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A systems perspective explains dynamics of human flourishing based on the relations between its constituents. Using cross-sectional data from emerging adults (ages 18–29) in 10 countries (N = 7221), this study explored the interrelatedness among constituents of flourishing – happiness & satisfaction with life, mental & physical health, meaning & purpose, character & virtue, close social relationships, and financial & material stability – within and across countries. Each country's sample was characterized by a unique flourishing network, although there were similarities. Except for financial & material stability, all constituents were positively related across samples. Financial & material stability showed the highest cross-country heterogeneity in its relations. Happiness & satisfaction with life and meaning & purpose showed the strongest interrelations. A higher level of one constituent was associated with lower network connectivity. This systems perspective extends existing knowledge about the conceptualization of flourishing and how people can be supported to achieve and maintain complete well-being. [ABSTRACT FROM AUTHOR]

The processes and outcomes of nurses' work are described extensively in studies about patient care, nursing education and training, job satisfaction, health care quality and management, and organizational behavior. These studies evaluate the relationship between nurses' behavior and organizational health (ie, productivity) or between nurses' behavior and patient health (ie, medical error). Fewer studies probe the association between the nature of nursing work and the status of nurses' health despite the logical connection between how well nurses feel and how well they perform, or even, whether they discontinue working altogether for health reasons. Yet, for many nurses working in today's health care environment, work is a stressful part of their lives. This article explores the connections between stressful work and nurses' health, especially given the restructuring of their work in the current health care system. The working conditions that give rise to stress and the potential health consequences from it are well described in the general stress literature and summarized herein. Moreover, studies about nurses' work and nurses' health are discussed in light of the limitations for connecting job stress to job changes or health outcomes over time. Current approaches for dealing with nurses' stress, such as the attraction to 'Magnetism', may inadvertently impede progress in this area. Recommendations for the future are included. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the effects of two exercise approaches, tai chi (TC) and computerized balance training (BT), on specified primary outcomes (biomedical, functional, and psychosocial indicators of frailty) and secondary outcomes (occurrences of fall). DESIGN: The Atlanta Frailty and Injuries: Cooperative Studies and Intervention Techniques, a prospective, randomized, controlled clinical trial with three arms (TC, BT, and education (ED)). Intervention length was 15 weeks, with primary outcomes measured before and after intervention and at 4-month follow-up. Falls were monitored continuously throughout the study. SETTING: Persons aged 70 and older living in the community. PARTICIPANTS: A total of 200 participants, 162 women and 38 men; mean age was 76.2. MEASUREMENTS: Biomedical (strength, flexibility, cardiovascular endurance, body composition), functional instrumental activities of daily living (IADL), and psychosocial well-being (Center for Epidemiological Studies for Depression scale, fear of falling questionnaire, self-perception of present and future health, mastery index, perceived quality of sleep, and intrusiveness) variables. RESULTS: Grip strength declined in all groups, and lower extremity range of motion showed limited but statistically significant changes. Lowered blood pressure before and after a 12-minute walk was seen following TC participation. Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group (P=.046 and P=.058, respectively). After adjusting for fall risk factors, TC was found to reduce the risk of multiple falls by 47.5%. CONCLUSION: A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty. This intervention can also have favorable effects upon the occurrence of falls. TC warrants further study as an exercise treatment to improve the health of older people. [ABSTRACT FROM AUTHOR]

This paper reviews the research and practice literature regarding the use of chemical and mechanical restraints in long term care. Impacts of use and non-use of restraints on residents, families, and long term care staff are evaluated, as well as ethical-legal considerations to balance resident autonomy and safety. Recent mandates for the reduction of restraint use are discussed with an emphasis on the processes needed to effect attitudinal and institutional changes. [ABSTRACT FROM AUTHOR]

In the United States, the Federal Aviation Administration has officially classified flight crews (FC) consisting of commercial pilots, cabin crew, or flight attendants as "radiation workers" since 1994 due to the potential for cosmic ionizing radiation (CIR) exposure at cruising altitudes originating from solar activity and galactic sources. Several epidemiological studies have documented elevated incidence and mortality for several cancers in FC, but it has not yet been possible to establish whether this is attributable to CIR. CIR and its constituents are known to cause a myriad of DNA lesions, which can lead to carcinogenesis unless DNA repair mechanisms remove them. But critical knowledge gaps exist with regard to the dosimetry of CIR, the role of other genotoxic exposures among FC, and whether possible biological mechanisms underlying higher cancer rates observed in FC exist. This review summarizes our understanding of the role of DNA damage and repair responses relevant to exposure to CIR in FC. We aimed to stimulate new research directions and provide information that will be useful for guiding regulatory, public health, and medical decision-making to protect and mitigate the risks for those who travel by air.

Previous studies on the associations between well-being and work outcomes, such as work distraction and job satisfaction, have largely been cross-sectional and typically focused on only one or two aspects of well-being. Using two waves of data from a sample of employees at a United States health insurance company ( n  = 1,234), the present brief research report examines prospective associations between six domains of well-being (emotional health, physical health, meaning & purpose, character strengths, social connectedness, and financial security) and two work outcomes (work distraction and job satisfaction). Lagged regression analyses provided some evidence indicating that higher-level well-being in several domains was associated with subsequent reduced work distraction and increased job satisfaction assessed approximately 1 year later, but the magnitude of associations with each outcome did vary by specific domain. Emotional health and social connectedness were most strongly associated with work distraction and job satisfaction. We discuss some implications of the findings, including the importance of applying a multidimensional approach to studying employee well-being and potential opportunities for organizations to support the well-being of their employees., Competing Interests: TV reports receiving licensing fees from Flerish, Inc. and Flourishing Metrics. TV and EM have received grants and personal fees from Aetna, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Fung, Cowden, Chen, Weziak-Bialowolska, Bialowolski, Lee, McNeely and VanderWeele.)

Background: The study objective was to assess disparities in outcomes in the waitlist and post-heart transplantation (HT) according to socioeconomic status (SES) in the old and new U.S. HT allocation systems., Methods: Adult HT candidates in the United Network for Organ Sharing database from 2014 through 2021 were included. Old or new system classification was according to listing before or after October 18, 2018. SES was stratified by patient ZIP code and median household income via U.S. Census Bureau and classified into terciles. Competing waitlist outcomes and post-transplantation survival were compared between systems., Results: In total, 26,450 patients were included. Waitlisted candidates with low SES were more frequently younger, female, African American, and with higher body mass index. Reduced cumulative incidence (CI) of HT in the old system occurred in low SES (53.5%) compared to middle (55.7%, p = 0.046), and high (57.9%, p < 0.001). In the new system, the CI of HT was 65.3% in the low SES vs middle (67.6%, p = 0.002) and high (70.2%, p < 0.001), and SES remained significant in the adjusted analysis. In the old system, CI of death/delisting was similar across SES. In the new system, low SES had increased CI of death/delisting (7.4%) vs middle (6%, p = 0.012) and high (5.4%, p = 0.002). The old system showed similar 1-year survival across SES. In the new system, recipients with low SES had decreased 1-year survival (p = 0.041)., Conclusions: SES affects waitlist and post-transplant outcomes. In the new system, all SES had increased access to HT; however, low SES had increased death/delisting due to worsening clinical status and decreased post-transplant survival., (Copyright © 2023 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

This paper presents cross-cultural comparisons of well-being among factory workers, as measured by the six well-being domains of happiness and life satisfaction, physical and mental health, meaning and purpose, character and virtue, close social relationships, and financial and material stability. Relative ranks of well-being domains across examined groups of workers are also compared. Results are based on survey data from factory workers in Cambodia, China, Mexico, Poland, Sri Lanka, and the United States. Average well-being scores are higher among factory workers in Mexico, China, and Cambodia than in the U.S., Poland, and Sri Lanka across all domains except financial and material stability. Close social relationships were the highest ranked domain in Cambodia and China but ranked much lower (5th) in the U.S. Meaning and purpose, as well as character and virtue were highly ranked across the board. Strong social relationships seem to thrive in contexts where financial insecurity is high., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© The Author(s) 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Frequent working from home (WFH) may stay as a new work norm after the COVID-19 pandemic. Prior observational studies on WFH and work outcomes under non-pandemic circumstances are mostly cross-sectional and often studied employees who worked from home in limited capacity. To provide additional insights that might inform post-pandemic work policies, using longitudinal data collected before the COVID-19 pandemic (June 2018 to July 2019), this study aims to examine the associations between WFH and multiple subsequent work-related outcomes, as well as potential modifiers of these associations, in a sample of employees among whom frequent or even full-time WFH was common (N = 1,123, Meanage = 43.37 years). In linear regression models, each subsequent work outcome (standardized score was used) was regressed on frequencies of WFH, adjusting for baseline values of the outcome variables and other covariates. The results suggested that WFH for 5 days/week versus never WFH was associated with subsequently less work distraction (ß = -0.24, 95% CI = -0.38, -0.11), greater perceived productivity/engagement (ß = 0.23, 95% CI = 0.11, 0.36), and greater job satisfaction (ß = 0.15, 95% CI = 0.02, 0.27), and was associated with subsequent work-family conflicts to a lesser extent (ß = -0.13, 95% CI = -0.26, 0.004). There was also evidence suggesting that long work hours, caregiving responsibilities, and a greater sense of meaningful work can all potentially attenuate the benefits of WFH. As we move towards the post-pandemic era, further research will be needed to understand the impacts of WFH and resources for supporting employees who work from home., Competing Interests: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr. McNeely and Dr. VanderWeele report receiving grants and personal fees from Aetna Inc. Dr. McNeely reports receiving grants from the Levi Strauss Foundation, and she also reports serving as Executive Director of SHINE at Harvard (Sustainability and Health Initiative for NetPositive Enterprise); Support is made possible through SHINE from multiple companies. Dr. VanderWeele reports receiving grants from the John Templeton Foundation. Other authors have no conflicts of interest to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Psychological climate for caring (PCC) is a psychosocial factor associated with individual work outcomes and employee well-being. Evidence on the impacts of various psychological climates at work is based mostly on self-reported health measures and cross-sectional data. We provide longitudinal evidence on the associations of PCC with subsequent diagnosed depression and anxiety, subjective well-being, and self-reported work outcomes. Employees of a US organization with a worker well-being program provided data for the analysis. Longitudinal survey data merged with data from personnel files and health insurance claims records comprising medical information on diagnosis of depression and anxiety were used to regress each outcome on PCC at baseline, adjusting for prior values of all outcomes and other covariates. PCC was found to be associated with lower odds of subsequent diagnosed depression, an increase in overall well-being, mental health, physical health, social connectedness, and financial security, as well as a decrease in distraction at work, an increase in productivity/engagement and possibly in job satisfaction. There was little evidence of associations between PCC and subsequent diagnosed anxiety, character strengths, and work-family conflict. Work policies focused on improving PCC may create a promising pathway to promoting employee health and well-being as well as improving work-related outcomes., Competing Interests: Declaration of competing interest The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr. McNeely reports receiving grants and personal fees from Aetna Inc. and from the Levi Strauss Foundation. She also reports serving as director of SHINE at Harvard (Sustainability and Health Initiative for NetPositive Enterprise); Support is made possible through SHINE from multiple companies. Dr. VanderWeele reports receiving grants and personal fees from Aetna Inc. and from the John Templeton Foundation. Dr. Weziak-Bialowolska reports receiving support from the Norwegian Financial Mechanism2014–2021 (UMO-2020/37/K/HS6/02772). Other authors have no conflicts of interest to declare. The research findings represent the perspective of the authors and do not reflect the opinions or endorsement of any organization., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Though billions of passengers and crew travel by air each year and are exposed to altitude equivalents of 7000-8000 feet, the health impact of cabin oxygenation levels has not been well studied. The hypoxic environment may produce ectopic heartbeats that may increase the risk of acute in-flight cardiac events. We enrolled forty older and at-risk participants under a block-randomized crossover design in a hypobaric chamber study to examine associations between flight oxygenation and both ventricular (VE) and supraventricular ectopy (SVE). We monitored participant VE and SVE every 5 min under both flight and control conditions to investigate the presence and rate of VE and SVE. While the presence of VE did not differ according to condition, the presence of SVE was higher during flight conditions (e.g. OR ratio = 1.77, 95% CI: 1.21, 2.59 for SVE couplets). Rates of VE and SVE were higher during flight conditions (e.g. RR ratio = 1.25, 95% CI: 1.03, 1.52 for VE couplets, RR ratio = 1.76, 95% CI: 1.39, 2.22 for SVE couplets). The observed higher presence and rate of ectopy tended to increase with duration of the flight condition. Further study of susceptible passengers and crew may elucidate the specific associations between intermittent or sustained ectopic heartbeats and hypoxic pathways., (© 2023. The Author(s).)

Purpose: Excellent character, reflected in adherence to high standards of moral behavior, has been argued to contribute to well-being. The study goes beyond this claim and provides insights into the role of strengths of moral character (SMC) for physical and mental health., Methods: This study used longitudinal observational data merged with medical insurance claims data collected from 1209 working adults of a large services organization in the US. Self-reported physical and mental health as well as diagnostic information on depression, anxiety, and cardiovascular disease were used as outcomes. The prospective associations between SMC (7 indicators and a composite measure) and physical and mental health outcomes were examined using lagged linear and logistic regression models. A series of sensitivity analyses provided evidence for the robustness of results., Results: The results suggest that persons who live their life according to high moral standards have substantially lower odds of depression (by 21-51%). The results were also indicative of positive associations between SMC and self-reports of mental health (β = 0.048-0.118) and physical health (β = 0.048-0.096). Weaker indications were found for a protective role of SMC in mitigating anxiety (OR = 0.797 for the indicator of delayed gratification) and cardiovascular disease (OR = 0.389 for the indicator of use of SMC for helping others)., Conclusions: SMC may be considered relevant for population mental health and physical health. Public health policies promoting SMC are likely to receive positive reception from the general public because character is both malleable and aligned with the nearly universal human desire to become a better person., (© 2022. The Author(s).)

Aircrew (consisting of flight attendants, pilots, or flight engineers/navigators) are exposed to cosmic ionizing radiation (CIR) at flight altitude, which originates from solar activity and galactic sources. These exposures accumulate over time and are considerably higher for aircrew compared to the general population, and even higher compared to U.S. radiation workers. Many epidemiological studies on aircrew have observed higher rates of specific cancers compared to the general population. Despite high levels of CIR exposure and elevated rates of cancer in aircrew, a causal link between CIR and cancer has yet to be established. Many challenges still exist in effectively studying this relationship, not the least of which is evaluating CIR exposure separately from the constellation of factors that occur as part of the flight environment. This review concentrates on cancer incidence and mortality observed among aircrew in epidemiologic studies in relation to CIR exposure and limitation trends observed across the literature. The aim of this review is to provide an updated comprehensive summary of the literature that will support future research by identifying epidemiological challenges and highlighting existing increased cancer concerns in an occupation where CIR exposure is anticipated to increase in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Scheibler, Toprani, Mordukhovich, Schaefer, Staffa, Nagel and McNeely.)

Suffering is an experiential state that every person encounters at one time or another, yet little is known about suffering and its consequences for the health and well-being of nonclinical adult populations. In a pair of longitudinal studies, we used two waves of data from garment factory workers (Study 1 [T1: 2017, T2: 2019]: n = 344) and flight attendants (Study 2 [T1: 2017/2018, T2: 2020]: n = 1402) to examine the prospective associations of suffering with 16 outcomes across different domains of health and well-being: physical health, health behavior, mental health, psychological well-being, character strengths, and social well-being. The primary analysis involved a series of regression analyses in which each T2 outcome was regressed on overall suffering assessed at T1, adjusting for relevant sociodemographic characteristics and the baseline value (or close proxy) of the outcome assessed at T1. In Study 1, associations of overall suffering with worse subsequent health and well-being were limited to a single outcome on each of the domains of physical health and mental health. Overall suffering was more consistently related to worse subsequent health and well-being in Study 2, with associations emerging for all but two outcomes. The pattern of findings for each study was largely similar when aspects of suffering were modeled individually, although associations for some aspects of suffering differed from those that emerged for overall suffering. Our findings suggest that suffering may have important implications for the health and well-being of worker populations., (© 2022. The Author(s).)

This paper examines demographic differences in flourishing, defined as "complete well-being" and consisting of six domains: emotional health, physical health, purpose, character strengths, social connectedness, and financial security. Results are based on a random, cross-sectional sample of 2363 survey respondents drawn from employees of a large, national, self-insured employer based in the United States. We found that well-being across domains tends to increase with age, although there are some variations. Results are similar across most domains for men and women, although women score higher on character strengths, while men had higher scores on financial security. Racial and ethnic differences were striking. Black employees score higher than the reference group (White employees) on the emotional, purpose, and character strengths domains, but considerably lower on financial security. Hispanics also score lower on financial security (though not as low as Blacks), but higher than Whites on purpose, character strengths, and social connectedness. Asians reported higher well-being than Whites across all domains except purpose., (© 2022. The Author(s).)

Depression and the subjective experience of suffering are distinct forms of distress, but they are sometimes commingled with one another. Using a cross-sectional sample of flight attendants ( n = 4,652), we tested for further empirical evidence distinguishing depression and suffering. Correlations with 15 indices covering several dimensions of well-being (i.e., physical health, emotional well-being, psychological well-being, character strengths, social well-being, financial/material well-being) indicated that associations with worse well-being were mostly stronger for depression than suffering. There was a large positive correlation between depression and suffering, but we also found evidence of notable non-concurrent depression and suffering in the sample. After dividing participants into four groups that varied based on severity of depression and suffering, regression analyses showed higher levels of well-being among those with both none-mild depression and none-mild suffering compared to those with moderate-severe depression, moderate-severe suffering, or both. All indices of well-being were lowest among the group of participants with moderate-severe depression and moderate-severe suffering. In addition to providing further evidence supporting a distinction between depression and suffering, our findings suggest that concurrent depression and suffering may be more disruptive to well-being than when either is present alone., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Cowden, Wȩziak-Białowolska, McNeely and VanderWeele.)

Objectives: Evidence on social stimuli associated with mental health is based mostly on self-reported health measures. We aimed to examine prospective associations between social connectedness and clinical diagnosis of depression and of anxiety. Methods: Longitudinal observational data merged with health insurance data comprising medical information on diagnosis of depression and anxiety were used. 1,209 randomly sampled employees of a US employer provided data for the analysis. Robust Poisson regression models were used. Multiple imputation was conducted to handle missing data on covariates. Results: Better social connectedness was associated with lower risks of subsequently diagnosed depression and anxiety, over a one-year follow-up period. Reports of feeling lonely were associated with increased risks of depression and anxiety. Association between community-related social connectedness and subsequent diagnosis of depression, but not of anxiety, was found. The associations were independent of demographics, socioeconomic status, lifestyle, and work characteristics. They were also robust to unmeasured confounding, missing data patterns, and prior health conditions. Conclusion: Social connectedness may be an important factor for reducing risks of depression and anxiety. Loneliness should be perceived as a risk factor for depression and anxiety., Competing Interests: EM reports receiving grants and personal fees from Aetna Inc and the Levi Strauss Foundation; EM also reports serving as director of SHINE at Harvard (Sustainability and Health Initiative for NetPositive Enterprise). TJV reports receiving grants and personal fees from Aetna Inc. and the John Templeton Foundation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Weziak-Bialowolska, Bialowolski, Lee, Chen, VanderWeele and McNeely.)

The longitudinal interrelationships between domains of human well-being or flourishing remain understudied empirically. While different aspects of flourishing may be sought as their own end, it is also the case that well-being in one domain may influence well-being in other domains. Using longitudinal data form a sample of employees from a large national employer in the United States (N = 1209, mean age = 43.52 years, age range 20-74 years), this study examined the temporal associations between various domains of flourishing, based on a 40-item index that assessed six domains of flourishing. These domains include emotional health, physical health, meaning and purpose, character strengths, social connectedness, and financial security. A set of linear regression models were used to regress subsequent composite flourishing on flourishing domain-specific scores at baseline. The results indicated that all domains were each independently associated with greater composite flourishing subsequently. The strongest and most robust links were observed for meaning and purpose (β = 0.19, 95% confidence interval [CI] 0.13, 0.25), social connectedness (β = 0.17, 95% CI 0.12, 0.22), and financial security (β = 0.32, 95% CI 0.28, 0.37). Further analyses that regressed subsequent composite flourishing on individual item indicators at baseline suggested that, out of all 40 items, one item under the character domain "I always act to promote good in all circumstances, even in difficult and challenging situations" and one item in the physical health domain ("Based on my past health, I expect to be healthy long into the future") had the most robust association with subsequent composite flourishing. Implications of these results for understanding the constituents of a flourishing life and for refinement of the flourishing assessments are discussed., (© 2022. The Author(s).)

Background: Both theory and empirical evidence suggest that financial conditions are influential for mental health and might contribute to physical health outcomes., Methods: Using longitudinal survey data and health insurance claims data from 1209 employees in a large U.S. health insurance company, we examined temporal associations between measures of financial safety, financial capability, financial distress, their summary index (financial security) and six subsequently measured mental and physical health outcomes., Results: We found that financial safety and financial capability were positively associated, while financial distress was negatively associated, with subsequent self-reported measures of physical and mental health, even after controlling for these health measures at baseline and other confounders. Additionally, financial conditions were associated with reduced risk of depression based on health insurance claims data. Financial safety was also associated with anxiety., Conclusions: Policy-makers might consider the introduction of more effective measures for ensuring favorable financial conditions as an important contributor to better population health. Furthermore, policy could encourage teaching adequate financial management techniques and the importance of understanding of long-term consequences of financial decisions, as those might be pivotal for health outcomes., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

There is a strong belief that in addition to making a profit, companies should act for the benefit of the society. This research has evaluated a novel cooperation model between a non-profit financial institution and a community service provider (a local YMCA) with the overarching aim of advancing customers' well-being. By offering a financial incentive (a savings account with higher interest payouts, contingent on account holders' increased participation in YMCA activities), the financial institution and the YMCA partnered to improve consumers' financial standing, positive health behaviors, and overall well-being. The collaboration exemplified a business engagement in the community that goes beyond philanthropy. Participation in YMCA activities was found not to be influenced by the financial incentive. However, households participating in the program swiftly transferred their financial resources to the incentivized account and along with that increased their activity in YMCA to boost the interest rate. Sport-related YMCA visits had some positive effects on momentary well-being, but none were observed for non-sport-related activities. Furthermore, the incentivized activities did not translate into improved well-being outcomes but had a potential to positively contribute to emergency savings. The evidence from qualitative feedback from in-depth participant interviews pointed to a reverse effect of the incentive, where YMCA engagement was a trigger for setting up the savings account. The findings have corroborated the understanding that designing interventions that target customers' well-being is not a straightforward task., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

In this article, we develop a measure of complete well-being. The framework is derived from the theoretical model of human flourishing understood as a state in which all aspects of a human life are favorable. The approach extends beyond psychological well-being and reflects the World Health Organization definition of health that not only considers the health of body and mind but also embraces the wholeness of the person. The Well-Being Assessment (WBA) is a comprehensive instrument designed to assess holistic well-being in six domains: emotional health, physical health, meaning and purpose, character strengths, social connectedness, and financial security. Although each of these domains is distinct, all of them are nearly universally desired, and all but financial security constitute ends in themselves. Data were collected from a representative sample of working adults. A sample of 276 employees participated in the pilot, 2,370 participated in the first wave and 1,209 in the second wave of the survey. The WBA showed a good fitting (40 items, six factors), satisfactory reliability, test-retest correlation, and convergent/discriminant validity in relation to stability over time and relevant health measures, as well as a good fit to the data that were invariant over time, gender, age, education, and marital status. The instrument can be of use for scientists, practitioners, clinicians, public health officials, and patients. Adoption of more holistic measures of well-being that go beyond psychological well-being may help to shift the focus from health deficiencies to health and well-being promotion., Competing Interests: EM and TV report receiving grants and personal fees from Aetna Inc. EM reports receiving grants from the Levi Strauss Foundation; she also reports serving as director of SHINE at Harvard (Sustainability and Health Initiative for NetPositive Enterprise); support is made possible through SHINE from multiple companies. TV reports receiving grants from the John Templeton and personal fees from Flerish Inc. and Flourishing Metrics. The research findings represent the perspective of the authors and do not reflect the opinions or endorsement of any organization., (Copyright © 2021 Weziak-Bialowolska, Bialowolski, Lee, Chen, VanderWeele and McNeely.)

Purpose: We examined the impact of an orientation to promote good-one aspect of strengths of character, understood as having consistent thoughts and taking actions that contribute to the good of oneself and others-on flourishing outcomes., Design: We used data from 2 longitudinal observational studies. The primary study used 2 waves of data collected in June 2018 and July 2019. The secondary study used 3 waves of data collected in February 2017, March 2018, and March 2019., Setting: Two culturally different populations of adults were examined: (1) a large service organization based in the United States and (2) a Mexican apparel company in the supply chain of a major global brand., Subjects: 1,209 U.S. employees and 495 Mexican apparel workers were included in the study., Measures: Self-reports of orientation to promote good, Well-Being Assessment, Flourishing Index, the CDC Health-Related Quality of Life and the Job-Related Affective Well-Being Scale were used., Analysis: An outcome-wide approach and lagged regression analyses were applied. To combine the estimates across samples meta-analytic estimates were computed. Bonferroni correction was used to correct for multiple testing. Robustness of the results to potential unmeasured confounding was examined using E-values., Results: Orientation to promote good was positively associated with subsequently higher levels of life satisfaction and happiness (β = 0.14, 95% CI: 0.09, 0.19), self-assessed mental health (β = 0.11, 95% CI: 0.06, 0.15) and physical health (β = 0.08, 95% CI: 0.04, 0.12), social connectedness (β = 0.102, 95% CI: 0.06, 0.15) and purpose in life (β = 0.07, 95% CI: 0.03, 0.11). It was also associated with decreased anxiety (β = -0.11, 95% CI: -0.17, -0.06), depression (β = -0.07, 95% CI: -0.1, -0.02) and loneliness (β = -0.09, 95% CI: -0.13, -0.04). Possible effects on both positive affect (feeling happy) and negative affect (feeling sad, stressed and lonely) in general and while-at-work were also identified., Conclusions: Policymakers and practitioners should consider orientation to promote good as an important factor for improving population health and human flourishing while also at work.

Elevated red blood cell distribution width (RDW), traditionally an indicator of anemia, has now been recognized as a risk marker for cardiovascular disease incidence and mortality. Experimental and acute exposure studies suggest that cadmium and lead individually affect red blood cell production; however, associations between environmental exposures and RDW have not been explored. We evaluated relationships of environmental cadmium and lead exposures to RDW. We used data from 24,607 participants aged ≥20 years in the National Health and Nutrition Examination Survey (2003-2016) with information on blood concentrations of cadmium and lead, RDW and socio-demographic factors. In models adjusted for age, sex, race/ethnicity, education, poverty income ratio, BMI, alcohol consumption, smoking status and serum cotinine, RDW was increasingly elevated across progressively higher quartiles of blood cadmium concentration. A doubling of cadmium concentration was associated with 0.16 higher RDW (95% CI: 0.14, 0.18) and a doubling of lead concentration with 0.04 higher RDW (95% CI: 0.01, 0.06). Also, higher cadmium and lead concentrations were associated with increased odds of high RDW (RDW>14.8%). The associations were more pronounced in women and those with low-to-normal mean corpuscular volume (MCV) and held even after controlling for iron, folate or vitamin B12 deficiencies. In analysis including both metals, cadmium remained associated with RDW, whereas the corresponding association for lead was substantially attenuated. In this general population sample, blood cadmium and lead exposures were positively associated with RDW. The associations may indicate hemolytic or erythropoietic mechanisms by which exposure increases mortality risk., Competing Interests: The authors have declared that no competing interests exist.

Financial fragility is recognized as a substantial issue for individual well-being. Various estimates show that between 46 and 59% of American adults are financially fragile and thus vulnerable in terms of their well-being. We argue that the role of financial control in shaping well-being outcomes-despite being less recognized in the literature than the role of financial fragility-is equally or even more important. Our study is a longitudinal cohort study that made use of observational data. Two waves of the Well-Being Survey data from 1448 U.S. adults were used in the analysis. Impacts of financial fragility and financial control on 17 well-being outcomes were examined, including emotional well-being (nine outcomes), physical well-being (four outcomes), social well-being (two outcomes), in addition to an unhealthy days summary measure and the flourishing index. Financial fragility was shown to be on average less influential for the well-being outcomes than financial control. Our results suggest that financial control plays a protective role for complete well-being. Less evidence in support of a harmful role of financial fragility for well-being is provided. Tests for moderation effects revealed no interaction between financial control and financial fragility within our sample, indicating that financial control did not modify the relationship between financial fragility and well-being., (© The Author(s) 2021.)

The current literature's focus on unidirectional effects of psychological and organizational climates at work on work outcomes fails to capture the full relationship between these factors. This article examines whether a psychological climate for caring contributes to specific work outcomes and investigates whether work outcomes support the climate for caring, creating a feedback loop. Results confirm a bi-directional, temporal association between perceived climate for caring and two of the four explored work outcomes: self-reported productivity and self-reported work quality. The effect of a perceived caring climate on these work outcomes was stronger than the effect in the opposite direction. The perception that the work climate was caring was also found to affect work engagement, but the reverse relationship was not identified. We did not find any evidence for a link between job satisfaction and a climate for caring at work in either direction.

Understanding reciprocal relationships between specific arenas in life and at work is critical for designing interventions to improve workplace health and safety. Most studies about the links between dimensions of well-being in life and at work have been cross-sectional and usually narrowly focused on one of the dimensions of the work-life well-being link. The issues of causality and feedback between life and work well-being have often not been addressed. We overcome these issues by measuring six aspects of well-being for both the work arena and life in general, using longitudinal data with a clear temporal sequence of cause and effect, and by explicitly accounting for feedback with potential effects in both directions. Nine hundred and fifty-four Mexican apparel factory workers at a major global brand participated in two waves of the Worker Well-Being Survey. Data on life satisfaction and job satisfaction, happiness and positive affect, meaning and purpose, health, and social relationships in life and at work were used. Lagged regression controlling for confounders and prior outcomes was employed. Sensitivity analysis was used to assess the robustness of the results to potential unmeasured confounding. For the relationships between life satisfaction and job satisfaction and between happiness in life and happiness at work effects in both directions were found. Nevertheless, indication of a larger effect of life satisfaction on job satisfaction than the reverse was obtained. For depression and meaning in life, there was evidence for an effect of life well-being on work-related well-being, but not for the reverse. For social relationships and purpose, there was evidence for an effect of work-related well-being on life well-being, but not the reverse. Relationships based on the longitudinal data were considerably weaker than their respective cross-sectional associations. This study contributes to our understanding of the nature of the relationship between aspects of well-being in the arenas of life and work. Findings from this study may facilitate the development of novel workplace programs promoting working conditions that enable lifelong flourishing in life and at work., (Copyright © 2020 Weziak-Bialowolska, Bialowolski, Sacco, VanderWeele and McNeely.)

Employer-sponsored health insurance is the most widely spread form of medical coverage in the United States. Substantial portion of the premiums' costs is covered by employers, thus contributing to labor costs for organizations. Although worker health and well-being have become increasingly important for businesses, most of them do not see a direct link between their health and well-being investments and work output and quality of work of their employees. This study aimed to estimate the cost of inefficiencies at work with emphasis on their internal causes, i.e., sick-related absenteeism and distraction at work. With data from 3,258 employees (2,775 office and 483 manufacturing) from a major US manufacturer with revenue of $6 billion, monetary loss in productivity due to sick-related absenteeism and distraction among office and factory floor employees was assessed. The Work Productivity and Activity Impairment scale and the Health-related Lost Productivity Time tool (both already validated) were used to estimate the cost of productivity loss. Survey data on health-related absenteeism and distraction time at work, together with company pay records, were used. A secondary analysis, using survey data collected from 615 Polish apparel factory workers at a major global brand complemented with their payroll records (absenteeism and salary), was conducted to validate the main findings. Results of the primary analysis indicated that annual productivity loss to the organization amounted to approximately $300 m. Distraction contributed to 93.6% of the annual productivity loss of the US manufacturer, while only 6.4% resulted from health-related absenteeism, implying that distraction at work cost this organization almost 15 times more than health related absenteeism, reducing the overall return on sales by over 6 pp. The secondary analysis corroborated the dominance of distraction induced productivity costs over the cost of health-related absenteeism. Evidence from the regression analysis conducted on cross-sectional data indicated that regardless of the type of work, work engagement and auditory privacy were evidently highly bound with productivity loss. For manufacturing workers, job security was also negatively correlated with productivity loss, while for office employees, better social relationships and lack of work-family conflict were positively associated with productivity. Despite being based on two case studies, our results are informative of the magnitude of distraction and health related productivity costs. They also show that workers with deficiencies in their well-being at work present a substantial opportunity for growth to companies in terms of reduced efficiency., Competing Interests: This study was supported by grants from the Robert Wood Johnson Foundation, the Levi Strauss Foundation, and Aetna Inc. Dr McNeely reports serving as director of SHINE at Harvard (Sustainability and Health Initiative for Netpositive Enterprise); SHINE conducts global research about well-being. Support is made possible through SHINE from multiple companies. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

University campuses represent an opportunity to advance the understanding of how the built environment influences health. We used de-identified billing codes from a private university clinic serving undergraduate students for academic years 2008 through 2012 linked to students' residential history and demographic information. We used a two-stage, hierarchical regression model to study the differences in the reported prevalence of diagnostic groups by dorm and the association between building characteristics and disease incidence rates. We found significant differences in the prevalence of mental health (MH), upper respiratory infections (URI) and substance abuse between freshmen and upperclassmen. In addition, we found systematic differences in the relative rates of URI and MH diagnoses across dorms. Among upperclasmen dorms, the only mechanically ventilated building had a lower rate of allergy cases. An increase in available dorm space of 100 ft 2 per student was associated to a decrease in 10.8 URI cases per 100 students per academic year (p < 0.01). Construction age was also associated with lower incidence rate of MH (1.1 fewer diagnoses/100 students-academic year for every 25-year increment in building age, p = 0.04). These results suggest the potential for the use of electronic health records (EHR) to identify differential health issues faced by students depending on the housing characteristics and on the stages of their academic career.

Background: Concomitant biceps tendon pathology is often present in patients undergoing rotator cuff repair (RCR). Management of biceps pathology has been reported to influence outcomes of RCR; however, the impact on the pace of recovery remains unclear. The purpose of this study was to analyze the effects of simultaneous RCR with biceps tenodesis (RCR-BT) on time to achieve maximum improvement and recovery speed for pain and function., Methods: A retrospective review of 535 patients who underwent primary RCR for full-thickness tears. Patients treated with simultaneous RCR-BT were compared with RCR-only. Outcome measures and motion were recorded at preoperative routine postoperative intervals. Plateau in maximal improvement and recovery speed were analyzed for both pain and functional recovery., Results: Baseline American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) function was significantly lower for the RCR-BT cohort (20.5) compared with RCR-only (23.9; P  = .008). For visual analog scale (VAS) pain and measured motion, the plateau in maximal improvement occurred at 6 months for RCR-BT compared with 12 months for the RCR-only group. The remainder of the patient-reported outcome measures took 12 months to achieve a plateau in maximal improvement. At 3 months, 79% of improvement in pain and 42%-49% of functional improvement was achieved in the RCR-BT cohort. Similarly, at 3 months, the RCR-only cohort achieved 73% of pain improvement and 36%-57% of functional improvement at 3 months., Conclusion: Patients requiring RCR with simultaneous biceps tenodesis have lower baseline ASES function and earlier postoperative plateaus in pain relief and motion improvement following surgery. Nonetheless, the speed of recovery was not influenced by the biceps tenodesis., (© 2020 The Authors.)

Measures of well-being have proliferated over the past decades. Very little guidance has been available as to which measures to use in what contexts. This paper provides a series of recommendations, based on the present state of knowledge and the existing measures available, of what measures might be preferred in which contexts. The recommendations came out of an interdisciplinary workshop on the measurement of well-being. The recommendations are shaped around the number of items that can be included in a survey, and also based on the differing potential contexts and purposes of data collection such as, for example, government surveys, or multi-use cohort studies, or studies specifically about psychological well-being. The recommendations are not intended to be definitive, but to stimulate discussion and refinement, and to provide guidance to those relatively new to the study of well-being., Competing Interests: Declaration of competing interest Tyler J. VanderWeele and Eileen McNeely report having previously received consulting fees from Aetna Inc., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Axillary radiographs traditionally have been considered sufficient to identify concentric glenoid wear in osteoarthritic shoulders; however, with variable glenoid wear patterns, assessment with use of computed tomography (CT) has been recommended. The purpose of the present study was to compare the use of axillary radiographs and mid-glenoid axial CT scans to identify glenoid wear., Methods: Preoperative axillary radiographs and mid-glenoid axial CT scans for 330 patients who underwent anatomic total shoulder arthroplasty were reviewed. Five independent examiners with differing levels of experience characterized the glenoid morphology as either concentric or eccentric. The morphologies determined with use of axillary radiographs and CT scans were assessed for correlation, and both intraobserver and interobserver consistency were calculated., Results: Concentric wear identified with use of radiographs was confirmed with use of CT scans in an average of 61% of cases (range, 53% to 76%). Intraobserver consistency averaged 75% for radiographs and 73% for CT scans. There was significant interobserver consistency, as higher levels of training corresponded with greater consistency between imaging analyses (p < 0.001). The most senior observer identified the highest proportion of concentric wear on radiographs (p < 0.001), showed the greatest consistency between attempts when using CT (p < 0.001), and had the greatest agreement of radiographs and CT evaluating glenoid morphology (p < 0.001)., Conclusions: For the experienced shoulder surgeon, concentric glenoid wear identified on axillary radiographs will appear concentric on 2-dimensional CT in approximately 75% of cases. Obtaining a CT scan to confirm glenoid wear patterns most greatly benefits less-experienced surgeons. Across all levels of experience, axillary radiographs and single-slice, mid-glenoid CT scans appear insufficient for consistently predicting wear patterns., Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence., (Copyright © 2020 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)

Background: The incidence of medial calcar resorption has been shown to be common after uncemented total shoulder arthroplasty (TSA). With etiologies including stress shielding, debris-induced osteolysis, and infection, the clinical impact of medial calcar resorption has not been specifically examined. The purpose of this study was to determine whether resorption is associated with inferior outcomes or higher rates of radiographic loosening in TSA patients., Methods: We conducted a retrospective review of TSA patients with minimum 2-year clinical follow-up. Patient-reported and functional outcome measures were recorded preoperatively and postoperatively. Postoperative radiographs were evaluated for glenoid and humeral component loosening. A new calcar resorption grading system was introduced to quantify the degree of resorption and assess the progression., Results: A total of 171 patients met the inclusion criteria, with average clinical and radiographic follow-up periods of 50 and 46 months, respectively. Calcar resorption was identified in 110 patients (64.3%). No significant overall differences were observed between the patients with and without calcar resorption. Subgroup analysis showed that patients with grade 3 resorption had a higher incidence of glenoid radiolucencies (50%, P = .001) and patients with a progression from grade 1 to grade 3 had higher incidences of glenoid (50%, P = .003) and humeral (9%, P = .039) radiolucencies., Conclusion: Medial calcar resorption following TSA with a standard-length press-fit humeral component is common. Overall, no differences in patient-reported outcome measures or radiographic loosening were found compared with patients without calcar resorption. However, grade 3 calcar resorption and more dramatic progression of resorption should raise the suspicion of prosthetic loosening., (Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Objectives: Elderly passengers and those with preexisting disease are flying with increasing frequency and in-flight cardiac emergencies are a more frequent occurrence. We conducted a study of the physiological effects of simulated cabin altitudes and resulting lower oxygen levels among such passengers. Methods: We monitored 41 participants in a hypobaric chamber for 2 days, one at an equivalent of 7,000 feet altitude (regulations limit pressurization to 8,000 feet) for a 4-5 h simulated flight and the other at ground level using generalized least squares models to account for repeated measures. We evaluated associations between simulated flight, heart rate (HR) and measures of heart rate variability(HRV) (root mean square of successive R-R interval differences [RMSSD], standard deviation of normal-to-normal intervals [SDNN], high-frequency power [HF], and low-frequency power [LF]). Results: Heart rate was 3.9% (95% CI: 2.1, 5.8) higher on simulated flight days compared with non-flight days. The RMSSD was 10.6% (95% CI: -21.3, 0.05) lower during simulated flight days, indicative of reduced HRV. The remaining HRV measures were also lower on simulated flight days, though associations were less precise. Conclusion: We report that typical simulated flight conditions elicit changes in cardiac autonomic control, suggesting sympathetic arousal or reductions in parasympathetic drive. Our findings, if confirmed, may suggest the need for guidelines to protect vulnerable passengers including prescreens, symptom evaluation after air travel, the use of oxygen concentrators, and education about healthy behaviors in flight., (Copyright © 2019 Meyer, Mordukhovich, Wellenius, Mittleman, McCracken, Coull and McNeely.)

This paper investigates human flourishing in five culturally distinct populations. Empirical differences in human flourishing were examined using the recently proposed Flourish Index (FI) and Secure Flourish Index (SFI). Five domains for human flourishing are proposed for FI: (D1) happiness and life satisfaction; (D2) physical and mental health; (D3) meaning and purpose; (D4) character and virtue; and (D5) close social relationships. Specification of SFI was augmented by an additional financial and material stability domain (D6). Psychometric properties of FI and SFI were examined using data from the SHINE Well-Being Survey. Between June 2017 and March 2018, a total of 8,873 respondents participated in the study - in the US (4083 participants), Sri Lanka (1284 participants), Cambodia (587 participants), China (419 participants), and Mexico (2500 participants). US participants were customers of a financial institution, while non-US participants were clothing industry workers in the supply chain of a global brand. Exploratory and confirmatory factor models were used to validate the proposed indices. An exploratory approach informed analysis for item groupings. Confirmatory factor models were used to investigate the hierarchical structure of the indices. Configural, metric, and partial scalar measurement invariance were established, which not only supported the universal character of the indices but also validated use of the indices for culturally distinct populations. Findings from our study enrich our knowledge about human flourishing in five culturally distinct populations. With the exception of happiness and life satisfaction, respondents in the US, despite enjoying the highest financial and material stability, scored the lowest in all other domains of human flourishing. Respondents in China excelled in close social relationship and health domains. In addition to life satisfaction and happiness, character and virtue were relatively high in Cambodia. Respondents in Mexico, despite having the lowest scores in financial and material stability, had the greatest meaning and purpose to their lives. Respondents in Sri Lanka were the least happy and satisfied with life.

Background: Workplace abuse, including sexual harassment, is frequently experienced worldwide and is related to adverse mental health outcomes, and injuries. Flight attendants are an understudied occupational group and are susceptible to harassment due to working in a feminized, client-facing occupation with few protections or sanctioned responses against aggressive behaviors. Objective: We investigated the relationship between workplace abuse and health in a cohort of cabin crew. We also aimed to characterize perpetrator profiles. Methods: We conducted our study among 4,459U.S. and Canada-based participants from the Harvard Flight Attendant Health Study using multivariate logistic regression. Our exposures of interest were episodes of workplace abuse in the past year. We evaluated several mental and physical health outcomes, including depression, fatigue, musculoskeletal injuries, and general workplace injuries. Results: We report that exposures to verbal abuse, sexual harassment, and sexual assault are common among cabin crew, with 63, 26, and 2% of respondents, respectively, reporting harassment in the past year alone. Workplace abuse was associated with depression, sleep disturbances, and musculoskeletal injuries among male and female crew, with a trend toward increasing odds ratios (ORs) given a higher frequency of events. For example, sexual harassment was related to an increased odds for depression (OR = 1.91, 95% confidence interval [CI]: 1.51-2.30), which increased in a dose response-like manner among women reporting harassment once (OR = 1.44, 95% CI: 0.93-1.95), 2-3 times (OR = 1.83, 95% CI: 1.29-2.38), and 4 or more times (OR = 4.12, 95% CI: 3.18-5.06). We found that passengers were the primary perpetrators of abuse. Conclusions: Our study is the first to comprehensively characterize workplace abuse and harassment and its relation to health in a largely female customer-facing workforce. The strong associations with health outcomes observed in our study highlights the question of how workplace policies can be altered to mitigate prevalent abuses. Clinicians could also consider how jobs with high emotional labor demands may predispose people to adverse health outcomes, educate patients regarding their psychological/physical responses and coping strategies, and be aware of signs of distress in patients working in such occupations in order to direct them to the appropriate treatments and therapies.

Objectives: Secondhand tobacco smoke (SHTS) is a tremendous public health hazard, leading to morbidity and premature mortality worldwide, with racial and ethnic minorities and those of lower socioeconomic status disproportionately affected. Flight attendants were historically exposed to high levels of SHTS in the aircraft cabin. The health effects of active smoking are known to persist for up to a lifetime, but the legacy effects of SHTS exposure have not been well characterized., Design: We aimed to evaluate the legacy health effects of occupational SHTS exposure among never smoking workers using the resources of the Harvard Flight Attendant Health Study, a large study of cabin crew health. We evaluated associations between SHTS exposure and a range of diagnoses using multivariate logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs), employing a case-control sampling method and applying the bootstrap method to increase accuracy and precision of results., Results: We found no evidence of positive associations between SHTS and any cancer, but observed associations between SHTS and cardiac outcomes, including myocardial infarction (OR = 140, 95% CI: 1·04, 3·27) and peripheral artery disease (OR = 1·27, 95% CI: 1·00, 1·97). We also found associations between SHTS exposure and repeated pneumonia (OR = 1·06, 95% CI: 1·02, 1·10)., Conclusions: Our study reports associations between legacy SHTS exposure going back decades and severe cardiac and respiratory health outcomes. Given the high prevalence of ongoing and historical SHTS exposure, our findings, if confirmed, have important implications for smoking cessation efforts, health education, and clinical guidelines., Competing Interests: The authors have declared that no competing interests exist.

Following the rising cost of real estate and a desire to increase collaboration and communication among employees, the open-plan office has been trending over the past decades. Research about the impact of the open-plan office on humans is equivocal in endorsing this trend. The mixed results are further confounded following the specific job requirements, such as the need for privacy in jobs requiring a high level of concentration or, in contrast, the need for open workspace in jobs benefitting from team work and knowledge sharing. This study aims to understand the relationship between perceptions of three characteristics of the open-plan office (acoustical privacy, visual privacy, and office density), and the impact they yield on employees' judgment as well as affect-driven behaviors. The study benefits from the data from 456 employees located in 20 regional office locations within the same architectural firm. The restriction to employees of a design firm enables examinations of participants, who are already sensitive to the impacts of space by the nature of their work. The variables of interest included employee perception of the workspace (privacy, office density, and fit into workspace), employee rating of social relationships, self-reported mood (irritability) and optimal functioning (number of limited ability days), and work impacts (job satisfaction, work engagement, and job performance). The Model of behavior in an open-plan office setting based on affective events theory is adopted. Mediation roles of irritability and perception of fit into the workspace are examined. Structural equation modeling is applied to test the joint significance of the association between independent and dependent variables (direct effect) and the association between independent variables, mediator, and dependent variables (indirect effect). Nested structure of the data is accounted for by adjusting the standard errors for clustering. The significance of indirect and total effects is evaluated by the bootstrapping method. Our results show that working in the open-plan office limits the experience of privacy and intensifies the perception of intrusion among employees of an architectural company, mostly architects and designers. Additionally, employees' perception of lack of privacy and high office density negatively affect job satisfaction, work engagement, and internal work relation as well as increases the number of limited ability days. Interestingly, the lack of privacy and high office density seem to positively affect expressive personal relations among coworkers and job performance. We find supporting evidence for mediation roles of negative emotions, that is, irritability and perception of fit into the workspace.

Objective: To measure sound levels in the aircraft cabin during different phases of flight., Methods: Sound level was measured on 200 flights, representing six aircraft groups using continuous monitors. A linear mixed-effects model with random intercept was used to test for significant differences in mean sound level by aircraft model and across each flight phase as well as by flight phase, airplane type, measurement location and proximity to engine noise., Results: Mean sound levels across all flight phases and aircraft groups ranged from 37.6 to >110 dB(A) with a median of 83.5 dB(A). Significant differences in noise levels were also observed based on proximity to the engines and between aircraft with fuselage- and wing mounted engines. Nine flights (4.5%) exceeded the recommended 8-h TWA exposure limit of 85 dB(A) by the NIOSH and ACGIH approach, three flights (1.5%) exceeded the 8-h TWA action level of 85 dB(A) by the OSHA approach, and none of the flights exceeded the 8-h TWA action level of 90 dB(A) by the OSHA PEL approach., Conclusions: Additional characterization studies, including personal noise dosimetry, are necessary to document accurate occupational exposures in the aircraft cabin environment and identify appropriate response actions. FAA should consider applying the more health-protective NIOSH/ACGIH occupational noise recommendations to the aircraft cabin environment.