The proposed study could give more insight into the mental and physiological processes behind athletic burnout. The relationship between perfectionism, anxiety, sleep, and burnout is one that requires further research but may be useful information for coaches, parents, and athletes to prevent athletic burnout.

This thesis describes the use of in vivo and in vitro models to better understand the molecular correlates of sleep and sleep deprivation. Unlike previous studies, we utilise a timecourse based experimental design throughout, which has the advantage of identifying how the abundance of molecules return to baseline following sleep deprivation. Chapter 3 outlines the transcriptome of mouse cortex collected over 54 hours from mice subjected to varied durations of sleep deprivation. The timecourse experimental design aids in the identification of genes that are induced during both spontaneous and enforced wakefulness, and facilitates the dissociation of genes whose expression is tightly linked to the current wake state of the animal from those whose expression is linked to the total amount of wakefulness recently experienced by the animal. Like previous studies, we identify several genes involved in the unfolded protein response and synaptic function that are upregulated by sleep deprivation. We also find that increasing durations of sleep deprivation progressively reduces the total number of rhythmically expressed genes in mouse cortex, with only a handful of transcripts identified as diurnal following 12 hour sleep deprivation. Chapter 4 outlines the proteomic and metabolomic effects of 12 hour sleep deprivation. Proteomic analyses indicate that the abundance of ribosomal and nucleosomal proteins is suppressed for at least 24 hours following sleep deprivation, whilst the abundance of several phosphodiesterases are acutely increased following sleep deprivation. Metabolomic analyses of sleep deprived mouse cortex identified 3 molecular species whose abundance profile implicate them as sleep homeostats. Finally, we also set out to develop an in vitro model of sleep deprivation based on the optogenetic activation of a neuroblastoma cell line, which is outlined in Chapter 5. Following several rounds of optimisation, the stable expression of an opsin was found to induce intracellular calcium spikes and immediate early gene expression during illumination. Transcriptomic profiling of illuminated SH-SY5Y cells induced large scale transcriptomic changes, and modulated the expression of genes involved in synapses, cholesterol synthesis, the molecular clock and the unfolded protein response. Although these functional classes are reminiscent of those modulated by in vivo sleep deprivation, there was only a slight enrichment of individual genes modulated by in vivo sleep deprivation amongst the blue light sensitive genes, indicating further work is required to more closely model in vivo sleep deprivation.

Extended duration and irregularly planned overnight shifts are becoming frequent features of current working time arrangements. However, there is great concern about the detrimental effect that these shifts are likely to have on the sleep, performance and fatigue levels of workers. To date, the empirical evidence regarding the effects of extended and irregular overnight shifts is sparse and workers have rarely been followed up longer term to assess possible changes over time. Because these types of overnight shifts are being introduced into transport settings such as aviation and shipping where safe and productive operations are paramount, there is a real imperative to examine and trial workplace-based methods aimed at counteracting night shift related fatigue and performance deficits. Taking short duration naps on the nightshift at work is one potential countermeasure that has shown promise in the laboratory but has yet to be examined in any real-world setting under conditions of extended duration or irregular night work. This thesis takes up these issues in a series of four empirical workplace-based studies. The impact of the introduction of regularly planned 12 h day and overnight shifts was examined on three occasions via questionnaire in a group of aircraft maintenance engineers, once before the change, and twice after the change from 8 h shifts. The results showed that high levels of acute fatigue on the 12 h night shifts and high chronic fatigue levels were common, and were strongly associated with poor overall job performance, poor safety of job performance, and longer recovery times, effects that persisted over time. Of major concern was the finding that over half of the engineers reported having nodded off while driving home from their extended overnight shifts. The impact of irregularly planned 8 h overnight shifts worked by cargo handlers in a shipping container terminal was also examined via self-report questionnaire. The findings revealed significant detrimental impacts on sleep, fatigue levels and performance at work. High fatigue levels were strongly associated with poor self-rated performance output and safety of performance at work on the overnight shifts. The primary focus of this thesis was to evaluate the effect of a scheduled 20 min nap opportunity taken in these two fully operational workplaces during the night shift on sleep, performance and alertness. Sleep was achieved by 50 to 59% of workers. Speed of performance in 24 male aircraft maintenance engineers on a vigilance task was significantly faster at the end of a 12 h overnight shift that had contained sleep during the nap compared to the control condition. There was no such effect of the nap on the performance of 22 cargo handlers working impromptu 8 h shifts in a shipping container terminal. However, the duration of sleep obtained by the 8 h workers was shorter in comparison and was likely to have been undermined by the high noise levels around the nap facility and time pressures related to the organisation of work. Actigraphy data recorded from all subjects showed that subsequent daytime sleep was not disrupted by the night shift nap opportunity. Overall, the most interesting findings were that simply being tired and presented with a sleep opportunity during the night shift did not guarantee either sleep, or recovery but that sleep, as opposed to rest, was necessary for the benefits to performance to be fully realised. These findings have shown for the first time that management of fatigue associated with extended duration night work can be achieved in some instances by the use of a short duration nap taken in the workplace on the night shift. However, operationalizing in-situ napping on the night shift has a range of organisational influences that must be considered for the potential of such a strategy to be fully harnessed.

In this dissertation, the effect of mild sleep deprivation on attentional allocation and performance monitoring was investigated using a variety of event-related potential (ERP) paradigms with ecologically realistic periods of sleep deprivation. Seventeen female young adults completed several tasks under alert and sleepy conditions, after 3 and 20 hours of wakefulness, respectively. Objective behavioural measures of response times and error rates indicated virtually no decrements that could be attributed exclusively to sleepiness; however, there were consistent alterations in the ERPs indicative of subtly reduced attentional resources and performance monitoring. The first study (Chapter 2) examined the effect of distraction on the P300, an ERP component related to attention and stimulus processing. Participants performed an auditory oddball task with and without a secondary visual working memory task. Response times (RTs) and P300 amplitudes were affected by the addition of the secondary working memory task. However, an interaction showed that the P300 latency was significantly increased by the secondary task only in the sleepy condition, indicating that processing speed is impaired by a secondary task only when the participant is sleepy. The next study (Chapter 3) used a Go/NoGo contingent negative variation (CNV) task. The CNV is reflective of sustained attention, and is known to be associated with frontal lobe functioning. This task was performed twice, with and without a financial incentive for fast responses, to assess the effect of motivation. The P300 amplitude to the first stimulus and CNV prior to the second were clearly larger to Go stimuli for both levels of alertness when the participant was motivated by the financial incentive. However, with no incentive in the sleepy condition, there was reduced differentiation of the two types of stimuli, indicating a reduced ability to discriminate between important and less important information. In chapters 4 and 5, performance monitoring was examined using two tasks, the Eriksen Flanker task and the Anti-Saccade task, producing an ERP related to errors with two basic components: the error-negativity (Ne/ERN) and error-positivity (Pe), thought to be related to error recognition and error evaluation, respectively. In both data sets, the amplitude of the Ne/ERN was not significantly reduced by sleep deprivation, but the amplitude of the Pe was. In addition, smaller anti-saccade errors produced reduced Ne/ERN amplitudes compared to larger anti-saccade errors. Another marker of performance monitoring is post-error slowing, which was present in the flanker task only during the alert condition. These results indicate that error detection or recognition (Ne/ERN) appears to be relatively preserved during sleep deprivation, but further error evaluation (Pe) and compensation (post-error slowing) are impaired. Taken together, the findings demonstrate that even mild sleep deprivation has a subtle but reliable effect on electrocortical activity associated with attention and performance monitoring despite an absence of behavioural changes, indicating deleterious effects before behavioural changes are observed. Therefore, relying on behavioural tests to determine at what point an individual becomes unsafe to operate machinery or perform various tasks may be misleading.

In this dissertation, the effect of mild sleep deprivation on attentional allocation and performance monitoring was investigated using a variety of event-related potential (ERP) paradigms with ecologically realistic periods of sleep deprivation. Seventeen female young adults completed several tasks under alert and sleepy conditions, after 3 and 20 hours of wakefulness, respectively. Objective behavioural measures of response times and error rates indicated virtually no decrements that could be attributed exclusively to sleepiness; however, there were consistent alterations in the ERPs indicative of subtly reduced attentional resources and performance monitoring. The first study (Chapter 2) examined the effect of distraction on the P300, an ERP component related to attention and stimulus processing. Participants performed an auditory oddball task with and without a secondary visual working memory task. Response times (RTs) and P300 amplitudes were affected by the addition of the secondary working memory task. However, an interaction showed that the P300 latency was significantly increased by the secondary task only in the sleepy condition, indicating that processing speed is impaired by a secondary task only when the participant is sleepy. The next study (Chapter 3) used a Go/NoGo contingent negative variation (CNV) task. The CNV is reflective of sustained attention, and is known to be associated with frontal lobe functioning. This task was performed twice, with and without a financial incentive for fast responses, to assess the effect of motivation. The P300 amplitude to the first stimulus and CNV prior to the second were clearly larger to Go stimuli for both levels of alertness when the participant was motivated by the financial incentive. However, with no incentive in the sleepy condition, there was reduced differentiation of the two types of stimuli, indicating a reduced ability to discriminate between important and less important information. In chapters 4 and 5, performance monitoring was examined using two tasks, the Eriksen Flanker task and the Anti-Saccade task, producing an ERP related to errors with two basic components: the error-negativity (Ne/ERN) and error-positivity (Pe), thought to be related to error recognition and error evaluation, respectively. In both data sets, the amplitude of the Ne/ERN was not significantly reduced by sleep deprivation, but the amplitude of the Pe was. In addition, smaller anti-saccade errors produced reduced Ne/ERN amplitudes compared to larger anti-saccade errors. Another marker of performance monitoring is post-error slowing, which was present in the flanker task only during the alert condition. These results indicate that error detection or recognition (Ne/ERN) appears to be relatively preserved during sleep deprivation, but further error evaluation (Pe) and compensation (post-error slowing) are impaired. Taken together, the findings demonstrate that even mild sleep deprivation has a subtle but reliable effect on electrocortical activity associated with attention and performance monitoring despite an absence of behavioural changes, indicating deleterious effects before behavioural changes are observed. Therefore, relying on behavioural tests to determine at what point an individual becomes unsafe to operate machinery or perform various tasks may be misleading.

published_or_final_version / Clinical Psychology / Master / Master of Social Sciences