Improving Efficiency in Hospital Pharmacy Services: An Integrated Strategy Using the OCTAGON-P Framework and Lean 5S Management Practices.

Background Hospital pharmacy departments have a critical role in the healthcare system, as they aim to provide excellent patient services while also ensuring cost-effectiveness. Lean methodologies are well-known for improving efficiency and quality in various industries, but their impact on healthcare, particularly in hospital pharmacy settings, has not been thoroughly investigated. Aim This quality improvement (QI) study aimed to assess the impact of implementing the sort, set in order, shine, standardize, and sustain (5S) methodology using the innovative orientation, coordination, training, awareness, governance, observation, normalization, and promotion (OCTAGON-P) framework on the operations of Mediclinic Parkview Hospital (MPAR) Pharmacy in Dubai, UAE. Methods The QI project spanned a period of six weeks, from December 18th, 2023, to January 28th, 2024. Throughout this period, a new novel OCTAGON-P framework's eight crucial elements were methodically integrated. Simultaneously, an extensive preparation process encompassing the five stages of the 5S method was carried out. Results The findings indicated a notable enhancement in organization, orderliness, cleanliness, medication storage, and workspace standardization. The significant improvement of 217% in terms of organization highlighted the effectiveness of resource arrangement. The orderliness of the workspace saw an increase of 800%, indicating a transformation in the systematic organization. Additionally, cleanliness improved by 138%, demonstrating a significant advancement in maintaining a spotless environment. The standardization of processes experienced a boost of 300%, reflecting a solidified approach to consistent operational methods. These refinements resulted in an overall improvement of 90% from the initial baseline of 20% on the 5S checklist scores. Efficiency gains were observed, with outpatient medication retrieval times reduced by 50%, inpatient times by 40%, emergency prescription serving by 16.7%, and pediatric prescription serving by 11%. The inpatient medication return process saw a 67% improvement. Patient counseling time increased by 23.3%, indicating a more patient-centered approach. Prescription verification and medication expiry checks increased by 50% and 200%, respectively, enhancing the quality of care. Inventory management efficiency improved by 36%, and medication label printing time decreased by 70% with the additional label printers. Installing extra medication label printers was done through the OCTAGON-P framework, specifically in the "orientation" and "coordination" phases. These two initial phases focused on leadership's 5S orientation, management support, and securing additional resources. Therefore, the OCTAGON-P framework provided a structured approach that promoted continuous improvement and sustained lean practices. Conclusion This research study presented the remarkable effectiveness of the OCTAGON-P framework in structurally implementing the 5S methodology into hospital pharmacy operations. The findings underscored the potential of lean 5S to enhance and optimize operational efficiency and overall quality within the critical environment of hospital pharmacy settings. Consequently, these improvements can conclusively result in the provision of superior and enhanced patient care, which is truly fundamental and central to the mission and objectives of any healthcare institution.

Changes in menstrual symptoms and work productivity after checklist-based education for premenstrual syndrome: an 8-month follow-up of a single-arm study in Japan.

BACKGROUND: Premenstrual syndrome (PMS) is prevalent among women of reproductive age, but most do not seek medical advice. We hypothesized that building PMS awareness could promote medical help-seeking for PMS and thus reduce menstrual symptoms and improve work productivity. METHODS: In January 2020, women aged between 25 and 44 years, having paid work, and not currently consulting with an obstetrics and gynecology doctor (n = 3090) responded to the Menstrual Distress Questionnaire (MDQ), the Premenstrual Symptoms screening tool, and the World Health Organisation Health and Work Performance Questionnaire. In addition, they received checklist-based online education for PMS. Of 3090 participants, 2487 (80.5%) participated in a follow-up survey in September 2020. We conducted multiple logistic regression analyses and text analyses to explore factors that encouraged and discouraged medical help-seeking. We also evaluated changes in menstrual symptoms and work productivity, using generalized estimating equations with interactions between the severity of PMS, help-seeking, and time. RESULTS: During the follow-up period, 4.9% of the participants (121/2487) sought medical help. Those having high annual income (adjusted odds ratio [aOR] = 2.07, 95% confidence interval [CI]: 1.21-3.53) and moderate-to-severe PMS (aOR = 2.27, 95% CI: 1.49-3.46) were more likely to have sought medical help. Those who did not seek medical help despite their moderate-to-severe PMS reported normalization of their symptoms (36%), time constraints (33%), and other reasons for not seeking medical help. Participants with moderate-to-severe PMS who had sought medical help showed a significant improvement of - 8.44 points (95% CI: - 14.73 to - 2.15 points) in intermenstrual MDQ scores during the follow-up period. However, there were no significant improvements in premenstrual and menstrual MDQ scores or absolute presenteeism. CONCLUSION: Medical help-seeking alleviated intermenstrual symptoms in women with moderate-to-severe PMS, but only a small proportion of them sought medical help after PMS education. Further research should be conducted to benefit the majority of women who are reluctant to seek medical help, including the provision of self-care information. TRIAL REGISTRATION: UMIN Clinical Trials Registry number: UMIN000038917.

Dataset on utilizing cropping system-based fertilization techniques to improve soil health and crop output while minimizing tillage.

The dataset provided details on how tillage methods and nutrient management impacted the productivity of the four crops (mustard>mungbean>Transplanting (T.) aus >Transplanting (T.) aman) cropping system and the overall soil health. The specific tillage techniques examined were minimum tillage (MT), conventional tillage (CT), and deep tillage (DT). Regarding nutrient management, NM1 utilized 100 % soil test-based (STB) fertilization following fertilizer gradient generation (FRG); NM2 applied 125 % of STB after FRG-2018; NM3 consisted of 100 % STB (with 80 % from chemical fertilizers and 20 % from cow dung); and NM4 relied on native fertility without any fertilization. Over three consecutive seasonal years (2018-19, 2019-20, and 2020-21), twelve treatments were replicated three times following a factorial totally randomized design. The comparative analysis of crop yield, rice equivalent yield, system productivity and production efficiency indicated superior performance of MT over both CT and DT. Furthermore, in relation to agricultural productivity metrics, the application of the nutrition package NM3 demonstrated performance levels exceeding the average. The adoption of MT and the incorporation of the NM3 nutrition package led to notable advancements in organic matter, field capacity, microbial biomass nitrogen, microbial biomass carbon and soil nutrient levels (N, P, K, S, Zn, and B). Consequently, the synthesis of the NM3 with MT is posited as a strategic approach for soil enhancement and the augmentation of crop productivity.

Heterotic growth of hybrids of Arabidopsis thaliana is enhanced by elevated atmospheric CO2.

PREMISE: With the global atmospheric CO2 concentration on the rise, developing crops that can thrive in elevated CO2 has become paramount. We investigated the potential of hybridization as a strategy for creating crops with improved growth in predicted elevated atmospheric CO2. METHODS: We grew parent accessions and their F1 hybrids of Arabidopsis thaliana in ambient and elevated atmospheric CO2 and analyzed numerous growth traits to assess their productivity and underlying mechanisms. RESULTS: The heterotic increase in total dry mass, relative growth rate and leaf net assimilation rate was significantly greater in elevated CO2 than in ambient CO2. The CO2 response of net assimilation rate was positively correlated with the CO2 response of leaf nitrogen productivity and with that of leaf traits such as leaf size and thickness, suggesting that hybridization-induced changes in leaf traits greatly affected the improved performance in elevated CO2. CONCLUSIONS: Vegetative growth of hybrids seems to be enhanced in elevated CO2 due to improved photosynthetic nitrogen-use efficiency compared with parents. The results suggest that hybrid crops should be well-suited for future conditions, but hybrid weeds may also be more competitive.

An economic evaluation of eptinezumab for the preventive treatment of migraine in the UK, with consideration for natural history and work productivity.

BACKGROUND: Migraine is a highly prevalent neurological disease with a substantial societal burden due to lost productivity. From a societal perspective, we assessed the cost-effectiveness of eptinezumab for the preventive treatment of migraine. METHODS: An individual patient simulation of discrete competing events was developed to evaluate eptinezumab cost-effectiveness compared to best supportive care for adults in the United Kingdom with ≥ 4 migraine days per month and prior failure of ≥ 3 preventive migraine treatments. Individuals with sampled baseline characteristics were created to represent this population, which comprised dedicated episodic and chronic migraine subpopulations. Clinical efficacy, utility, and work productivity inputs were based on results from the DELIVER randomised controlled trial (NCT04418765). Timing of natural history events and treatment holidays-informed by the literature-were simulated to unmask any natural improvement of the disease unrelated to treatment. The primary outcomes were monthly migraine days, migraine-associated costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio, and net monetary benefit, each evaluated over a 5-year time horizon from 2020. Secondary analyses explored a lifetime horizon and an alternative treatment stopping rule. RESULTS: Treatment with eptinezumab resulted in an average of 0.231 QALYs gained at a saving of £4,894 over 5 years, making eptinezumab dominant over best supportive care (i.e., better health outcomes and less costly). This result was confirmed by the probabilistic analysis and all alternative assumption scenarios under the same societal perspective. Univariate testing of inputs showed net monetary benefit was most sensitive to the number of days of productivity loss, and monthly salary. CONCLUSIONS: This economic evaluation shows that from a societal perspective, eptinezumab is a cost-effective treatment in patients with ≥ 4 migraine days per month and for whom ≥ 3 other preventive migraine treatments have failed. TRIAL REGISTRATION: N/A.

Comparative dataset on productivity, proximate, biochemical and pigment content of marine Gonyostomum sp. and freshwater Tetraedron sp. microalgae.

The dataset includes a comparative analysis of Gonyostomum sp. and Tetraedron sp. to characterize their productivity, proximate composition, biochemical composition and pigments. Growth data were collected through cell density and optical density and subsequently mass-cultured to utilize biomass for other analyses. The onset of the stationary phase (12 to 18 days) varied between the species. Volumetric productivity, areal productivity, and SGR were also significantly higher (p ˂ 0.05) in Gonyostomum sp. whereas, Tetraedron sp. showed significantly higher (p ˂ 0.05) cell duplication time and cell doublings per day (K). Gonyostomum sp. showed significantly higher (p ˂ 0.05) protein (42.86±1.13%), carbohydrate (13.56±0.48%) and lipid (27.4 ± 0.69%) content than Tetraedron sp. Significantly higher (p ˂ 0.05) polyunsaturated fatty acids (PUFA) were obtained from both Gonyostomum sp. and Tetraedron sp. Non-essential amino acids were prevalent in both microalgae than essential amino acids. Significantly higher (p ˂ 0.05) chlorophyll-a (5.51±0.00), chlorophyll-b (2.27±0.04) and phycobiliprotein (2.32±0.05) were found in Tetraedron sp. Conversely, Gonyostomum sp. exhibited higher (p ˂ 0.05) carotenoid content (2.48±0.05). These findings may contribute to the screening and utilization of these microalgae in the aquaculture, pharmaceuticals, and nutraceuticals sectors.

Macroalgae farming for sustainable future: Navigating opportunities and driving innovation.

Seaweed cultivation has garnered significant interest, driven by its wide range of biomass benefits. However, comprehensive assessments from various perspectives are imperative to ensure the sustainable cultivation of seaweed. Biotic and Abiotic factors can significantly impact seaweed yield in complex commercial farming. Biotic factors include bacteria, fungi, viruses, and other algae, while abiotic factors include environmental conditions such as temperature, salinity, light intensity, and nutrient availability. Additionally, the susceptibility of seaweeds to pests and diseases further compounds the issue, leading to potential crop losses. This study endeavours to shed light on the immense potential of macroalgae cultivation and underscores the pressing need for scientific advancements in this field. The comprehensive review clearly explains the latest developments in seaweed cultivation and highlights significant advances from diverse seaweed research. Moreover, it provides insightful glimpses into possible future developments that could shape the trajectory of this promising industry.

Improvements in Psoriasis-Related Work Productivity with Tildrakizumab: Results from a Phase 4 Real-World Study in Patients with Moderate-to-Severe Plaque Psoriasis.

INTRODUCTION: Plaque psoriasis is a chronic condition that may impact patients' work productivity. Tildrakizumab, an interleukin-23 p19 inhibitor, is approved for treatment of moderate-to-severe plaque psoriasis in adults. However, the effect of tildrakizumab treatment on work productivity in patients with psoriasis is not well characterized. METHODS: In this multicenter, open-label, uncontrolled phase 4 study (NCT03718299), patients with moderate-to-severe plaque psoriasis received tildrakizumab 100 mg at week 0, week 4, and every 12 weeks thereafter through week 52. Patients completed the Work Productivity and Activity Impairment Questionnaire: Psoriasis (WPAI:PSO) at baseline and every 12 weeks from week 16 through week 64. The following four domains of the WPAI:PSO were examined: absenteeism (percentage of time missed from work due to psoriasis), presenteeism (percentage reduction of productivity while at work due to psoriasis), total activity impairment (percentage impairment in activities other than work due to psoriasis), and total work productivity impairment (total percentage of work impairment from both absenteeism and presenteeism due to psoriasis). Missing data were not imputed. RESULTS: Of the 55 patients enrolled, 31 patients completed all domains of the WPAI:PSO at week 64. From baseline to week 64, respectively, mean ± standard deviation (SD) scores improved for presenteeism (20.5 ± 21.7 to 2.6 ± 5.8; P < 0.001), total activity impairment (29.5 ± 26.6 to 4.4 ± 9.4; P < 0.001), and total work productivity impairment (20.9 ± 22.2 to 2.6 ± 5.8; P < 0.001). The mean ± SD score for absenteeism decreased from 1.1 ± 5.7 at baseline to 0.0 ± 0.0 at week 64, but this change was not statistically significant. CONCLUSION: Tildrakizumab treatment mitigated work productivity loss due to psoriasis as measured by the presenteeism, total activity impairment, and total work productivity impairment domains of the WPAI:PSO. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT03718299.

How does the development of the digital economy influence carbon productivity? The moderating effect of environmental regulation.

Improving carbon productivity is of great significance to China's "30 · 60" carbon target, while the development of the digital economy is a driving force for green transformation. However, few studies discuss the relationship between the digital economy and carbon productivity. We investigate the influence of digital economic development on carbon productivity using panel data from 30 Chinese provinces from 2011 to 2020. Spatial econometric and moderating effects are considered. The results show that (i) digital economy has a positive direct and negative spatial spillover effect on carbon productivity, and this conclusion is still valid after the robustness test and endogeneity test; (ii) digital infrastructure has a greater impact on carbon productivity than digital industrialization and industrial digitalization; (iii) the mechanism analysis shows that environmental regulation negatively moderates the relationship between the digital economy and carbon productivity; (iv) heterogeneity analysis shows that the effect of the digital economy on carbon productivity is more obvious in the central region compared to the western region, while it is not significant in the eastern region. Overall, this paper not only provides a new analytical perspective for understanding the improvement of carbon productivity in the digital economy but also provides policy inspiration for promoting carbon peak and carbon neutrality goals.

The impact of the free trade zones construction on green technological innovation efficiency --evidence from 288 cities in Chinese.

We measure the green technology innovation efficiency of 288 cities in China from static and dynamic dimensions using the super-SBM model and Malmquist-Luenberger index, and employ "Difference in Difference" (DID) model to evaluate the impact of FTZs construction on green technology innovation efficiency using panel data from 288 prefecture-level cities from 2008 to 2020. The findings show: (1) The FTZs significantly improve green technology innovation efficiency. The decomposition indexes promote the green technology innovation efficiency more from the dynamic productivity dimension (GTFP) functioning on technological advancement. (2) The FTZs can boost the efficiency of green technology innovation through industrial agglomeration, digital economy, and government financial support; (3) The effect of FTZs on the efficiency of green technology innovation differs based on the size and location of the city. Green technology innovation will reach maximum potential when promoting FTZ policy in less developed central, western, and interior regions. This study addresses whether FTZ policies can genuinely support regional green innovation and policy insights to expand opening up and enhance high-quality economic growth.

Greenhouse gas emissions, carbon stocks and wheat productivity following biochar, compost and vermicompost amendments: comparison of non-saline and salt-affected soils.

Understanding the impact of greenhouse gas (GHG) emissions and carbon stock is crucial for effective climate change assessment and agroecosystem management. However, little is known about the effects of organic amendments on GHG emissions and dynamic changes in carbon stocks in salt-affected soils. We conducted a pot experiment with four treatments including control (only fertilizers addition), biochar, vermicompost, and compost on non-saline and salt-affected soils, with the application on a carbon equivalent basis under wheat crop production. Our results revealed that the addition of vermicompost significantly increased soil organic carbon content by 18% in non-saline soil and 52% in salt-affected soil compared to the control leading to improvements in crop productivity i.e., plant dry biomass production by 57% in non-saline soil with vermicompost, while 56% with the same treatment in salt-affected soil. The grain yield was also noted 44 and 50% more with vermicompost treatment in non-saline and salt-affected soil, respectively. Chlorophyll contents were observed maximum with vermicompost in non-saline (24%), and salt-affected soils (22%) with same treatments. Photosynthetic rate (47% and 53%), stomatal conductance (60% and 12%), and relative water contents (38% and 27%) were also noted maximum with the same treatment in non-saline and salt-affected soils, respectively. However, the highest carbon dioxide emissions were observed in vermicompost- and compost-treated soils, leading to an increase in emissions of 46% in non-saline soil and 74% in salt-affected soil compared to the control. The compost treatment resulted in the highest nitrous oxide emissions, with an increase of 57% in non-saline soil and 62% in salt-affected soil compared to the control. In saline and non-saline soils treated with vermicompost, the global warming potential was recorded as 267% and 81% more than the control, respectively. All treatments, except biochar in non-saline soil, showed increased net GHG emissions due to organic amendment application. However, biochar reduced net emissions by 12% in non-saline soil. The application of organic amendments increased soil organic carbon content and crop yield in both non-saline and salt-affected soils. In conclusion, biochar is most effective among all tested organic amendments at increasing soil organic carbon content in both non-saline and salt-affected soils, which could have potential benefits for soil health and crop production.

Could coping with your inner critic be the key to unlocking your scholarly writing?

INTRODUCTION: Though various barriers to productive writing habits exist in academia, scholarship is a critical part of faculty expectations. One barrier that has not been well addressed in the literature is the presence and interference of a negative inner critic, an internal voice or dialogue that criticizes work, halts creativity, and paralyzes writing. COMMENTARY: The purpose of this commentary is to describe the limited evidence-base and anecdotal strategies shown to support increased writing productivity by acknowledging and navigating the inner critic. With strategies such as proper identification, acknowledgment, strong mentor-mentee relationships, personifying the inner critic, embracing a growth mindset, and considering the distinct phases of writing, faculty can cope with their critical inner voice and reclaim control of their scholarly writing productivity. IMPLICATIONS: With such a heavy emphasis on writing productivity for faculty, faculty are encouraged to more formally explore and implement professional development strategies to help navigate their inner critic and bolster writing productivity.

Has environmental protection tax reform promoted green transformation of enterprises? Evidence from China.

Facing the increasingly stringent constraints of resources and the environment, the green transformation of enterprises is imperative. This study selects A-share listed companies in Shanghai and Shenzhen from 2014 to 2021 as samples, using the difference-in-differences method to examine the impact of the environmental protection tax reform (EPTR) on the green transformation of enterprises. The results indicate that the EPTR can promote the green transformation of enterprises, achieving this through three channels: raising the cost of pollution, strengthening the rigidity of law enforcement, and breaking the collusion between the government and enterprises. Notably, this promotional effect is more significant in non-state-owned enterprises, companies in the eastern and western regions, firms with low financing constraints, and those with high media attention. Further analysis shows that the EPTR has a positive impact on the green total factor productivity (GTFP) of enterprises, which implies that enterprises are not only proactively pushing for a green transformation at the strategic level but also taking practical actions. This study responds to the problem of the greening of tax system to promote the green development of enterprises from two aspects of enterprise strategic implementation and productivity and explores the impact mechanism from the perspective of institutional logic. It enriches the research on the effectiveness of the EPTR at the micro-level and broadens the research perspective on the impact mechanisms of environmental regulation. The findings of this study provide references for further optimising relevant policies and regulations and also offer insights for other countries and regions seeking sustainable development.

Impact of aerosol concentration changes on carbon sequestration potential of rice in a temperate monsoon climate zone during the COVID-19: a case study on the Sanjiang Plain, China.

The emission reduction of atmospheric pollutants during the COVID-19 caused the change in aerosol concentration. However, there is a lack of research on the impact of changes in aerosol concentration on carbon sequestration potential. To reveal the impact mechanism of aerosols on rice carbon sequestration, the spatial differentiation characteristics of aerosol optical depth (AOD), gross primary productivity (GPP), net primary productivity (NPP), leaf area index (LAI), fraction of absorbed photosynthetically active radiation (FPAR), and meteorological factors were compared in the Sanjiang Plain. Pearson correlation analysis and geographic detector were used to analyze the main driving factors affecting the spatial heterogeneity of GPP and NPP. The study showed that the spatial distribution pattern of AOD in the rice-growing area during the epidemic was gradually decreasing from northeast to southwest with an overall decrease of 29.76%. Under the synergistic effect of multiple driving factors, both GPP and NPP increased by more than 5.0%, and the carbon sequestration capacity was improved. LAI and FPAR were the main driving factors for the spatial differentiation of rice GPP and NPP during the epidemic, followed by potential evapotranspiration and AOD. All interaction detection results showed a double-factor enhancement, which indicated that the effects of atmospheric environmental changes on rice primary productivity were the synergistic effect result of multiple factors, and AOD was the key factor that indirectly affected rice primary productivity. The synergistic effects between aerosol-radiation-meteorological factor-rice primary productivity in a typical temperate monsoon climate zone suitable for rice growth were studied, and the effects of changes in aerosol concentration on carbon sequestration potential were analyzed. The study can provide important references for the assessment of carbon sequestration potential in this climate zone.

Menopause in the workplace: Challenges, impact, and next steps.

INTRODUCTION: Menopause is a natural part of a woman's life that coincides with a time when many women play significant roles in the workforce. Menopause symptoms, such as hot flashes, fatigue, and difficulty with concentration and memory, can have a negative effect on work productivity and efficiency. OBJECTIVES: This paper summarizes the impact of menopause in the workplace, with an emphasis on the impact of symptoms on employed women and how the workplace influences their experiences. It highlights economic implications, promotes awareness, and suggests potential next steps. METHODS: A search for papers was conducted between August and November 2023 in the PubMed and Medline databases. Papers were selected based on personal experience and interpretation of the findings. Recommendations for managing menopause symptoms in the workplace and guidance on an optimal workplace intervention strategy were provided. RESULTS: Women experiencing severe menopause symptoms are more likely to report adverse work outcomes, including absenteeism and job-related decisions such as quitting, retiring early, or declining promotions than women experiencing few symptoms. Factors such as a lack of awareness about menopause, inflexible work conditions, and high-stress jobs can exacerbate the severity of these symptoms. Additionally, unaddressed menopause symptoms contribute to both direct and indirect economic costs, including medical resource utilization and lost work productivity, resulting in a substantial economic burden. CONCLUSION: Menopause symptoms impair women's work experiences and productivity. In addition to dismantling the stigma associated with menopause, it is critical to create and implement menopause workplace policies and interventions aimed at supporting women in this universal life stage.

Predicting Academic Productivity Among American Shoulder and Elbow Surgeons (ASES) Fellowship Faculty from Publications Acquired Before and During Surgical Training.

BACKGROUND: Orthopedic residency and fellowship applicants with a strong research record are highly valued for their potential in continuing academic excellence. Despite this, the association between research productivity during training and future academic productivity as an attending orthopedic surgeon is not well-established. We assess the effects of research output during different periods of surgical training as well as residency location on long-term academic productivity as an attending shoulder and elbow surgeon. METHODS: A search of the 2022-2023 American Shoulder and Elbow Surgeons (ASES) Fellowship Directory was conducted to identify a list of orthopedic shoulder and elbow fellowship faculty members. Each surgeon's residency, fellowship and current institution of practice were determined and stratified by geographic location. Total publication counts acquired before residency, during residency, during fellowship, and after fellowship were collected for each faculty member. Attending publication rates and H-indices were calculated. A multivariate linear regression model was created, and significance was set at a P-value < 0.05. RESULTS: A total of 149 shoulder and elbow fellowship faculty members representing 34 fellowship programs were identified. The average number of total publications per surgeon was 88.8 ± 102. The average attending publication rate was 5.29 ± 6.89 publications per year. The average H-index for included surgeons was 27.8 ± 24.4. The number of publications acquired before residency (ß = 0.293; P < 0.001), during residency (ß = 0.110; P = 0.025) and during fellowship (ß = 0.593; P < 0.001) were significantly associated with an increased attending publication rate, but no association was observed with the H-index [before residency (ß = -0.221; P = 0.574), during residency (ß = 0.045; P = 0.866), during fellowship (ß = 0.198; P = 0.678)]. There were no significant differences in total publication count (P = 0.397), attending publication rate (P = 0.237), or H-index (P = 0.364) based on location of residency training. DISCUSSION: Research output before and during surgical training is predictive of continued academic productivity as a shoulder and elbow surgeon. In particular, greater productivity during surgical fellowship was most predictive of academic output as an attending. While long-term academic productivity does not seem to be influenced by the geographic location of residency training, attending surgeons practicing in the Midwest had significantly greater total publication counts and H-indices but similar annual publication rates. LEVEL OF EVIDENCE: Survey Study; Cross Sectional Design; Literature and Internet Sources.

Enhancing the productivity and proliferation of CHO-K1 cells by oncoprotein YAP (Yes-associated protein).

CHO cells are extensively employed in biological drug industry to manufacture therapeutic proteins. Nevertheless, production of biopharmaceuticals faces obstacles such as limited growth and inadequate productivity. Employing host cell engineering techniques for CHO cells serves as a valuable approach to address the constraints encountered in biologics manufacturing. Despite advancements, most techniques focus on specific genes to address individual cellular challenges. The significance of YAP, transcriptional co-activator, cannot be overstated due to its involvement in regulating organ size and tumor formation. YAP's influence extends to various cellular processes and is regulated by kinase cascade in the Hippo pathway, which phosphorylates serine residues in specific LATS recognition motifs. Activation of YAP has been observed to impact both the size and quantity of cells. This research investigates the effects of YAP5SA on proliferation, apoptosis, and productivity in CHO-K1 cells. YAP5SA, with mutations in all five LATS-target sites, is selected for its heightened activity and resistance to repression through the Hippo-LATS1/2 kinase signaling pathway. Plasmid harboring YAP5SA was transfected into EPO-CHO and the influence of YAP5SA overexpression was investigated. According to our findings, transfection of EPO-CHO cells with YAP5SA exhibited a substantial enhancement in CHO cell productivity, resulting in a 3-fold increase in total protein and EPO, as well as a 1.5-fold increase in specific productivity. Additionally, it significantly contributes in augmenting viability, size, and proliferation. Overall, the findings of this study exemplify the potential of utilizing YAP5SA to impact particular cellular mechanisms, thereby presenting an avenue for customizing cells to fulfill production demands. KEY POINTS: • YAP5SA in CHO cells boosts growth, reduces apoptosis, and significantly improves productivity. • YAP5SA regulates genes involved in proliferation, survival, and mTOR activation. • YAP5SA increases productivity by improving cell cycle, c-MYC expression, and mTOR pathway.

Afforestation using a range of tree species, in New Zealand: New Forest trial series establishment, site description, and initial data.

Global climate change and shift towards a bio-economy has heightened the need to design sustainable forestry systems that balance economic, environmental and social benefits. In New Zealand, production forests are dominated by planted Pinus radiata, which makes up 90 % of the planted forest area. There is very little data driven evidence in New Zealand to support diversifying across a range of tree species and what timber and non-timber benefits may be gained by diversifying tree species in New Zealand's production forests. The New Zealand New Forest Trial Series (NFTS) was designed and established in 2013 on marginal pastoral land to address the knowledge gap for how afforesting land with different trees species, both exotic and indigenous to New Zealand, across a climate range can deliver to both timber and non-timber benefits. These trials were planted with Cupressocyparis ovensii, Eucalyptus fastigata, Fraxinus excelsior, Nothofagus fusca (plus Leptospermum scoparium), Pinus radiata, Podocarpus totara and Sequoia sempervirens plus a control with no planting to monitor natural succession. The Before-After-Control-Impact (BACI) experiment design has collected pre-planting data describing the present vegetation and a range of soil properties, presented in this paper. This will allow the comparative monitoring of the changes that will occur through planting the various tree species on marginal land in different environments through time. With time the long-term trials will deliver data evidence on tree species survival when planted into marginal pastoral land, tree productivity and the flow of economic, environmental and social benefits from the new plantings. This knowledge will strengthen New Zealand's forestry sector confidence to make informed decisions to diversify tree species with changing climatic and social challenges.

Work Productivity Impairment in Persons with Inflammatory Bowel Diseases: A Systematic Review and Meta-analysis.

BACKGROUND AND AIMS: The impact of inflammatory bowel disease (IBD) on work productivity remains unclear. In this systematic review and meta-analysis, we quantify work-related outcomes and employment data among persons with IBD. METHODS: A systematic literature search was conducted in MEDLINE, EMBASE, the Cochrane library, Scopus, ProQuest, and clinicaltrials.gov from inception to February 2023 to identify studies on work productivity in persons with IBD aged >18 years. Work productivity was defined primarily by the Work Productivity and Activity Impairment (WPAI) questionnaire which includes absenteeism, presenteeism, overall work impairment, and non-work activity impairment. In addition, we included data on employment, sick leaves, disability pensions, and indirect costs due to productivity loss. Pooled effect analysis was conducted using a random-effects model for pooled estimates of continuous and proportional data with 95% confidence intervals. RESULTS: Among all patients with IBD, the pooled estimates were 16.4% for absenteeism, 35.9% for presenteeism, 39.4% for overall work impairment, and 46.0% for non-work activity impairment. Indirect costs from overall work impairment were 5,131.09 euros/patient/year. Only two thirds of IBD patients were employed and 1 in 3 patients lost their jobs due to IBD. Among those employed, 39.5% report sick days, 21.3% report work disability, and 12.3% receive disability pensions. Most studies demonstrate clinically meaningful improvements in work productivity with medical and/or surgical therapies. CONCLUSION: Persons with IBD experience significant work impairment and associated indirect costs. This highlights the need for appropriate workplace accommodations and timely medical therapy to alleviate the burden of disease and improve work outcomes.

Does ecological economic zone policy affect pollutant emission: Evidence from a case study of Dongting Lake.

Environmental pollution affects human health, reduces work motivation, and addressing environmental pollution is a common challenge faced by the world. The Chinese government has recently implemented a new environmental policy - the national-level ecological economic zone - to develop a green economy and reduce environmental pollution. This study utilizes the difference-in-difference method to analyze the impact of the Dongting Lake ecological economic zone on environmental pollution. The results show that: policy led to a 68 % reduction in sulfur dioxide emissions. This impact was more pronounced in economically developed areas, regions with a high concentration of foreign-invested, and areas with greater economic openness. Mechanism tests indicate that the policy reduces environmental pollution by promoting technological progress. Robustness checks show that the policy also resulted in a 37 % reduction in industrial wastewater emissions. The results offer new insights to advance the development of the ecological economic zone more effectively. The ecological economic zone should focus on enhancing technological advancement and green total factor productivity to amplify the policy's positive effects.