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Purpose: To quantify the change in session rating of perceived exertion training impulse (RPE-TRIMP) that may occur in response to increased running distance at 3 running velocity ranges in elite sprinters. Methods: We monitored training load in elite sprinters (women: n = 7; men: n = 11) using wearable Global Positioning System technology and RPE-TRIMP for a total of 681 individual training sessions during a 22-week competition-preparation period. Internal training load was operationalized by RPE-TRIMP, and external training load was operationalized by distance covered in 3 velocity ranges. A linear mixed-effects model with athlete as a random effect was fit to RPE-TRIMP with total distance covered at ≤69.99% (low-velocity running [LVR]), 70% to 84.99% (high-velocity running [HVR]), and 85% to 100% (very-high-velocity running [VHVR]) of individual maximum velocity. Results: Increased running distance in all 3 velocity ranges (LVR, HVR, and VHVR) resulted in a significant (P <.001) increase in RPE-TRIMP. Coefficients (95% CIs) were.10 (.08–.11) for LVR,.23 (.18–.28) for HVR, and.44 (.35–.53) for VHVR. A 50-m increase in running distance covered in the LVR, HVR, and VHVR velocity ranges was associated with increases in RPE-TRIMP of 5, 11.5, and 22 arbitrary units, respectively. Conclusions: Internal training load, calculated as RPE-TRIMP, increased with increases in total distance covered in the LVR, HVR, and VHVR velocity ranges (P <.001). RPE-TRIMP can be a practical solution for monitoring global training-session load in elite sprinters. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to conduct a comparative analysis of physical performance indicators and assess the levels of performance monotony and strain experienced by basketball referees. Methods: The study involved the participation of 12 basketball referees (mean age: 40.0 [4.9] y) affiliated with the International Basketball Federation. The investigation was carried out throughout 2 density tournaments, wherein the maximum heart rate, average heart rate, performance monotony, and performance strain were documented for 3 variables. Results: The findings indicated significant variations in the mean heart rate, maximum heart rate, total distance monotony, total distance strain, the total number of sprints monotony, the total number of sprints strain, calories monotony, and calories strain (P <.05). Decreasing the density of elite-level basketball competitions has been observed to reduce the monotony and strain experienced by referees. However, this action does not increase motion distance or speed zones. Conclusions: The environmental stressors experienced by senior-level athletes (World Cup) differ from those encountered by younger athletes (World Cup Under 19). Further investigation is required to ascertain the potential effects of competition monotony and strain on decision-making processes and the overall quality of refereeing. [ABSTRACT FROM AUTHOR]

Introduction: This study investigates the performance of a commercially available artificial intelligence (AI) system to identify normal chest radiographs and its potential to reduce radiologist workload. Methods: Retrospective analysis included consecutive chest radiographs from two medical centers between Oct 1, 2016 and Oct 14, 2016. Exclusions comprised follow-up exams within the inclusion period, bedside radiographs, incomplete images, imported radiographs, and pediatric radiographs. Three chest radiologists categorized findings into normal, clinically irrelevant, clinically relevant, urgent, and critical. A commercial AI system processed all radiographs, scoring 10 chest abnormalities on a 0–100 confidence scale. AI system performance was evaluated using the area under the ROC curve (AUC), assessing the detection of normal radiographs. Sensitivity was calculated for the default and a conservative operating point. the detection of negative predictive value (NPV) for urgent and critical findings, as well as the potential workload reduction, was calculated. Results: A total of 2603 radiographs were acquired in 2141 unique patients. Post-exclusion, 1670 radiographs were analyzed. Categories included 479 normal, 332 clinically irrelevant, 339 clinically relevant, 501 urgent, and 19 critical findings. The AI system achieved an AUC of 0.92. Sensitivity for normal radiographs was 92% at default and 53% at the conservative operating point. At the conservative operating point, NPV was 98% for urgent and critical findings, and could result in a 15% workload reduction. Conclusion: A commercially available AI system effectively identifies normal chest radiographs and holds the potential to lessen radiologists' workload by omitting half of the normal exams from reporting. Clinical relevance statement: The AI system is able to detect half of all normal chest radiographs at a clinically acceptable operating point, thereby potentially reducing the workload for the radiologists by 15%. Key Points: The AI system reached an AUC of 0.92 for the detection of normal chest radiographs. Fifty-three percent of normal chest radiographs were identified with a NPV of 98% for urgent findings. AI can reduce the workload of chest radiography reporting by 15%. [ABSTRACT FROM AUTHOR]

AbstractThe successful transition from a two-pilot to a single-pilot mode cannot solely rely on simply augmenting advanced automation in the cockpit. The degree of support provided by functions at different levels of automation varies, and introducing new functions simultaneously brings new demands for the single pilot, leading to imbalanced workload. To address these shortcomings and enhance the rationality of function allocation under workload constraints, this paper introduces an iterative function allocation method. Initially, the functions are categorized and classified into different levels of automation to obtain the initial function allocation scheme. Subsequently, a novel bicluster mining algorithm called K-Miner is proposed to identify elements requiring iterative design. As a case study, the multitask surface scenario in SPO is considered. By applying the proposed iterative design method, the task performance of the single pilot is improved, the workload of the single pilot is effectively reduced, and situational awareness is improved to a certain extent. [ABSTRACT FROM AUTHOR]

Featured Application: Seasonal analysis of the intensive team training and competition periods for non-contact injuries showed a correlation with pre-season endurance diagnostics, particularly individual lactate thresholds. Individual endurance performance levels should therefore always be taken into account when quantitatively assessing the intensive parts of training and competition periods. The chronic component of the ACWR in conjunction with endurance capacity appears to be a particularly sensitive indicator in the two weeks prior to an injury. Therefore, even during seasonal periods with large load fluctuations, e.g., due to the competition calendar, attention should be paid to constant weekly load management. Acute (AW) and chronic (CW) workload imbalances, including their ratio (ACWR), are largely associated with increased injury risk. However, the inclusion of personal endurance performance (EP) in this calculation as a means of improving accuracy has been neglected in previous studies. The aim of this longitudinal observational study was to evaluate the relevance of the high metabolic load distance (ACWRHMLD) to EP in relation to non-contact injuries. Twenty-three German male first division soccer players (age: 24.5 ± 3.5 years; VO2max: 53.7 ± 4.9 mL/min/kg; v4: 15.2 ± 0.9 km/h) were analyzed. Eleven players with non-contact injuries were identified and matched with players without any injuries within the same time interval. Players were monitored using GPS and LPS tracking to calculate ACWRHMLD on a daily basis over the course of one competitive season. Relationships between different endurance performance parameters (v2, v4, vLT, VO2max) and the ACWRHMLD, AW, CW were established for statistical analysis. An area under the curve analysis (AUC) was performed. Based on the four weeks preceding the non-contact injuries, the CW, especially for the last two weeks before the injury, proved to be the most suitable parameter to estimate the risk of injury. The highest significant AUC value (0.81, 95% CI: 0.59–1.00) was calculated for the CW (last week before injury) in relation to the vLT (suitable cut-off: 0.04 km; sensitivity: 78%, specificity: 80%). With regard to the injury rate, the ACWRHMLD seems to be the most appropriate method of calculation, especially for CW related to EP (vLT). The sole use of ACWR, AW, and CW is not recommended. [ABSTRACT FROM AUTHOR]

Ethical conflicts (ECs), dilemmas auditors face when personal values or professional obligations clash with their actions, pose significant challenges to the auditing profession, potentially influencing turnover intention (TI). This study addresses a knowledge gap in the related research by focusing on two critical EC triggers: workload (WL) and perceived auditor ethical failure (PAEF: ethical sensitivity), which refers to auditors' perceptions of ethical violations within their profession. Grounded in role theory and ethical climate theory, our study investigates the impact of WL and PAEF on ECs and explores how these conflicts mediate the relationship between PAEF/WL and TI. Additionally, we examine the moderating role of organisational ethical climate (EtC) in these relationships. Using a survey of auditors and employing partial least squares structural equation modelling (PLS-SEM), our results reveal that both WL and PAEF increase ECs, thus escalating TI. The findings suggest that a firm's perceived EtC can negatively moderate the relationship between PAEF and ECs. The study underlines the importance of fostering a strong EtC to manage ECs effectively and provides valuable implications for professionals, regulators, and academics seeking to improve ethical practices within auditing firms and to reduce auditor turnover. [ABSTRACT FROM AUTHOR]

IntroductionObjectiveMethodResultsConclusionThe impact of instant messaging (IM) tools on employee workload is a concern in both academic and professional contexts. Despite the widespread use of mobile instant messaging (MIM) and its challenges for organizations, research on this topic remains limited.This study aims to explore the mediating roles of interactivity and job interruption, and the moderating role of communication quality, in the relationship between MIM use and perceived workload, using the job demands-resources model, distraction-conflict theory, and media synchronicity theory.A total of 235 employees completed self-report questionnaires measuring MIM use, interactivity, job interruption, perceived workload, and communication quality.The study found that MIM use has indirect effects on perceived workload. While MIM usage increases interactivity, reducing perceived workload, it also increases job interruptions, leading to a higher perceived workload. Mediation analysis showed that both job interruption and interactivity mediate the MIM use-workload relationship. Furthermore, communication quality weakens the negative impact of interactivity on perceived workload and the positive impact of job interruption on perceived workload.These findings challenge the belief that IM is solely disruptive in the workplace, highlighting the importance of communication quality for effective management. This enhances our understanding of MIM's role in corporate and personal productivity. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Implications for the Profession and/or Patient Care Reporting Method Patient or Public Contribution To explore and validate an end of shift survey with a low response burden, practical application and generated evidence of related associations between workload, quality of work and patient care, missed care and job satisfaction.A retrospective cross‐sectional survey of the experiences of nursing staff.Data were collected from 265 nurses who responded to a questionnaire at the end of their shift in 2022. Exploratory factor analysis was undertaken using IBM SPSS v.27 and confirmatory factor analysis was undertaken using IBM AMOS v27. Hypotheses testing was undertaken using IBM SPSS v.27 using multiple regression analyses.All of the hypotheses were supported. There was a negative association between workload and quality of work and job satisfaction. Quality of work was negatively associated with workload and missed care and positively associated with job satisfaction. The association between missed care and job satisfaction was negative.The EOSS is a valid and reliable tool with a low response burden. The tool supports previous research which demonstrated there is a negative relationship between level of workload and shift type with satisfaction, quality of work and potentially nurse retention.In the context of a global nursing shortage nursing leaders must ensure that care we provide is of the highest quality. We must take every action to address high workload to reduce the risk that fundamental care is not sacrificed, job satisfaction is improved and nurses remain in the profession. The EOSS gives nurse leaders a reliable, practical, consistent, applied tool that will better enable associations to be observed between resource configuration, workload and critical impacts on nursing and patient care.We have adhered to the relevant EQUATOR guidelines using the STROBE reporting method.No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Student assistants play an important role in the smooth operation of the library for effective and efficient delivery of services to users. This descriptive-regression research design was utilized to determine whether student assistants' library workload has a significant influence on their academic performance. It involved 100 academic library student assistants from Regions 11 and 12, who were selected using Purposive and Universal Sampling techniques. A wellstructured and self-made questionnaire was used to gather data from the respondents who worked in the library for more than two semesters. Mean scores and simple linear regression analysis were utilized to interpret and analyze all the data gathered. Results showed that the level of library student assistant's workload was not significantly related to the level of their academic performance. It also revealed that the student workload could not significantly influence student academic performance. Thus, the study failed to reject the null hypothesis. One of the recommendations is that students' assistants should develop effective time-management strategies to balance work responsibilities with academic commitments to improve academic performance. [ABSTRACT FROM AUTHOR]

Aims: The number of older people with diabetes requiring care from district nursing teams is increasing. The role of district nursing teams in diabetes management has expanded to involve diagnosis, treatment and medication administration. As the complexity of caseloads increases, the current model is likely unsustainable. This study aims to understand the current diabetes workload of district nursing teams. Methods: An online survey was distributed via social media and key stakeholder networks to district nursing teams. Survey items were designed by the researchers prior to pilot testing with potential participants. Descriptive statistical and qualitative analyses were conducted. Data are median ± IQR. Results: 159 district nursing teams completed the survey. The median caseload per team was 300 (IQR 176–407) patients including 21 with diabetes (IQR 14–40; 8.7% (4–20%)). 1.09 home visits per day per person with diabetes lasting 13.8 minutes (excluding travel time) were needed, with most requiring insulin administration. 96% of nursing teams undertake multiple daily visits for some patients. 91% reported workloads relating to diabetes management had increased over the last 2 years; 76% stated current diabetes workloads were unsustainable. More insulin usage, more referrals and a lack of ability or willingness to self‐administer insulin has increased the diabetes workload. Possible solutions include better collaboration between healthcare professionals, simplification of insulin administration and glucose monitoring, better training and upskilling of healthcare assistants and promotion of self‐efficacy. Conclusions: Diabetes management forms an increasing component of district nursing workload and is likely to be unsustainable unless new models are found. [ABSTRACT FROM AUTHOR]

Workload is an important influencing factor of airworthiness maintenance errors control and personnel performance improvement in the bonding repair of civil aircraft composite materials. To study the workload, the eye movement and EEG (electrooculogram) generated in the repairing process were used. Firstly, the experimental scene of composite sandwich structure repair was established. Then, the eye movement behaviors and EEG signals were collected in three typical repairing tasks of “damage materials removal”, “scarf patch materials preparation” and “layering and curing environment construction” and the work performance and workload based on NASA-TLX were calculated. Finally, the feature pattern of “eye movement + EEG” which was significantly related to the workload was extracted by correlation analysis. Based on this pattern, BP neural network and support vector machine method were used to construct the workload prediction model. The results show that with the increase of workload, the level of work performance declines, the fixation time, saccade time, saccade frequency and average saccade frequency are higher, the distribution of fixation hotspots and trajectories are more scattered, the spectral density of EEG power in theta, alpha and beta bands are higher, and the EEG signals in the frontal and temporal lobes of the brain are stronger. The workload predicting model of “ eye movement + EEG” feature mode combined with support vector machine method has higher accuracy, which can support the airworthiness maintenance process monitoring of civil aircraft composite materials effectively. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study explores the situation of workload, work–family conflict and job burnout among primary health workers in China in the context of COVID‐19 and identifies the mediating effect of work–family conflict between workload and job burnout. Background: Since the breakout of the COVID‐19 pandemic, primary health workers have been working on the frontline of the epidemic and may experience increasing workload, work–family conflict and job burnout. It is important to focus on the issue of how to alleviate job burnout of primary health workers. Design: A cross‐sectional study (STROBE) was used. Methods: Data were collected from 785 primary health workers in China. Multiple regression analysis was used to examine the mediating effect of work–family conflict between workload and job burnout. Results: 18.7%, 10.4% and 39.5% of respondents had high job burnout in the dimensions of emotional exhaustion, depersonalization and personal accomplishment, respectively. 34.6% of the respondents had high or very high workload, and 12.8% of the respondents had high or very high work–family conflict. Results of multiple regression analysis indicated that work–family conflict mediated the relationship between workload and job burnout. Workload (β =.163, CI =.207–.549) and work–family conflict (β =.211, CI =.311–.640) positively influenced job burnout, and workload (β =.428, CI =.375–.508) positively influenced work–family conflict. Conclusion: The study indicated that primary health workers experienced a high level of job burnout, especially in the personal accomplishment dimension. Furthermore, this study verified the mediating effect of work–family conflict between workload and job burnout. Relevance to Clinical Practice: Some interventions for alleviating workload, work–family conflict and job burnout should be taken, including workplace assistance programmes, family‐friendly policies and a well‐integrated healthcare system. No Patient or Public Contribution: This study does not involve patient or public contribution in any part. Impact Statement: Nurses and other primary health workers are health gatekeepers of residents and play a vital role in the healthcare system. Due to the breakout of COVID‐19, they have taken more work and are more vulnerable to work overload, work–family conflict and the consequent job burnout. Some interventions should be taken to effectively alleviate their job burnout and improve their health and performance. [ABSTRACT FROM AUTHOR]

The COVID pandemic temporarily altered the functioning of all sections of society. In England, it led to major disruption in the teacher education sector leading to curtailed training in schools and a rapid shift to alternative approaches to teaching and learning. By the 2021–2022 academic year, it was hoped that activity would return to a level of normalcy. However, the continued hangover of the pandemic together with the return of high‐stakes inspections by Ofsted, and a decision by the UK Government to instigate an accreditation process for all English initial teacher education (pre‐service teacher education) programmes, required to allow institutions to continue offering initial teacher education beyond 2024, all combined to create the potential for a very difficult year. We surveyed 159 teacher educators to capture reflections of their experiences form the 2021–2022 academic year, understanding their perceptions through the lens of the Job Demands‐Resources Model (Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). Journal of Applied Psychology, 86(3), 499–512, 10.1037//0021‐9010.86.3.499) which identifies those factors which may lead to stress and burnout in the work environment (demands) and those which balance against this and offer emotional well‐being (resources). The results show a number of high demands over the course of the year, especially related to accreditation and Ofsted pressures, and the extra demands made by the overhang of the pandemic, all factors leading to increased workload. Counteracting these demands are the resources present, particularly the support between colleagues and a strong commitment and enjoyment gained form working with student teachers. However, the long‐term sustainability of the role of teacher educator is in question. [ABSTRACT FROM AUTHOR]

Objective: Clinical care ratios are used to quantify and benchmark the activity of allied health professionals. This study aims to review previous recommendations and identify what variables may influence them. Method: Data was collected from the core allied health professions (audiology, nutrition and dietetics, occupational therapy, physiotherapy, podiatry, prosthetics and orthotics, psychology, social work and speech pathology) across eight Australian hospitals. Data for 113 staff who were casual or from smaller professions (audiology, podiatry, prosthetics and orthotics and psychology) were excluded due to insufficient numbers for analysis. The remaining data were analysed according to profession, seniority (tiers 1, 2 and 3) and employment status (permanent versus casual staff). A two-way ANOVA was performed to assess the association of clinical care ratios with tier, profession, employment status and gender. Results: Data from 1246 staff from the five larger professions at participating hospitals were analysed. There were no interactions between profession and gender (P = 0.185) or employment status (P = 0.412). The relationship between clinical care ratio and profession was modified by tier (interaction term, P = 0.014), meaning that differences in clinical care ratios between professions depended on the tier. Conclusion: This research has confirmed that clinical care ratios are a useful tool in workload management and determining staffing levels for allied health professionals. The recommendations from this research provide a starting point that can be finessed with reference to profession, model of care, workforce structure, governance and training requirements. This will lead to increased staff wellbeing and improved patient outcomes. What is known about this topic? Clinical care ratios are a useful tool to quantify, monitor and compare workloads of allied health professionals. What does this paper add? This paper confirms that clinical care ratios are a useful workforce planning tool and that when developing roles and models of care, clinical care ratios need to be incorporated into staffing requests and considered as part of workload management tools. What are the implications for practitioners? Clinical care ratios enable the quantification and benchmarking of direct and clinical support activity components of a workload and can be used when planning new services and reviewing current services. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To gain an understanding of nurse managers’ experiences of the COVID-19 pandemic • To appreciate that fear, related to fear of infection and information overload, was a major issue for nurse managers during the pandemic • To consider adopting already-established COVID-19 guidelines to support effective infection control procedures and communication in future pandemics. Background: Research shows that front-line nurses’ workload and stress levels increased during the coronavirus disease 2019 (COVID-19) pandemic, however, there is little research of these factors in relation to nurse managers. Previous research undertaken in Austria found that some nurse managers working in nursing homes undertook clinical as well as managerial functions during the pandemic, a double burden that could have increased their stress levels and have had adverse psychological, physical and social consequences. Aim: To investigate the effects of the COVID-19 pandemic on nurse managers’ workload, perceptions of teamwork and stress levels, and the physical, psychological and social consequences of working during the pandemic. Method: A cross-sectional design was used. Respondents (n=238) were sent an online questionnaire during the second wave of the pandemic (which in Austria was November 2020 to March 2021) containing questions on demographics and fear of infection, their current workload compared with pre-pandemic workload, their perceptions of the influence of the pandemic on teamwork, their levels of stress measured using the Perceived Stress Scale (PSS), and the physical, psychological and social consequences of working during the pandemic. Results: Most respondents (95%) had to undertake more or much more work than usual during the pandemic, while just over half (52%) perceived that the influence of the pandemic on teamwork had been positive throughout or partially positive. Overall, the respondents’ level of stress was moderate, as measured by the PSS. Around 28% of respondents were afraid of infecting someone other than themselves, notably their families, employees and patients. Fear for themselves, their families and their patients or residents were commonly reported psychological consequences of working during the pandemic, while confusion due to information overload was the second most commonly reported psychological consequence. Conclusion: Comparing results with previous research is difficult due to the lack of research of nurse managers’ experiences of the pandemic. Fear appears to have been a major issue for nurse managers during the pandemic, particularly in relation to infection and information overload. This emphasises the need for healthcare organisations to focus on the mental health and well-being of nurse managers, as well as front-line staff, during and after crisis situations such as a pandemic. Organisations may consider reworking and adopting already-established COVID-19 regulations, schedules and local guidelines, particularly in terms of communication and infection control, which could help to reduce nurse managers’ fear in future crisis situations. [ABSTRACT FROM AUTHOR]

Introduction: The demand for occupational therapy services in Australia has experienced considerable growth in the last decade. Despite an increase in occupational therapy numbers, there remains a substantial workforce shortage. One reason for this shortage is difficulty with the retention of occupational therapists and subsequent workforce attrition. The literature attributes planning to leave as being influenced by high workloads, insufficient time, a negative workplace culture, and stress impacting well‐being. However, much of this research is specific to a practice area, such as mental health, and does not explore the experiences of those who have already left. Knowing why people leave occupational therapy will inform our understanding of how to support and retain our occupational therapy workforce. Methods: A qualitative study was undertaken using narrative inquiry in an Australian context. In 2022, stories were gathered from six former occupational therapists who left within the previous 5 years. Data were collected via semi‐structured in‐depth interviews using Zoom. Interviews were recorded and transcribed verbatim. The data were analysed using narrative and thematic analysis. Findings: Four themes were developed: "I just want to help this person"; "there was no real understanding"; "Trying to find where occupational therapy fits for me"; and "I'm not able to continue ... anymore." Participants experienced dissonance between enacting their occupational therapy values and the expectations of their management. They were challenged by unsupportive workplace cultures and leadership styles that undermined their autonomy. They responded with resilience, and trying new ways to continue being occupational therapists, but became increasingly uncomfortable and stressed until they reached a tipping point where they decided to leave. Conclusion: Increasing leadership development within the profession is essential, along with creative strategies for meeting funding requirements and fulfilling occupational therapy values. Workplaces that provide autonomy and respect the occupational therapy role are likely to support retention. PLAIN LANGUAGE SUMMARY: Occupational therapists are leaving the profession, leading to not having enough occupational therapists in the workforce to meet the needs in Australia. This research asked people who had left the occupational therapy profession to share their stories about why they chose to leave. Six people agreed to participate in an interview, and analysis of this data led to the development of four themes to represent their collective experiences. We found that participants were frustrated by being unable to help their clients in ways that aligned with their occupational therapy values, and they did not always feel supported by their managers when they expressed their concerns. They described their autonomy as constrained by funding models and external processes, and while they tried different strategies to address their growing disillusionment, they eventually decided to leave the profession. This decision was accelerated by issues arising with their health and well‐being, which they attributed to the stressors they were experiencing. This research highlighted a need to closely align work processes with the occupational therapy role and instill workplace cultures that are supportive with sufficient flexibility for occupational therapists to have appropriate autonomy. A review of leadership structures and creative strategies for meeting both the employer and employee expectations is recommended. The participants were all women, but they came from diverse practice areas with a wide range of years of experience prior to leaving. [ABSTRACT FROM AUTHOR]

Purpose: Multidisciplinary team meetings (MDTMs) are an important component of the workload of radiologists. This study investigated how often subspecialized radiologists change patient management in MDTMs at a tertiary care institution. Materials and methods: Over 2 years, six subspecialty radiologists documented their contributions to MDTMs at a tertiary care center. Both in-house and external imaging examinations were discussed at the MDTMs. All imaging examinations (whether primary or second opinion) were interpreted and reported by subspecialty radiologist prior to the MDTMs. The management change ratio (MCratio) of the radiologist was defined as the number of cases in which the radiologist's input in the MDTM changed patient management beyond the information that was already provided by the in-house (primary or second opinion) radiology report, as a proportion of the total number of cases whose imaging examinations were prepared for demonstration in the MDTM. Results: Sixty-eight MDTMs were included. The time required for preparing and attending all MDTMs (excluding imaging examinations that had not been reported yet) was 11,000 min, with a median of 172 min (IQR 113–200 min) per MDTM, and a median of 9 min (IQR 8–13 min) per patient. The radiologists' input changed patient management in 113 out of 1138 cases, corresponding to an MCratio of 8.4%. The median MCratio per MDTM was 6% (IQR 0–17%). Conclusion: Radiologists' time investment in MDTMs is considerable relative to the small proportion of cases in which they influence patient management in the MDTM. The use of radiologists for MDTMs should therefore be improved. Clinical relevance statement: The use of radiologists for MDTMs (multidisciplinary team meetings) should be improved, because their time investment in MDTMs is considerable relative to the small proportion of cases in which they influence patient management in the MDTM. Key Points: • Multidisciplinary team meetings (MDTMs) are an important component of the workload of radiologists. • In a tertiary care center in which all imaging examinations have already been interpreted and reported by subspecialized radiologists before the MDTM takes place, the median time investment of a radiologist for preparing and demonstrating one MDTM patient is 9 min. • In this setting, the radiologist changes patient management in only a minority of cases in the MDTM. [ABSTRACT FROM AUTHOR]

Interpreting ankle stress radiographs is subjective and time-consuming. We aimed to train an AI model that efficiently screens negative cases, assess the agreement with expert with and without AI-assistance, and compare the workload reduction. We collected anterior draw test (ADT) and talar tilt test (TTT) ankle stress radiographs from Seoul St. Mary's Hospital and St. Vincent's Hospital. Patients with prior surgery, severe joint fusion, or incomplete images were excluded. Expert measurements of tibio-talar distance (TTD) and tibio-talar angle (TTA) served as reference, defining positive labels as TTD ≥ 8.3 mm or TTA ≥ 6.2°. We trained a VGG16 model on data from hospital A and tested it on three separate test sets (testset1, 2 from St. Mary's Hospital, and testset3 from St. Vincent's Hospital). Three readers (expert, reader2, and the collective reading reports) evaluated the test sets, with and without AI-assistance (focusing only on AI-predicted positive cases). We measured agreement with the expert using Cohen's weighted Kappa and assessed the hypothetical workload reduction. AI-assistance did not significantly affect agreement with the expert for any reader in all test sets. Reader2 showed moderate-substantial agreement for all test sets, while collective reports reached fair agreement. The AI alone demonstrated fair to moderate agreement with the expert. AI-assistance reduced the hypothetical workload by 68.8–89.2% for ADT and 58.3–70.4% for TTT. We successfully trained an AI model for ankle stress radiography, achieving an average of 70% workload reduction while maintaining agreement with expert radiologists. [ABSTRACT FROM AUTHOR]

Caring for toddlers is a demanding profession that could lead to negative emotions and behaviors. The objective of this study was to examine the impact of a positive organizational climate, job satisfaction, and self-efficacy on burnout and commitment, in turn leading to the reporting of misconduct and turnover intentions among childcare teachers. The study included 1,190 female childcare teachers from 119 daycare centers throughout Israel. The findings indicate that workload contributes to burnout (B = -.27; SE =.02) and dissatisfaction (B =.60; SE =.01). Furthermore, the findings suggest that a positive organizational climate and strong employee-employer relationship are negatively correlated with employee burnout (r = −0.356; p < 0.001; r = −0.178; p < 0.001). The more supportive the organizational climate the less likely that employee burnout will occur. The study concludes that nurturing a supportive organizational climate and building a strong employee-employer relationship can reduce employee burnout and its consequences. [ABSTRACT FROM AUTHOR]

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Background: There is little evidence and no agreement on what constitutes full-time working for GPs. This is essential for workforce planning, resource allocation, and accurately describing GP activity. Aim: To clarify the definition of full-time working for GPs, how this has changed over time, and whether these changes are explained by GP demographics. Design and setting: Data were obtained from repeated cross-sectional national surveys for GPs, which were conducted between 2010 and 2021. Method: A comparison was undertaken of three measures of working time commitments (hours and sessions per week and hours per session) plus a measure of workload intensity across survey years. Multiple regression was used to adjust the changes over time for age, sex, ethnicity, contract type, area deprivation, and rurality. Unadjusted hours and sessions per week were compared with definitions of full-time working. Results: Average hours and sessions per week reduced from 40.5 (95% confidence interval [CI] = 38.5 to 42.5) to 38.0 (95% CI = 36.3 to 39.6) and 7.3 (95% CI = 7.2 to 7.3) to 6.2 (95% CI = 6.2 to 6.3) between 2010 and 2021, respectively. In 2021, 54.6% of GPs worked at least 37.5 hours per week and 9.5% worked at least nine sessions. Hours per session increased from 5.7 (95% CI = 5.7 to 5.7) to 6.2 (95% CI = 6.2 to 6.3) between 2010 and 2021. Partners worked more hours, sessions, and hours per session. Adjustments expanded the increase in hours per session from 0.54 to 0.61. Conclusion: At the current average duration of sessions, six sessions per week aligns with the NHS definition of full-time hours. However, hours per week is a more consistent way to define full-time work for GPs. [ABSTRACT FROM AUTHOR]

A typical weekly periodization strategy in soccer positions the most demanding sessions four and three days before the match-day (MD-4/MD-3). However, a modified periodization strategy could intersperse the two most demanding sessions with a low-load training session. This study aimed to investigate the impact of these periodizations on external loads and MD readiness. Twenty academy players were tested. The modified weekly periodization strategy included a low-load training session between the two most demanding sessions, while the typical periodization implemented them consecutively. Players wore a GPS and rated their perceived exertion (RPE) during the most demanding sessions. Players were also tested using a CMJ, a 20-m sprint, the Illinois agility test (IAT), and the Hooper questionnaire on MD-4 to obtain baseline values (CONTROL) and on the match-day (TEST). CONTROL values were similar during experimental weeks. During the second most demanding session, players covered greater distances for the modified versus the typical periodization in the 20-25 km/h (306.3 ± 117.1 m vs. 223.5 ± 92.2 m, p < 0.05) and >25 km/h speed zones (89.5 ± 44.8 m vs. 67.2 ± 44.5 m, p < 0.05). On the MD, CMJ, 20-m sprint, and IAT performances were similar between both periodizations. However, 10-m time (1.89 ± 0.10 s vs. 1.92 ± 0.09 s, p < 0.05) and the Hooper index score (7.90 ± 2.14 a.u. vs. 9.50 ± 3.44 a.u., p < 0.05) were significantly lower during the modified periodization strategy. A decreased training load session positioned between the most demanding sessions may be of interest in elite academy soccer players as it can lead to increased weekly external loads and readiness on the MD. [ABSTRACT FROM AUTHOR]

This study investigated the number of operator errors, task completion time, and workload of subjects at different levels by imposing conditions such as focused text boldness, noise disturbance, and time pressure to simulate a realistic cloud change business process in the laboratory. Results of the study showed that the text bolding of important content reduced the number of errors, whereas noise interference increased the number of errors. Text boldness only reduced the number of corrected errors, and noise interference only increased the number of uncorrected errors. Moreover, bolding was found to have different effects on the number of errors under different noise levels and time pressure levels, with text boldness significantly reducing the number of total errors only in quiet or low time pressure states. Time pressure had no effect on cloud change task error counts, but high time pressure resulted in higher subjective workload. Practitioner Summary: Operator error is one of the main causes of service failure, and reducing operator error in cloud change operations is of practical importance. In this study, we found focused text boldness could reduce operator errors, while noise could increase the number of errors. High time pressure would lead to a high workload. [ABSTRACT FROM AUTHOR]

In order to explore the effects of constant and altered workload sequences on mental fatigue in a thermoneutral environment, experiments and surveys were carried out in this study. n‐back tasks were used to design different workload sequences. Fifteen healthy right‐handed males were required to experience three different workload sequences for 30 min, respectively, including a constant workload (2‐back task) and 2 altered workload sequences that contained an elevating workload sequence (1‐2‐3‐back tasks) and a reducing workload sequence (3‐2‐1‐back tasks). The PANAS, VAS‐F, and NASA‐TLX scales were selected to investigate changes in the mood, the perceived fatigue, and the perceived workload. Meanwhile, the skin temperature during these three workload sequences was continuously collected. Results from the NASA‐TLX scale indicated that no significant difference in total workload was observed among all three workload sequences. Meanwhile, results from the VAS‐F scale showed that no significant changes in self‐reported mental fatigue were observed among these three workload sequences, which meant that mental fatigue was only related to the total workload. However, self‐reported "energy" from the VAS‐F scale did not reduce significantly during the reducing workload sequence, which meant that the reducing workload sequence could conserve more "energy" than that of the elevating and constant workload sequences. Furthermore, both positive and negative moods changed significantly under the constant workload sequence (2‐back task), but they did not show much changes under altered workloads, which meant that the altered workload sequence could attenuate the mood deterioration. What is more, the mental demand, physical demand, temporal demand, effort, and the total workload increased significantly after both the constant workload and elevating workload sequence, but no significant changes in all these six items of the NASA‐TLX scale were observed under the reducing workload sequence. Finally, the mean skin temperature under the constant workload sequence was lower than that under the altered workload sequences (p > 0.05), but significant changes in skin temperature at the left hand and neck were only observed between the constant and reducing workload sequences. In conclusion, constant and altered workload sequences contributed equally to the mental fatigue in a thermoneutral environment, but the differences in workload sequence produced some differences in mood, energy, and mental demand, which would affect the working performance. Findings of this study provided implications for the proper planning, assignment, and management of tasks in real working settings. [ABSTRACT FROM AUTHOR]

Background: In recent years, eHealth has received much attention as an opportunity to increase efficiency within healthcare organizations. Adoption of eHealth might consequently help to solve perceived health workforce challenges, including labor shortages and increasing workloads among primary care professionals, who serve as the first point of contact for healthcare in many countries. The purpose of this systematic review was to investigate the impact of general eHealth use and specific eHealth services use on general practice workload in the pre-COVID-19 era. Methods: The databases of CINAHL, Cochrane, Embase, IEEE Xplore, Medline ALL, PsycINFO, Web of Science, and Google Scholar were searched, using combinations of keywords including 'eHealth', 'workload', and 'general practice'. Data extraction and quality assessment of the included studies were independently performed by at least two reviewers. Publications were included for the period 2010 – 2020, before the start of the COVID-19 pandemic. Results: In total, 208 studies describing the impact of eHealth services use on general practice workload were identified. We found that two eHealth services were mainly investigated within this context, namely electronic health records and digital communication services, and that the largest share of the included studies used a qualitative study design. Overall, a small majority of the studies found that eHealth led to an increase in general practice workload. However, results differed between the various types of eHealth services, as a large share of the studies also reported a reduction or no change in workload. Conclusions: The impact of eHealth services use on general practice workload is ambiguous. While a small majority of the effects indicated that eHealth increased workload in general practice, a large share of the effects also showed that eHealth use reduced workload or had no impact. These results do not imply a definitive conclusion, which underscores the need for further explanatory research. Various factors, including the study setting, system design, and the phase of implementation, may influence this impact and should be taken into account when general practices adopt new eHealth services. Study registration number: PROSPERO (International Prospective Register of Systematic Reviews) CRD42020199897; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=199897. [ABSTRACT FROM AUTHOR]

Mechanical load is a potent regulator of cardiac structure and function. Although high workload during heart failure is associated with disruption of cardiomyocyte t‐tubules and Ca2+ homeostasis, it remains unclear whether changes in preload and afterload may promote adaptive t‐tubule remodelling. We examined this issue by first investigating isolated effects of stepwise increases in load in cultured rat papillary muscles. Both preload and afterload increases produced a biphasic response, with the highest t‐tubule densities observed at moderate loads, whereas excessively low and high loads resulted in low t‐tubule levels. To determine the baseline position of the heart on this bell‐shaped curve, mice were subjected to mildly elevated preload or afterload (1 week of aortic shunt or banding). Both interventions resulted in compensated cardiac function linked to increased t‐tubule density, consistent with ascension up the rising limb of the curve. Similar t‐tubule proliferation was observed in human patients with moderately increased preload or afterload (mitral valve regurgitation, aortic stenosis). T‐tubule growth was associated with larger Ca2+ transients, linked to upregulation of L‐type Ca2+ channels, Na+–Ca2+ exchanger, mechanosensors and regulators of t‐tubule structure. By contrast, marked elevation of cardiac load in rodents and patients advanced the heart down the declining limb of the t‐tubule–load relationship. This bell‐shaped relationship was lost in the absence of electrical stimulation, indicating a key role of systolic stress in controlling t‐tubule plasticity. In conclusion, modest augmentation of workload promotes compensatory increases in t‐tubule density and Ca2+ cycling, whereas this adaptation is reversed in overloaded hearts during heart failure progression. Key points: Excised papillary muscle experiments demonstrated a bell‐shaped relationship between cardiomyocyte t‐tubule density and workload (preload or afterload), which was only present when muscles were electrically stimulated.The in vivo heart at baseline is positioned on the rising phase of this curve because moderate increases in preload (mice with brief aortic shunt surgery, patients with mitral valve regurgitation) resulted in t‐tubule growth. Moderate increases in afterload (mice and patients with mild aortic banding/stenosis) similarly increased t‐tubule density.T‐tubule proliferation was associated with larger Ca2+ transients, with upregulation of the L‐type Ca2+ channel, Na+–Ca2+ exchanger, mechanosensors and regulators of t‐tubule structure.By contrast, marked elevation of cardiac load in rodents and patients placed the heart on the declining phase of the t‐tubule–load relationship, promoting heart failure progression.The dependence of t‐tubule structure on preload and afterload thus enables both compensatory and maladaptive remodelling, in rodents and humans. [ABSTRACT FROM AUTHOR]

Contraction of cardiomyocytes is initiated at subcellular elements called dyads, where L‐type Ca2+ channels in t‐tubules are located within close proximity to ryanodine receptors in the sarcoplasmic reticulum. While evidence from small rodents indicates that dyads are assembled gradually in the developing heart, it is unclear how this process occurs in large mammals. We presently examined dyadic formation in fetal and newborn sheep (Ovis aries), and the regulation of this process by fetal cardiac workload. By employing advanced imaging methods, we demonstrated that t‐tubule growth and dyadic assembly proceed gradually during fetal sheep development, from 93 days of gestational age until birth (147 days). This process parallels progressive increases in fetal systolic blood pressure, and includes step‐wise colocalization of L‐type Ca2+ channels and the Na+/Ca2+ exchanger with ryanodine receptors. These proteins are upregulated together with the dyadic anchor junctophilin‐2 during development, alongside changes in the expression of amphiphysin‐2 (BIN1) and its partner proteins myotubularin and dynamin‐2. Increasing fetal systolic load by infusing plasma or occluding the post‐ductal aorta accelerated t‐tubule growth. Conversely, reducing fetal systolic load with infusion of enalaprilat, an angiotensin converting enzyme inhibitor, blunted t‐tubule formation. Interestingly, altered t‐tubule densities did not relate to changes in dyadic junctions, or marked changes in the expression of dyadic regulatory proteins, indicating that distinct signals are responsible for maturation of the sarcoplasmic reticulum. In conclusion, augmenting blood pressure and workload during normal fetal development critically promotes t‐tubule growth, while additional signals contribute to dyadic assembly. Key points: T‐tubule growth and dyadic assembly proceed gradually in cardiomyocytes during fetal sheep development, from 93 days of gestational age until the post‐natal stage.Increasing fetal systolic load by infusing plasma or occluding the post‐ductal aorta accelerated t‐tubule growth and hypertrophy.In contrast, reducing fetal systolic load by enalaprilat infusion slowed t‐tubule development and decreased cardiomyocyte size.Load‐dependent modulation of t‐tubule maturation was linked to altered expression patterns of the t‐tubule regulatory proteins junctophilin‐2 and amphiphysin‐2 (BIN1) and its protein partners.Altered t‐tubule densities did not influence dyadic formation, indicating that distinct signals are responsible for maturation of the sarcoplasmic reticulum. [ABSTRACT FROM AUTHOR]

The article highlights the value-based metrics that need to be considered in critical care clinical pharmacy. Topics mentioned include the pitfalls of clinical pharmacy productivity metrics, the main paradigm shift for the pharmacy profession, a description of key performance indicators, the importance of providing direct patient care and the use of the medication regimen complexity-intensive care unit.

The article discusses the key factors that need to consider to enhance the quality of critical care pharmacy practice education. Topics mentioned include the integration of holistic team approach, the incremental increases in workload, the importance of focus on patient-centered outcomes and the implementation of science and open-source resources.

The article offers strategies on how to manage burnout among critical care pharmacists. Topiccs mentioned include the common job demands faced by critical care pharmacists, the role of leadership, the need to change the work role of the critical care pharmacists and the common job resources and examples of resource deficits faced by critical care pharmacists.

Background/Objectives: As the elderly population grows, the prevalence of dementia is rising, with 70–95% of patients in hospital settings exhibiting problematic behaviors such as aggression. These behaviors significantly contribute to increased nursing workloads, affecting nurses' well-being and patient care quality. This study aims to review workload-related issues among nurses caring for dementia patients, highlighting the need for targeted interventions to mitigate stress and improve care quality. Methods: A scoping review was conducted using the five-stage framework of Arksey and O'Malley. The literature search covered studies published between 2013 and 2023, focusing on quantitative research about nurses' workload-related stress when managing patients with dementia and problematic behaviors. Databases such as PubMed and PsycINFO were searched, and 13 studies were selected based on predefined inclusion and exclusion criteria. Results: The review revealed that problematic behaviors, particularly aggression, significantly increase nurses' stress and workload. This stress has negative consequences on nurses' physical and mental health, often leading to burnout, decreased job satisfaction, and a decline in care quality. Inadequate staffing and support systems exacerbate these issues. Conclusions: Targeted education, sufficient staffing, and support are essential to reduce the workload and stress experienced by nurses caring for dementia patients. Implementing these strategies can enhance the quality of care provided and improve the well-being of healthcare professionals. [ABSTRACT FROM AUTHOR]

Background: Too high or too low patient volumes and work amounts may overwhelm health care professionals and obstruct processes or lead to inadequate personnel routine and process flow. We sought to evaluate, whether an association between current caseload, current workload, and outcomes exists in intensive care units (ICU). Methods: Retrospective cohort analysis of data from an Austrian ICU registry. Data on patients aged ≥ 18 years admitted to 144 Austrian ICUs between 2013 and 2022 were included. A Cox proportional hazards model with ICU mortality as the outcome of interest adjusted with patients' respective SAPS 3, current ICU caseload (measured by ICU occupancy rates), and current ICU workload (measured by median TISS-28 per ICU) as time-dependent covariables was constructed. Subgroup analyses were performed for types of ICUs, hospital care level, and pre-COVID or intra-COVID period. Results: 415 584 patient admissions to 144 ICUs were analysed. Compared to ICU caseloads of 76 to 100%, there was no significant relationship between overuse of ICU capacity and risk of death [HR (95% CI) 1.06 (0.99–1.15), p = 0.110 for > 100%], but for lower utilisation [1.09 (1.02–1.16), p = 0.008 for ≤ 50% and 1.10 (1.05–1.15), p < 0.0001 for 51–75%]. Exceptions were significant associations for caseloads > 100% between 2020 and 2022 [1.18 (1.06–1.30), p = 0.001], i.e., the intra-COVID period. Compared to the reference category of median TISS-28 21–30, lower [0.88 (0.78–0.99), p = 0.049 for ≤ 20], but not higher workloads were significantly associated with risk of death. High workload may be associated with higher mortality in local hospitals [1.09 (1.01–1.19), p = 0.035 for 31–40, 1.28 (1.02–1.60), p = 0.033 for > 40]. Conclusions: In a system with comparably high intensive care resources and mandatory staffing levels, patients' survival chances are generally not affected by high intensive care unit caseload and workload. However, extraordinary circumstances, such as the COVID-19 pandemic, may lead to higher risk of death, if planned capacities are exceeded. High workload in ICUs in smaller hospitals with lower staffing levels may be associated with increased risk of death. [ABSTRACT FROM AUTHOR]

AbstractIn complex industrial and chemical process control rooms, effective decision-making is crucial for safety and efficiency. The experiments in this paper evaluate the impact and applications of an AI-based decision support system integrated into an improved human-machine interface, using dynamic influence diagrams, a hidden Markov model, and deep reinforcement learning. The enhanced support system aims to reduce operator workload, improve situational awareness, and provide different intervention strategies to the operator adapted to the current state of both the system and human performance. Such a system can be particularly useful in cases of information overload when many alarms and inputs are presented all within the same time window, or for junior operators during training. A comprehensive cross-data analysis was conducted, involving 47 participants and a diverse range of data sources such as smartwatch metrics, eye-tracking data, process logs, and responses from questionnaires. The results indicate interesting insights regarding the effectiveness of the approach in aiding decision-making, decreasing perceived workload, and increasing situational awareness for the scenarios considered. Additionally, the results provide insights to compare differences between styles of information gathering when using the system by individual participants. These findings are particularly relevant when predicting the overall performance of the individual participant and their capacity to successfully handle a plant upset and the alarms connected to it using process and human-machine interaction logs in real-time which resulted in a 95.8% prediction accuracy using hidden Markov model. These predictions enable the development of more effective intervention strategies. [ABSTRACT FROM AUTHOR]

Introduction It is critical to develop and implement lab-based computer experiments that simulate real-world tasks in order to characterize operational requirements and challenges or identify potential solutions. Achieving a high degree of laboratory control, operational generalizability, and ease-of-use for a task is challenging, often leading to the development of tasks that can satisfy some facets but not all. This can result in insufficient solutions that leave real-world stakeholders with unsolved problems. Materials and Methods This issue is addressed using a customized passive sonar simulator application that provides extensive researcher control over the design and manipulation of a sonar task; a visual appearance and cognitive demand similar to a true submarine-based sonar task; and a convenient and short training routine for sonar novices. The task requires participants to watch for multiple signal sources of varying appearance and salience and subsequently classify these signals into their respective categories. Results The current study investigated the effects of stimulus signal strength and signal density on sonar task performance—including metrics of classification accuracy, classification confidence, and response times—finding an interaction between signal density and signal strength that resulted in greater performance errors with high signal density at the weakest signal strength. Conclusions The lab-based sonar application provides new possibilities for research, not limited to signal intensity and signal density but also through the manipulation of parameters such as the number of unique targets, target appearance, and task duration. This application may illuminate the operational demands that each of these factors may have on operator behavior within the dynamic tasks. [ABSTRACT FROM AUTHOR]

Introduction Between June 2021 and December 2022, the Practice-Based Implementation (PBI) Network conducted a pilot to study the optimization of behavioral health technicians (BHTs) within military behavioral health (BH) care system specialty BH clinics. Behavioral health technicians are paraprofessionals found in all branches of the military, and with training across a variety of clinic functions. Behavioral health technicians support BH specialty providers in many clinic functions (i.e. administrative, case management, clinical, and outreach). The primary aim of the BHT optimization pilot was to increase BHTs' involvement in clinical care. Materials and Methods Four military BH outpatient clinics participated in the BHT optimization pilot. Participants from the 4 clinics included 12 BHTs, 3 providers, 3 internal facilitators, and 3 dual-role providers/internal facilitators. The pilot asked each clinic to assess their BHT utilization needs, and then barriers and facilitators to BHT optimization were addressed by creating site-specific BHT optimization plans. Results The degree to which clinic optimization of BHTs impacts provider workload, clinic capability or capacity, and patient access to evidence-based care could not be determined during the BHT optimization pilot. However, individualized clinic BHT optimization plans and strategies appeared to be feasible and acceptable methods for military health system BH clinics to optimize BHTs' clinical skills. Lessons learned from this pilot included that: (1) clinics should consider establishing and maintaining action plans with specific, actionable goals for use of BHTs, and (2) BHT supervision, training, and clinic processes supporting optimization should be prioritized despite time constraints. Conclusion Overall, individualized clinic BHT optimization plans and strategies appear to be feasible and acceptable methods for military health system BH clinics to optimize BHTs' clinical skills. [ABSTRACT FROM AUTHOR]

Introduction Winter warfare training (WWT) is a critical component of military training that trains warfighters to operate effectively in extreme environments impacted by snow and mountainous terrain. These environmental factors can exacerbate the disruption to the hormone milieu associated with operating in multi-stressor settings. To date, there is limited research on the physiological responses and adaptations that occur in elite military populations training in arduous environments. The purpose of this study was to quantify hormone responses and adaptations in operators throughout WWT. Materials and Methods Participants engaged in baseline laboratory metrics at their home station, Fort Carson, located in Colorado (CO) prior to WWT, for one week in Montana (MT) and one week in Alaska (AK). WWT periods were separated by approximately one month. Blood was collected upon wake at baseline (CO) and on the first and last day of WWT at each location (MT and AK). Plasma was analyzed for stress, metabolic, and growth-related hormones via enzyme-linked immunoassay (ELISA). Sleep quality was assessed via the Pittsburg Sleep Quality Index (PSQI) at baseline (CO) and on the first day of training in MT and AK. Cognitive function was evaluated using the Defense Automated Neurobehavioral Assessment (DANA) at baseline (CO) and on the first and last day of WWT in both MT and AK. Results Fourteen US Army operators in 10th Special Forces Group (SFG) Operational Detachment participated in winter warfare training (WWT; age: 31.5 years; 95%CI[28.1, 34.3]; height: 180.6 cm; 95%CI[177.3, 183.4]; weight: 87.4 kg.; 95%CI[80.6, 97.7]; body fat: 18.9%; 95%CI[13.7, 23.1]; male: n=13; female: n=1). Plasma adrenocorticotropic hormone (ACTH) levels increased from baseline (19.9 pg/mL; 95%CI[8.6, 24.2])  to pre-WWT (26.9 pg/mL; 95%CI [16.2, 37]; p=0.004), decreased from pre-  (26.9 pg/mL; 95%CI [16.2, 37]) to post-WWT in MT (22.3 pg/mL; 95% CI [8, 23.7]; p=0.004;), and increased from pre-  (25 pg/mL; 95%CI[ 28.4) to post-WWT (36.6 pg/mL; 95%CI [17.9, 48.9]) in AK (p=0.005). Plasma cortisol levels decreased from pre- (174 ng/mL; 95%CI[106.2, 233.6])  to post-WWT (94.5 ng/mL; 95%CI[54.8, 101.7]) in MT (p=0.001) and, conversely, increased from pre- (123.1 ng/mL; 95%CI[97.5, 143.9]) to post-WWT  (162.8 ng/mL; 95%CI[128, 216.7]) in AK (p<0.001). Alterations in growth-related hormones (insulin-like growth factor 1 [IGF-1], insulin-like growth factor binding protein 3 [IGFBP-3], and sex hormone binding globulin [SHBG]) were observed throughout WWT (p<0.05). The Total Testosterone / Cortisol ratio (TT / CORT; molar ratio) was lower pre-WWT in MT (0.04; 95%CI[0.01,0.04) compared to baseline in CO (0.07; 95%CI[0.04, 0.07]; p=0.042). Triiodothyronine (T3) levels increased from pre-  (101.7 ng/dL; 95%CI[93.7, 110.4]) to post-WWT  (117.8 ng/dL; 95%CI[105.1, 129.4]) in MT (p=0.042). No differences in sleep quality were reported between locations (CO, MT, and AK). Alterations in cognitive function were exhibited between locations and during WWT in both MT and AK (p<0.05). Conclusions Over the course of WWT, elite operators experienced alterations in stress, metabolic, and growth-related hormones, as well as cognitive performance. The increase in stress hormones (i.e. ACTH and cortisol) and reduction in cognitive performance following training in AK are suggestive of heightened physiological strain, despite similarities in physical workload, self-reported sleep quality, and access to nutrition. The variation in hormone levels documented between MT and AK may stem from differences in environmental factors, such as lower temperatures and harsh terrain. Further research is warranted to provide more information on the combined effects of military training in extreme environments on operator health and performance. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study are to examine the trajectories of nursing hours per patient day (NHPPD) over the course of hospitalization according to the patient's length of stay (LOS) and to estimate changes in the total nursing hours during hospitalization, average NHPPD, and the number of nurses additionally required when the LOS was reduced by 1 day. Design: This retrospective longitudinal study analyzed patient data collected from a tertiary university hospital located in Seoul, South Korea. The study sample included 11,316 inpatients who were discharged between September 1 and October 31, 2022. Methods: NHPPD over the course of each patient's hospitalization was estimated using the total score of the Korean Patient Classification System‐1 (KPCS‐1), which nurses evaluated and recorded every day from admission to discharge. The NHPPD trajectories were examined using linear mixed models to analyze repeated KPCS‐1 measurements and control for the effects of patient characteristics. The changes in the average NHPPD when LOS was reduced by 1 day were estimated using maximum and minimum estimations. The impact of a 1‐day reduction in LOS on staffing requirements was calculated as the number of nurses additionally required to work each shift and to be hired. Findings: The average LOS was 5.6 days, and the short (1–6 days) and medium (7–14 days) LOS groups accounted for 78.9% and 14.3% of patients, respectively. The NHPPD trajectories showed a "rise‐peak‐decline" pattern. Patients in the short LOS group received the most NHPPD on day 1 (day of admission) or day 2, whereas the NHPPD for patients in the medium LOS group peaked on days 3–6. After peaking, the NHPPD tended to decrease toward the end of hospitalization, with the least NHPPD on the day of discharge, followed by the day before discharge. When LOS was reduced by 1 day, the average NHPPD was estimated to increase by 7.7–50.0% in the maximum estimation, and 0.9–12.5% in the minimum estimation. In response to a 1‐day reduction, 1.10–7.44 nurses were additionally required to care for 100 patients each shift and 5.28–35.70 additional nurses needed to be hired in the maximum estimation. In the minimum estimation, these values were 0.13–1.85 additional nurses per shift and 0.65–8.90 additional nurses to be hired, respectively. Conclusions: Since NHPPD exhibited a "rise‐peak‐decline" trajectory, reducing the LOS by 1 day was estimated to increase the average NHPPD and lead to additional staffing requirements. The additional nurse requirement for a 1‐day reduction was not constant; instead, it increased with each day subtracted from an already shorter LOS. Clinical Relevance: Sufficient nurse staffing is necessary to provide increased NHPPD as a result of shortened LOS. Changes in the LOS should be considered when determining nurse staffing requirements. [ABSTRACT FROM AUTHOR]

This study aims to determine and analyze the Influence of Placement, Workload and Communication Skills on Employee Performance of BPJS Ketenagakerjaan Makassar City. This type of research is quantitative research with a sample of 77 respondents using a questionnaire as a source of data collection, the analysis used is Multiple Linear Regression Analysis using the SPSS V.24 application. The results of the study indicate that: 1. Placement has a positive and significant effect on employee performance 2. Workload has a negative but not significant effect on employee performance and 3. Communication skills have a positive and significant effect on employee performance. [ABSTRACT FROM AUTHOR]

The objective benefit of transvaginal mesh with concomitant total hysterectomy (TVM-HTX) repair to high-grade uterine prolapse (UP) patients has not been fully established. This study aimed to clarify the impact of TVM-HTX on the voiding function of high-grade UP patients by comparing pre- and post-operatively measured pressure–flow and pressure–volume investigations. Urodynamic and thermodynamic studies were conducted on 15 high-grade UP patients (stage III/IV, POP-Q system) who underwent TVM-HTX (January 2019–December 2022) in a tertiary-care university hospital. The parameters analyzed included voiding resistance (Rvod), voiding pressure (Pvod), voiding flow (Fvod), voided volume (Vvod), voiding time (Tvod), and the trajectory-enclosed area of the pressure–volume loop (Apv). Post-operative results showed a significant reduction in Rvod (p < 0.001, N = 15), Pvod (p = 0.021, N = 15), and Apv (p = 0.006, N = 15), along with an increase in Fvod (p = 0.003, N = 15) and a decrease in Tvod (p < 0.001, N = 15). The operation-associated changes in Rvod (ΔRvod) correlated with alterations in Pvod and Fvod (ΔPvod and ΔFvod, r = 0.444, p = 0.004, r = 0.717, p = 0.003, respectively; both N = 15); ΔFvod correlated with the change in Tvod (ΔTvod, r = 0.629, p = 0.012, N = 15) but not with that in ΔVvod (r = 0.166, p = 0.555, N = 15). Changes in Apv (ΔApv) correlated with ΔPvod (r = 0.563, p = 0.029, N = 15) but not with ΔVvod (r = 0.353, p = 0.197, N = 15). Collectively, TVM-HTX reduced the voiding resistance, which improved the voiding efficacy and decreased the pressure gradient required for driving urine flow, thereby lessening the bladder's workload. [ABSTRACT FROM AUTHOR]

This study aims to analyze the effect of work stress, workload, and work environment on employee performance. The data for this study were obtained from 84 employees of PT Rajawali Dwi Putra Indonesia through a quantitative approach. The sampling technique used was non-probability sampling with saturated sampling category. Data were collected using a questionnaire and analyzed using multiple linear regression with the help of SPSS software as an analytical tool. The T test results showed that: (1) Work stress does not have a significant effect on employee performance, (2) Workload also does not have a significant effect on employee performance, (3) Work environment has a significant effect on employee performance, and (4) Work stress, workload, and work environment simultaneously affect employee performance at PT Rajawali Dwi Putra Indonesia. This research is expected to be a reference, suggestion, and alternative solution for companies or organizations in dealing with problems related to work stress, workload, and work environment, which in turn is expected to improve employee performance and support the achievement of organizational goals. [ABSTRACT FROM AUTHOR]

This study aims to determine the influence of managerial communication, workload, and compensation on turnover intention, with job satisfaction serving as a mediating variable. The study was conducted at the XYZ Insurance office in Tangerang, involving 138 employees, with sample size determined using the Krejcie-Morgan formula and purposive sampling method. Data was collected through questionnaires distributed via Google Forms, containing 40 questions with 1-5 Likert scale. The data was analyzed using the partial least squares structural equation modeling (PLS-SEM) method. The results indicate that managerial communication, workload, and compensation negatively affect turnover intention among XYZ Insurance employees. Furthermore, the study demonstrates that job satisfaction mediates the relationship between managerial communication, workload, and compensation on turnover intention. [ABSTRACT FROM AUTHOR]

Manufacturing companies do produce many products and with daily targets that must be implemented for each worker. Not a few companies give a lot of workload tasks on the grounds that the number of employees is limited. One of these conditions is experienced by a pharmaceutical manufacturing company. One factor that can increase work productivity is the provision of appropriate compensation. This study aims to analyze the effect of workload, work stress, and compensation on work productivity. This research method uses a quantitative approach with data analysis using PLS software. The results show that work productivity can be increased because of the provision of appropriate compensation. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that women farmers are particularly vulnerable to mental health disorders such as depression and anxiety. Aims: This study aimed to investigate the prevalence of anxiety and depression in women farmers from Ecuador Coastal and Highlands regions. Method: General Anxiety Disorder‑7 (GAD‑7) and Patient Health Questionnaire‑9 (PHQ‑9) were applied. In addition, self-reported number of children, days off, hours of work, pesticide use, sleep habits and years of work in agriculture, were also collected. This cross-sectional study occurred during 2023 with 443 women, for Coastal (197) and Highlands (246), respectively. Multivariable binary logistic regression models were performed to obtained adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI). Results: 34.5% of Coastal women had depression, while 27.2% of Highlands women had depression. 20.3% of coastal women farmers had anxiety, while in the Highlands 24.8% had anxiety. Coastal mestizo and montubio women exhibited lower probability of depression, but this was not significant in the Highlands. Coastal women farmers that did not have children showed lower odds of depression (aOR 0.05, 95% CI [0.01, 0.34]). A lower likelihood of depression was observed in coastal women that worked more than 8 hours (aOR 0.22, 95% CI [0.07, 0.72]). Women from the Highlands that had shortened sleep duration exhibited lower odds of depression and anxiety. Conclusions: A higher proportion of depressed women farmers was observed in the Coast region and slightly higher numbers of anxiety cases in the Highlands. The number of children may cause workload and is correlated with depression in Coastal women. [ABSTRACT FROM AUTHOR]

In the context of global concerns about teacher workload and the relationship between workload and attrition, understanding the nature, quantity and intensity of teachers' work is an essential first step in formulating robust solutions to this significant problem. Understanding teachers' work, however, is a complex undertaking, and prior attempts have largely been focused on the quantity rather than the intensity or quality of work required and undertaken. This article reports on a pilot study of the Teacher Time Use app, a bespoke tool developed by the research team to 'get inside' teachers' subjective experience of time through a focus on both workload and intensity. Our analysis shows that the app provides a simple, non-demanding way for teachers to record their work in a timely and efficient way. It also highlights the capacity of this approach to understand both the range and quantum of tasks that comprise teachers' work and consequently the nature and subjective experience of work intensification. We argue the need for a more nuanced empirical understanding of the layering and multi-tasking of teachers' work that characterises work intensity, and suggest that the Teachers' Time Use app provides an effective means for recording and representing the complex dimensions of teachers' work and time use. [ABSTRACT FROM AUTHOR]

The rapid technology growth in the maritime defense sector demands efficient and effective human performance, particularly in roles involving navigation, tactical decision-making, and emergency responses. To accommodate this demand, our study aims to find the effects of the two most significant performance influencing factors i.e., mental alertness and workload on the performance of Electronic Support Measures (ESM) receiver operators in complex task environments of a surface combat ship. A Discrete Event Simulation model with the Task Network Modeling approach was developed in IPME software. Alertness, measured by the Karolinska Sleepiness Scale (KSS), was predicted for Crew Chiefs' schedules (4–8, 6–6, and 8–8) using the Three Process Model in FIPS software. The simulation integrated KSS predictions and VACP workload values, with 10 simulation runs, for each schedule, to assess the effects of mental alertness and workload on the total number of signals missed, the total number of signals logged, and percentage time at risk. The findings reveal that mental alertness variation due to different shift patterns in combination with mental workload significantly influence performance metrics, especially during night time operations, highlighting potential attention lapses and reduced efficiency. This comprehensive analysis provides valuable insights into the dynamics of shift work and task demands, aiming to enhance operational safety and performance in critical environments. The study's methodology and findings offer a foundation for further research and practical applications in various industries where managing mental alertness and workload is crucial for safety and efficient crew performance. [ABSTRACT FROM AUTHOR]

Objective: This study uses a detection task to measure changes in driver vigilance when operating four different partially automated systems. Background: Research show temporal declines in detection task performance during manual and fully automated driving, but the accuracy of using this approach for measuring changes in driver vigilance during on-road partially automated driving is yet unproven. Method: Participants drove four different vehicles (Tesla Model 3, Cadillac CT6, Volvo XC90, and Nissan Rogue) equipped with level-2 systems in manual and partially automated modes. Response times to a detection task were recorded over eight consecutive time periods. Results: Bayesian analysis revealed a main effect of time period and an interaction between mode and time period. A main effect of vehicle and a time period x vehicle interaction were also found. Conclusion: Results indicated that the reduction in detection task performance over time was worse during partially automated driving. Vehicle-specific analysis also revealed that detection task performance changed across vehicles, with slowest response time found for the Volvo. Application: The greater decline in detection performance found in automated mode suggests that operating level-2 systems incurred in a greater vigilance decrement, a phenomenon that is of interest for Human Factors practitioners and regulators. We also argue that the observed vehicle-related differences are attributable to the unique design of their in-vehicle interfaces. [ABSTRACT FROM AUTHOR]

This study investigated the influence of using optical see-through head-mounted displays (OST-HMDs) as a replacement for conventional monitors for an extended duration, as required for laparoscopic surgery. We developed the experiment scenario including two displays (surgical field and patient vitals) in three different combinations of the HMD and conventional monitors. An experiment was conducted to compare the task performance, situation awareness, physical discomfort, and perceived workload in the three different display settings. From this study, it was shown that even though the OST-HMD resulted in higher physical discomfort and lower self-perceived performance rating, the surgical task performance, and situation awareness were not worse, and in some conditions even better than conventional monitors. The main obstacle to using OST-HMDs to replace conventional monitors in laparoscopic surgery would be the weight of the HMDs and the head discomfort caused by wearing them for a long time. [ABSTRACT FROM AUTHOR]

In December 2022, the epidemic prevention and control policy was upgraded, and China entered a different stage of epidemic control. This study aims to identify implications for better infection control and health care supply during the epidemic. A longitudinal quantitative and qualitative study was performed based on 2 comprehensive questionnaire surveys among 497 hospital infection prevention and control practitioners (HIPCPs) before and during the epidemic peak in Tianjin, China. The workload (8.2 hours vs 10.14 hours, P = 0) and self-reported mental health problems (23.5% vs 61.8%, P <.05) among the HIPCPs increased significantly in the peak period. Ward reconstruction and resource coordination were the most needed jobs in hospital infection control, and rapidly increased medical waste during the epidemic needs to be considered in advance. Community support for health care personnel and their families, maintaining full PPE to reduce simultaneous infection of medical staff, and clinical training of infectious diseases for medical staff, especially doctors, in advance are the most important things we learned. Although it has been 4 years since the first outbreak of coronavirus disease 2019, more improvements should be made to prepare for the next epidemic of potential diseases. • A comprehensive research on hospital infection prevention and control practitioners. • Workload and mental health problems increased among HIPCPs during the pandemic. • Infection among family members is an important source of anxiety and depression. • Clinical training on infectious diseases shall be applied for doctors in advance. • Online diagnosis and prescriptions alleviated the shortage of medical resources. [ABSTRACT FROM AUTHOR]

This study aimed to identify the required capabilities and workload of medical staff in accelerator-based boron neutron capture therapy (BNCT). From August to September 2022, a questionnaire related to the capabilities and workload in the accelerator-based BNCT was administered to 12 physicians, 7 medical physicists and 7 radiological technologists engaged in BNCT and 6 other medical physicists who were not engaged in BNCT to compare the results acquired by those engaged in BNCT. Only 6–21% of patients referred for BNCT received it. Furthermore, 30–75% of patients who received BNCT were treated at facilities located within their local district. The median required workload per treatment was 55 h. Considering additional workloads for ineligible patients, the required workload reached ~1.2 times longer than those for only eligible patients' treatment. With respect to capabilities, discrepancies were observed in treatment planning, quality assurance and quality control, and commissioning between medical physicists and radiological technologists. Furthermore, the specialized skills required by medical physicists are impossible to acquire from the experience of conventional radiotherapies as physicians engaged in BNCT were specialized not only in radiation oncology, but also in other fields. This study indicated the required workload and staff capabilities for conducting accelerator-based BNCT considering actual clinical conditions. The workload required for BNCT depends on the occupation. It is necessary to establish an educational program and certification system for the skills required to safely and effectively provide BNCT to patients. [ABSTRACT FROM AUTHOR]