Search Results (693)

Background: Overtime adversely affects physical and mental health, contributing to irritability, anxiety, reduced sleep, and even cardiovascular issues, ultimately lowering care quality and increasing turnover intentions. This study aimed to investigate whether prolonged overtime increases the risk of occupational burnout over time among healthcare workers. Methods: We conducted a four-year longitudinal observational study using secondary data from annual surveys (2021–2024) of healthcare workers at a medical university hospital in Taichung, Taiwan. Burnout was assessed using the personal burnout (PB) scale from the Copenhagen Burnout Inventory (CBI), with high PB levels (HPBL) defined as scores in the upper quartile of the 2021 baseline. Survival analysis utilizing the Kaplan–Meier method and Cox regression investigated burnout progression and the effects of overtime. Results: HPBL was defined as PB scores ≥45.83 (upper quartile in 2021). The proportions of HPBL were 30.28% (2021), 33.29% (2022), 36.75% (2023), and 32.51% (2024). Survival analysis confirmed that the risk of burnout increased over time, with the survival time estimated at 2.50 ± 0.03 years and lower survival probabilities observed among participants working overtime (Log-rank test, p < 0.0001). Multivariate logistics revealed overtime work, female gender, being a physician/nurse, and reduced sleep as independent risk factors for HPBL (OR = 3.14 for overtime, p < 0.001). These findings support the hypotheses on burnout progression and the impact of overtime. Conclusions: Overtime significantly heightens the risk of burnout, which worsens over time. Female sex, healthcare roles, obesity, and insufficient sleep are additional risk factors. Limiting overtime and proactive interventions are crucial to preventing burnout in healthcare workers. Full article

This study characterized collagen remodeling in an electron-beam-sterilized porcine acellular dermal matrix (E-PADM) by evaluating host response kinetics during wound healing. E-PADM (n = 6 lots/time point) was implanted in an abdominal wall bridging defect in nonhuman primates (N = 24). Histological, immunohistochemical, and biochemical assessments were conducted. Pro-inflammatory tissue cytokines peaked 1 month post-implantation and subsided to baseline by 6 months. E-PADM-specific serum immunoglobulin G antibodies increased by 213-fold from baseline at 1 month, then decreased to <10-fold by 6–9 months. The mean percentage tissue area staining positively for matrix metalloproteinase-1 plateaued at 3 months (40.3 ± 16.9%), then subsided by 6 months (16.3 ± 11.1%); tissue inhibitor matrix metalloproteinase-1 content plateaued at 1 month (39.0 ± 14.3%), then subsided by 9 months (13.0 ± 8.8%). Mean E-PADM thickness (1.7 ± 0.2 mm pre-implant) increased at 3 months (2.9 ± 1.5 mm), then decreased by 9 months (1.9 ± 1.1; equivalent to pre-implant). Histology demonstrated mild inflammation between 1–3 months, then a peak in host tissue deposition, with ≈75%–100% E-PADM collagen turnover, and fibroblast infiltration and neovascularization between 3–6 months. Picrosirius red staining revealed that mature E-PADM collagen was replaced by host-associated neo-collagen by 6 months. E-PADM implantation induced wound healing, which drove dermal E-PADM collagen remodeling to native, functional fascia-like tissue at the implant site. Full article

A process evaluation was embedded in the multinational Music Interventions for Dementia and Depression in ELderly care (MIDDEL) trial to better understand barriers and facilitators for implementing music-based interventions (MBIs). Stakeholders from 66 care home units across 5 countries completed a survey at baseline (n = 229) and after a six-month intervention period (n = 101), comparing expectations and experiences between countries, intervention groups, and stakeholders. MBIs were evaluated and found to be relevant and feasible. Barriers include a lack of support, turnover among employees, and a lack of motivation. Facilitators include individual stakeholders who proactively facilitate and stimulate implementation, as well as the presence of stable, well-functioning teams, clear communication, and adhering to project plans. Fewer barriers than expected related to care staff workload and the time needed for implementing new MBIs in care homes. MBIs can be beneficial for people with dementia, yet implementation in care homes can be challenging due to contextual factors. Involving stakeholders in key positions is essential: care home managers are pivotal for policy-making and the sustainable adoption of MBIs, whereas the commitment and the involvement of care staff are needed for day-to-day implementation. Insight into these barriers to and facilitators of implementation can contribute to the interpretation of trial results. Full article

Osteoporosis is a chronic disease associated with significant morbidity and mortality and requires long-term therapy. Efficacious and well-tolerated treatments are available, but their effect is either short-lived or lost following their discontinuation. The exception is bisphosphonates that reduce bone resorption and turnover, can be administered in regimens ranging from once-daily to once-yearly, and have been shown in randomized clinical trials to reduce the incidence of all osteoporotic fractures, but their effect persists following their discontinuation. This is due to their property of being taken-up selectively by the skeleton and being slowly released following treatment arrest. This property allows the discontinuation of bisphosphonate treatment for different periods of time, the so-called drug holiday, which reduces the risk of rare adverse events while maintaining the effect; an action particularly important for patients at very high risk of fractures for whom sequential therapy with different agents is currently advised. Thus, bisphosphonates, apart from being the treatment of choice for certain groups of patients, are also indispensable for the consolidation and maintenance of the gains of all other treatments, providing, in addition, the opportunity of temporary treatment arrest. Most patients with postmenopausal osteoporosis will, therefore, receive bisphosphonate at some stage during therapy of their disease, regardless of their initial fracture risk. Full article

Background: Optimizing critical care sedation is an important and complex task. Although intravenous sedatives are widely used, they do have limitations compared to volatile sedatives, such as faster awakening and minimal accumulation. However, volatiles are still rarely used due to technical barriers and costs. We intended to conduct an economic evaluation on the workload and efficiency of short-term volatile sedation. Methods: Retrospective secondary data analysis of the cost of 60 min sedation after cardiac valve surgery performed at a tertiary center (n = 94), including assessment of material turnover, substance consumption and personnel expenses combined on a monetary basis. Results: The time required for bedside preparation was extended from almost 18 min (i.v. sedation) to an additional 9–10 min when applying volatile sedatives. We calculated a median sevoflurane consumption of 23 mL using MIRUS^TM and 14 mL using Sedaconda, resulting in an average price of EUR 38.43 for propofol, EUR 13.24 for sevoflurane under Sedaconda, and EUR 15.03 using MIRUS^TM for application in the monetary evaluation. The total prices were calculated based on an additionally optimized scenario of weekly use of a MIRUS^TM reflection device system, at EUR 128.99 versus EUR 119.73 (Sedaconda) versus EUR 48.44 for conventional propofol-based sedation. Conclusions: The use of volatile sedation in intensive care has a higher price in short-term use due to the cost of the single-use reflector of the anesthetic conserving device, which is difficult to offset financially against the pharmacological benefits in terms of faster recovery. However, the additional setup times are relatively short. Clinical benefits such as faster recovery were not included in the cost analysis. Full article

Background: Employee turnover poses a multi-faceted challenge to organizations by undermining productivity, morale, and financial stability while rendering recruitment, onboarding, and training investments wasteful. Traditional machine learning approaches often struggle with class imbalance and lack transparency, limiting actionable insights. This study introduces an Explainable AI (XAI) framework to achieve both high predictive accuracy and interpretability in turnover forecasting. Methods: Two publicly available HR datasets (IBM HR Analytics, Kaggle HR Analytics) were preprocessed with label encoding and MinMax scaling. Class imbalance was addressed via GAN-based synthetic data generation. A three-layer Transformer encoder performed binary classification, and SHapley Additive exPlanations (SHAP) analysis provided both global and local feature attributions. Model performance was evaluated using accuracy, precision, recall, F1 score, and ROC AUC metrics. Results: On the IBM dataset, the Generative Adversarial Network (GAN) Transformer model achieved 92.00% accuracy, 96.67% precision, 87.00% recall, 91.58% F1, and 96.32% ROC AUC. On the Kaggle dataset, it reached 96.95% accuracy, 97.28% precision, 96.60% recall, 96.94% F1, and 99.15% ROC AUC, substantially outperforming classical resampling methods (ROS, SMOTE, ADASYN) and recent literature benchmarks. SHAP explanations highlighted JobSatisfaction, Age, and YearsWithCurrManager as top predictors in IBM and number project, satisfaction level, and time spend company in Kaggle. Conclusion: The proposed GAN Transformer SHAP pipeline delivers state-of-the-art turnover prediction while furnishing transparent, actionable insights for HR decision-makers. Future work should validate generalizability across diverse industries and develop lightweight, real-time implementations. Full article

Fracture risk is a serious yet underrecognized complication among patients with chronic kidney disease (CKD), especially in those with stages G3-G5D. The overlap between CKD-Mineral and Bone Disorder (CKD-MBD) and osteoporosis leads to complex bone changes that increase the likelihood of fragility fractures. Studies show that 18% to 32% of CKD patients also have osteoporosis, and these individuals are more than 2.5 times as likely to suffer from fractures compared to those without CKD. In the advanced stages of the disease, fracture risk is up to four times higher than in the general population, with the femur, forearm, and humerus being the most commonly affected sites. Hip fractures are of particular concern as they are linked to longer hospital stays and higher rates of morbidity and mortality. Furthermore, dialysis patients who experience hip fractures have a mortality rate 2.4 times higher than those in the general population with similar fractures. This increased risk underscores the need for proactive bone health maintenance in CKD patients to prevent fractures and related complications. This review explores the underlying pathophysiological mechanisms, diagnostic challenges, and treatment options related to bone fragility in CKD. Diagnostic tools, such as bone mineral density (BMD) assessments, the trabecular bone score (TBS), and biochemical markers, remain underused, especially in advanced CKD stages. Recent treatment strategies emphasize a multidisciplinary, stage-specific approach, incorporating calcium and vitamin D supplements, anti-resorptive agents like denosumab, and anabolic therapies such as teriparatide and romosozumab. Effective management needs to be tailored to the patient’s bone turnover status and stage of CKD. Despite progress in understanding bone fragility in CKD, significant gaps remain in both diagnosis and treatment. Personalized care, guided by updated KDIGO recommendations and based on an interdisciplinary approach, is essential to reduce fracture risk and improve outcomes in this vulnerable population. Further research is needed to validate risk assessment tools and refine therapeutic protocols. Full article

Background/Objectives: Increasing evidence suggests that metabolic dysfunction-associated steatotic liver disease (MASLD) and hypertension (HTN), a well-established cardiometabolic risk factor, both negatively impact bone metabolism. This study aimed to investigate the associations between bone turnover markers (BTMs)—namely, osteopontin (OPN) and procollagen type 1 N-terminal propeptide (P1NP)—and metabolic health indicators, non-invasive measures of liver disease severity, as well as skeletal muscle mass (SMM), muscle strength, and bone mineral density (BMD) in patients with MASLD and HTN. Methods: We enrolled 117 patients diagnosed with MASLD and HTN and conducted anthropometric measurements, laboratory analyses, abdominal ultrasound, and point shear-wave elastography. Muscle strength was evaluated using grip strength measurements and the Five Times Sit-to-Stand Test (FTSST). SMM and BMD were quantified using dual-energy X-ray absorptiometry (DEXA). Serum OPN and P1NP concentrations were quantified using enzyme-linked immunosorbent assays (ELISAs). Results: Serum OPN concentrations below 2.89 ng/mL were associated with significantly elevated levels of AST (p = 0.001), ALT (p = 0.006), and GGT (p = 0.025), while serum P1NP concentrations above 47.5 pg/mL were associated only with significantly elevated GGT levels (p = 0.024). In addition, patients with MASLD and HTN with lower serum OPN levels had higher liver stiffness values (p = 0.003). Serum OPN concentrations were inversely associated with the following metabolic health indicators: waist circumference (WC, p < 0.001) and epicardial fat thickness (EFT, p = 0.001). In addition, they were significantly elevated in patients with MASLD and HTN who had decreased spinal BMD (p = 0.017). In turn, serum P1NP levels were reduced in patients with decreased SMM (p = 0.023). Conclusions: These findings in patients with MASLD and HTN suggest an association between serum P1NP levels and SMM, and between OPN levels and spinal BMD, indicating a potential interplay among liver function, muscle mass, and bone health. Furthermore, OPN appeared to be strongly associated with overall metabolic health indicators, such as WC and EFT, whereas P1NP exhibited a stronger association with muscle mass. Full article

Rotator cuff tears are a leading cause of shoulder pain and dysfunction, yet the molecular mechanisms that link tendon injury to inflammation and nociceptive signaling remain poorly understood. Netrin-1, a classical axon guidance cue signaling through dependence receptors UNC5B and Neogenin-1, has been implicated in both neuronal plasticity and inflammatory processes, but its role in tendon pathology has not been explored. A rat supraspinatus tear model was employed to assess, in vivo, the expression of genes encoding netrin-1 (Ntn1) and its receptors (Unc5b and Neo1) at 0, 7, 14, 28, and 56 days post-injury (n = 10 per time point). Primary rat tenocytes isolated from rotator cuff tissue were treated in vitro with recombinant netrin-1, and transcriptional changes in genes encoding TNF-α (Tnfa), IL-6 (Il6), MMP-1 (Mmp1), and MMP-3 (Mmp3) were quantified by qRT-PCR. Separately, human iPSC-derived sensory neurons were exposed to netrin-1, and dose- and time-dependent effects on neurite outgrowth were measured at 4 and 14 days in culture. In injured tendons, Ntn1 mRNA increased significantly at day 14 (p = 0.010) and 28 (p = 0.042), Unc5b at day 7 (p = 0.002) and 14 (p < 0.001), and Neo1 at day 14 (p < 0.001) versus intact controls. Tenocyte exposure to 500 ng/mL netrin-1 induced transient upregulation of Tnfa (3 h, p = 0.023; 6 h, p = 0.009) and Il6 (3 h–24 h, all p < 0.013), as well as Mmp3 (3–24 h, p < 0.043) and Mmp1 (6 h–24 h, p < 0.024); no induction was observed at 50 ng/mL. In sensory neurons, 50 ng/mL of netrin-1 enhanced neurite extension at day 4 (p = 0.006) but not at 500 ng/mL or at day 14 for either dose. Netrin-1 and its receptors are upregulated in a rat rotator cuff tear model, and netrin-1 elicits distinct pro-inflammatory and matrix-remodeling responses in tenocytes while promoting early neurite growth in sensory neurons. These findings suggest netrin-1 as a key modulator of tendon inflammation, matrix turnover, and peripheral nerve plasticity following injury. Full article

Circadian rhythms govern cellular metabolism, redox balance, and endocrine signaling in numerous tissues. However, chronic disturbance of these biological rhythms, mediated by modern lifestyle factors including shift work, sleep irregularity, and prolonged light exposure, has been increasingly associated with oxidative stress, metabolic dysregulation, and the pathogenesis of chronic diseases. This review discusses recent mechanistic advances that link circadian misalignment with tissue-specific metabolic reprogramming and impaired proteostasis, focusing on metabolic inflammation and associated pathologies. Emerging work reveals a close interdependence between the circadian clock and proteasome-mediated protein turnover and highlights this interplay’s importance in maintaining redox homeostasis. Furthermore, circadian modulation of the activity of the inflammasome complex is suggested to represent an important, but largely unexplored, risk factor in the pathobiology of both malignancy and metabolic syndrome. Recently, researchers have proposed them as novel endocrine regulators of systemic energy balance and inflammation, with a focus on their circadian regulation. In addition, the emerging domains of chrono-epigenetics and tissue-specific programming of the clock pathways may serve to usher in novel therapies through precision medicine. Moving ahead, circadian-based therapeutic approaches, including time-restricted feeding, chronopharmacology, and metabolic rewiring, have high potential for re-establishing physiological domain homeostasis linked to metabolic inflammation pathologies. Elucidating this reciprocal relationship between circadian biology and cellular stress pathways may one day facilitate the generation of precise interventions aiming to alleviate the health burden associated with circadian disruption. Full article

Musculoskeletal (MSK) disorders remain a major global cause of disability, with diagnostic complexity arising from their heterogeneous presentation and multifactorial pathophysiology. Recent advances across imaging modalities, molecular biomarkers, artificial intelligence applications, and point-of-care technologies are fundamentally reshaping musculoskeletal diagnostics. This review offers a novel synthesis by unifying recent innovations across multiple diagnostic imaging modalities, such as CT, MRI, and ultrasound, with emerging biochemical, genetic, and digital technologies. While existing reviews typically focus on advances within a single modality or for specific MSK conditions, this paper integrates a broad spectrum of developments to highlight how use of multimodal diagnostic strategies in combination can improve disease detection, stratification, and clinical decision-making in real-world settings. Technological developments in imaging, including photon-counting detector computed tomography, quantitative magnetic resonance imaging, and four-dimensional computed tomography, have enhanced the ability to visualize structural and dynamic musculoskeletal abnormalities with greater precision. Molecular imaging and biochemical markers such as CTX-II (C-terminal cross-linked telopeptides of type II collagen) and PINP (procollagen type I N-propeptide) provide early, objective indicators of tissue degeneration and bone turnover, while genetic and epigenetic profiling can elucidate individual patterns of susceptibility. Point-of-care ultrasound and portable diagnostic devices have expanded real-time imaging and functional assessment capabilities across diverse clinical settings. Artificial intelligence and machine learning algorithms now automate image interpretation, predict clinical outcomes, and enhance clinical decision support, complementing conventional clinical evaluations. Wearable sensors and mobile health technologies extend continuous monitoring beyond traditional healthcare environments, generating real-world data critical for dynamic disease management. However, standardization of diagnostic protocols, rigorous validation of novel methodologies, and thoughtful integration of multimodal data remain essential for translating technological advances into improved patient outcomes. Despite these advances, several key limitations constrain widespread clinical adoption. Imaging modalities lack standardized acquisition protocols and reference values, making cross-site comparison and clinical interpretation difficult. AI-driven diagnostic tools often suffer from limited external validation and transparency (“black-box” models), impacting clinicians’ trust and hindering regulatory approval. Molecular markers like CTX-II and PINP, though promising, show variability due to diurnal fluctuations and comorbid conditions, complicating their use in routine monitoring. Integration of multimodal data, especially across imaging, omics, and wearable devices, remains technically and logistically complex, requiring robust data infrastructure and informatics expertise not yet widely available in MSK clinical practice. Furthermore, reimbursement models have not caught up with many of these innovations, limiting access in resource-constrained healthcare settings. As these fields converge, musculoskeletal diagnostics methods are poised to evolve into a more precise, personalized, and patient-centered discipline, driving meaningful improvements in musculoskeletal health worldwide. Full article

Food waste significantly impacts the restaurant industry’s financial viability and environmental sustainability. This study explores training practices used to minimize food waste and identifies obstacles encountered in implementing these practices. Semi-structured interviews with 10 chefs from diverse restaurants in a mid-South U.S. state were conducted. Two themes emerged from the qualitative analysis. The results revealed that the predominant training methods were verbal instruction, mentoring, and hands-on coaching, emphasizing real-time feedback and individualized guidance. Training for front-of-house staff primarily included reducing unnecessary table items, whereas back-of-house employees focused on portion control and repurposing ingredients. Mentoring emerged as critical, especially for new employees with limited culinary experience, ensuring that they develop critical thinking skills and resourcefulness in minimizing waste. Chefs identified significant barriers, including staff cooperation, knowledge gaps, employee turnover, and resource limitations. Overcoming these challenges necessitates stronger managerial commitment, standardized guidelines, and incentive-based reinforcement. This study concludes that cultivating an organizational culture that embeds sustainability into training practices is essential. Practical strategies such as mentoring and continuous reinforcement can mitigate food waste, enhance operational efficiency, and promote a sustainable food system. Future research should quantify training impacts on waste reduction and examine consumer-side factors influencing restaurant food waste. Full article

The widespread application of pesticides in agriculture has raised increasing concerns regarding their ecological impact, particularly in aquatic environments. Among these, α-cypermethrin, a highly active isomeric form of cypermethrin, has been extensively used due to its potent insecticidal efficacy and low mammalian toxicity. However, its toxicity to non-target aquatic organisms remains insufficiently understood at the metabolic level. In this study, a targeted metabolomics approach was employed to investigate the biochemical effects of α-cypermethrin in adult zebrafish. Acute toxicity was first determined to establish sublethal exposure concentrations (0.15 µg/L and 1.5 µg/L), followed by a 48 h exposure under a controlled flow-through system. GC-MS/MS-based analysis quantified 395 metabolites, and multivariate statistical models (principal component analysis (PCA) and partial least square-discriminant analysis (PLS-DA)) revealed clear dose-dependent metabolic alterations at two time points. Pathway analysis identified disruptions in glycolysis, glycerolipid metabolism, amino acid turnover, and glutathione pathways. Notably, glutamate depletion and associated reductions in GABA (4-Aminobutanoate) and TCA (Tricarboxylic acid) cycle intermediates suggest oxidative stress-induced metabolic bottlenecks. These results provide mechanistic insights into α-cypermethrin-induced toxicity and demonstrate the utility of metabolite-level biomarkers for environmental monitoring. This study contributes to a systems-level understanding of how sublethal pesticide exposure affects vertebrate metabolism, offering a basis for improved ecological risk assessment and pesticide regulation. Full article

There are very few data linking recent climatic changes to changes in biological communities in the Russian Arctic, and no palaeoecological data are available from the Novaya Zemlya archipelago (NZ). We studied chironomid, cladoceran, and diatom communities from a 165-year-old sediment core from a lake on Southern Island, NZ. Sixteen diatom and four cladoceran species new to NZ were found in the lake. Significant changes occurred in biological communities; species turnover was highest for diatoms (2.533 SD), followed by chironomids (1.781 SD) and cladocerans (0.614 SD). Biological communities showed a correlation with meteorologically recorded climate parameters. For chironomids, the strongest relationships were found for T_June, T_July, and T_ann. Both planktonic proxies, diatoms, and cladocerans showed a relationship with summer and annual air temperature and precipitation. The largest shifts in communities can be linked to recent climatic events, including the onset of steady warming following the variable conditions at the end of the LIA (ca. 1905), the cooling associated with the highest precipitation on record between 1950 and 1970, and, probably, the anthropogenic influence specific to Novaya Zemlya at this time. The new data provide a valuable basis for future ecological studies in one of the least explored and remote Arctic regions. Full article

Indonesia’s high logistics costs—approximately 14.6% of its GDP—pose a significant challenge to national economic competitiveness. Key contributing factors include complex geography, fragmented multimodal transport systems and inefficient container terminal operations, particularly concerning the handling of empty containers. This study investigates operational optimization in a container terminal using Agile and Lean principles, without additional investment or infrastructure expansion. It compares throughput before and after optimization, focusing on equipment productivity and reduction in idle time, especially related to equipment and human resources. Field implementation began in 2015, followed by simulation-based validation using system dynamics modeling. The terminal demonstrated a sustained increase in capacity beginning in 2016, eventually exceeding its original design capacity while maintaining acceptable berth and Yard Occupancy Ratios (BOR and YOR). Agile practices improved empty container handling, while Lean methods enhanced berthing process efficiency. The findings confirm that significant reductions in port operational costs, shipping operational costs, voyage turnover time, and logistics costs can be achieved through strategic operational reforms and better resource utilization, rather than through capital-intensive expansion. The study provides a replicable model for improving terminal efficiency in ports facing similar constraints. Full article