Personalized and continuous care intervention affects rehabilitation,living quality,and negative emotions of patients with breast cancer

BACKGROUND Breast cancer is among the most common malignancies worldwide.With progress in treatment methods and levels,the overall survival period has been prolonged,and the demand for quality care has increased.AIM To investigate the effect of individualized and continuous care intervention in patients with breast cancer.METHODS Two hundred patients with breast cancer who received systemic therapy at The First Affiliated Hospital of Hebei North University(January 2021 to July 2023)were retrospectively selected as research participants.Among them,134 received routine care intervention(routing group)and 66 received personalized and continuous care(intervention group).Self-rating anxiety scale(SAS),self-rating depression scale(SDS),and Functional Assessment of Cancer Therapy-Breast(FACT-B)scores,including limb shoulder joint activity,complication rate,and care satisfaction,were compared between both groups after care.RESULTS SAS and SDS scores were lower in the intervention group than in the routing group at one and three months after care.The total FACT-B scores and five dimensions in the intervention group were higher than those in the routing group at three months of care.The range of motion of shoulder anteflexion,posterior extension,abduction,internal rotation,and external rotation in the intervention group was higher than that in the routing group one month after care.The incidence of postoperative complications was 18.18%lower in the intervention group than in the routing group(34.33%;P<0.05).Satisfaction with care was 90.91% higher in the intervention group than in the routing group(78.36%;P<0.05).CONCLUSION Personalized and continuous care can alleviate negative emotions in patients with breast cancer,quicken rehabilitation of limb function,decrease the incidence of complications,and improve living quality and care satisfaction.

Personalized Perioperative Care for a Patient with a 10-Year-Old Postpartum Old Thrombus after Neoadjuvant Therapy for Breast Cancer

Breast cancer is one of the most common malignant tumors in women, and has become the main cause threatening women’s health. A case of breast cancer with neoadjuvant chemotherapy was discharged after active treatment and nursing.

Optimizing outcomes:Implementing enhanced recovery after surgery in orthopedic surgery

In the realm of orthopedics,the adoption of enhanced recovery after surgery(ERAS)protocols marks a significant stride towards enhancing patient well-being.By embracing a holistic approach that encompasses preoperative counseling,dietary optimization,minimally invasive procedures,and early postoperative mobilization,these protocols have ushered in a new era of surgical care.Despite encountering hurdles like resistance to change and resource allocation challenges,the efficacy of ERAS protocols in improving clinical outcomes is undeniable.Noteworthy benefits include shortened hospital stays and bolstered improved patient-safety measures.Looking ahead,the horizon for ERAS in orthopedics appears bright,with an emphasis on tailoring care to individual needs,integrating cutting-edge technologies,and perpetuating research endeavors.This shift towards a more personalized,streamlined,and cost-efficient model of care underscores the transformative potential of ERAS in reshaping not only orthopedic surgery but also the journey to patient recovery.This editorial details the scope and future of ERAS in the orthopedic specialty.

A Pilot Study of Health Coaching on Older Adults’ Personal Healthcare and Maintenance during the Outbreak of Covid-19 in Singapore

With a rapidly ageing population in Singapore, older adults and their family members face challenges of age-related diseases, caregiver stress, and increasing demand for caregiving services. To address this pressing issue, this pilot study aims to introduce online health coaching for older adults in Singapore and evaluate its effectiveness on maintenance of personal healthcare. In the midst of the COVID-19 outbreak, older adults’ activities were largely restricted by measures on social distancing. The online health coaching provided a solution for older adults to achieve a healthy lifestyle in a contactless manner. In this pilot study, 18 older adults (≥55 years old) who were willing to be coached by trained health coaches (n = 10) for 8 weeks (once a week) were recruited. Pre- and post-surveys with older adults were conducted. Furthermore, health coaching booklet was used to control the quality of coaching and to record diet and exercise plans. The pilot study demonstrated that the health coaching provided older adults with knowledge of nutrition and exercise, raised their awareness of well-being in terms of daily meals and regular exercise, and provided an alternative to maintain a healthy lifestyle amidst global pandemic. Additionally, we also identified that the older adults’ satisfactions with health coaching were positively associated with educational levels (R2 = 0.31). Lastly, this pilot study highlighted that health coaching standardization process for older adults is critical for researchers and healthcare practitioners in the future.

Method Optimization and Application Extension of Bovine Corneal Opacity and Permeability Assay

This paper systematically summarizes the improvements in bovine corneal opacity and permeability assay(BCOP),an alternative method of eye irritation test,further explores the usage mode of combinatorial methods with BCOP at the core module,introduces the application of each single method and their combination in the assessment of pesticides,plant extracts,medical devices and medicines.By optimizing traditional methods,the alternative method is more scientific and individually applicable.

Nursing Students’Clinical Learning Environment in Norwegian Nursing Homes:Lack of Innovative Teaching and Learning Strategies

Background: Nursing students hesitate to choose aged care as a career, and the aged care sectors are on an edge regarding nursing positions. Clinical learning environments may influence nursing students’ career choices. Few studies have explored learning environments in nursing homes, although students increasingly have placements there. Objectives: The aim was to produce information for developing nursing students’ learning opportunities in nursing homes. Design: A cross-sectional survey design was used. Settings: The study was conducted at a university college in southeast Norway. Participants: Students in two cohorts of a bachelor degree program in nursing participated, N = 499. Methods: Data were collected on nursing students’ perceptions of clinical learning environments during placements in five nursing homes. A 42-item validated questionnaire with the subscales personalization, individualization, involvement, task orientation, innovation, and satisfaction was used. Data analysis used descriptive statistics, t-tests, and linear regression analysis. Results: Total scores showed overall satisfaction with clinical learning environments in nursing homes. However, innovation subscale scores were very low. First year students had significantly higher scores than third year students on the total scale, and most subscales. Age was significantly associated with total scale scores and subscale satisfaction scores. Higher education and work experience before entering nursing education were significantly associated with involvement subscale scores. Conclusions: Students are more positive than negative about their clinical learning environments. Low valuation of innovation seems to be a consistent finding in studies in both nursing homes and hospitals internationally. For innovative learning strategies to function they must be anchored at the organizational level. Future research should develop and test more innovative learning strategies for nursing students.

A review on analytical methods for pharmaceutical and personal care products and their transformation products

Pharmaceutical and personal care products(PPCPs)and corresponding transformation products have caused widespread concern due to their persistent emissions and potential toxicity.They have wide octanol-water partition coefficients(K_(ow))and different ionization constants(pK_(a))resulting in a poor analysis accuracy and efficiency.A suitable analytical method is the first prerequisite for further research on their environmental behavior to prioritize the substances.This study reviewed a full-scale analytical protocol for environmental samples in the recent ten years:from sampling to instrumental methods.Passive sampling techniques were compared and recommended for long-term continuous and scientific observation.A quick and effective sample extraction and clean-up method are highly required.Chromatographic methods coupled to mass spectrometry for determining PPCPs with a wide range of logK_(ow)(-7.53 to 10.80)were summed up.High-resolution mass spectrometry was confirmed to be a promising strategy for screening unknown transformation products,which would provide a nanogram level of detection limits and more accurate mass resolution.Screening strategies and mass change principles were summarized in detail.The recovery rate was important in multiple contaminants analysis identification and factors affecting the recovery rate of PPCPs were also discussed in this review,including sample matrix,target compounds characteristics,extraction method and solid-phase adsorbent.This review provides useful information for the selection of appropriate analytical methods and future development directions.

An efficient resin for solid-phase extraction and determination by UPLCMS/MS of 44 pharmaceutical personal care products in environmental waters

In this study,a hydrophilic resin named GCHM was fabricated based on poly(N-vinyl pyrrolidone-codivinylbenzene),characterized,and applied as a solid-phase extraction(SPE)material.Up to 44 pharmaceuticals and personal care products(PPCPs)belonging to 10 classes were recovered in environmental water samples.Different variables affecting extraction,such as adsorbent amount,sample pH,and loading speed,were optimized.Under optimal conditions,the average absolute recovgy of 44 PPCPs was 75.6%using GCHM,indicating a better performance than the commercial Oasis^HLB.SPE with home-made hydrophilic polymeric sorbent followed by ultra-performance liquid chromatography and tandem mass spectrometry was validated,and the method achieved good linearity(r2>0.991,for all analytes).In addition,the method detection limits of target compounds ranged from 0.03 to 0.6 ng/L.The developed method was applied to determine PPCPs in 10 environmental water samples taken from the Yangtze River,Huaihe River,and Taihu Lake,1 groundwater sample from Changzhou in Jiangsu Province,1 wastewater sample from Xiamen and 2 seawater samples from the Jiulong River in Fujian Province,China.In these samples,22 compounds were determined at levels ranging from 0.5 to 1590 ng/L.

Pharmaceuticals and personal care products (PPCPs) in the freshwater aquatic environment

Pharmaceuticals and personal care products(PPCPs)are a unique group of emerging environmental contaminants,due to their inherent ability to induce physiological effects in human at low doses.An increasing number of studies has confirmed the presence of various PPCPs in different environmental compartments,which raises concerns about the potential adverse effects to humans and wildlife.Therefore,this article reviews the current state-of-knowledge on PPCPs in the freshwater aquatic environment.The environmental risk posed by these contaminants is evaluated in light of the persistence,bioaccumulation and toxicity criteria.Available literature on the sources,transport and degradation of PPCPs in the aquatic environment are evaluated,followed by a comprehensive review of the reported concentrations of different PPCP groups in the freshwater aquatic environment(water,sediment and biota)of the five continents.Finally,future perspectives for research on PPCPs in the freshwater aquatic environment are discussed in light of the identified research gaps in current knowledge.

Occurrence, sources and fate of pharmaceuticals and personal care products in the groundwater: A review

The presence of pharmaceuticals and personal care products(PPCPs)in the aquatic environment may pose potential threat to the ecosystem and human health,hence PPCPs have aroused much concern over the world.The contamination of PPCPs in the groundwater,the main source of drinking water supply in many countries and regions,has been extensively studied in the last decade.This paper reviews the occurrence of frequently detected PPCPs,including antibiotics,anti-inflammatories,lipid-regulators,carbamazepine,caffeine,and N,N-diethyl-m-toluamide in groundwater,with special concern to the progress made over the past three years.Possible emission sources for PPCPs in groundwater,such as wastewater and contaminated surface water,landfills,septic systems,livestock breeding and sewer leakage,are summarized.Besides,adsorption,migration and degradation,the dominant mechanisms in the subsurface transport and fate of PPCPs,are discussed,and the insights into the future study of PPCPs in the groundwater are provided.

Occurrence,seasonal variation and human exposure to pharmaceuticals and personal care products in surface water,groundwater and drinking water in Lagos State,Nigeria

The occurrence of 28 pharmaceuticals and personal care products(PPCPs)was investigated in 17 surface water samples(rivers,canals,and lagoons),12 groundwater samples(wells and boreholes,which can also be consumed for drinking)and 8 drinking water samples(bottles and sachets)during dry and rainy seasons in Lagos state,Nigeria.The most prevalent compound detected in all samples was amoxicillin(an antibiotic)at median concentrations of 1614,238 and 358 ng/L in surface water,ground water and drinking water,respectively.This is of concern due to potential impact on development of antibioticresistant microbial strains.Other frequently-detected compounds include acetaminophen,nicotine,ibuprofen,and codeine with detection frequencies of more than 70%.Investigation of seasonal variability revealed that glyburide,caffeine,naproxen and diclofenac concentrations were significantly(P<0.05)higher during the dry season(winter),while Nicotine and Codeine levels were higher during the rainy season(summer).The factors influencing such seasonal variability include:dilution by extensive rainfall,agricultural activity(for nicotine)and usage patterns of pharmaceuticals among the local community.Measured concentrations in drinking water samples were used to assess inadvertent human exposure to PPCPs in Nigerian adults.Results revealed average daily exposures of 81,14 and 3 ngƩPPCPs/kg BW/day via drinking borehole,sachet water and bottled water,respectively.While there exists no health-based limit value(HBLV)for chronic exposure to mixtures of PPCPs,our results raise concern and warrant further investigation of the potential health implications of such unintended PPCPs exposure.

Occurrence and discharge of pharmaceuticals and personal care products in dewatered sludge from WWTPs in Beijing and Shenzhen

This study mainly focused on the occurrence of pharmaceutical and personal care products(PPCPs)in sewage dewatered sludge and their discharges through sludge disposal from wastewater treatment plants(WWTPs).The data were obtained and calculated from seven PPCPs in dewatered sludge collected from 12WWTPs in two typical cities,Beijing and Shenzhen in China.Four of seven PPCPs,diclofenac acid,carbamazepine,mefenamic acid and N,N-diethyl-m-toluamide were detectable in dewatered sludge from Beijing and Shenzhen with concentration up to 4240,11,060,92 and 219μg/kg respectively.While,the other three compounds,trimethoprim,chloramphenicol and bezafibrate were not detected in collected samples from these two cities.The highest discharge of diclofenac acid and carbamazepine were 1023 g/d and 494 g/d respectively.In addition,the total discharge of these four detected PPCPs from each plant ranged from 5 to 1092 g/d in Beijing and 4e497 g/d in Shenzhen.Thus,PPCP discharge through sludge disposal cannot be neglected,and further research on transfer of PPCPs during sludge disposal onto agriculture land and influence of sludge application is required and essential.

Occurrence of pharmaceutical and personal care products(PPCPs)in wastewater and receiving waters in South Africa using LC-Orbitrap™MS

There is continued interest in the occurrence and monitoring of emerging contaminants(ECs)in wastewater treatment plants(WWTPs)to assess their potential impact when released into the environment.The objective of this study was to determine the occurrence of pharmaceutical and personal care products(PPCPs)in WWTP influents and effluents and receiving river waters in Pretoria,South Africa.Targeted screening and identification of PPCPs in the samples was done using liquid chromatography(LC)coupled with high resolution mass spectrometry(HRMS)Orbitrap™HRMS,after clean-up and preconcentration with Waters Oasis®hydrophilic-lipophilic-balanced(HLB)solid phase extraction(SPE)cartridges.Of the 156 target analytes screened in the study,120 could be satisfactorily determined under the study conditions,with 71 and 73 compounds being detected and quantified in the influent and effluent samples,respectively.Concentrations in the influents ranged from<ILOQ-14.2 mgL^-1and those in the effluent from<ILOQ-2.45 mgL^-1.It was found that 84%of the quantified compounds belonged to various classes of pharmaceuticals.Ibuprofen,caffeine,paracetamol and estradiol were the major individual contaminants in influent samples with average concentrations of 14.2,8.68,4.79 and 1.02 mgL^-1,respectively.In the effluent samples,the highest concentrations were recorded for estradiol(2.45 mgL^-1),ibuprofen(1.03 mgL^-1)and efavirenz(0.58 mgL^-1).The highest mean concentrations(above 0.5 mgL^-1)recorded in the river water samples were for ibuprofen,(4.14 mgL^-1downstream;3.19 mgL^-1upstream),caffeine(2.98 mgL^-1downstream;1.42 mgL^-1upstream),paraxanthine(1.22 mgL^-1downstream;0.798 mgL^-1upstream).Analysis of river water samples also revealed that PPCP contamination in the river system cannot be solely attributed to the WWTP effluents.Twenty-four compounds presented in this study are reported for the first time in South African surface waters.

Discharge inventory of pharmaceuticals and personal care products in Beijing,China

Pharmaceuticals and personal care products(PPCPs)are emerging environmental contaminants,whose potential risk for the ecological environment has caused wide attention in recent years.In China,quite a large amount of PPCPs were annually emitted into the environment.Their existence in different matrix has been reported frequently,including river water,sediment and soil.However,the contribution from different sources was seldom reported and still unclear in China.Wastewater treatment plant(WWTP)was usually considered to be the main source to the urban river,but livestock and aquaculture farms were also reported as significant pollution sources of PPCPs due to poor environmental management in China.This study summarized environmental discharges of different PPCPs from various sources and obtained the discharge data through different environment media in Beijing,the statistical source of PPCPs was analyzed in detail.The sources comprised WWTPs,excess sludge,hospital wastewater,municipal untreated wastewater,aquaculture wastewater and landfill leachate.This article helps understand the general situation and the potential risk of PPCPs in Beijing.

Determination and occurrence of endocrine disrupting compounds, pharmaceuticals and personal care products in fish （Morone saxatilis）

Endocrine disrupting compounds （EDCs）, pharmaceuticals and personal care products （PPCPs） have attracted much attention due to widespread contamination in aquatic environment. In this study, we determined 13 EDCs and PPCPs in fish blood, bile and muscle by using gas chromatography-mass spectrometry （GC-MS）. The limits of quantitation （LOQ） were in the ranges of 0.23-2.54, 0.22-2.36ng·mL^-1, and 0.24-2.57 ng· g^-1 dry weight （dw） for fish blood, bile and muscle, respectively. Recoveries of target compounds spiked into sample matrices and passed through the entire analytical procedure ranged from 65% to 95%, from 60% to 92% and from 62% to 91% for blood, bile and muscle, respectively. The methods were applied to the analysis of fish from a lake in California. Target compounds were relatively low in bile, and only bisphenol A （BPA） and diclofenac were measurable near the LOQ. Seven of 13 compounds were detected in blood, with total concentrations up to 39 ng· g^-1. Only BPA was frequently found in muscle, with mean concentration of 7.26 ng· g^-1 dw. The estimated daily intake of BPA through fish consumption for U.S. resident was significantly lower than the tolerable daily intake recommended by the European Food Safety Authority. This study showed that the exposure to the bisphenol A from fish diet is unlikely to pose a health risk.

Enhanced antibiotic degradation performance of Cd_(0.5)Zn_(0.5)S/Bi_(2)MoO_(6) S-scheme photocatalyst by carbon dot modification

S-scheme heterojunction engineering is an effective strategy to attain distinctive photocatalysts.Herein,a carbon dots modulated S-scheme hetero-structured photocatalyst of Cd_(0.5)Zn_(0.5)S nanoparticles/Bi_(2)MoO_(6) microspheres/carbon dots (CZCBM),aiming to conquer the photo-corrosion and strengthen the photocatalytic property of Cd_(0.5)Zn_(0.5)S,was developed via a facile solvothermal route.Under visible light,the optimal CZCBM-2 affords a 1.8-,1.5-,or 0.6-time reinforcement in the oxytetracycline degradation rate constant compared to Bi_(2)MoO_(6),Cd_(0.5)Zn_(0.5)S or Cd_(0.5)Zn_(0.5)S/Bi_(2)MoO_(6),which is credited to the strengthened visible-light response,increased reactive sites,and efficient dissolution of photo-carriers with optimal redox capacity because of the co-effect of carbon dots and S-scheme heterostructure.Significantly,the photo-corrosion of Cd_(0.5)Zn_(0.5)S is significantly suppressed and CZCBM-2 affords superior stability and reusability during cycling tests.Besides,CZCBM-2 can be well adapted to various environments.The toxicology appraisement unravels the decreased eco-toxicity of most intermediates compared to oxytetracycline.Lastly,an S-scheme charge transfer mechanism with carbon dots as electron reservoir in CZCBM is deduced,which uncloses that •O_(2)− and h+ dominantly account for oxytetracycline eradication and detoxification.This study demonstrates the design of unique carbon dots favored S-scheme heterostructures as an effective “Two Birds with One Stone” strategy to achieve high anti-photo-corrosion performance and reinforced photocatalytic performance of sulfides.

Bidirectional role of synthetic musk tonalide as photosensitizer and activator on amino acids:Formation of sensitizer imine at aqueous chemistry interface of skin

Personal care products(PCPs)inevitably come into contact with the skin in people’s daily life,potentially causing adverse effects on human health.The adverse effects can be exacerbated under UV irradiation but are rarely studied.In this study,to clearly understand the damage of representative PCPs to human skin and their photochemical transformation behaviors,fragrance tonalide(AHTN)was measured in the presence of amino acids as a basic building block of human tissue.The results showed that amino acids could decelerate the photochemical transformation rate of AHTN,increasing the likelihood of AHNT persisting on the skin surface and the health risk to the human being.Further,the interaction between amino acids and AHTN was investigated.AHTN could play bidirectional roles in damaging amino acids:the photosensitizer and reactive activator.As a photosensitizer,the ^(1)O_(2) generated from the AHTN photosensitization was partly employed to oxidative damage amino acids.Furthermore,by combining experiments with quantum chemical computation,the carbonyl group of the activator AHTN was found to be the active site to activate the N-containing group of amino acids.The activation mechanism was the electron transfer between AHTN and amino acids.Imines formed during the photochemical transformation of AHTN with histidine/glycine were the molecular initiating event for potential skin sensitization.This study reported for the first time that skin photosensitizer formation threatens human health during the photochemical transformation of AHTN.

Analysis of Emerging Contaminants in Surface Water,Aquaculture Ponds and Wastewater Treatment Facilities in the Taige Canal Basin

Emerging contaminants(ECs)have aroused great concerns due to their widespread presence as well as their potential health and ecological risks.Currently monitoring data about ECs in Chinese rural areas are still limited.In this study,Taige Canal basin was selected as a typical rural area for a pilot study.The occurrence of ECs,including pharmaceutical and personal care products(PPCPs),pesticides,plasticizers and flame retardants,in surface water and aquaculture ponds,as well as in wastewater treatment facilities,was comprehensively investigated.The effectiveness of rural decentralized wastewater treatment facilities and centralized wastewater treatment plant(WWTP)in removing ECs was also analyzed.Among 126 commonly used pesticides for target analysis,25 compounds were detected in surface water with high frequency of>80%.Besides,55 PPCPs,21 pesticides and 18 other industrial products were identified by non-target analysis using high resolution mass spectrometry(HRMS).Totally 18 compounds were detected in surface water with a frequency of>60%and 6 of them were found in all samples,including irbesartan,valsartan,propazine,buprofezin,bis(2-ethylhexyl)phthalate(DEHP)and tri-(2-chloroisopropyl)phosphate(TCPP),with mean concentrations of 3022,195,125,218,3738 and 545 ng/L,respectively.There are 29 compounds(11 PPCPs,8 pesticides and 10 other industrial products)detected in water samples from the aquaculture ponds,of which 13 compounds were found in all three ponds.The removal efficiencies of ECs in wastewater treatment facilities are generally limited,except valsartan(82%–86%),nobiletin(100%)and diisodecylphthalate(100%)were found to be significantly removed.

Effects of rural domestic sewage reclaimed irrigation and regulation on heavy metals,PPCPs,water and nitrogen utilization,and microbial diversity in paddy field

Rural domestic reclaimed water(RDRW)is rural domestic sewage that being safely treated,the irrigation and reuse of RDRW are an effective way to alleviate the contradiction between supply and demand of water resources in South China.In this study,four kinds of irrigation water sources(primary and secondary treated water R1 and R2,purified water R3 and river water CK)and three kinds of water level regulations(low,medium,and high field water level control of W1,W2 and W3)were set to study the impact of RDRW on soil and crop safety,water and nitrogen utilization and biodiversity for establishing the regulation mechanism of RDRW irrigation with field experiment,and monitoring was carried out in RDRW irrigation demonstration area to assess the effectiveness of RDRW.The results showed that,under RDRW irrigation,the contents of Cd and Pb increased slightly,while the contents of Cr,Cu and Zn decreased in paddy soil.The heavy metals content decreased along the direction of stem,leaf and grain in rice plants,but did not increase significantly in rice grains.With the increase of field water level,pharmaceutical and personal care products(PPCPs)content in 60-80 cm soil layer was accumulated,and the PPCPs content in rice husks was higher than that in grains,but it was at a very low level.Compared to CK,RDRW irrigation can effectively increase rice yield,rainwater use efficiency(RUE)and nitrogen use efficiency(NUE)by 5.4%-7.6%,6.7%-9.4%and 21.7%-24.2%,respectively,and the species diversity,community diversity and richness in rice fields were improved.Additionally,water level regulation of W3 with R2 water resource irrigation was conducive to the exertion of comprehensive benefits.The monitoring of demonstration area showed that the consumption of fresh water was reduced by 530 mm,yield was increased by 9.6%,and the soil and crop were both safety.Short-term irrigation of RDRW did not cause soil and crops pollution,however,it is still necessary to track and monitor the effect of the system on soil,crop,and underground water with long-term reclaimed water irrigation.

An Empirical Research on the Relationship Between Transformational Leadership and Counterproductive Work Behavior of Knowledge Employee

Based on the view of transformational leadership theory, the relationship between transformational leadership and the counterproductive work behavior of knowledge employee was researched. 221 valid questionnaires were obtained through the survey. Hierarchical regression analysis results showed that the virtue was significantly negative related to all the six dimensions of knowledge employee counterproductive work behavior, the vision incentive was significantly negative related to five dimensions of the knowledge employee counterproductive behavior except conservative intellectual behavior, the charisma was significantly negative related to five dimensions of the knowledge employee counterproductive work behavior except passive obedience behavior, personalized care was significantly negative related to five dimensions of the knowledge employee counterproductive behavior except immoral behavior. In short, transformational leadership was negatively related to the knowledge employee counterproductive work behavior.