Barriers to healthcare and health seeking behaviors among elderly people living in rural regions of India: a study based on 9 villages in Eastern Uttar Pradesh

Background: The elderly population in India is experiencing exponential growth and facing various health and well-being challenges. This demographic shift is especially pronounced in rural areas, affecting social, financial, family, and transportation aspects, subsequently impacting health and well-being. This study aims to comprehensively understand these needs and priorities by exploring the multifaceted challenges faced by the elderly in India. Methods: An exploratory qualitative research study with a quantitative component was conducted in 9 villages in Uttar Pradesh’s Siddhartha Nagar District. Participants included individuals aged 60 years and above (n=29, M:F ratio of 13:16). Data were collected using Focus Group Discussions and Personal Interviews to assess the challenges faced by the geriatric population. The methodology involved multi-directional interactive sessions focusing on health, illness, and coping. Results: Participants averaged over 5.8 medical conditions. Those with better Socio-Economic Status (SES) reported multiple conditions but fewer troubles, while the majority, being very poor, did not consider health a primary concern. There were no complaints about the lack of public health facilities or transportation. The study highlights the complex interactions between healthcare, family, and financial difficulties that older people in rural India experience, underscoring the need for specialised treatments. The low level of knowledge about government programmes emphasises the need for improved outreach techniques to close existing accessibility gaps. Conclusions: The study recommends focused interventions and improved policies to meet the unique needs of India's rural elderly population. Policymakers and healthcare providers can enhance the well-being of this vulnerable demographic by understanding the complex nature of their issues.

Analysis of constraints and policy recommendations for the development of pediatric drugs in China:Based on the perspective of pharmaceutical enterprises / 中国卫生政策研究

Objective:To provide a basis for improving the design and implementation of policies for ensuring the supply of pediatric drugs in China.Method:Based on the perspective of pharmaceutical enterprises,reviewed literature and conducts questionnaire surveys to identify the constraints in the development of pediatrict drugs throughout the entire drug lifecycle,and analyzes the constraints'concentration and urgency.Result:The main constraints include:difficulty in conducting clinical trials for children;the current registration and approval rules lack consideration for the specificity of pediatric drugs and specific requirements for application materials;lack of implementation rules and measures in the implementation process of incentive policies for pediatric drug production;The market interest mechanism of pediatric drugs is not yet perfect.Among them,research and development and payment for use are currently relatively concentrated issues.Discussion and suggestions:It is recommended that China fully utilize existing clinical trial data of pediatric and broaden sources,take multiple measures to increase investment in pediatric drug R&D;Develop special guidelines for pediatric drug application and encourage adult drug registration to submit pediatric research plans;Explore the optimization path of pediatrict drug production and supply based on typical cases;Provide more space for pediatric drugs in the rules of drug use and payment.

Constraints and Suggestions of Fruit Crop Growers of Vijayapura District, India

The study was conducted in Vijayapura district of Karnataka during 2019-20 to analyse the constraints and suggestions of fruit crop growers. Forty each grape, lime and pomegranate growers were selected by use of simple random sampling technique. Thus, making a total sample size of 120. Personal interview method was used to collect data and appropriate statistical tools were applied to analyse the data. The findings revealed that, with respect to the constraints faced by fruit crop growers in fruit crop production, production constraints were lack of irrigation facilities (87.50%) followed by high cost of inputs (73.33%). Major financial constraints were non-availability of credit at right time (73.33%) followed by inadequate credit (70.83%). High wages (70.00%) and non-availability of labourer (61.67%) were the main issues relating to labour constraints. Regarding marketing constraints, fluctuating price (87.17%) followed by delayed cash payment and exploitation by middlemen (77.50%) were the major constraints. The suggestions offered by the fruit crop growers are provision for irrigation facility (85.00%) followed by provision of timely and adequate market information (76.67%), protection from exploitation by middlemen (75.00%). Provision for suitable market infrastructure, timely and adequate credit, timely and adequate cash payment, continuous power supply, interest free credit and longer repayment period for credit were other suggestions offered to improve the returns from fruit crop cultivation.

Ranking of the Constraints Faced by the Khoya Producers in Production and Marketing of Khoya, in Almora District of Uttarakhand, India

The Almora district in Uttarakhand is renowned for its roasted khoya, a processed milk product. Khoya is sourced from the rural areas surrounding Almora, and its production and marketing play a vital role in supporting the local economy. In light of this, a comprehensive study was conducted to assess and rank the challenges faced by khoya producers throughout the production and marketing processes.To conduct this study, various constraints were identified, and a sample of 200 khoya producers supplying their products to nearby markets was selected through a multistage sampling approach. These producers were personally interviewed to gather insights into their challenges. The study employed the Garrett ranking technique to determine the relative importance of these constraints in the khoya production and marketing context. The findings of the study revealed that in the production stage, the most significant challenges were a lack of knowledge concerning cattle disease symptoms with mean score of 58.16, high cost of feed for dairy animals, with mean score of 54.33. In the marketing stage, the primary constraints along with their mean scores included post-preparation losses (70.78), low prices obtained for khoya, (60.47) delayed payment (51.78), and ongoing storage issues (27.00). In light of these results, it is evident that there is an urgent need to improve veterinary services to address the issue of cattle disease symptoms, as well as to establish fair pricing mechanisms in the rural belts under consideration. These measures are essential to support and sustain the khoya industry and the livelihoods of the local producers.

Rapeseed-Mustard Farming in Begusarai, Bihar, India: A Holistic Exploration of Growth, Economic Viability, and Hindrances

The present study conducted a comprehensive analysis of the rapeseed-mustard sector's economic dynamics in India, with a focus on Bihar's Begusarai district. The study has been carried out with the objectives of analyzing the trend in area, production and productivity along with the cost and return from rapeseed-mustard production. Further the constraints faced by the famers were also documented and ranked. Primary data was collected from 120 rapeseed-mustard growers of District from a cluster of three villages each from two blocks through SRSWOR Technique and secondary data were collected from different published sources. A negative growth rate (CGR) in area (-0.05%) was observed while the growth in production and productivity of Rapeseed-Mustard during 1998-99 to 2018-19 in Bihar was positive and significant. Districts wise analysis in entire period together there was positive Growth in the area, production and productivity. The average cost of cultivation per hectare was ? 63,873.1, while the gross income stood at ? 83,746.92, yielding a favourable return-to-cost ratio of 1:1.39, implying that rapeseed–mustard fetched an additional return of 39 paisa on each rupee spent. Primary constraints identified included the absence of high-quality seed varieties and elevated transportation expenses, both warranting attentions. To bolster the future of rapeseed-mustard, widespread dissemination of advanced farming techniques and the establishment of processing facilities among smallholders is recommended.

Constraints Perceived by Farmers in Fish Farming: A Review Analysis

The adoption of scientific fish farming faces multiple constraints encompassing economic, infrastructural, technological, marketing, societal, and extension-related challenges. Economically, the substantial upfront investment required for infrastructure and operational costs deters potential fish farmers, especially small-scale operators. Inadequate access to financing further exacerbates this issue. Insufficient infrastructure, including poor transportation networks and processing facilities, hampers the efficient distribution and marketing of fish products. Limited access to scientific farming technology and disease management techniques hinders the adoption of advanced practices, while price fluctuations and a lack of organised markets pose marketing-related challenges. Cultural norms and societal dynamics can influence fish farming practices, sometimes hindering the adoption of sustainable farming. To overcome these constraints, collaborative efforts among the government departments, institutes, banks, NGOs etc. are essential. Strategies include providing financial support mechanisms, infrastructure development, dissemination of latest technical known how and training, establishing market chain, and respecting local social norms. Addressing these issues collectively could unlock the full potential of fish farming, promoting food security, livelihood enhancement and sustainable development.

A Study on Knowledge Level and Attitude of Farmers towards Organic Farming in Ananthapuramu District, Andhra Pradesh, India

Organic farming is practicing in 187 countries, and 72.3 million hectares of agricultural land were managed organically by at least 3.1 million farmers. India is home to 30% of total organic producers in the world having 2.30 million ha (NCOF, 2021). A study was conducted in ten mandals of Ananthapuramu district with sample size of 100 and farmers were selected randomly. Pearson correlation, frequency, percentage, mean were calculated. From the results it was noticed that farmers have more knowledge related to statements viz., organic farming is a type of farming system in which crops are grown without the use of chemical inputs (85%) and knowledge gap percentage was 15. Farmers have positive attitude on statement I can obtain optimum production level in organic farming if we rear livestock at our farm with score of 244 and attitude gap percentage of 20 followed by organic farming will decrease the production cost by reducing the input purchases score of 243 and attitude gap percentage of 19. Education, extension contact, information seeking behaviour and awareness about organic farming variables were positively significant and highly correlated with attitude of farmers towards organic cultivation. Major constraints faced by the farmers were lack of skill regarding the preparation and usage of organic inputs (80%) followed by complicated methods for production of organic inputs and absence of premium price for organic produce in the local market (71%). Major suggestion were direct procurement of organic produce by government and supply to Midday Meals Scheme and Public Distribution System.

Constraints Perceived by the Farmers Regarding Opportunity and Challenges of Climate Smart Agriculture in Central Plain Zone of Uttar Pradesh, India

This research article discussed about the constraints faced by farmers in the adoption of climate smart agriculture in the Central Plain Zone of Uttar Pradesh. Climate Smart Agriculture (CSA) is basically a management strategy for agriculture in the face of climate change. Farmers face obstacles to adopting diverse Climate Smart Agriculture practices. Farmers face many barriers when it comes to adopting new or unfamiliar practices, such as Climate Smart Agriculture. These include lack of awareness, high cost of machines and input, and insufficient knowledge and guidance. Garrett's ranking technique is used to determine the most important factor influencing the response. The major constraints faced by the farmers in their knowledge and adoption of Climate Smart Agriculture were ‘lack of awareness', 'uncertain returns', 'limited extension activities’ common problems in the study area having the Garrett rank of first (Average Value 114.95), second (Average Value 113.26) and third (Average Value 101.22) respectively, and so forth the other constraints too. The study sought to identify the barriers to Climate Smart Agriculture adoption as well as potential solutions.

Economic Feasibility of Carnation Cultivation in the Nilgiris District of Tamil Nadu, India

Aim: To estimate the economics of Carnation Production under Protected cultivation, to estimate the feasibility of the protected cultivation of Carnation in the study district, and to assess the constraints faced by the farmers in scaling up the protected cultivation in the study district and to suggest suitable solutions.Study Design: An ex-post-facto study was conducted, among the carnation cultivators of Nilgiris district of Tamil Nadu.Place and Duration of Study: The Nilgiris district was purposively selected for the study as it possesses the largest area under carnation flower cultivation in Tamil Nadu and the study was conducted between April 2023 and June 2023.Methodology: The present study employed a multi-stage purposive cum random sampling technique to select the district, blocks, villages, and respondents for research. The Nilgiris district was purposefully chosen for its significance in carnation flower cultivation within Tamil Nadu. Specifically, Kothagiri, Coonoor, and Uthagai blocks of the Nilgiris district were selected as focal areas for this investigation. Within each of these selected blocks, two villages were chosen, resulting in a total of six villages as study locations. To ensure representation, 30 farmers engaged in carnation cultivation were then selected, with a proportion of 5 farmers per village. The respondents were interviewed with a pre-structured questionnaire through a random approach. Furthermore, the study incorporated feasibility analysis, which included evaluating key financial metrics such as the Benefit-Cost Ratio, Net Present Worth, and Internal Rate of Return. These financial analyses were conducted to assess the economic viability and potential returns associated with carnation cultivation in the Nilgiris district.Results: The results reveal that the net return/ 4000 m2 is Rs. 16.67 lakhs. The BCR was found to be 1.40 (Financially feasible). The NPV was found to be Rs. 70.35 lakhs and the IRR was estimated to be 40.00 per cent. Major constraints encountered by the farmers include the higher cost of polyhouse material and construction, followed by the higher cost of the seedlings and the poor availability of skilled labour.Conclusion: Protected cultivation technology unlocks the potential to produce crops with high productivity and superior quality.

Level of Awareness, Adoption and Constraints of Jasmine Growers

The Tiruchirappalli (Trichy) and Dindigul districts of Tamil Nadu state were purposively taken for studying objectives viz., profile, awareness, adoption and constraints faced by the jasmine growers. The sampling technique was multi-stage purposive sampling and the research design adopted was descriptive method. A total sample size of 160 (jasmine growers). The secondary data was collected through structured interview schedule. The frequency and percentage were worked-out to quantify the secondary data. PRA preference ranking/problem ranking matrix methodology was used to rank the production and marketing led constraints based on the perceived level of severity by the jasmine growers. Likewise to study the determinants of awareness and adoption with that of the profile, the correction and regression co-efficient was used. It was evident that, there was cent percent awareness and adoption of variety, planting season. Though there was cent percent awareness on pruning technique, only 88.13 % adopted the practice. Very least awareness level (7.50 % & 14.38 %) was observed with respect to post harvest management practice like enhancing shelf-life and off-season flowering technology respectively. The proportion of non-adopter were high with respect to bio-fertilizer application (78.13 %), use of bio-stimulant (81.88 %), off-season flowering spraying (90.63 %) and enhancement of shelf-life through boric acid (100 %). Majority (71.88 %) of farmers were having only medium level of awareness, similarly little more than half (58.75 %) of the farmers had only medium level of adoption. The score obtained through problem matrix ranking revealed that, labour shortage during peak flowering season with highest mean score of 35.50 was ranked as foremost constraint in production and Price fluctuation /market risk with highest mean score of 37.50 was perceived as the foremost constraint in marketing of jasmine.

Constraints Experienced by the Paddy Farmers in Three Agroclimatic Zones of Telangana State, India

The present investigation was conducted during 2021-22 to assess the constraints experienced by the paddy farmers in three agroclimatic zones of farming sustainability in Telangana state. Findings revealed that, constraints such as high cost of seed varieties (I), lack of knowledge and skill for determining economic threshold level of pests and diseases (II), labour scarcity due to Mahatma Gandhi National Rural Employment Guarantee Scheme (I), labour scarcity during peak operations (II), insufficient finance with farmers (I), high rental charges for farm machinery (II), lack of new technologies and uneconomically viable solutions for residue management (I), lack of knowledge about input management (II), lack of information about government schemes (I), lack of information about recent pest-management strategies (II) were the first and second priority constraints under ecological, social, economical, technical and institutional dimensions respectively. Accordingly, Government organisations, NGO’s, ATMA, KVK’s, DAATC’s, SAU’s should look after certain issues such as providing seeds at affordable cost , Mahatma Gandhi National Rural Employment Guarantee Scheme must give prioritize to agricultural field operations along with other activities, crop loan must be sanctioned to every farmer by considering crop yield assurance and bring out new technologies like happy seeder to remove residues but also allows the farmer to seed the new crop without involving manual labour, which saves time and money for the farmers. Extension education functionaries and line departments experts must use the Situation Based Extension with Participatory Approach (SBEA) in order to effectively overcome constraints and get feedback, which act as source for ATMA action plans to implement at grass root level.

An Analysis of Constraints Faced by Organic Farmers in the Cauvery Delta Zone of Tamil Nadu, India

Aim: This study examines the multifaceted challenges encountered by organic farmers operating within the Cauvery Delta Region of Tamil Nadu.Study Design: Ex-post facto research design was used to investigate and reveal the challenges that organic farmers have encountered over the preceding years.Place and Duration of Study: The study was conducted in the Cauvery Delta Zone of Tamil Nadu. Five districts were selected for the study namely, Thanjavur, Thiruvarur, Nagapattinam, Mayiladuthurai and Tiruchirapalli. Respondents were interviewed during the period of June 2023 – July 2023.Methodology: The study aimed to include 40 organic farmers from each district, resulting in a collective sample size of 200 respondents across these districts, facilitated through snowball sampling technique. A well – structured interview schedule which included the major constraints faced by organic farmers of the CDZ was developed based on review of past literatures and discussion with experts in the area of organic farming. Based on the ranks given by the respondents to the constraints, the data was analyzed and conclusive results were obtained using the Rank Based Quotient (RBQ) technique. Constraints were studied in 7 different dimensions namely, labour, technical, service and supply, credit and economic, environmental, cropping and marketing constraints. Results: The prime constraints with a higher RBQ values identified in these dimensions were, Labour scarcity due to MGNREGA (93.13), Cumbersome (Slow and complicated) certification process (79.90), Lack of supportive institutions for organic farming (91.80), Inadequate subsidies for organic agriculture (92.75), Use of polluted river water for irrigation (93.90), Lack of inputs specifically for weed management (96.63), Challenge in finding proper marketing channel (90.38). In addition to this, some minor issues were also identified as constraints in the study area.Conclusion: Through an in-depth exploration of these challenges, the study aims to provide insights that can guide policy makers, practitioners, and stakeholders in devising strategies to overcome the obstacles faced by organic farmers in the Cauvery Delta Zone which could have a threshold effect in boosting up the organic productivity of the state.

A propósito dos dilemas da comunicação / About the communication dilemmas / À propos des dilemmes de la communication

Les règles que nous appliquons et les normes auxquelles nous obéissons dans les activités communicatives sont tellement intériorisées qu'elles sont pratiquement imperceptibles. Adriano Duarte Rodrigues, au cours des trois dernières décades, a cherché les conditions du déchainement de l'activité communicative en tant que processus interactionnel situé. Dans cette critique, je souligne la question centrale présentée dans A natureza da atividade comunicativa (La nature de l'activité communicative), son dernier livre: l'observation du comportement des personnes dans les interactions auxquelles elles participent comme point de départ pour comprendre la communication. Cette attitude émique, fondée sur l'approche ethnométhodologique, cherche à découvrir les méthodes de sens commun utilisées par les individus dans leurs productions et in-terprétations au cours de leurs interactions. Le grand dilemme des études de communication découle, selon l'auteur, de la naturalisation de dispositifs qui ont été internalisés au cours du processus de socialisation et qui échappent à notre perception lorsque nous nous impliquons dans des interactions reglées sur eux.

As regras que aplicamos e as normas a que obedecemos nas atividades comunicativas estão de tal modo in-teriorizadas que são praticamente imperceptíveis. Adriano Duarte Rodrigues tem dedicado as últimas três décadas a tentar equacionar as condições que desencadeiam a atividade comunicativa enquanto processo interacional situado. Nesta resenha, destaco a questão central apresentada em A natureza da atividade comunicativa, seu mais recente livro: a observação dos comportamentos das pessoas nas interações das quais participam como ponto de partida para a compreensão da comunicação. Esta atitude êmica, funda-mentada na abordagem etnometodológica, procura descobrir os métodos do senso comum, usados pelos indivíduos nas produções e interpretações no decurso das suas interações. O grande dilema dos estudos da comunicação decorre, segundo o autor, da naturalização de dispositivos interiorizados ao longo do processo de socialização e que escapam à nossa percepção quando estamos envolvidos nas interações reguladas por eles

The rules we apply and the norms we obey in communicative activities are so internalized that they are practically imperceptible. Adriano Duarte Rodrigues has dedicated the last three decades to trying to equate the conditions that trigger communicative activity as a situated interactional process. In this review, I highlight the central question presented in A natureza da atividade comunicativa (The nature of commu-nicative activity), his most recent book: the observation of people's behavior in the interactions in which they participate as a starting point for understanding communication. This emic attitude, based on the ethnomethodological approach, seeks to discover the commonsense methods employed by individuals in their productions and interpretations in the course of their interactions. The great dilemma of the commu-nication studies stems, according to the author, from the naturalization of devices internalized throughout the socialization process, devices that escape our perception when we are involved in interactions regulated by them

Constraints to Integrated Farming System in Hadoti Region of Rajasthan, India

The study's major goal was to find out the challenges (high cost of input, pest attack, marketing problems, high transportation cost etc.,) that farmers face in the integrated farming system. Farmers' constraints in different enterprises of the integrated farming system were recorded through a well-structured and pretested survey schedule. To confirm their validity and determine the extent to which the identified constraints were seen in crop production as well as in cattle production, goat rearing, backyard poultry production and orange cultivation, the severity of the indicated constraints in the real field condition was measured. The fieldwork was carried out in sixteen villages of the Hadoti region out of which Kota, Bundi, Baran, and Jhalawar were selected randomly. A total of 112 farmers were interviewed and data was gathered through group discussions and personal interviews. The data were quantified by ranking the limitations based on the responses of the respondents.

Practice of daytime surgery management at a tertiary general hospital based on the incentive compatibility theory / 中华医院管理杂志

Under the background of performance evaluation in nationwide tertiary public hospitals and the DRGs reform, how to improve the efficiency of daytime surgery management is becoming a hotspot for hospital managers. Since July 2020, a tertiary general hospital applied the theory of incentive compatibility to guide the medical workers to consciously strive to achieve such management goals as improving the quantity and quality of daytime surgeries by constructing an organizational management system, increasing performance rewards for daytime surgical teams, rewarding advanced collectives and individuals, convening work coordination and promotion meetings, formulating penalty terms, and strengthening supervision of surgical quality and safety indicators. The implementation rate of daytime surgery in hospitals, the number of departments conducting daytime surgery, the number of covered diseases, and the satisfaction rate of inpatients had increased from 6.94%, 6 departments, 64 diseases, and 90.5% in 2019 to 24.08%, 21 departments, 125 diseases, and 95.0% in 2022, respectively. The incidence of daytime surgical bleeding, and readmissions within 15 days decreased from 0.6% and 0.5% in 2019 to 0.5% and 0.2% in 2022, respectively. The theory of incentive compatibility was in line with the development goals of daytime surgery in China, providing an optimal strategy for improving the management efficiency of daytime surgery according to local conditions.

Analysis of the Pathogenesis and Treatment of Pulmonary Nodules based on the “Six Constraints” Theory / 中医杂志

Based on ZHU Zhenheng's “six constraints” theory， it is proposed that the formation of pulmonary nodules is closely related to the six constraints， which are constraint of qi， blood， phlegm， fire， dampness and food. All six constraints might lead to pulmonary nodules， among which qi constraint is the dominant one. When qi constraint lasts for a long time， it will turn into fire constraint， resulting in the failure of spleen to transport， which may lead to phlegm constraint， dampness constraint and food constraint； when qi fails to move blood， blood constraint is formulated. Mutual generation of six constraints lead to the disease， and the pathogenesis is interrelated， jointly promoting the occurrence and development of pulmonary nodules. The treatment is mainly to unblock qi， usually using Yueju Pills （越鞠丸）， a classic formula commonly used for six constraints， as the basic formula. And according to the six constraints partiality， it is suggested to flexibly add the medicinals of soothing the liver and rectifying qi， clearing heat and dissipating masses， dissolving phlegm and dissipating masses， fortifying spleen and dissipating dampness， promoting digestion and removing accumulation， invigorating blood and dissolving stasis.

Mediating effects of social participation quality on the relationship between perceived social constraints and mental health status in first stroke patients / 中国实用护理杂志

Objective:To explore the relationships among perceived social constraints, social participation, as well as anxiety and depression in first stroke patients, and to further analyze the mediating effect of social participation on these variables.Methods:A total of 216 first stroke patients in the Department of Neurology of Affiliated Hospital of Qingdao University from April to December 2020 were recruited by convenience sampling and investigated by general information questionnaire, Social Constraints Scale (SCS), Chinese version of Impact on Participation and Autonomy Questionaire (IPA-C) and Hospital Anxiety and Depression Scale (HADS).Results:The total score of SCS, IPA-C, depression and anxiety were 33.49 ± 6.81, 43.42 ± 9.62, 8.05 ± 4.15 and 8.61 ± 2.59. Social constraints were positively correlated with social participation as well as anxiety ( r=0.644, 0.383, both P<0.05). Social constraints were positively correlated with social participation as well as depression ( r=0.482, 0.371, both P<0.05). The quality of social participation partially mediated the relationship between social constraints and anxiety (intermediary effect was 0.119), and also partially mediated the relationship between social constraints and depression (intermediary effect was 0.270). Conclusions:First stroke patients experience high level of social constraints, low quality of social participation and severe anxiety and depression. Social constraints can affect anxiety and depression through social participation. Medical staff should build a good environment to meet the needs of stroke patients of social participation, help patients to establish a correct psychological coping style, reduce patients' avoidance of social participation due to perceived constraints and exclusion, and thus promote the mental health of patients.

Development of metabolic models with multiple constraints: a review / 生物工程学报

Constraint-based genome-scale metabolic network models (genome-scale metabolic models, GEMs) have been widely used to predict metabolic phenotypes. In addition to stoichiometric constraints, other constraints such as enzyme availability and thermodynamic feasibility may also limit the cellular phenotype solution space. Recently, extended GEM models considering either enzymatic or thermodynamic constraints have been developed to improve model prediction accuracy. This review summarizes the recent progresses on metabolic models with multiple constraints (MCGEMs). We presented the construction methods and various applications of MCGEMs including the simulation of gene knockout, prediction of biologically feasible pathways and identification of bottleneck steps. By integrating multiple constraints in a consistent modeling framework, MCGEMs can predict the metabolic bottlenecks and key controlling and modification targets for pathway optimization more precisely, and thus may provide more reliable design results to guide metabolic engineering of industrially important microorganisms.

Analysis on the Relationship between Corporate Social Responsibility ，Financing Constraints and Corporate Performance of Listed Pharmaceutical Companies in China / 中国药房

OBJECTIVE：To study the r elationship between corporate social responsibility ，financing constraints and corporate performance of listed pharmaceutical companies ，so as to provide reference for pharmaceutical enterprises to fulfill their social responsibility in China. METHODS ：Taking 211 A-share listed pharmaceutical companies in China from 2015 to 2018 as samples ， using corporate performance as explained variables ，corporate social responsibility and financing constraints as explanatory variables，asset size ，equity nature ，growth，R&D investment ，marketing investment and annual as control variables ，a multiple regression equation was constructed to study the relationship among corporate social responsibility performance ，financial constraints and corporate performance and put forward the suggestions. RESULTS ：Corporate social responsibility had a significant positive impact on corporate financial performance ；in the promotion of corporate social responsibility on corporate performance ， finacing constratins couldn ’t inhibit the promote function. CONCLUSIONS ：In China ’s pharmaceutical industry ，the awareness of corporate social responsibility needs to be improved ；pharmaceutical enterprises actively perform social responsibility will interactively promote corporate performance. The overall financial constraints faced by Chinese pharmaceutical enterprises are not high，and enterprises which facing financial constraints will better improve their performance by fulfilling corporate social responsibility. It is suggested that the government should promote the legislative process of corporate social responsibility ； pharmaceutical enterprises should enhance the awareness of social responsibility and pay attention to the impact of financing constraints；investors should pay real-time attention to the responsibility information and actual performance of pharmaceutical enterprises.

Study on nurses scheduling based on multi-objective integer programming model in COVID-19 pandemic / 中华医院管理杂志

Objective:To establish a scientific and reasonable nurse scheduling model for ward nursing during COVID-19, to achieve collaborative and efficient scheduling of manpower and materials, and to provide an algorithm basis for the computerized scheduling as well as references for optimizing manpower scheduling in public health emergencies.Methods:The qualitative interview method was used to learn the challenges in nursing manpower scheduling at designated hospitals. In view of the nursing scheduling in the mild case wards during the pandemic and the premise of meeting the needs of different shift types and patient care, the goal was set as minimizing the consumption of nursing human resources and protective equipments. The objective functions, constraints and corresponding parameters were established. A multi-objective integer programming model was established by MATLAB software for solution by CPLEX solver.Results:Two objective functions, three hard constraints, two soft constraints and corresponding parameters were established. Calculations by the model so established found that a 28-day period requires at least 62 nurses, and at least 52 nurses in the contaminated wards, including 7 nurses in the department of intensive care, the infectious and the respiratory wards respectively. This number could meet in general the needs of epidemic care. In comparison, the manual scheduling of the mild care wards during the pandemic in February 2020 needed at least 69 nurses, and 61 in the contaminated wards, yet with a failure to meet all constraints.Conclusions:The model can solve the scheduling challenges in public health emergencies, namely numerous shift types, different nursing needs in different types of shifts, and complex staff structure.Furthermore, the model can save manpower and materials, serving a useful reference for manpower scheduling.