Objective To determine the association between poor sleep quality, fatigue, and self-reported safety outcomes among Emergency Medical Services (EMS) workers. Methods We used convenience sampling of EMS agencies and a cross-sectional survey design. We administered the 19-item Pittsburgh Sleep Quality Index (PSQI), 11-item Chalder Fatigue Questionnaire (CFQ), and 44-item EMS Safety Inventory (EMS-SI) to measure sleep quality, fatigue, and safety outcomes, respectively. We used a consensus process to develop the EMS-SI, which was designed to capture three composite measurements of EMS worker injury, medical errors and adverse events (AE), and safety compromising behaviors. We used hierarchical logistic regression to test the association between poor sleep quality, fatigue, and three composite measures of EMS worker safety outcomes. Results We received 547 surveys from 30 EMS agencies (a 35.6% mean agency response rate). The mean PSQI score exceeded the benchmark for poor sleep (6.9, 95%CI 6.6, 7.2). Greater than half of respondents were classified as fatigued (55%, 95%CI 50.7, 59.3). Eighteen percent of respondents reported an injury (17.8%, 95%CI 13.5, 22.1), forty-one percent a medical error or AE (41.1%, 95%CI 36.8, 45.4), and 89% (95%CI 87, 92) safety compromising behaviors. After controlling for confounding, we identified 1.9 greater odds of injury (95%CI 1.1, 3.3), 2.2 greater odds of medical error or AE (95%CI 1.4, 3.3), and 3.6 greater odds of safety compromising behavior (95%CI 1.5, 8.3) among fatigued respondents versus non-fatigued respondents. Conclusions In this sample of EMS workers, poor sleep quality and fatigue is common. We provide preliminary evidence of an association between sleep quality, fatigue, and safety outcomes.

The product of the CDC7 gene of Saccharomyces cerevisiae appears to have multiple roles in cellular physiology. It is required for the initiation of mitotic DNA synthesis. While it is not required for the initiation of meiotic DNA replication, it is necessary for genetic recombination during meiosis and for the formation of ascospores. It has also been implicated in an error-prone DNA repair pathway. Plasmids Use of the budding yeast Saccharomyces cerevisiae as a model for studies on the eucaryotic cell cycle relies heavily on temperature-sensitive mutations in cell division cycle (CDC) genes (32, 35). Characterization of these mutants has led to the formulation of a model in which progression through the cell cycle is determined by a set of interrelated pathways, each organized as a dependent sequence of events requiring the action of specific gene products. One such pathway, operating late in the Gi phase of the cell cycle, requires the function of the CDC7 gene product (12). Cells carrying a thermosensitive lesion in the CDC7 gene arrest at the restrictive temperature as budded cells with separated spindle-pole bodies but without an elongated spindle apparatus and without initiating DNA synthesis (5, 12). Upon return to permissive conditions cdc7 cells are able to enter the S phase and subsequently complete a round of DNA synthesis without further protein synthesis (14).In contrast to the requirement for CDC7 function to initiate mitotic DNA synthesis, premeiotic DNA replication occurs normally in cdc7 homozygous diploids under the restrictive condition (43). However, these diploids fail to form a synaptonemal complex, to show commitment to genetic recombination, or to form ascospores (40). Thus, although cdc7 strains are defective in both mitotic and meiotic cell cycles, the lesion appears to affect each pathway in a quite distinct manner. In addition to having roles in the mitotic and meiotic pathways, the CDC7 gene product has been implicated in DNA repair as a member of the RAD6 epistasis group, since strains carrying a cdc7 mutation show almost no mutagenic repair in response to a variety of damaging agents (31).To elucidate the role of the CDC7 gene product in the various cellular functions in which it is implicated and to determine whether differential expression of the CDC7 gene is involved with its cell cycle functions, we and others (24) have begun a molecular analysis of the CDC7 gene. In this paper we describe the cloning of the CDC7 gene, the characterization of its transcriptional product, the nucleotide sequence of the gene, and the regions of homology between the predicted protein products of the CDC7 and CDC28 genes. MATERIALS AND METHODSStrains and media. Escherichia coli HB101 (F-thi leu pro hsdR hsdM recA end!) and HW87 [F-A(araD139-leu) lacX74 galK hsdR rpsL srb recA] were used as hosts for the routine maintenance and propagation of plasmids. Bacterial cultures were grown in L broth or supplemented M9 medium (26); when necessary, ampicillin was added to media to a final concentration of...

Although human immunodeficiency virus (HIV)-infected subjects without AIDS have a high frequency of HIV-specific CD8 T lymphocytes, cellular immunity is unable to control infection. Freshly isolated lymphocytes often do not lyse HIV-infected targets in 4-