Search Results (293)

Emergency Departments (EDs) are the primary hospital interface during disasters and mass-casualty incidents, yet surge capacity assessments predominantly emphasize workforce and logistics while overlooking measurable spatial determinants. Observations from five tertiary hospitals in India indicate that circulation bottlenecks, incompatible functional adjacencies, and contamination risks can compromise safety and operational performance. This study develops and validates the Spatial Surge Capacity Assessment Framework (SSCAF) to operationalize spatial resilience as a quantifiable dimension of healthcare infrastructure preparedness. A sequential mixed-methods design was applied across five tertiary hospitals using structured spatial walkthroughs; architectural and disaster-planning document review; and focus group discussions involving 81 clinicians, administrators, and facility planners. The outcome of this thematic analysis produced 42 spatial indicators, refined through three Delphi rounds with a multidisciplinary expert panel. Consensus retained 30 key performance indicators (median ≥ 4/5; IQR ≤ 1; Kendall’s W = 0.855; χ² = 297.42; p < 0.001). Content validity was strong (I-CVI 0.75–1.00; S-CVI/Ave = 0.93), and reliability was high (ICC 0.82–0.91), structured into eight operational domains. The resulting weighted scoring matrix standardizes the measurement of spatial surge preparedness. The SSCAF provides an evidence-based audit and planning tool supporting resilient hospital infrastructure. It aligns with the Sendai Framework, enabling governance audits, guiding ED retrofitting, and supporting performance-based evaluation for planners and architects. Full article

Background: Work-related stress represents a major challenge for nursing professionals and has significant implications for well-being, job satisfaction, and workforce stability. This study aimed to assess psychosocial working conditions and workplace stress among nurses in Slovenia and to identify organisational and occupational factors associated with stress exposure across different levels of care. Methods: A cross-sectional, non-experimental study was conducted using an online self-administered questionnaire. The sample included 736 nurses employed in outpatient settings, hospital wards, and high-intensity care units. Work-related stress was assessed using the Health and Safety Executive (HSE) Work-Related Stress Indicator Tool. Group differences were examined using the Kruskal–Wallis test with Bonferroni-adjusted post hoc comparisons. Associations between HSE dimensions and sociodemographic and work-related variables were analysed using Spearman’s correlation coefficients and multiple linear regression models. Results: Statistically significant differences between job positions by level of care were observed for all HSE domains except Demands. Differences in psychosocial working conditions were observed across levels of care, with several domains showing more favourable scores in outpatient and hospital ward settings compared with high-intensity care environments. Regression analyses identified job position by level of care, education level, income, workload indicators, continuous healthcare provision, and job mobility intentions as significant predictors across multiple HSE dimensions. Correlation analyses revealed consistent associations between adverse psychosocial working conditions, increased workload, and indicators of job mobility. Conclusions: This study shows that psychosocial working conditions among nurses in Slovenia differ by level of care, with several domains showing more favourable scores in outpatient and hospital ward settings than in high-intensity care environments. Work organisation—especially workload, role clarity, and managerial and peer support—was central to stress, linking adverse conditions to workforce instability and retention risks. Full article

The decarbonization of the transportation sector necessitates the adoption of practical measures that can be implemented within existing fleets. One such measure is the installation of solar panels on trucks, which has shown potential to reduce fuel consumption in heavy-duty vehicles (HDVs). This study presents lessons learned from a monitoring project involving 200 commercial trucks retrofitted with 300–500 W solar panels, aimed at supplementing battery charging and minimizing alternator operation. The system incorporated commercially available flexible photovoltaic (PV) modules, adhesive mounting techniques, a charge controller, and a data logger housed within a control box. Documentation covered installation procedures, wiring practices, and safety considerations across various truck models, with additional insights from electrical contractors regarding labor time and costs. Results indicate that adhesive-based mounting can be carried out safely and reliably without structural modifications, although wiring and control box placement constitute the most significant portions of the installation process. The project further identified variability in installation duration and economic viability, depending on vehicle configuration and technician expertise. Overall, the findings affirm that vehicle-integrated photovoltaic (VIPV) retrofits are both technically feasible and operationally robust. They also underscore the practical requirements, constraints, and workforce considerations essential for scaling deployment within commercial fleets. Full article

Given the global aging of the population and the rising retirement age, the development of cross-generational technologies is crucial for a sustainable workforce supply. While AI-powered smart glasses can provide continuous cognitive support, current industrial solutions often prioritize work efficiency at the expense of the physical, cognitive, and socio-emotional needs of older workers. This study employed a mixed-methods approach grounded in embodied cognition. First, semi-structured interviews with ten participants were analyzed using grounded theory to develop a four-dimensional model of embodied experience: Perceived Pressure, Action Feedback, Collaboration Embedding, and Belonging. Subsequently, four interaction strategies—Rhythm Control, Transparent Feedback, Non-intrusive Assistance, and Legible Privacy & Social Signaling—were formulated and implemented. A high-fidelity prototype was developed to embody these strategies. Finally, a team of eight multidisciplinary experts evaluated the device using the System Usability Scale (SUS) and a proprietary twelve-item questionnaire. The results showed that the device’s overall usability was borderline acceptable (SUS = 68.13 ± 8.94). While the devices received stronger ratings for Control & Safety, the ratings for dignity and social acceptance were comparatively low. These findings contribute to the development of wearable device operation strategies suitable for users of different generations, and underline the importance of social and emotional compatibility as a prerequisite for future practice tests. Full article

Background: Health and social care workers (HSCWs) experience high levels of stress, burnout and emotional strain. Psychological safety is increasingly recognised as a protective factor, yet limited research has examined how individual psychological safety and team psychological safety jointly contribute to mental health outcomes in frontline care environments. Methods: A total of 821 HSCWs completed validated measures assessing individual psychological safety (NPSS), team psychological safety (TPSS), well-being, burnout and acute stress. Correlational analyses and hierarchical regression models were used to evaluate the unique and shared contributions of individual and team psychological safety to each outcome. Results: Both NPSS and TPSS were significantly associated with well-being, burnout and acute stress. Team psychological safety emerged as the strongest predictor of burnout and acute stress, accounting for substantial additional variance beyond individual psychological safety, with increases in explained variance ranging from 0.14 to 0.16. For well-being, NPSS (β = 0.38) and TPSS (β = 0.36) were both significant predictors. TPSS demonstrated large effects for burnout (β = 0.67) and acute stress (β = 0.72). Conclusions: Psychological safety plays a central role in the mental health of HSCWs. Team-based psychological safety was particularly influential in protecting against burnout and acute stress, while individual neuroceptive safety remained important for supporting overall well-being. Strengthening both individual and team-level psychological safety may enhance resilience and reduce psychological risk within health and social care settings. Implications: Incorporating NPSS and TPSS within workforce assessment may support early identification of psychological vulnerability, inform trauma-informed organisational interventions and promote more resilient, supportive workplace cultures. Full article

The well-being of healthcare professionals (HCPs) is widely recognised as a critical construct related to workforce sustainability, patient safety, and healthcare system performance; however, research in this area remains conceptually fragmented. This systematic review identifies and critically analyses conceptual models, assessment instruments, and factors associated with HCPs’ subjective well-being. A comprehensive literature search was conducted across six databases covering 2014 to 2024, focusing on quantitative empirical studies published in English in peer-reviewed journals. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using the Joanna Briggs Institute criteria, and the methodological quality of measurement instruments was evaluated with the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist in validation-focused studies. Of the 7838 records initially identified, 48 studies met the inclusion criteria. Three primary thematic areas emerged: (1) conceptual models framing subjective well-being, (2) measurement instruments assessing subjective well-being, and (3) factors associated with subjective well-being among HCPs. Frequently applied conceptual frameworks included the job demands–resources model, Maslach burnout theory, and WHOQOL-related approaches. Commonly used instruments comprised the WHO-5, Maslach Burnout Inventory, and Mini-Z. In validation-focused studies assessed using COSMIN criteria, internal consistency and aspects of construct validity were generally reported as acceptable; however, reporting across measurement property domains was variable. Factors examined in relation to subjective well-being included workload, emotional exhaustion, social support, autonomy, and work–life balance. Overall, the reviewed literature demonstrates substantial variability in conceptual and methodological approaches and frequently focuses on single dimensions of well-being. These findings highlight the potential value of developing integrated, sector-specific frameworks to inform future measurement development and research in this field. Full article

Musculoskeletal symptoms (MSS) and sleep problems are prevalent in nurses. Evidence exploring associations between sleep and MSS in nurses is limited by self-reported sleep measures and recalling MSS over a long period. The purpose of this study was to examine the relationship between MSS and sleep in nurses using objective sleep measures and real-time MSS assessment. This 7-day observational study included 31 nurses who work day shifts. Sleep duration and efficiency were measured using accelerometers, and MSS were reported using ecological momentary assessment. Sleep metrics and MSS were compared between workdays and days off, and a regression model analyzed the effect of sleep duration on MSS while controlling for age and body mass index (BMI). On average, nurses did not sleep the minimum recommended duration of 7 h (6.28, SD = 1.31), and they slept significantly less prior to a workday (5.98 h, SD = 1.12) than a day off work (6.69 h, SD = 1.43) (t(185) = −5.92, p < 0.0001). Short sleep duration was associated with 18% higher MSS when controlling for age and BMI (t(822) = 2.63, p = 0.009). Understanding the association between sleep and MSS is important to healthcare organizations and policy makers because sleep is essential for health and recovery, and occupational characteristics, such as shift length and consecutive shifts, influence sleep. Nurse fatigue is detrimental to patient safety and the health of the nursing workforce, and musculoskeletal problems contribute to nurse attrition. This study may inform future research on organizational policies related to nurse fatigue and musculoskeletal symptoms. Full article

Background/Objectives: Machiavellianism has long been associated with unethical tendencies and behaviors. High-Mach people have been stereotyped to choose business-related professions, contrary to low-Mach individuals choosing the helping professions. There has been a clear shift in scholarly focus, such as Machiavellian leadership and Machiavellian personality traits in healthcare. The objective of this narrative literature review was to provide a structured synthesis of empirical evidence on Machiavellianism within healthcare settings, focusing on its prevalence, manifestations, and organizational implications, while identifying conceptual and research gaps in the field. Methods: Literature research was conducted for articles published in PubMed, Scopus, and Google Scholar from 2014 until 2025. Articles written in English, examining Machiavellian traits in healthcare workers and students, were included in this review. Results: The search strategy produced 347 items, of which 11 original studies were included. Machiavellianism was described as a personality trait featuring emotional coldness and manipulativeness for the achievement of one’s own ends; individuals exhibiting those traits may prioritize personal gain over collective welfare. Machiavellian tendencies manifesting in organizational culture often lead to a toxic work environment where manipulation might become normalized. Machiavellians show high commitment to their careers, but low commitment to their current organizations, supervisors, and teams. Conclusions: Machiavellianism emerges as a relevant but underexplored personality trait in healthcare, associated with unethical behaviors, reduced organizational commitment, and toxic work environments. Addressing its impact requires ethical leadership development, supportive organizational environments, and early identification during professional training to safeguard workforce well-being and patient safety. Full article

Underground tunnel construction projects using tunnel boring machines (TBMs) require a holistic risk perspective. Such projects face various risks arising from social, economic, political, workforce, and regulatory aspects during project execution. It is necessary to develop preventive strategies for managing these risks and thereby ensure timely project delivery, cost efficiency, and safety. In this study, we aimed to develop a comprehensive hybrid decision-making framework for analyzing risks in TBM-based tunnel construction projects. The proposed approach integrates the best–worst method (BWM), data envelopment analysis (DEA) model-based risk assessment, and the preference ranking organization method for enrichment evaluation (PROMETHEE). The BWM was applied to determine the weights of decision criteria with fewer comparisons and improved consistency. Subsequently, the DEA model was then used to compute local risk scores under multiple input and output conditions. Finally, PROMETHEE was employed to analyze the risks based on positive and negative outranking flows. The proposed approach was applied to a realistic metro construction project in Bangkok. The findings indicated that the proposed approach effectively compromised all the decision-making attributes to manage the uncertainties. The proposed methodology can support project managers, stakeholders, engineers, and relevant authorities in identifying high-priority risks and implementing effective mitigation strategies to enhance risk management in tunnel construction. Full article

Background/Objectives: Primary care faces transformation due to workforce shortages and reform. Italy’s Decree 77/2022 promotes Community Centers and extended care, while postgraduate training in general practice involves early clinical responsibility. In South Tyrol, trainees assume significant patient care duties early in a three-year program. This review examines traditional apprenticeship-based training and explores system-based supervision and AI as strategies for improving quality and safety. Methods: A narrative review synthesized the literature and policy on postgraduate general practice education, supervised autonomy, and AI tools in primary care. Searches used the PubMed and Consensus platforms, focusing on Italian primary care reform and South Tyrol. Evidence was analyzed using SANRA guidance. Results: Evidence consistently indicates that training quality depends less on individual supervisors and more on structured, system-based supervision frameworks, clear entrustment criteria, and supportive organizational contexts. Early supervised clinical autonomy in community-based primary care settings can accelerate competency development without compromising the quality of care when robust supervision and team structures are in place. AI-supported educational tools have the potential to augment feedback, assessment, and learning analytics, especially in settings with limited supervisory capacity; however, current evidence supports their use only as adjuncts to human supervision. Conclusions: Evidence supports system-based, competency-oriented supervision models over traditional apprenticeships in settings characterized by workforce constraints and distributed training sites. Integrated general-practitioner-led primary care settings offer favorable learning environments for postgraduate training, while service-oriented community hubs need careful governance as training sites. Though AI may support supervision, professional oversight remains essential for quality and safety. Full article

The Saudi construction industry relies heavily on a multinational workforce, raising safety concerns under high productivity demands. Although productivity pressure is widely assumed to influence workers’ risk perception and unsafe behavior, empirical evidence directly testing this assumption in culturally diverse construction settings remains limited. This study examines whether perceived productivity pressure predicts risk perception among construction workers from different national backgrounds working on the same project. Survey data were collected from 247 construction workers representing five nationalities on a university construction site in Saudi Arabia. Correlation analysis, regression modeling, and linear mixed-effects models were used to assess the relationship between productivity pressure and risk perception while controlling for age and nationality. The results show that perceived productivity pressure does not significantly influence workers’ risk perception, and this relationship is not moderated by age or nationality. Although cultural adjustment differed significantly across national groups, nationality did not alter the pressure risk perception relationship. These findings challenge prevailing assumptions in construction safety research and suggest that productivity pressure may affect unsafe behavior through mechanisms other than cognitive risk appraisal. The study contributes empirical evidence from a controlled multicultural setting and highlights the need for safety interventions that extend beyond productivity pressure management to address decision-making processes, communication, and risk assessment competencies within multinational construction workforces. Full article

The COVID-19 pandemic disrupted the global construction industry, resulting in workforce shortages, project delays, and contractual disputes. This study used an online survey of private engineering and construction companies to assess their responses to the challenges posed by COVID-19. The survey focused on workforce management, technological advancements, safety protocols, and project execution. Workforce adaptations, particularly the shift to telework, saw 66% of respondents reporting partial telework and 22% indicating that telework became permanent after the pandemic. Technological advancements were crucial for maintaining operations during the pandemic, with 82% of respondents reporting the adaptation of new digital tools. These included widespread adoption of Microsoft Teams and Zoom by both office and field staff. Training was identified as essential for the effective implementation of these technologies, enabling employees to maximize their benefits. The pandemic affected project design and construction activities, with 69% of respondents reporting delays during the design phase and 70% during construction. Cost overruns of up to 25% were reported in the public sector and 67% of respondents in the private sector reported cost overruns, highlighting the financial impact of the pandemic. The findings provide insights into organizational resilience strategies adopted by private firms and offer lessons that can inform preparedness for future disruptions. Full article

Artificial intelligence (AI), including machine learning (ML) and deep learning (DL), is rapidly transforming clinical veterinary practice by enhancing diagnostics, disease surveillance and decision support processes across animal health domains. The safe and effective clinical deployment of these technologies, however, depends critically on the preparedness of the veterinary workforce, positioning veterinary education as a strategic enabler of translational adoption. This narrative review examines the integration of AI within veterinary education as a foundational step toward its responsible application in clinical practice. We synthesize current evidence on AI-driven tools relevant to veterinary curricula, including generative and multimodal large language models, intelligent tutoring systems, virtual and augmented reality platforms and AI-based decision support tools applied to imaging, epidemiology, parasitology, food safety and animal health. Particular attention is given to how the structured educational use of AI mirrors real-world clinical workflows and supports the development of competencies essential for clinical translation, such as data interpretation, uncertainty management, ethical reasoning and professional accountability. The review further addresses ethical, regulatory and cognitive considerations associated with AI adoption, including algorithmic bias, data privacy, equity of access and the risks of overreliance, emphasizing their direct implications for diagnostic reliability and animal welfare. By framing veterinary education as a controlled and reflective environment for AI engagement, this article highlights how pedagogically grounded training can facilitate safer clinical deployment, foster interdisciplinary collaboration and align technological innovation with professional standards in veterinary medicine. Full article

Background and Objectives: The concurrent management of cholelithiasis and inguinal hernia remains a subject of surgical debate, primarily due to concerns regarding prosthetic mesh infection in a clean-contaminated field. This study evaluates the safety, cost-effectiveness, and functional outcomes of simultaneous totally extraperitoneal (TEP) repair and laparoscopic cholecystectomy (LC). Materials and Methods: A retrospective analysis was conducted on patients treated between 2015 and 2025 using a prospectively maintained institutional registry. The cohort was stratified into two arms: the Simultaneous Group (n = 16), undergoing synchronous TEP and LC; and the Staged Group (n = 13), managed via separate sessions. A strict “hernia-first” operative sequence was enforced to maintain sterility. Key endpoints included perioperative morbidity, long-term recurrence (mean follow-up: 53.9 months), economic burden, and quality of life (EuraHS-QoL). Results: No surgical site or prosthetic infections were documented in either cohort. The Simultaneous arm demonstrated a significantly reduced total operative duration compared to the cumulative time of the Staged approach (164.6 ± 44.9 vs. 226.2 ± 57.4 min; p = 0.003) and yielded a shorter hospitalization period (1.44 ± 0.51 vs. 2.31 ± 0.85 days; p = 0.002). Workforce reintegration was markedly accelerated in the simultaneous group (9.43 ± 3.36 vs. 24.69 ± 12.35 days; p < 0.001), translating to a total cost reduction of approximately 51% for unilateral cases. Conclusions: Concomitant TEP and LC represents a clinically viable and financially prudent strategy that does not compromise patient safety or prosthetic durability. Adherence to a strict “hernia-first” surgical sequence appears critical to preventing infectious morbidity. Given the superior resource utilization, this dual approach merits consideration as a primary therapeutic algorithm. Full article

The construction industry is increasingly challenged by an aging workforce and persistent labor shortages, underscoring the need for automation and the integration of construction robotics. However, the high uncertainty and variability of real construction environments impose significant constraints on robot design and deployment. In particular, accurately estimating the required operational force—without unnecessary overdesign—is essential for ensuring operational safety, energy efficiency, and battery endurance. Conducting on-site experiments that reflect diverse field conditions is often impractical, making simulation-based approaches a viable alternative. This study proposes a simulation-driven method for deriving energy-efficient, task-appropriate operational forces for construction robots. As a case study, an aluminum formwork dismantling operation was modeled in NVIDIA Isaac Sim, and a dataset of environmental variables was generated through random sampling. Sensitivity analysis revealed that the dynamic friction coefficient at the aluminum–aluminum interface had the greatest impact on the required dismantling force. To mitigate this influence, a lubrication strategy was introduced to reduce surface friction. With a 10% safety margin applied, the dismantling operation achieved a 99.5% success probability at an operational force of 50 N-representing an 11.71 N reduction and an 18.97% decrease compared to the non-lubricated scenario. These results demonstrate a practical and evidence-based approach for optimizing operational forces in construction robotics, contributing to reduced energy consumption, improved operational efficiency, and mitigation of construction schedule delays. Full article