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Aim To evaluate missed nursing care and patient safety during the first wave of the COVID‐19 pandemic at in‐patient cardiology wards. Design A cross‐sectional design with a comparative approach. Method Registered nurses and nurse assistants at a cardiology department were invited to answer the MISSCARE Survey‐Swedish version, and questions on patient safety and quality of care during the COVID‐19 pandemic. The data were compared with a reference sample. Results A total of 43 registered nurses and nurse assistants in the COVID‐19 sample and 59 in the reference sample participated. The COVID‐19 sample reported significantly more overtime hours and more absence from work due to illness in comparison with the reference sample. The patient safety and quality of care were perceived significantly worse, 76.7% (N = 33) versus 94.7% (N = 54), and 85.7% (N = 36) versus 98.3% (N = 58, respectively. The COVID‐19 sample reported more missed nursing care in wound care and in basic nursing.

Although there has been substantial literature on the economic impact of labour legislation in the world, the number of studies related to Vietnam is, surprisingly, very small. Our article provides the first evidence on the link between labour law and various labour market outcomes using the Vietnamese context. We examine how labour supply, earnings and social protection outcomes adjusted to labour contract reform under the 2012 Labour Code. The study uses three waves of the Vietnam Labour Force Survey to examine both medium‐term and short‐term impacts of the reform. Difference‐in‐differences and fixed‐effect techniques are utilised. Overall, we find that the law change significantly affected hours worked, work absenteeism, monthly allowance and incidence of bonuses among contracted workers. However, the effects on workers’ monthly wages, overtime remuneration and other allowances, and the social protection‐related outcomes were not clear in the short run.

Aims To review the comprehensive characteristics of adverse nurse work schedules and to synthesise the evidence of their relationships with adverse patient outcomes. Background To manage nurse shortages and fluctuations in patient censuses, nurses often work overtime. This increases nurses' work hours and causes them to have fewer breaks. Such extended work schedules, long shift length, long weekly work hours and insufficient beaks can be considered as adverse nurse work schedules. Understanding how these adverse nurse work schedules affect patient outcomes is important to ensure patient safety. Design A systematic review of nursing and healthcare literature was conducted in this study. Methods Eight electronic bibliographic databases (CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO, RISS and Web of Science) were used to search research articles published from 2000 to 2019. The study selection process followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Results From the search, 2,366 articles were identified, 22 of which were included in this review. Working more than 12 hours in a day had an adverse effect on patient outcomes, as was working more than 40 hours per week. There were mixed findings in the relationship between nurse overtime and adverse patient outcomes. Conclusions This study found a conclusive relationship between excessive nurse work hours and adverse patient outcomes. This review highlights the importance of managing adverse nurse schedules such as long daily and weekly work hours to improve patient safety and prevent adverse patient outcomes. Relevance to clinical practice Study findings support the importance of monitoring and regulating nurse work schedules and adverse scheduling practices to improve nurse well-being and health and to prevent adverse patient outcomes.

This study makes use of rich firm‐level and linked firm‐employee datasets that span the 2009–2015 period in Vietnam to examine how SMEs' credit constraints affect their strategic employment decisions and employees' labour outcomes. Our results show that constrained SMEs enlarge total employment by employing relatively more temporary workers and paying their employees relatively lower wages than unconstrained borrowing firms. Meanwhile, discouraged firms, mostly informal businesses, do not behave differently from unconstrained counterparts. In order to maintain a stable employment portfolio, discouraged firms are relatively more willing to reward their employees with an overtime payment.

BACKGROUND Injury prevention is an important goal for electric utility line workers who are among the top 10 U.S. occupational groups sustaining fatal injuries on the job. METHODS Using narrative text fields, we identified 10 high-risk tasks among electric utility line workers. We performed a case-control study of task-injury associations using data from the Electric Power Research Institute Occupational Health and Safety Database (1995-2013). RESULTS Drawn from 12,323 line worker injuries, cases were individuals with a major injury (5 or more days lost work) matched to controls, individuals with a minor injury (less than 1 day lost work), on company and year of injury. Conditional logistic regression estimated adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Some tasks associated with higher odds for major injuries among line workers included: climbing up/down ladder/stairs/elevator (OR = 4.3; 95% CI = 2.6, 7.4); climbing down poles and transmission towers (OR = 5.5; 95% CI = 3.6, 8.4); entering/stepping out/approaching utility trucks, bucket, or vaults (OR = 5.8; 95% CI = 4.0, 8.4); and performing repetitive work/overtime (OR = 5.5; 95% CI = 3.2, 9.5). CONCLUSIONS Knowledge gained can be used to focus efforts and plan efficient preventive measures that reduce injury rates, time lost from work, and costs within the electric power industry.

AORN conducted its 18th annual compensation survey for perioperative nurses in June 2020. A multiple regression model was used to examine how several variables, including job title, education level, certification, experience, and geographic region, affect perioperative nurse compensation. Comparisons between the 2020 data and data from previous years are presented. The effects of other forms of compensation (eg, on-call compensation, overtime, bonuses, shift differentials, benefits) on total compensation are also examined. Additional analyses explore the current state of the nursing shortage, sources of job satisfaction and dissatisfaction, and the effects of the Coronavirus Disease 2019 pandemic.

Purpose This study aimed to examine the effects of work environments and occupational fatigue on care left undone in rotating shift nurses, and to identify the indirect (mediation) effect of work environments on care left undone through nurses' occupational fatigue in South Korean acute care hospitals. Design This study employed a cross-sectional design using an online survey to collect data from 488 rotating shift nurses of acute care hospitals in Korea between November and December 2018. Methods A mobile schedule management application for shift nurses was used to advertise the study and to send a link to the online survey. The survey included questions on the nurses' work environment characteristics, care left undone activities, and the Korean version of the Occupational Fatigue Exhaustion/Recovery scale. Poisson regression was used to explore the relationships among work environments, occupational fatigue, and care left undone. Hayes' Model 4 and a bootstrapping analysis were used to identify the mediating effect of occupational fatigue on the relationship between work environments and care left undone. Findings The average number of tasks left undone was 3.45 (SD = 2.19). The higher the acute and chronic fatigue levels noted among nurses, the higher were the occurrences of care left undone. Conversely, the higher the intershift recovery level, the lower were the occurrences of care left undone. The results showed a positive relationship between care left undone and overtime hours and the number of patients per nurse. Moreover, nurses' occupational fatigue mediated the relationship between work environments and care left undone. Night shifts per month and the number of consecutive days off had an indirect effect on care left undone through occupational fatigue. Conclusions High levels of occupational fatigue and poor intershift recovery among nurses can lead to care left undone. Nurses' occupational fatigue mediates the effect of work environment on care left undone. Clinical relevance It is crucial for healthcare administrators and leaders to develop policies and mandatory regulations to facilitate better working conditions for nurses, consequently reducing their occupational fatigue and decreasing the occurrence of care left undone in acute care hospitals.

Mining is a multi‐billion‐dollar industry spanning major to artisanal and small‐scale mines, with diverse local to regional socio‐economic and environmental impacts. Sub‐Saharan Africa (SSA) has large deposits of minerals, which has made it a global epicentre for investors in the extractive industries. Here, we identified and mapped 469 company‐owned and community‐managed mines across SSA, most of which are formal, to explore their distribution and areal extents and understand the potential threats they pose to conservation. The dominant eight commodities in SSA are gold, copper, iron, limestone, uranium, diamond, bauxite and petroleum, making up 405 mines and occupying 85% of the 3,055 km2 total areal extent. Mining significantly expanded between 2000 and 2018, with 260 (58%) new mines created and major expansion of many older mines. Hotspots of mining activity are apparent in the copper‐belt of the Democratic Republic of Congo and Zambia, Ghana, and the Niger‐delta region of Nigeria. These mining ‘hotspots’ are distributed in close proximity to regions of high carbon stocks and value to biodiversity conservation, with the areal extent of mines more than doubling between 2000 and 2018 to 1192 km2 within 10 km of a protected area, suggesting susceptibility to deforestation and other environmental consequences. The identification of mines and their changing spatial extent is imperative for monitoring future encroachments in SSA and to conservation and habitat recovery. Furthermore, Africa needs to introduce sustainable mineral development policies to safeguard and protect its forests, especially reducing the frequency of protected area downgrading, downsizing and degazettement (PADDD) events.

Drawing on systems theory, we conducted a moderated meta-analysis of the training and organisational performance relationship using 119 primary studies. We examined the moderating effects of quality versus quantity of training, time, institutional, and organisational context factors in the relationship between training and organisational performance. Our findings reveal that training is positively and directly related to organisational performance with no statistically significant difference between measures of training quality and quantity. We found that the relationship was stronger overtime, and that country performance orientation and country labour cost moderate the training and organisational performance relationship. We found no evidence for the moderating effects of the three organisational context moderators we examined (i.e., industry sector, organisational size, and technology intensity). Finally, our results reveal that training type (i.e., general or firm-specific) does not moderate the training and organisational performance relationship. peer-reviewed 2022-02-03

Pediatric Hospital Medicine (PHM), a field early in its development and with a robust pipeline of women, is in a unique position to lead the way in gender equity. We describe the proportion of women in divisional and fellowship leadership positions at university-based PHM programs (n = 142). When compared with the PHM field at large, women appear to be underrepresented as PHM division/program leaders (70% vs 55%; P < .001) but not as fellowship directors (70% vs 66%; P > .05). Women appear proportionally represented in associate/assistant leadership roles when compared with the distribution of the PHM field at large. Tracking these trends overtime is essential to advancing the field. Journal of Hospital Medicine 2020;15:XXX-XXX. © 2020 Society of Hospital Medicine

The current Australian Medical Association doctors in training enterprise agreement dictates that hours beyond 38 or 43 ordinary hours per week incur overtime. Costly overtime has led to strict adherence to ordinary hours with dramatically reduced rostered and unrostered overtime. The stringent regulation over ordinary hours may protect doctors at a cost to training and potentially patient safety. Reduced shift duration adds to the number of clinical handovers, while reduced exposure to patients and training opportunities may prolong training time. Now is the time for renegotiation of working hours, which are most favourable for doctor training and well-being.

AORN conducted its 17th annual compensation survey for perioperative nurses in June 2019. A multiple regression model was used to examine how several variables, including job title, education level, certification, experience, and geographic region, affect perioperative nurse compensation. Comparisons between the 2019 data and data from previous years are presented. The effects of other forms of compensation (eg, on-call compensation, overtime, bonuses, shift differentials, benefits) on total compensation also are examined. Additional analyses explore the current state of the nursing shortage and the sources of job satisfaction and dissatisfaction.

Background Construction is among the most dangerous industries. In addition to traditional hazards for workplace injury and illness, other threats to health and well-being may occur from work organization and work environment factors, including irregular employment, long commutes, long work hours, and employer policies regarding health and safety. These nontraditional hazards may affect work and health outcomes directly, or through effects on health behaviors. The cumulative impacts of both traditional and nontraditional hazards on health-related outcomes among construction workers are largely unknown. Methods We conducted a survey among apprentice construction workers to identify relationships between work organization and environmental factors with five outcomes of economic relevance to employers: missed work due to work-related injury, missed work due to any pain or injury, self-reported workability, health-related productivity, and use of prescription medications for pain. Results A total of 963 surveys were completed (response rate 90%) in this young (mean age 28) working cohort. Multivariate Poisson regression models found associations between the outcomes of interest and multiple work factors, including job strain, safety behaviors of coworkers, and mandatory overtime. Univariate analysis showed additional associations, including precarious work, and supervisor support for safety. Conclusions Findings from this cross-sectional study suggest that work organization and environment factors influence health and work outcomes among young construction trade workers. Future work with longitudinal data will examine the hypothesized paths between work factors, health behaviors, health outcomes, and work outcomes.

This study focuses on determining the appointment scheduling for healthcare facilities with series patients. “Series” patients are patients who are scheduled for a series of appointments instead of a single appointment. Examples of healthcare services with series patients include radiotherapy/chemotherapy for cancer, physical therapy, kidney dialysis, diabetes treatment, etc. The aim of this study is to design appointment scheduling policies taking into account revenues per service per patient, costs of staffing, overtime, overbooking and delay. The appointment scheduling problem is formulated using an MDP model. However, due to the huge state space, computing the optimal policy is impractical. Hence, we propose the Index Policy (IP) based on a one‐step policy improvement algorithm applied to the MDP model. We study a further simplification obtained by approximating the distribution of the number of patient visits by a Geometric distribution. A key analytical contribution is to prove the MDP to be a uni‐chain, which implies that there exists an optimal policy that maximizes the long‐run average profit. We also find that the IP provides a significant improvement over the other policies. Especially with the Geometric approximation, the IP requires minimal effort in implementing, and works almost as well. To test the effectiveness of our proposed IP in a real‐world setting, we use the data from a local physical therapy center to compare its performance with two other commonly used policies, namely, the Next Available Day Policy and the Shortest Queue Policy. We recommend the IP with Geometric approximation for series patients’ scheduling, which is computationally efficient and can significantly increases profits by incorporating the series feature of the patients’ appointments. Finally, we provide analysis that incorporates several practical considerations such as accounting for patient heterogeneity in number of visits and inter‐visit times, the option to reject new patients when the system is at full capacity, and incorporating patients with known number of visits at the time of the scheduling decision.

Objectives Well‐managed workplace communication may promote well‐mental health status among workers, even those who may have experienced drastic changes in their workplace and living environment after the Fukushima Daiichi Nuclear Power Plant accident. This study aimed to compare the workplace and living environment of workers in the evacuation area to the non‐evacuation area, as well as the association between workplace communication and psychological distress. Method This cross‐sectional questionnaire survey was conducted in two manufacturing companies in the evacuation area and a company in the non‐evacuation area. Psychological distress was defined by a Kessler K6 distress scale score ≥5. Workplace communication was measured by the status of communication (“Do you feel that you can talk freely?”) and consultation (“Can you consult when having troubles?”) with superiors, managers and colleagues. Work burden, overtime, and irregular mealtimes as changes in the workplace and domestic life were determined. Differences in the workplace and living environment were compared using the chi‐squared test, with the association between workplace communication and psychological distress analyzed by logistic regression. Results The proportion of workers with an increased work burden, overtime, and irregular meals was significantly higher among workers in the evacuation areas. There was also a significant association between low‐psychological distress status and communication and consultation with superiors or managers, with no significant association with colleagues. Conclusion Only workplace communication with superiors or managers was associated with low‐psychological distress, even after drastic changes in the workplace. Therefore, superiors or managers should initiate open communication and active consultation after a disaster.

Aims To identify nurse staffing groups in acute care facilities. Design This retrospective descriptive study used a configurational approach. Methods Data from a two‐month target period from January–March 2016 were collected for 40 facilities in four different hospitals in one of the largest regions of Quebec. Multiple factorial analysis and hierarchical ascendant classification were used to generate a limited number of nurse staffing groups. Results/Findings Four distinct nurse staffing groups emerged from this study. The least resourced model relied mainly on less qualified personnel and agency staff. The moderately resourced basic model was assessed as average across all staffing dimensions, but employed less overtime, relying mostly on auxiliary nurses. The moderately resourced professional group, also moderate in most variables, involved more overtime and fewer less qualified personnel. The most resourced group maximized highly qualified personnel and minimized instability in the nursing team. Conclusion This study covered multiple staffing groups with widely varying characteristics. Most groups entailed risks for quality of care at one or more levels. Few care units approached the theoretical staffing ideal.

To clarify the subgroups of overtime work motivations and to determine how fatigue, mental status, and work engagement differ among the subgroups.Cross-sectional.Questionnaires were distributed to 1,075 full-time nurses working in four hospitals in Japan from October 2015 - February 2016. Nurses were categorized into subgroups of overtime work motivation by latent class analysis. An analysis of covariance was conducted to examine how fatigue, mental status, and work engagement differ among subgroups.We identified five types of overtime workers differing greatly in fatigue, mental status, and work engagement.Even when nurses worked approximately the same work hours, the difference in motivation corresponded to different degrees of fatigue, mental status, and work engagement. When introducing policies to reduce overtime work, managers should consider the different groups of overtime workers, as effective measures may differ.目的: 明确加班动机的亚组,并确定各子类护理人员的疲劳程度、精神状态和工作投入程度的差异。 设计: 横断面研究 方法: 2015年10月至2016年2月期间,对在日本境内四家医院工作的共1075名全职护士进行问卷调查。通过潜在的班级分析方法,将所有护士分为加班动机存在差异的亚组,并通过协方差分析的方法,对不同亚组之间的疲劳、精神状态和工作投入的程度进行了分析。 结果/发现: 我们共确定五种加班人员,而此五种加班人员在疲劳程度、精神状态和工作投入程度方面均存在极大差异。 结论: 尽管护理人员的工作时间大致相同,然而,其工作动机的差异同样与其疲劳程度、精神状态以及工作投入程度有关。在推行减少加班时间的政策时,管理人员应将不同的加班工人群体纳入考虑范围,原因在于具体的有效措施可能存在差异。.

To conduct a comparative analysis of four cohorts of newly licensed Registered Nurses and their work schedule, daily shift length, weekly work hours, second job, and weekly overtime hours. Nurses also reported their preferences regarding work schedule and daily shift length.We used a retrospective, comparative design analysing four cross-sectional surveys from new nurses first licensed between 2004-2015.Using state licensure lists, nurses who were first licensed between 1 August 2004 and 31 July 2005 were randomly sampled using a nested design in 23 geographical areas in 13 states and Washington, DC. The same sampling strategy was conducted for subsequent cohorts in January 2009, 2012, and 2016. We sent a mailed survey measuring demographics, education, work attributes, and attitudes to participants with a $5 incentive, following methods by Dillman.There were no statistically significant differences in average weekly work hours (39.4 hrs) or holding more than one job for pay (11.6-14.6% across all cohorts). There were statistically significant differences in overtime across cohorts and shift length by unit type. The preferred shift length was 12 hrs and day shift was the preferred work schedule.New nurses are predominantly scheduled for 12-hrs shifts and nearly half work weekly overtime, trends that have remained relatively stable over the past 10 years. Nurse managers, policy-makers, and researchers should pay attention to new nurses' schedule and shift preferences and guard against mandatory overtime hours.目的: 对四组新注册护士的工作时间、日班时长、周工作时间、第二职业、周加班时间进行对比分析。护士们还报告了他们对工作时间和日班长度的偏好。 设计: 我们采用评估性、对比设计,分析了2004年至2015年首次获得执业资格的新护士的四项横断面调查。 方法: 使用州许可证清单,在2004年8月1日至2005年7月31日期间首次获得执业资格的护士使用嵌套设计在13个州和华盛顿特区的23个地理区域进行随机抽样。在2009年1月、2012年1月和2016年1月对随后的队列进行了相同的抽样策略。我们按照Dillman的方法,通过电子邮件向参与者发送了一份调查问卷,测量其人口统计学特征、教育程度、工作性质和态度,奖金为5美元。 结果: 每周平均工作时间(39.4小时)或一份以上带薪工作(不同队列11.6-14.6%)没有统计学上的显著差异。不同队列的加班时间和单位类型的轮班时长差异具有统计学意义。首选轮班时间为12小时,白班是首选工作时间。 结论: 新护士主要安排12小时轮班和每周近一半的工作加班,这一趋势在过去10年中保持相对稳定。护士长、政策制定者和研究人员应注意新护士的时间表和轮班偏好,并防止出现强制加班的情况。.

This paper examines whether union membership reduces gender earnings differentials in the Chinese labour market using an employer–employee matched data set. We have three main findings. First, union membership helps reduce the gender differentials in hourly wage and monthly allowance, but not in monthly basic wage and yearly bonus. Second, ensuring that female workers receive overtime pay is one way by which union membership helps reduce the gender earnings differentials. Third, controlling for firm fixed effects reduces the effect of union membership on the gender gap in hourly wage and monthly allowance, which means that the unobserved firm characteristics might impact the effect of union membership on gender earnings differentials.

Operating rooms (ORs) are the greatest source of revenues for hospitals and also their largest cost centers. When scheduling surgeries, hospitals face a trade‐off between the need to conduct planned elective surgeries and the need to be responsive to emergency cases. However, scheduling ORs, especially at Level‐1 trauma hospitals, is challenging due to significant uncertainties in the arrivals of patients requiring emergent surgery. The issue of allocating limited capacity to emergent surgery cases while scheduling elective patients has major policy implications. We develop a model for allocating the OR capacity to elective patients in such a way that the emergency patients who arrive randomly can be accommodated without incurring excessive delays. The objective is to develop a framework for aggregate weekly schedules and generate detailed daily schedules that minimize the total cost of the ORs’ expected operating time, idle time, and overtime. We present optimization procedures for generating effective schedules and rescheduling procedures that adjust the schedules of elective patients affected by emergency arrivals. Initially, the procedures assume deterministic surgery times for elective patients; the procedures are then extended to include stochastic surgery times. We show that for a given arrival rate of emergency patients, the total expected cost is convex in the weekly load of elective surgeries being scheduled. Numerical experiments are devised to obtain total expected cost curves for various emergency arrival rates. Using these curves, the optimal capacity allocation of ORs to elective patients can be determined as a function of the emergency arrival rate.

Purpose Pediatric hospice is a comprehensive model of care for medically complex children at end of life. The Affordable Care Act changed regulatory requirements for pediatric Medicaid enrollees to allow for enrollment into hospice services while still receiving life-prolonging therapy. There are gaps in understanding factors associated with pediatric concurrent hospice care use. The objectives were to examine the prevalence of concurrent hospice care overtime and investigated the relationship between medical complexity and concurrent hospice care among Medicaid children. Design and methods We used national Medicaid data and included children less than 21 years with an admission to hospice care. Medical complexity was defined with four criteria (i.e., chronic conditions, functional limitations, high health care use and substantial needs). Using multivariate logistic regression, we evaluated the influence of medical complexity on concurrent hospice care use, while controlling for demographic, hospice, and community characteristics. Results Thirty-four percent of the study sample used concurrent hospice care. Medical complexity was unrelated to concurrent hospice care. However, the four individual criteria were associated. A complex chronic condition was negatively related to concurrent hospice care, whereas technology dependence, multiple complex chronic conditions, and mental/behavioral disorders were positively associated to concurrent care use. Practice implications These findings suggest that concurrent hospice care may be important for a subset of medically complex children with functional limitations, high health utilization, and substantial needs at end of life.

Physicians belong to the risk group for sleep disorders as a result of work related stress, excessive working time, large amount of on-call duties and shift work. Poor sleep quality of healthcare providers threatens not only their safety, but also the safety of their patients. This study examines if there are any differences in how working either long hours or at night duties relates to self-reported sleep time, sleep quality and daytime sleepiness in primary care physicians. We analyzed data from a survey research of 807 participants. Respondents were divided into four groups based on their reported work hours per week and number of nights on duty per month. Overtime was associated with shorter sleep time and worse subjective sleep quality even when compared with that of participants who work on night duties. All investigated groups of participants reported short sleep latencies which suggests that sleep debt is a common problem in this population. Surprisingly in the case of poor sleep quality participants rarely used recommended methods like regular physical activity or specialist advice. The most frequently reported answer was that they do nothing to improve sleep and every third participants uses hypnotics to do that. These results suggest that primary care physicians despite being at high risk for sleep disorders due to working overtime and at night, pay less attention to their sleep quality and do not use recommended strategies to improve it.

Many public sector programs, such as those directed at public health, are often multiagency tasks where structural incongruity in the program design is liable to emerge overtime from changing operational requirements. Yet, successful implementation remains possible because of the interactions and relationships between implementation parties that encourage cooperation and collaboration despite incongruence in the program design. We examine how the dynam-ics of these interparty relationships influence implemen-tation success in a comparative study of India's NationalHealth Insurance Scheme. We find that implementation par-ties exhibiting support and complementarity in their inter-actions created a virtuous cycle of continually encourag-ing better performance and vice versa. Thus, our findings exhibit a distinct functionary role of interparty interactions and relationships for eliciting effective implementation and governance. The analysis also showcases the need for pol-icy makers and policy designers to be cognizant of the inadvertent introduction of structural inconsistencies and vetopoints into program designs and their potential influence on implementation outcomes

BACKGROUND Research evidence suggests harmful effects of overtime work on risk of heart disease. However, whether withdrawing compensation for overtime work (time-off or money) provides a relevant explanation of this association has not been explored. METHODS Using cohort data, we included 6345 employees from Germany (3079 men and 3266 women), and applied Poisson regression analysis to examine the prospective association of overtime work without compensation with risk of self-reported incident heart disease over 2 years. RESULTS Uncompensated overtime work was associated with an elevated risk of heart disease after adjustment for relevant variables (RR = 1.85, 95%CI: 1.05-3.25), compared to no overtime work. Stratified analyses indicated particularly strong effects among women and among employees with low socioeconomic position. CONCLUSIONS In line with the stress-theoretical model of effort-reward imbalance at work, these findings document an important role of compensation on heart disease in the frame of overtime work.

This paper provides novel evidence on the effect of deregulating overtime hours restrictions on women by using the 1985 Amendments to the Labour Standards Act (LSA) in Japan as a natural experiment. The original LSA of 1947 prohibited women from working overtime exceeding two hours a day; six hours a week; and 150 hours a year. The 1985 Amendments exempted a variety of occupations and industries from such an overtime restriction on women. Applying a difference-in-difference model to census data, we find causal evidence pointing to the positive effect of this particular piece of labour market deregulation on the proportion of female employment. We then carry out a series of sensitivity analyses to ensure the robustness of our finding. Especially, we conduct a falsification test and an event study to show that our causal inference is not threatened by the differential pretreatment trends. Finally, we use quantile regressions and find that for jobs with more rapidly growing proportion of female employment, the effect of the exemption from the overtime work restriction on women is larger.

We examine how physicians affect the flow of patients through Perioperative Services (POS) on the day of surgery by studying the effects of surgeon experience and surgeon quality (measured by Healthgrades rating) on patients' flow. We control for the work environment created by the POS manager's resource allocation decision, which determines the utilization levels of the three POS departments: Pre-operative (PreOp), Operating Room (OR), and Post Anesthesia Care Unit (PACU). Using patient level data from a large teaching hospital, we find that POS managers in all three departments view overtime costs as more important than idle time costs, which implies that they keep capacity slack available for patient care in each department. Further, our findings suggest that highly experienced surgeons take ownership of their patients' experience in the POS and that their patients spend less time in PreOp and the OR. We argue that not only do more experienced surgeons perform surgical procedures more efficiently, but they also coordinate better with PreOp to reduce patient waiting time there. We find that a surgeon's rating has no direct effect on a patient's actual surgery time in the OR, but that the effect of surgeon experience on actual surgery time is higher, in magnitude, for a lower-rated surgeon than for a higher-rated surgeon. Finally, we conduct a counterfactual analysis and find that highly experienced surgeons reduce the total length of a patient's stay in the POS.

This paper examines Argentine exports at the firm level between 2003 and 2011, a period of exceptional and sustained export growth. While at the product level, the pattern of specialisation barely changed, exporters exhibit new dynamics in international markets: firms not only expanded sales abroad by increasing their exports in existing markets, but also by entering into new destinations and adding new products. That is, new export strategies allowed exporters achieve greater resistance to the variations in the macroeconomic environment. We find that the importance of the different export margins changes overtime: while the currency is depreciated, the intensive margin explains most of export growth, whereas the subextensive and extensive margins become the main source of export growth once the currency appreciates. We also uncover a strong complementarity between import and export growth.

Objective Women with metastatic breast cancer face numerous, complex treatment and advance care planning (ACP) decisions. Our aim was to develop a better understanding of women with metastatic breast cancer's decision-making preferences overtime and relative to specific types of decisions. Methods Convergent, parallel mixed-methods study. Participants completed the Control Preferences Scale (CPS) and a semi-structured interview of decision-making experiences at enrollment (T1; n = 22) and when facing a decision or 3 months later (T2; n = 19). We categorized women's decision-making experience descriptions into one of the CPS decisional styles and compared them to their CPS response. We constructed an analytic grid that aligned the interview-determined treatment and ACP decisional preferences with the CPS categories at T1 and T2 and calculated Cohen's kappa coefficient and congruence percentages. Results Participants (n = 22) were White (100%), averaged 62 years, married (54%), retired (45%), and had a bachelor's degree (45%). Congruence between CPS response and interview-determined treatment preferences at T1 was 32% (kappa = 0.083) and 33% (kappa = 0.120) at T2. Congruence between CPS survey response and interview-determined ACP preferences at T1 was 22.7% (kappa =0.092) at T1 and 11% (kappa = 0.011) at T2. Conclusions Although women selected a "shared" treatment decision-making style using the CPS validated tool, when interviewed their descriptions generally reflected a passive process in which they followed the oncologists' treatment suggestions. Future research should explore whether the incongruence between stated and actual decision-making style is a function of misinterpreting the CPS choices or a true inconsistency that could lead to adverse consequences such as decisional regret.

Author(s): Pourat, Nadereh; Choi, Moonkyung Kate; Chen, Xiao | Abstract: OBJECTIVES:Preventive dental health services are intended to reduce the likelihood of development of tooth decay and the need for more intensive treatment overtime. The evidence on the effectiveness of preventive dental care in reducing treatment services and expenditures is lagging for adults, particularly those with lower incomes and chronic conditions. We assessed the impact of preventive dental services on dental treatment service use and expenditures overall and by category of service. METHODS:We calculated the annual numbers of preventive (periodic diagnostic and prophylactic procedures) and treatment (restorative, surgery, prosthodontic, endodontic, and periodontic) services per beneficiary using Medicaid enrollment and claims data for beneficiaries with three categories of conditions (diabetes, heart disease, and respiratory disease) from 10 largest California counties. We used Cragg hurdle exponential regression models controlling for past service use, demographics, length of enrollment, and county. RESULTS:We found that using preventive services in 2005-2007 was associated with higher likelihood and number of treatment dental services used, but associated with lower treatment expenditures in 2008. The reduction in expenditures was noted only in restorative, prosthodontics, and periodontic services. CONCLUSIONS:The findings provide much needed evidence of the contribution of preventive dental care in maintaining oral health of low-income adults with chronic conditions and potential for savings to the Medicaid program. Providing lower cost preventive dental care to the individuals with chronic conditions would achieve better oral health and lower treatment expenditures.

Realizing the many benefits from Facebook require users to share information reciprocally, which has overtime created trillions of bytes of information online—a treasure trove for cybercriminals. The sole protection for any user are three sets of privacy protections afforded by Facebook: settings that control information privacy (i.e., security of social media accounts and identity information), accessibility privacy or anonymity (i.e., manage who can connect with a user), and those that control expressive privacy (i.e., control who can see a user's posts and tag you). Using these settings, however, involves a trade†off between making oneself accessible and thereby vulnerable to potential attacks, or enacting stringent protections that could potentially make someone inaccessible thereby reducing the benefits that are accruable through social media. Using two theoretical frameworks, Uses and Gratifications (U&G) and Protection Motivation Theory (PMT), the research examined how individuals congitvely juxtaposed the cost of maintaining privacy through the use of these settings against the benefits of openness. The application of the U&G framework revealed that social need fulfillment was the single most significant benefit driving privacy management. From the cost standpoint, the PMT framework pointed to perceived severity impacting expressive and information privacy, and perceived susceptability influencing accessibility privacy.

Many parts of the healthcare system remain fragmented and outpatient surgical care is no exception. In this paper, we develop a coordinated pre-operative scheduling approach between Anesthesiology and Internal Medicine to optimize patients’ medical conditions prior to surgery. Coordinating these two services has conceptual appeal because any health issues discovered by the anesthesiologist can often be addressed by a general internist. We design a patient-centered approach that allows the patient to see both providers, if necessary, on a single visit. This problem is modeled as a two-station stochastic network, where each station (or clinic) may be staffed by multiple parallel providers and patients see the first available provider. To solve the scheduling problem, we formulate an optimization model to maximize the net benefit of scheduling patients. The objective balances benefits against patient waiting time and clinic overtime costs. We develop a scheduling method with a booking limit to create a balanced network schedule. Due to the complexity of this problem, the solution approach is myopic. In addition, we develop a hybrid method that combines analytical calculation and simulation-based optimization. We demonstrate our approach on a healthcare network at The University of Texas Health Sciences Center in San Antonio. We compare our method against other policies and show that it yields high quality and robust results. Based on the level of generality of our model and results, the insights gained are not limited to the particular application, but can be applied to other patient-centered models where scheduling coordination can be used. This article is protected by copyright. All rights reserved.

We sometimes decide to take an offered option that results in apparent loss (e.g., unpaid overtime). Mainstream decision theory does not predict or explain this as a choice we want to make, whereas such a choice has long been described and highly regarded by the traditional Chinese dogma "" (suffering a loss is good fortune). To explore what makes the dogma work, we developed a celebrity anecdote-based scale to measure "Chikui" (suffering a loss) likelihood and found that:(i) people with higher scores on the Chikui Likelihood Scale (CLS) were more likely to report higher scores on subjective well-being and the Socioeconomic Index for the present and (ii) the current Socioeconomic Index could be positively predicted not only by current CLS scores but also by retrospective CLS scores recalled for the past, and the predictive effect was enhanced with increasing time intervals. Our findings suggest that "suffering a loss is good fortune" is not a myth but a certain reality.

Lead firms in apparel global supply chains are increasingly using social compliance programmes that require worker-management participation committees in their supplier factories. These committees are designed to ensure respect for internationally recognized labour standards, to empower workers, and to reduce labour unrest. However, these committees have remained weak, and in countries such as Vietnam worker unrest remains common. This article argues that this is because lead firms in these CSR programmes are imposing a ‘sourcing squeeze’ on supplier factors by reducing the prices and production times they allot to their suppliers, which undermines efforts by committees to address cost-sensitive issues and overtime violations. At the same time, the sourcing squeeze increases strike leverage, providing workers with a much more effective source of worker voice.

We investigate the scheduling practices of a multidisciplinary, multistage, outpatient health care program. Patients undergo a series of assessments before being eligible for elective surgery. Such systems often suffer from high rates of attrition and appointment no-shows leading to capacity underutilization and treatment delays. We propose a new scheduling model where the clinic assigns patients to an appointment day but postpones the decision of which assessments patients undergo pending the observation of who arrives. In doing so, the clinic gains flexibility to improve system performance. We formulate the scheduling problem as a Markov decision process and use approximate dynamic programming to solve it. We apply our approach to a data set collected from a bariatric surgery program at a large tertiary hospital in Toronto, Canada. We examine the quality of our solutions via structural results and compare them with heuristic scheduling practices using a discrete-event simulation. By allowing multiple assessments, delaying their scheduling, and by optimizing over an appointment book, we show significant improvements in patient throughput, clinic profit, use of overtime, and staff utilization. This article is protected by copyright. All rights reserved.

There are structural and individual factors that contribute to and compound the current and continuing under-representation of women in leadership and senior management positions. We explore these factors by investigating the beliefs and intentions of male and female senior managers with respect to applying for promotion to executive level in local government organisations in South Australia. Survey data from 148 senior managers indicated that men and women have similar belief structures when it comes to their intentions to apply for promotion in South Australian local government. The imbalance in the proportion of women and men in CEO positions in South Australian local government, we suggest, reflects earlier findings of the inherent bias towards men in the selection process for these positions. Our analysis supports a number of structural and managerial recommendations, which we believe will address this imbalance overtime.

Background Urban transit operators have high rates of obesity, hypertension, and other cardiovascular risk-factors compared to other occupations. There have been few qualitative studies exploring the interrelationships between the organization of transit work, stress, and health including obesity, from the perspective of operators. Methods Five focus groups were conducted at five Divisions in a transit authority in Southern California and included 65 bus and rail operators. Results Operators reported a great deal of stress related to their work, including 1) time pressures and lack of recovery time; 2) long work shifts and overtime; 3) feeling unsafe when dealing with the public; 4) lack of respect from supervisors and management. Operators believed stressful working conditions negatively impacted their health and weight. Conclusion This qualitative study yielded new as well as confirmatory data about stress and transit work organization, health, and weight in operators. This study will add to future survey research and interventions in this population.

This study analyzes the relation between works councils and overtime hours in Germany. The estimated effects differ considerably in dependence of standard contracted working time. Furthermore, we find differences across the quantiles of the overtime hours distribution and these differences between quantiles also vary between employees of establishment with and without works councils. By considering contracted working time effects and comparing conditional quantiles we find in some quantiles that employees of establishments with a works council have a higher amount of overtime hours if an employee regularly works 35 hours per week. This effect diminishes with increasing quantiles of the distribution of overtime hours. If an employee of a codetermined establishment regularly works 40 hours per week, overtime hours are reduced. This reduction becomes larger if higher quantiles are analyzed.

Background Acute occupational hand injuries are a common occurrence in China's metal manufacturing industries. This study aimed to explore the transient risk factors for acute occupational hand injuries among metal manufacturing workers. Methods A case-crossover study was conducted from October 2013 through December 2013 in Zhongshan city, southern China. Face-to-face interviews were used to collect information on the occurrence of 12 transient risk factors during the "hazard" period (a 60-min period prior to occupational hand injury) and a "control" period (the week before the injury). Results One hundred ninety-four qualified acute occupational hand injury cases (139 male, 55 female) were enrolled in this study, with a mean age of 35.5 (standard deviation [SD] 10.4) years. The most common (64.9%) type of work was punching, and the most common injures were crushes and fractures (28.8 and 23.7%, respectively). Of these cases, 62.9% were regarded as severe or major. Among the 12 transient risk factors, 11 ones were significantly associated with acute occupational hand injuries occurring during the hazard period: "replacing sharp knives" (IRR = 14.38, 95%CI 11.43-18.08), "using malfunctioning machinery" (IRR = 30.59, 95%CI 17.84-52.48), "using different tools" (IRR = 10.96, 95%CI 4.77-25.17), "using different machines" (IRR = 5.20, 95%CI 2.25-12.00), "performing unusual work tasks" (IRR = 24.38, 95%CI 14.11-42.15), "working overtime" (IRR = 13.40, 95%CI 7.70-23.29), "performing a task with a different method" (IRR = 56.41, 95%CI 23.61-134.81), "being in a bad mood" (IRR = 108.11, 95%CI 55.10-211.11), "feeling ill" (RR = 12.27, 95%CI 4.95-30.43), "rushing" (IRR = 5.16, 95%CI 2.49-10.70), and "not wearing gloves" (IRR = 1.63, 95%CI 1.23-2.15). Conclusions Our study suggested that multiple transient risk factors were responsible for the acute occupational hand injuries in China's metal manufacturing industries. Am. J. Ind. Med. 59:832-840, 2016. © 2016 Wiley Periodicals, Inc.

Objective Working long hours is a potential health hazard. Although self-reporting of working hours in various time frames has been used in epidemiologic studies, its validity is unclear. The objective of this study was to examine the validity and reproducibility of self-reported working hours among Japanese male employees. Methods The participants were 164 male employees of four large-scale companies in Japan. For validity, the Spearman correlation between self-reported working hours in the second survey and the working hours recorded by the company was calculated for the following four time frames: daily working hours, monthly overtime working hours in the last month, average overtime working hours in the last 3 months, and the frequency of long working months (≥45 h/month) within the last 12 months. For reproducibility, the intraclass correlation between the first (September 2013) and second surveys (December 2013) was calculated for each of the four time frames. Results The Spearman correlations between self-reported working hours and those based on company records were 0.74, 0.81, 0.85, and 0.89 for daily, monthly, 3-monthly, and yearly time periods, respectively. The intraclass correlations for self-reported working hours between the two questionnaire surveys were 0.63, 0.66, 0.73, and 0.87 for the respective time frames. Conclusions The results of the present study among Japanese male employees suggest that the validity of self-reported working hours is high for all four time frames, whereas the reproducibility is moderate to high.

We present research from an investigation on developing a learning progression (LP) for sea level rise (SLR), a major effect of global climate change. We began our research by drafting a hypothetical LP for sea level rise, informed by extant knowledge of the topic in the scientific community, in science education literature, and in science education policy documents such as the Next Generation Science Standards. Causes and mechanisms, scale and representations, and impacts made up the three components of the LP. Our confidence in our hypothetical LP was greater for the lower and upper anchors than for the levels between them. For all levels, however, we remained tentative due to the limitation of empirical data from learners. We next developed an assessment instrument as well as an online activity as a way to elicit learners’ thinking about sea level rise. These instruments were administered to middle school students (N = 95) and undergraduate pre-service teachers (N = 77). An analysis of the data suggested that our hypothetical LP for sea level rise was a necessary first step, but it underscored the necessity of probing learners’ thinking of the construct to develop a robust understanding of learners’ conceptual understanding overtime of SLR. The assessment data provided essential information about learner understanding of the construct of sea level rise that assisted us in moving our SLR LP from a hypothetical state to a more stable state, which we term as “conditional.” The development of a conditional SLR LP, along with the accompanying assessment instruments, contributes to research and thinking about learning progressions and climate change education. © 2016 Wiley Periodicals, Inc. J Res Sci Teach 53: 1471–1499, 2016

Magnetic resonance imaging and other multifunctional diagnostic facilities, which are considered as scarce resources of hospitals, typically provide services to patients with different medical needs. This article examines the admission policies during the appointment management of such facilities. We consider two categories of patients: regular patients who are scheduled in advance through an appointment system and emergency patients with randomly generated demands during the workday that must be served as soon as possible. According to the actual medical needs of patients, regular patients are segmented into multiple classes with different cancelation rates, no-show probabilities, unit value contributions, and average service times. Management makes admission decisions on whether or not to accept a service request from a regular patient during the booking horizon to improve the overall value that could be generated during the workday. The decisions should be made by considering the cancelation and no-show behavior of booked patients as well as the emergency patients that would have to be served because any overtime service would lead to higher costs. We studied the optimal admission decision using a continuous-time discrete-state dynamic programming model. Identifying an optimal policy for this discrete model is analytically intractable and numerically inefficient because the state is multidimensional and infinite. We propose to study a deterministic counterpart of the problem (i.e., the fluid control problem) and to develop a time-based fluid policy that is shown to be asymptotically optimal for large-scale problems. Furthermore, we propose to adopt a mixed fluid policy that is developed based on the information obtained from the fluid control problem. Numerical experiments demonstrate that this improved policy works effectively for small-scale problems. © 2016 Wiley Periodicals, Inc. Naval Research Logistics 63: 287–304, 2016

Objectives This study aimed to identify the practical abilities required by nonspecialist occupational physicians and specify the priorities for training programs. Methods A practical abilities list was developed through a focus group meeting of specialists. We created a survey questionnaire and asked three groups, namely, occupational physicians, occupational health nurses, and health officers, to rate the importance of each practical ability. Results The mean scores for all 45 items were greater than 4, i.e., in the middle of the 7-point Likert scale, for all the three groups. The occupational physicians' responses had a correlation with the other groups' responses. However, there were differences with regard to some practical abilities between the three groups. Five practical abilities from the top quartile were marked "A" by all the three groups: "Submit opinions on fitness for duty and work accommodation on the basis of data from health examination," "Respect employee privacy," "Submit opinion on fitness for duty and work accommodation on the basis of data from face-to-face interviews with employees," "Submit opinions on fitness for duty and work accommodation on the basis of data from health surveillance," and "Implement face-to-face interviews for employees who have worked overtime and evaluate the subjects' conditions including mental and physical health status, degree of accumulated fatigue, and depression." Conclusions This study resulted in a rank-ordered list of 45 practical abilities that are required by nonspecialist occupational physicians. This result may be useful to review and redesign the existing training program for nonspecialist occupational physicians.

Foreign currency (FX)-based loans and deposits became very popular in Central and Eastern European countries (CEECs) over the 2000–2011 period. In this paper, I simultaneously examine the demand-side (consumer-related) and supply-side (bank-related) determinants of the quick spread of FX banking. I use a newly constructed dataset on FX and domestic currency loans, deposits and interest rates, covering 16 CEECs overtime. Local-FX interest rate and market share spreads are: (1) lower in managed currency regimes; (2) strongly affected by the prevalence of FX funding, currency mismatch and FX banking restrictions, and (3) wider after economic crises.

Shift-share and input-output models are combined to explore the resilience of Greek regions to economic crisis. Model results indicate that rural regions are more resistant to recessionary shocks than urban regions. The analysis of the space-specific ability of sectors to withstand economic shocks portrayed the resilience of agriculture, while food industry, although its impact overtime declined, managed to increase its employment in seven out of thirteen regions. The tourism sector contracted but showed more resilience in the island regions than in the continental regions. The spatial heterogeneity in the effects of the recessionary shocks re-emphasizes the need for targeted and differentiated regional development policies.

The main purpose of this paper is to propose several new maintenance policies that can be performed at suitable middle times for trivariate preventive maintenance scenarios. Firstly, characteristics and limitations for the approaches of whichever occurs first and whichever occurs last are analyzed, and their respective maintenance models, which are called first maintenance and last maintenance, are given directly. Secondly, a combined approach of first and last is employed and middle maintenance is proposed. Thirdly, the aforementioned policy is modified to be performed at discrete working cycles, using the method of overtime maintenance. Finally, a new approach of whichever occurs middle is proposed for modelings. We give the analyses of how to formulate the middle maintenances and obtain their expected maintenance cost rates, using the technique of cumulative damage models. Numerical examples are given to compare the optimal policies among first, last, and middle maintenances. Finally, a potential application of middle maintenance is provided for future studies. Copyright © 2015 John Wiley & Sons, Ltd.