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Background One factor influencing mental health is cognitive flexibility and emotion regulation. Employing adaptive strategies positively impacts the development of appropriate responses to emotional situations. Nursing students, particularly during initial patient and family interactions, may experience high stress and anxiety, often accompanied by reduced cognitive flexibility and emotion regulation. Therefore, incorporating strategies to enhance these skills, such as transactional analysis (TA) training, into nursing curricula is essential. TA is one of the theories that has provided practical solutions in the field of interpersonal relationships, increasing self-concept, and adapting to existing conditions in the field of interpersonal issues. This study aimed to evaluate the effect of TA training on cognitive flexibility and emotion regulation in nursing students. Methods This experimental study was conducted with a pre-test and post-test design with intervention and control groups among employed 80 sixth-semester nursing students from Razi School of Nursing and Midwifery affiliated with Kerman University of Medical Sciencesin southeastern Iran. The participants were included in the study via a census method and were randomly assigned to either an intervention group ( n  = 40) or a control group ( n  = 40). The intervention group received four weeks of TA training, consisting of two 90-minute sessions per week. The control group received no intervention during this period. Both groups completed the Cognitive Flexibility Inventory and the Affective Style Questionnaire before and one month after the intervention. Results Results indicated no significant difference in pre-test cognitive flexibility scores between the intervention (100.4 ± 17.38) and control groups (102.07 ± 15.53; p  = 0.065). However, post-test scores revealed a significant increase in cognitive flexibility in the intervention group (113.72 ± 10.73) compared to the control group (61 ± 16.85/101; p  = 0.001). Additionally, the intervention group exhibited a significant increase in post-test emotion regulation score (67.85 ± 7.42) compared to pre-test scores (64.58 ± 10.55; p  = 0.003). However, no significant difference in post-test emotion regulation scores was observed between the intervention and control groups (65.6 ± 10.64; p  = 0.27). Conclusion The results of this study demonstrated the efficacy of TA programs in enhancing cognitive flexibility and emotion regulation among nursing students. It is recommended that this intervention be implemented in medical education, particularly for nursing students who frequently interact with patients and may experience increased stress, anxiety, and reduced cognitive flexibility and emotion regulation during initial patient encounters. TA as an educational method, can enhance self-awareness, interpersonal relationship, and emotional regulation among nursing and nursing students in clinical setting. It can also It can be used to improve the quality of professional interactions and clinical practice of nursing students, finally enhancing the quality of nursing care.

Food rescue—the collection of perishable products from food suppliers who are willing to make donations, and their distribution to welfare agencies that serve individuals in need—has become increasingly widespread in recent years. This phenomenon is a result of economic crises, but it is also encouraged by the tax and good image it provides to donor companies. The problem we study in this paper focuses on the logistic challenges of a food bank that on a daily basis uses vehicles of limited capacity to distribute food collected from suppliers in the food industry to welfare agencies, under an imposed maximal traveling time. We model this problem as a routing resource allocation problem, with the aim of maintaining equitable allocations to the different agencies while delivering overall as much food as possible. We introduce an innovative objective function that satisfies desired properties of the allocation, that is easy to compute and implement within a mathematical formulation, and that balances effectiveness and equity acceptably. We present both an exact solution method and a heuristic approach, based on the large neighborhood search framework, which relies on the fact that a certain subproblem is easy to solve. Numerical experiments on several real-life and randomly generated data sets confirm that high-quality solutions may be obtained. The online appendices are available at https://doi.org/10.1287/opre.2018.1751 .

For people with private health insurance in the United States, contracts between insurers and providers are important to fostering health care competition and improving efficiency. However, insurer-provider contract provisions do not always advance competition and consumer welfare. This essay discusses the contracting strategies used by insurers to increase competition, and four anticompetitive contract terms: anti-tiering or anti-steering, all-or-nothing, most favored nation, and gag clauses, that may be used by dominant health systems to protect themselves from competition. I conclude with a discussion of policy responses that can be used to address provider use of anticompetitive clauses and that can reduce the negative impacts of provider market power. Understanding anticompetitive contract provisions and the potential policy responses to limit their impact is critical to health care competition.

How should decentralized supply chains set the profit sharing terms using minimal information on demand and selling price? We develop a distributionally robust Stackelberg game model to address this question. Our framework uses only the first and second moments of the price and demand attributes, and thus can be implemented using only a parsimonious set of parameters. More specifically, we derive the relationships among the optimal wholesale price set by the supplier, the order decision of the retailer, and the corresponding profit shares of each supply chain partner, based on the information available. Interestingly, in the distributionally robust setting, the correlation between demand and selling price has no bearing on the order decision of the retailer. This allows us to simplify the solution structure of the profit sharing agreement problem dramatically. Moreover, the result can be used to recover the optimal selling price when the mean demand is a linear function of the selling price (cf. Raza 2014) [Raza SA (2014) A distribution free approach to newsvendor problem with pricing. 4OR—A Quart. J. Oper. Res. 12(4):335–358.]. The online appendix is available at https://doi.org/10.1287/opre.2017.1677 .

Production planning in the blood supply chain is a challenging task. Many complex factors such as uncertain supply and demand, blood group proportions, shelf life constraints and different collection and production methods have to be taken into account, and thus advanced methodologies are required for decision making. This paper presents an integrated simulation-optimization model to support both strategic and operational decisions in production planning. Discrete-event simulation is used to represent the flows through the supply chain, incorporating collection, production, storing and distribution. On the other hand, an integer linear optimization model running over a rolling planning horizon is used to support daily decisions, such as the required number of donors, collection methods and production planning. This approach is evaluated using real data from a blood center in Colombia. The results show that, using the proposed model, key indicators such as shortages, outdated units, donors required and cost are improved.

Deriving from the analogy between contingent reward transactional leaders (featured by clarity, consistency, consideration, and consequences) and “good parents,” we develop a moderated mediation model where attachment insecurity (avoidance and anxiety attachment) mediates the relationship of contingent reward transactional leadership with follower job insecurity, burnout, job performance, and organizational citizenship behaviors, and meaningful work moderates the relationship between contingent reward transactional leadership and attachment insecurity. Results based on two-wave data from two independent samples largely support our hypotheses. Specifically, supporting attachment theory, the relationship of contingent reward transactional leadership and follower outcomes (i.e., job insecurity, burnout, and job performance) is mediated by both avoidance attachment and anxiety attachment. Supporting the contingency theory of leadership, meaningful work strengthens the relationship between contingent reward transactional leadership and avoidance and anxiety attachment. Additionally, the indirect effect of contingent reward transactional leadership and follower outcomes via avoidance and anxiety attachment is contingent upon meaningful work.

Teaching is often characterized as a stressful profession, with a substantial proportion of teachers experiencing chronic stress and burnout. Research indicates that teachers often experience stress upon entering the workforce, leading to detrimental effects on their health, occupational well-being, and work performance and adversely impacting student outcomes. While meta-analyses have demonstrated the efficacy of internet-based stress management interventions (iSMIs) for both experienced professionals and university students, there remains a gap in research on the efficacy of iSMIs tailored to teachers and career starters. We tailored an iSMI to beginning teachers and added a newly developed web-based classroom management skill training. This study examined the effectiveness of the tailored iSMI in reducing perceived stress and improving further secondary outcomes. In addition, this study was the first to explore problem-solving ability and emotion regulation skills as potential mechanisms of change within an iSMI grounded in transactional stress theory. Participants were 200 highly stressed beginning teachers (Perceived Stress Scale score of >21) undergoing German teacher induction randomized to either an intervention group (IG) with guidance or a waitlist control group. Outcomes were assessed online at baseline, 8 weeks after randomization (postintervention time point; T2), and at both the 3-month (T3) and extended 6-month follow-up. At T2, data were collected from 84% (84/100) of the participants in the IG and 90% (90/100) of the participants in the waitlist control group. The IG reported significant, practically meaningful, and sustained improvements in both perceived stress (T2: d=0.52, 95% CI 0.24-0.80, and P<.001; T3: d=0.49, 95% CI 0.21-0.77, and P<.001) and most secondary outcomes in the intention-to-treat analysis using analyses of covariance. Postintervention (T2) effects on mental health indicators, including depression, work-related rumination, anxiety, and insomnia, were substantial (d≥0.60), whereas no significant effects were observed for absenteeism (P=.22) and presenteeism (P=.80). The investigated mediators, problem-solving ability (d=0.57) and emotion regulation skills (d=0.69), improved. Moreover, parallel mediation analysis revealed that the iSMI exerted its effect on perceived stress through improved problem-solving ability (indirect path a b =-0.77, 95% CI -1.50 to -0.04) and emotion regulation skills (indirect path a b =-0.97, 95% CI -1.73 to -0.22). This study contributes to the growing body of evidence on iSMIs for beginning teachers during a highly demanding transition phase and supports the integration of these interventions into teacher training programs. Findings from the mediation analysis suggest that both problem-focused and emotion-focused coping strategies should be equally considered in stress management interventions. This strengthens the program theory based on the transactional stress model. Finally, these findings encourage further research on iSMIs for other groups of career starters to support their transition into the workforce. German Clinical Trials Register (DRKS) DRKS00013880; https://tinyurl.com/3mpsyvw5.

Although no prospective epidemiological studies have evaluated the relationship between family interactions and the development of borderline personality disorder (BPD), there is considerable evidence for the central role of family interactions in the development of BPD. This paper describes the role of family interactions or processes, especially those that might be regarded as invalidating or conflictual, negative or critical, and the absence of more validating, positive, supportive, empathic interactions, in the development of BPD. Perhaps more importantly, the proposed model considers how these parental and family behaviors transact with the child's own behaviors and emotional vulnerabilities, resulting in a developmental model of BPD that is neither blaming of the family member with BPD nor of her or his parents and caregivers, and has important and specific implications for both prevention and intervention.

Food insecurity (FI) and water insecurity (WI) are linked with HIV vulnerabilities, yet how these resource insecurities shape HIV prevention needs is understudied. We assessed associations between FI and WI and HIV vulnerabilities among urban refugee youth aged 16–24 in Kampala, Uganda through individual in-depth interviews (IDI) (n = 24), focus groups (n = 4), and a cross-sectional survey (n = 340) with refugee youth, and IDI with key informants (n = 15). Quantitative data was analysed via multivariable logistic and linear regression to assess associations between FI and WI with: reduced pandemic sexual and reproductive health (SRH) access; past 3-month transactional sex (TS); unplanned pandemic pregnancy; condom self-efficacy; and sexual relationship power (SRP). We applied thematic analytic approaches to qualitative data. Among survey participants, FI and WI were commonplace (65% and 47%, respectively) and significantly associated with: reduced SRH access (WI: adjusted odds ratio [aOR]: 1.92, 95% confidence interval [CI]: 1.19–3.08; FI: aOR: 2.31. 95%CI: 1.36–3.93), unplanned pregnancy (WI: aOR: 2.77, 95%CI: 1.24–6.17; FI: aOR: 2.62, 95%CI: 1.03–6.66), and TS (WI: aOR: 3.09, 95%CI: 1.22–7.89; FI: aOR: 3.51, 95%CI: 1.15–10.73). WI participants reported lower condom self-efficacy (adjusted β= -3.98, 95%CI: -5.41, -2.55) and lower SRP (adjusted β= -2.58, 95%CI= -4.79, -0.37). Thematic analyses revealed: (1) contexts of TS, including survival needs and pandemic impacts; (2) intersectional HIV vulnerabilities; (3) reduced HIV prevention/care access; and (4) water insecurity as a co-occurring socio-economic stressor. Multi-method findings reveal FI and WI are linked with HIV vulnerabilities, underscoring the need for HIV prevention to address co-occurring resource insecurities with refugee youth.