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Abstract During this time of unprecedented staffing challenges, identifying factors impacting staff engagement may be one step towards rebuilding the healthcare workforce. This study was designed to identify work factors differentiating positively engaged employees from others. In May 2023, 350 employees (response rate=30%) from across a healthcare system (including skilled nursing facilities, adult day centers, community services, and assisted living) serving older adults in New York City and Westchester County, completed surveys examining employee engagement and satisfaction with five work factors. Engagement was measured using the employee net promoter scale (eNPS) in which employees rate from 1 (Not At All) to 10 (Very) “How likely is it that you would recommend the organization as a workplace.” Those answering 9-10 are classified as “Promoters” (engaged/positive concerning the workplace), 7-8 “Neutrals”, and 1-6 are “Detractors” (unengaged/negative). Participants also responded 1 “very unsatisfied” to 5 “very satisfied” on work factors: general work satisfaction, having enough resources/equipment, receiving timely information, supervisor support, and coworker respect. Based on eNPS responses, 160 (45.7%) employees were “Promoters”, 65 (18.6%) “Neutrals”, and 125 (35.7%) “Detractors.” A series of one-way analysis of variance and post-hoc Bonferonni analyses then examined work factor satisfaction by staff engagement level. As expected, “Promoters” and “Neutrals” were significantly more satisfied than “Detractors” on all five work factors however, only having enough resources/equipment separated “Promoters” (M=3.63, SD=1.24) from “Neutrals” (M=4.06, SD=89, p <.05). These findings indicate that providing staff with sufficient resources/equipment should be prioritized in the effort to establish a healthcare workforce of “Promoters.”

The impact of climate change on human and environmental health is of critical concern. Population exposures to air pollutants both indoors and outdoors are influenced by a wide range of air quality, meteorological, behavioral, and housing-related factors, many of which are also impacted by climate change. An integrated methodology for modeling changes in human exposures to tropospheric ozone (O 3 ) owing to potential future changes in climate and demographics was implemented by linking existing modeling tools for climate, weather, air quality, population distribution, and human exposure. Human exposure results from the Air Pollutants Exposure Model (APEX) for 12 US cities show differences in daily maximum 8-h (DM8H) exposure patterns and levels by sex, age, and city for all scenarios. When climate is held constant and population demographics are varied, minimal difference in O 3 exposures is predicted even with the most extreme demographic change scenario. In contrast, when population is held constant, we see evidence of substantial changes in O 3 exposure for the most extreme change in climate. Similarly, we see increases in the percentage of the population in each city with at least one O 3 exposure exceedance above 60 p.p.b and 70 p.p.b thresholds for future changes in climate. For these climate and population scenarios, the impact of projected changes in climate and air quality on human exposure to O 3 are much larger than the impacts of changing demographics. These results indicate the potential for future changes in O 3 exposure as a result of changes in climate that could impact human health.

Prostate cancer (PRCA) is the most common cancer in males in the western world. In Finland PRCA has an age-adjusted incidence of 81.5 per 100,000. We previously reported that in Finland, the late-onset cases in families with \"no-male-to-male\" (NMM) transmission of PRCA accounted for most of the linkage to the HPCX region (Xq27-28). The aim of the present study was to test for linkage disequilibrium (LD) and haplotype-sharing around marker DXS1205 between cases from hereditary prostate cancer (HPC) families and population controls. The initial allelic association was performed between 108 PRCA cases and 257 population controls genotyped for 23 markers in the Xq26-28 region. This resulted in a highly significant nominal one-sided Fisher's exact P-value of 0.0003 for allele ''180'' of marker DXS1205. Subsequently, a similar level of significance was observed for the same allele for marker DXS1205 (P=0.0002) when comparing 60 NMM cases and 257 controls. These results were still significant after Bonferroni correction for multiple testing. Fine mapping efforts included the genotyping of four additional markers D3S2390, bG82i1.9, bG82i1.1, bG82i1.0 and four single nucleotide polymorphisms (SNPs) to augment the original markers around DXS1205. Our major finding is that markers extending from ''D3S2390'' to ''bG82i1.0'' flank the critical locus, about 150 kb. Levin and Bertell's LD measure (delta), a guide to localization of a possible variant, was 0.42 and 0.41 for alleles of markers bG82i1.9 and DXS1205, respectively. In this study, the most significant haplotype comprised the three tightly linked, contiguous markers: ''cen-bG82i1.9-SNP-Hap B-bG82i1.1-tel'' [''197-2-234''] among several possible haplotypes (nominal Fisher's one-sided P=0.003). The two transcription units mapping within this interval are the LDOC1 and SPANXC genes. Positional cloning of the HPCX gene(s) is being facilitated by this exploration of the Xq26-28 region. This study represents the first report identifying a haplotype in the Xq27-28 region for an association between HPCX and X-linked prostate cancer with no-male-to-male transmission in the Finnish population.