Search Results (647)

Background: Workplace bullying constitutes a persistent psychosocial risk in public service settings, where hierarchical structures and limited exit opportunities may intensify employees’ psychological strain. Although previous research has documented associations between workplace bullying and burnout, less is known about the psychological processes through which bullying translates into emotional exhaustion and the contextual conditions under which these processes are activated, particularly in public sector contexts. Method: This study used survey data from 234 public service employees working in administrative, educational, and non-clinical healthcare institutions across three major cities in Türkiye (Istanbul, Ankara, and Izmir). Participants who were frequently exposed to workplace bullying were selected to examine the detrimental cycle that victims experience. A moderated mediation model (PROCESS Model 7) was tested to examine emotion-focused coping as a mediating mechanism between workplace bullying and burnout, operationalized through emotional exhaustion, and to assess whether this indirect effect was conditional on perceived bystander silence. Results: Findings indicated that workplace bullying was associated with increased reliance on emotion-focused coping only when perceived bystander silence was high. The conditional indirect effect of workplace bullying on burnout via emotion-focused coping was significant at higher levels of bystander silence, whereas no indirect effect emerged under low silence conditions. Conclusions: These findings suggest that burnout does not arise as an automatic consequence of bullying exposure but unfolds through coping processes that are activated in socially silent environments. By highlighting the conditional role of bystander silence, this study emphasizes the value of social context in shaping how public service employees respond to workplace bullying and how burnout develops. We discuss the practical implications for organizational interventions that aim to reduce bystander silence and support healthier coping processes in organizations. Full article

Frameworks for water resources management lack alignment with the action arenas where stakeholders have influence. Decision processes without stakeholder involvement across the sequence of problem-solving in multiple situations may be ineffective. By aligning stakeholder roles with situational contexts, water management can be improved. This paper identifies stakeholder roles for archetypes of management and an improved way to classify them. Systems analysis and the IAD framework provided a framework to organize stakeholders and context, and case studies were used to explain them. The analysis showed patterns among the cases, and seven categories of stakeholders with logical involvement emerged. Four categories stood out: interest groups, who represent people and causes; officials with governance and management responsibilities; stakeholders, who are involved due to the context; and bystanders, like researchers. Stakeholder roles can include dominators, brokers, and communicators, as well as those with less involvement. Dominators facilitate coordination, synthesize viewpoints, and exert pressure for compliance. Brokers work to coordinate collective actions, and communicators work as risk mediators. Stakeholder roles should be identified at the front end of the process to solve complex water problems. Full article

Background: Severe hypoglycemia is a major reason for emergency medical service (EMS) activation among patients with diabetes. However, real-world epidemiology, including onset location, timing, caller identity, and prehospital management, remains insufficiently described. This study aimed to characterize these cases and assess prehospital interventions and patient outcomes. Methods: We conducted a retrospective, descriptive study using EMS transport records and emergency department (ED) data from two core hospitals and their regional EMS systems in Japan between January 2018 and December 2023. Included patients were those transported by EMS for hypoglycemia with a corresponding ED diagnosis. Extracted data included patient characteristics, episode location and time, EMS caller identity, prehospital interventions, and clinical outcomes. Results: Among 237 episodes, the median age was 74 years and 59.9% were male. Most events occurred at home (78.1%) and during evening or nighttime hours (51.9%). Family members were the most frequent EMS callers (67.5%), yet 12.5% of patients received bystander medical intervention. EMS teams performed most prehospital interventions (68.8%), primarily intravenous glucose administration (65.2%). At EMS arrival, 16.0% were fully conscious and 21.1% were comatose. Hospitalization occurred in 44.3%. The hospitalization rate was 34.2% among patients who received prehospital intervention and 53.2% among those who did not. Conclusions: Most hypoglycemia episodes were discovered by family members, but bystander intervention was uncommon. Differences in hospitalization rates were observed according to the presence and timing of prehospital intervention. Full article

Spray drift is one of the most significant challenges in the application of Plant Protection Products (PPPs), as it contributes to water, soil, and food contamination and is highly associated with health risks to agricultural workers, bystanders, and rural residents. Spray drift is defined as the fraction of PPP that is carried away from the target area by air currents during application. Factors such as high wind speeds, low relative humidity, and elevated temperatures increase the risk of drift by promoting droplet evaporation and off-target movement. Technological advancements in spraying equipment, such as low-drift and air induction nozzles, have been shown to significantly reduce drift potential. Air induction nozzles mix air with the spray liquid, creating larger droplets that are less susceptible to drift. The primary objective of this study was to quantify the spray drift reduction achieved using cost-effective and easily applicable drift mitigation techniques that do not require specialized and expensive equipment compared to conventional application methods in vineyards under Southern European conditions. Field measurements followed the ISO 22866:2005 protocol, using a conventional axial fan air-assisted sprayer that is commonly used by vineyard farmers in Greece. This study was conducted on Savatiano vines, the most widely cultivated winemaking variety in the Attica region, characterized by its low height. The spraying techniques evaluated as spray drift mitigation measures were one-sided spraying applications of the outer vineyard row; one-sided spraying applications of the two last rows; spraying with closed air assistance on the outer rows; and finally, spraying with the use of air induction nozzles. Results indicated that each technique produced varying amounts of sedimenting drift over distance. Spraying without air assistance consistently generated the lowest levels of drift at almost all distances. While air induction nozzles initially increased drift deposition within the first 4 m, they significantly reduced drift beyond 5 m. These findings demonstrate that simple operational adjustments to conventional vineyard sprayers, particularly reducing or switching off air assistance in outer rows, can substantially decrease spray drift without requiring additional investment in specialized equipment. Overall, spraying without air support achieved the greatest drift reduction across all distances from the vineyard, followed by air induction nozzles, which were equally effective at further distances (past 5 m) but less so near the application area. The results provide practical guidance for vineyard growers seeking low-cost strategies to minimize agricultural input losses, environmental contamination, and improve the sustainability of pesticide applications. Full article

Conventional axial sprayers are poorly suited to orchards located in sensitive contexts (near water bodies, frequented by bystanders) or to large-volume trees. The result is often poor distribution within the canopy leading to more or less effective disease or insect control, off-target drift leading to environmental pollution and economic inefficiency. Trunk microinjection of plant protection products (PPPs) as a target-precise delivery system could greatly reduce the drift and improve the PPPs application. This study investigated the efficacy of five PPPs (flonicamid, spirotetramat, azadirachtin, lambda-cyhalothrin and deltamethrin) microinjected into the trunk of apple trees in 2022, 2023 and 2024 for managing Apple Rosy Aphid (Dysaphis plantaginea). Observations focused on aphid colonization and residue dynamics in buds, leaves and fruits. Under the conditions of the experiments, azadirachtin microinjection significantly reduced autumn infestation from 87 to 100% and spring infestation from 88 to 97%. The results obtained with flonicamid showed greater variability: from 50 to 80% fall infestation reduction and from 26 to 89% spring infestation reduction depending on the strategy and year. Spirotetramat and the two pyrethroids tested did not provide satisfactory control of populations. Residue levels varied by injected compound and the analyzed tissues. This study demonstrated that trunk microinjection could be an effective delivery method for existing PPPs, depending on the active ingredient, for controlling rosy apple aphids in orchards. Full article

Third-party punishment involves bystanders voluntarily incurring costs to punish norm violators, thereby maintaining social norms and cooperation. While prior research shows reduced punishment when the bystander and violator are friends, less is known about how the violator–victim relationship affects such punishment. Based on deterrence theory, punishment serves both to sanction violations and deter future threats. Accordingly, using the Dictator Game–third-party punishment paradigm across five experiments with a primary adult sample, this study investigated the impact of social relationships on third-party punishment, examined the mediating role of threat perception, and validated the applicability of deterrence theory within the context of third-party punishment. A pilot experiment confirmed that bystanders punish friends less than strangers. Experiment 1 showed that when the bystander and violator were friends, punishment was stronger if the violator and victim were also friends. Experiment 2 showed that congruent social relationships (e.g., all parties are friends) elicit greater punishment than incongruent ones. Experiment 3 demonstrated that threat perception mediates this effect: consistency increases threat perception, which in turn heightens punishment. In summary, consistency of social relationships increases third-party punishment, mediated by elevated threat perception. These findings support the use of deterrence theory in third-party punishment contexts and deepen our understanding of how social relationships shape punitive behavior. Full article

Our paper presents an intuitive model of bystander intervention to workplace mistreatment. Drawing on the literature on moral intuition, our paper proposes (1) that bystanders match an observed conduct to mistreatment descriptions (the first type of mistreatment prototypes), and (2) that bystanders make intuitive judgments and take immediate interventions when intervention prescriptions (the second type of mistreatment prototypes) exist in their long-term memory. Our paper also argues that bystanders’ intuitive judgments and interventions depend on the accessibility of their mistreatment prototypes, which are formed through learning mechanisms. Our paper contributes to the literature on bystander responses to workplace mistreatment. Full article

(1) Background: Out-of-hospital cardiac arrest (OHCA) remains a major public health issue, with survival largely determined by the initial rhythm and timeliness of resuscitation. Comprehensive population-based data are essential for guiding prevention, emergency medical services (EMS) planning, and improving outcomes. (2) Methods: We performed a retrospective observational study of all adult OHCA cases managed by EMS in Lecce (Italy) between January 2013 and March 2025. Demographics, arrest circumstances, initial rhythm, time intervals, and return of spontaneous circulation (ROSC) were analyzed across age, sex, temporal, and pandemic-related strata. Rhythm classification followed European Resuscitation Council guidelines. (3) Results: A total of 11,653 cases were analyzed (mean age 76.8 ± 15.5 years, 56.6% male). Asystole (AS) was the predominant rhythm (88.7%), followed by ventricular fibrillation (VF, 7.6%), pulseless electrical activity (PEA, 1.3%), and pulseless ventricular tachycardia (pVT, 0.08%). VF was more common in younger and male patients, while AS increased with age. Hour-level analysis revealed circadian peaks: VF in late afternoon and AS in early morning. Pandemic analysis showed reduced VF and increased AS during COVID-19, with partial recovery post-pandemic. ROSC occurred in 3.47% overall, strongly associated with shockable rhythms. EMS response times were stable across day–night and pandemic phases. (4) Conclusions: AS dominates OHCA presentations, especially among the elderly, whereas VF remains the strongest predictor of ROSC. Circadian variation at the hourly level suggests potential for EMS optimization. Pandemic-related shifts in rhythm highlight the vulnerability of the chain of survival to societal disruptions. Strengthening bystander CPR, expanding AED availability, and tailoring EMS strategies remain key priorities for improving OHCA outcomes. Full article

While school bullying has received substantial academic attention, the specific roles of teachers as (co-)perpetrators or bystanders in (cyber-)bullying dynamics remain markedly underexplored—particularly in the Austrian context. This article foregrounds pupils’ perception of teachers’ involvement in (cyber-)bullying. Drawing on feminist perspectives and insights from digital and gender(-queer) geographies, as well as interdisciplinary (cyber-)bullying research, it explores how pupils perceive teachers’ involvement in bullying dynamics and how they believe it shapes the perceived severity, trajectories, and outcomes of (cyber-)bullying. In doing so, the article contributes a specific but underexplored perspective on power and violence in schools. The analysis is based on 41 written narratives produced by young people attending upper secondary vocational colleges in Austria. The findings reveal that pupils subjectively perceive teachers as taking on various roles in (cyber-)bullying dynamics, including preventers, (silent) accomplices, defenders, outsiders, and (co-)perpetrators. In these accounts, teacher involvement in bullying reinforces power hierarchies, intensifies victimisation, and intersects with peer bullying dynamics, creating a complex system of interrelated influences. The study highlights the intersectional nature of discrimination and bullying, showing how pupils’ identities are entangled with their embodied experiences of both teacher- and peer-perpetrated bullying. These findings suggest an urgent need for spatially and structurally informed reforms in school policies and teacher training programmes to address teacher-perpetrated bullying, raise awareness of teachers’ responsibility in peer bullying dynamics, and foster safer, more inclusive learning spaces for pupils in Austria. Full article

Backgrounds: Cyberbullying represents a major concern for students, yet most studies rely on quantitative and adult-centered perspectives. Understanding adolescents’ views on cyberbullying is crucial for prevention. Method: We conducted sixteen focus groups with 220 Italian middle school students (ages 11–13). Transcripts were inductively analyzed to identify domains, core ideas, and the occurrence of categories (general, typical, variant) using the Consensual Qualitative Research method. Results: Four main domains emerged: definitions, behaviors, roles, and coping strategies. Adolescents defined cyberbullying as a hostile online interaction marked by publicity, often followed by anonymity; few mentioned repetition. Direct acts such as insults, threats, and non-consensual image sharing were viewed as the most harmful behaviors, followed by impersonation and identity theft, while online challenges and other forms were less mentioned. Students mainly perceived cyberbullying as a dyadic interaction between bully and victim, showing limited awareness of pro-bullies, few references to bystanders, and no mention of defenders. Finally, participants focused on victims’ responses with little attention to bystanders’ coping strategies. Conclusions: By revealing a nuanced understanding of cyberbullying, adolescents emphasize the need for prevention programs that not only address online risks but also build on their own language, perspectives, and experiences. Full article

Purpose: Castration-resistant prostate cancer (CRPC) responds poorly to conventional chemotherapy. We evaluated a cell-based enzyme–prodrug therapy using adipose-derived stem cells (ADSCs) engineered to express cytosine deaminase (CD) or carboxylesterase 2 (CE2), paired with their respective prodrugs 5-fluorocytosine (5-FC) or irinotecan (CPT-11), to compare their antitumor efficacy. Materials and Methods: Human telomerase reverse transcriptase (hTERT)-immortalized ADSCs were transduced with CD or CE2, and transgene expression and stem cell phenotype were confirmed. CD expression was verified at the transcript level and by functional 5-FC-to-5-fluorouracil (5-FU) conversion, whereas CE2 expression was verified by transcript analysis and immunoblotting. Tumor tropism toward PC3 prostate cancer cells was tested using migration assays and analysis of chemoattractant ligand/receptor expression. Prodrug-induced self-killing and bystander tumor cell killing were assessed through viability assays and co-culture with PC3 cells. For the CE2/CPT-11 system, SN-38 was not directly quantified; functional activity was inferred from prodrug-dependent cytotoxicity and in vivo efficacy. In vivo efficacy was evaluated in nude mice with PC3 tumors treated systemically with engineered ADSCs plus prodrug. Results: CD- and CE2-expressing ADSCs were successfully established and retained mesenchymal stem cell (MSC) characteristics. Both cell types exhibited significant migration toward PC3 cells. The CE2/CPT-11 system produced stronger prodrug-mediated cytotoxicity than CD/5-FC, with CE2-modified ADSCs showing higher sensitivity to CPT-11 and inducing greater apoptosis in co-cultured PC3 cells. In vivo, both treatments suppressed tumor growth, but CE2/CPT-11 achieved greater inhibition (tumor volume ~26% of control vs. ~32% for CD/5-FC at day 14). No overt clinical toxicity was observed based on body weight and daily clinical monitoring; however, hematology/serum chemistry were not assessed. Conclusions: Engineered ADSCs home to CRPC tumors and enable local prodrug activation, producing significant antitumor effects. Within the constraints of our in vitro assays and subcutaneous xenograft model, CE2/CPT-11 demonstrated stronger efficacy outcomes than CD/5-FC. Mechanistic attribution to intratumoral SN-38 exposure should be confirmed by direct metabolite measurements in future studies. Full article

HER2-positive breast cancer accounts for 15–20% of all breast cancers. The introduction of anti-HER2 therapies has markedly improved the clinical outcomes; however, overcoming drug resistance in metastatic disease remains a major challenge. This review summarizes the multilayered mechanisms of resistance to trastuzumab and pertuzumab and outlines the rationale for sequential treatment strategies based on the emerging evidence. Resistance arises through diverse and often coexisting mechanisms, including structural alterations in the HER2 receptor (e.g., p95HER2 and HER2 mutations), constitutive activation of the PI3K–AKT–mTOR pathway, and engagement of bypass signaling through receptors such as HER3 and IGF-1R, as well as immune evasion and metabolic reprogramming. Given this complexity, the strategic sequencing of agents with distinct mechanisms of action is critical beyond first-line therapy. Trastuzumab deruxtecan demonstrates substantial antitumor activity through potent cytotoxic effects and a bystander effect, supporting its efficacy in tumors with intratumoral heterogeneity or downstream pathway activation. In contrast, tucatinib-based regimens represent an important option for patients with brain metastases and tumors expressing p95HER2. The ongoing development of novel antibody–drug conjugates and bispecific antibodies is expected to further advance personalized sequential therapy targeting composite resistance mechanisms. Full article

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of sudden death worldwide, with wide variation in reported incidence and outcomes driven by heterogeneity in registries, emergency medical services (EMS) organization, and case definitions. Despite substantial advances in resuscitation systems, survival after EMS-treated OHCA generally remains below 10%, and outcomes are critically time dependent. Delays in emergency call activation, bystander cardiopulmonary resuscitation (CPR), and—most importantly—early defibrillation are associated with a rapid decline in return of spontaneous circulation and favorable neurological recovery. This narrative review synthesizes current evidence and implementation strategies aimed at reducing “time-to-CPR” and “time-to-shock,” with a specific focus on public-access defibrillation (PAD) as a tool to mitigate avoidable delay. Randomized trials and large registry studies consistently demonstrate that automated external defibrillator (AED) use before EMS arrival is a key determinant of survival in patients with shockable rhythms. However, the real-world effectiveness of PAD remains limited by suboptimal AED placement, restricted 24/7 accessibility, low public awareness, and underutilization driven by fear and lack of confidence. We compare different PAD delivery models—including EMS-based, police and first-responder-based, and fully integrated community systems—and summarize evidence supporting targeted, high-yield AED deployment and cost-effectiveness. In addition, we review emerging strategies to reduce avoidable delay and strengthen the early links of the chain of survival, such as school-based training programs, smartphone- and SMS-based citizen-responder networks, improved dispatch recognition of cardiac arrest (including artificial intelligence–supported tools), and drone-enabled AED delivery. Across these approaches, patient benefit critically depends on system integration, alert performance, and true AED accessibility. Finally, we describe the Italian “Progetto Vita” experience as a community-integrated model explicitly designed to minimize avoidable delay through widespread AED deployment, lay responder training, and real-time integration with EMS. We conclude by outlining future priorities, including the development of robust national OHCA registries and scalable solutions for the high burden of cardiac arrests occurring at home, such as population-level deployment of low-cost, ultra-portable AEDs. Full article

Background: Cyberbullying has emerged as a major public health concern with profound psychological repercussions on the adolescent population. The shift toward virtual communication has fundamentally altered interpersonal dynamics, removing the spatio-temporal barriers of aggression and creating new challenges for mental health. Methods: A systematic review was conducted following PRISMA 2020 guidelines, including a comprehensive update executed in February 2026. Searches were performed across PubMed, EBSCO, Web of Science, and Scopus. The review included observational and experimental studies involving adolescents (aged 10–19 years) reporting clinical mental health outcomes. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Results: Forty-two high-quality articles were selected. Key findings include the following: Prevalence: A median cyber-victimization prevalence of 19.1% was identified, although significant methodological heterogeneity exists with ranges between 2.1% and 88.0%. Clinical Impact: Victims exhibited significantly elevated rates of depression (90%) and anxiety (87%) compared to uninvolved peers. Suicidality: Victimization is a critical risk factor, with suicide attempts reported in 19.0% of victims, compared to 3.0% in aggressors. Vulnerable Groups: Adolescents with autism spectrum disorder (ASD) demonstrated extreme vulnerability, with victimization rates between 64.1% and 68.9%. Additionally, females and LGBTQ+ youth showed a higher risk of symptom internalization and post-traumatic stress. The Role of the Bystander: Observers experienced fear, moral frustration, and helplessness, acting as either passive reinforcers or active upstanders depending on the school climate. Conclusions and Implications: Effective prevention requires a socio-ecological approach that transcends the classroom, integrating families, healthcare centers, and technological platforms. A transition toward modernized cyber-education is recommended, utilizing interactive tools and “serious games” to foster empathy. Full article