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Despite the improvements in safety since the advent of Process Safety Management regulations in 1992, human factors still play a large role in catastrophic accidents. Worker fatigue is a significant risk in the petroleum industry, where rotating shiftwork is relied upon to staff round the clock production. Using reports of work organization factors that contributed to fatigue from the listening sessions hosted by the California Interagency Taskforce on Refinery Safety in 2013, we developed a survey for rotating shiftworkers in the refining industry. We administered the survey among hourly shift workers in the oil sector represented by the United Steelworkers union. Collecting self-reported data on sleep, mental health, job stress, quality of life, and certain health outcomes associated with shift work, we explored associations between these outcomes and participants’ work history, current work schedules and staffing allocations. Our findings revealed that the 12-hour shift, initially intended as a compressed work week, currently provides limited recovery when rest breaks are interrupted with one or more overtime shifts per week. Sleep durations were also shortest on the 12-hour shift, and averaged more than an hour shorter than previous research on 8-hour rotating shift workers. Recent work schedules reported tended to comply with the American Petroleum Institute’s (API) recommended hours of service guidelines, but despite this, more than one half of our study participants reported having trouble staying awake during engaged activities (24% monthly and 27% weekly or more), and sleep disorder prevalence approached 80% in the study population. Those who exceeded the API hours of service guidelines reported greater job demands, shorter sleep durations, and more frequent drowsiness, indicating that they were at greatest risk for fatigue. Mandatory overtime was a stressor, associated with higher job stress, lower staffing coverage, and anxiety (but not additional hours worked). The impacts of mandatory overtime and on-call work were described further in the quality of life data, where participants described the difficulty of keeping personal commitments, resulting in family conflict, social isolation and neglected personal interests; and they expressed a desire for greater control over their time.

Warthin's tumor (WT) is a common benign salivary gland neoplasm with a negligible risk of malignant transformation. However, there is a risk of malignant tumors being misdiagnosed as WT on cytology and inappropriately managed conservatively.Patients from nine centers in Italy and the United Kingdom undergoing parotid surgery for cytologically diagnosed WT were included in this multicenter retrospective series. Definitive histology was compared with preoperative cytological diagnoses. Surgical complications were recorded.A total of 496 tumors were identified. In 88.9%, the final histological diagnosis was WT. In 21 cases (4.2%) a malignant neoplasm was diagnosed, which had been incorrectly labeled as WT on cytology.The risk of undiagnosed malignancy should be balanced against surgical risks when considering the management of WT. Although nonsurgical management remains an appropriate option, there may be a rationale for serial clinical or radiological evaluation if surgical excision is not performed.

Additional file 1: Supplementary Figure 1. Pipeline for automatic counting of FISH signals in DCIS epithelial cells. Supplementary Figure 2. The probability density of HER2-FISH signal/cell in DCIS_noamp and DCIS_amp references. The reference samples (18 non-amplified DCISs and 29 amplified DCISs) were handpicked from HER2-positive patients and the cells within each sample were combined into one reference for each group. The HER2-FISH signal/cell represents the absolute number of HER2-FISH signals in an epithelial cell in DCIS. The distribution of HER2-FISH signal/cell for all detected epithelial cells in a DCIS was represented by the probability density using kernel density estimation. Supplementary Figure 3. The probability distribution of HER2-FISH signal/cell in DCISs for each HER2-positive patient. The HER2-FISH signal/cell represents the absolute number of HER2-FISH signals in an epithelial cell in DCIS. The distribution of HER2-FISH signal/cell for all detected epithelial cells in a DCIS was represented by the probability density using kernel density estimation. For each patient, the density plots of HER2-FISH signal for each individual DCIS were overlayed into one plot. Supplementary Figure 4. Principal Component Analysis (PCA) on the distribution of HER2-FISH signal/cell in DCISs for each HER2-positive patient. The HER2-FISH signal/cell represents the absolute number of HER2-FISH signals in an epithelial cell in DCIS. The distribution of HER2-FISH signal/cell in a DCIS was represented by the probability density. Supplementary Figure 5. Pipeline of inferring genome-wide copy number variations (CNVs) from Smart-3SEQ and WGS data. Supplementary Figure 6. Principal Component Analysis (PCA) from gene expression data on combined DCISs of all HER2-positive patients showing that ‘patient’ factor explains the most variability. Supplementary Figure 7. (a) Heatmap of the mean-centered expressions of the 43 interferon-stimulated genes (ISGs) in DCIS_amp/DCIS_noamp and IDC_amp. These 43 ISGs were identified by gene set enrichment analysis on the up-regulated genes in comparison between DCIS_amp and DCIS_noamp. Patient IDs and sample types were denoted as the top bar. (b) Mean ISG signature scores in 5 patients with paired DCIS_amp and IDC_amp samples. The mean ISG score was calculated per case for DCIS_amp and IDC_amp separately if there are >1 samples in each group. Paired T-test was performed to determine the statistical significance between DCIS_amp and IDC_amp. p