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To evaluate clinical effectiveness of regdanvimab, a monoclonal antibody agent for treating coronavirus 2019 (COVID-19). A retrospective cohort study was conducted at two general hospitals during the study period of December 2020 to May 2021. Mild COVID-19 patients with risk factors for disease progression admitted to the hospitals within seven days of symptom onset were enrolled and followed until discharge or referral. Multivariate analyses for disease progression were conducted in the total and propensity score (PS)-matched cohorts. A total of 778 mild COVID-19 patients were included and classified as the regdanvimab (n = 234) and supportive care (n = 544) groups. Significantly fewer patients required O supplementation nasal prong in the regdanvimab group (8.1%) than in the supportive care group (18.4%, < 0.001). The decreased risk for O support by regdanvimab treatment was noticed in the multivariate analysis of the total cohort (HR 0.570, 95% CI 0.343-0.946, = 0.030), but it was not statistically significant in the PS-matched cohort ( = 0.057). Progression to severe disease was also significantly lower in the regdanvimab group (2.1%) than in the supportive care group (9.6%, < 0.001). The significantly reduced risk for progression to severe disease by regdanvimab treatment was observed in the analysis of both the total cohort (HR 0.262, 95% CI 0.103-0.667, = 0.005) and PS-matched cohort (HR 0.176, 95% CI 0.060-0.516, = 0.002). Potential risk factors for progression were investigated in the supportive care group and SpO < 97% and CRP elevation >1.5 mg/dL were common risk factors for O support and progression to severe disease. Among the patients with any of these factors, regdanvimab treatment was associated with decreased risk for progression to severe disease with slightly lower HR (HR 0.202, 95% CI 0.062-0.657, = 0.008) than that of the total cohort. Regdanvimab treatment was associated with a decreased risk of progression to severe disease.

Immune-evading severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are emerging continuously. The clinical effectiveness of monoclonal antibody agents that exhibit decreased activity against SARS-CoV-2 variants needs to be elucidated. A nationwide, multicenter, retrospective cohort study was designed to evaluate the effectiveness of regdanvimab, an anti-SARS-CoV-2 monoclonal antibody agent. Regdanvimab was prescribed in South Korea before and after the emergence of the delta variant, against which the activity of regdanvimab was decreased but present. Mild to moderate coronavirus 2019 (COVID-19) patients with risk factors for disease progression who were admitted within seven days of symptom onset were screened in four designated hospitals between December 2020 and September 2021. The primary outcomes, O requirements and progression to severe disease within 21 days of admission, were compared between the regdanvimab and supportive care groups, with a subgroup analysis of delta variant-confirmed patients. A total of 2,214 mild to moderate COVID-19 patients were included, of whom 1,095 (49.5%) received regdanvimab treatment. In the analysis of the total cohort, significantly fewer patients in the regdanvimab group than the supportive care group required O support (18.4% vs. 27.1%, < 0.001) and progressed to severe disease (4.0% vs. 8.0%, < 0.001). In the multivariable analysis, regdanvimab was significantly associated with a decreased risk for O support (HR 0.677, 95% CI 0.561-0.816) and progression to severe disease (HR 0.489, 95% CI 0.337-0.709). Among the 939 delta-confirmed patients, O support (21.5% vs. 23.5%, = 0.526) and progression to severe disease (4.2% vs. 7.3%, = 0.055) did not differ significantly between the regdanvimab and supportive care groups. In the multivariable analyses, regdanvimab treatment was not significantly associated with a decreased risk for O support (HR 0.963, 95% CI 0.697-1.329) or progression to severe disease (HR 0.665, 95% CI 0.349-1.268) in delta-confirmed group. Regdanvimab treatment effectively reduced progression to severe disease in the overall study population, but did not show significant effectiveness in the delta-confirmed patients. The effectiveness of dose increment of monoclonal antibody agents should be evaluated for variant strains exhibiting reduced susceptibility.

In this paper, we explore the effect of the implementation of lean production on energy efficiency. Additionally, using inventory turnover data to measure the degree of lean production adoption, we examine the relationship between firm size and the marginal effect of inventory turnover on energy efficiency. The results reveal that inventory turnover positively impacts energy efficiency, and firm size is positively related to the marginal effect of inventory turnover on energy efficiency. Based on the results, we offer managerial implications and identify future research topics for improving energy efficiency in the light of operations management (OM).

In this paper, we explore the effect of the implementation of lean production on energy efficiency. Additionally, using inventory turnover data to measure the degree of lean production adoption, we examine the relationship between firm size and the marginal effect of inventory turnover on energy efficiency. The results reveal that inventory turnover positively impacts energy efficiency, and firm size is positively related to the marginal effect of inventory turnover on energy efficiency. Based on the results, we offer managerial implications and identify future research topics for improving energy efficiency in the light of operations management (OM).

The Association to Advance Collegiate Schools of Business (AACSB) accreditation process establishes that a business school meets the high standards set by a peer review board with administrators and faculty members from various accredited colleges and universities. This paper will synthesize the use of the balanced scorecard across four performance dimensions (financial, customer, internal process, and innovation) with the accreditation process for an online MBA program development effort. Specifically, the balanced scorecard will be examined as a strategic management tool for leveraging resource prioritization and allocation decisions needed to maintain accreditation while meeting the various stakeholders' needs, such as students, university, faculty, and administrators.

A wide range of operations management initiatives are currently being investigated and pursued in U.S. hospitals by both practitioners and academics (Kc and Terwiesch). Even as healthcare providers are being forced to drive down costs, maintaining acceptable levels of quality, while retaining cost efficiency continues to be a major challenge. The objective of this three-essay dissertation is to investigate the impacts of a focused factory approach to healthcare operations, the role of competition as a driver to adopting focused factory approach in healthcare on quality and cost efficiency of large U.S. hospitals, and provide insights on current practices and their efficacy. The first essay investigates the impact of operational focus on quality of care in U.S hospitals, and the determinants of adopting focused operations. The relationship between increasing competition among hospitals and quality performance, and the degree of influence of regional competition on a hospital’s decision to implement a focused factory concept are examined in depth. The concept of a hospital as a ‘focused factory’ has drawn attention in recent years in healthcare management (Herzlinger, Huckman and Zinner, McDermott and Stock). The concept of a focused factory was first articulated in the seminal work of Skinner , in which it was argued that by reducing complexity, manufacturing plants can concentrate on a smaller number of tasks and be more effective and efficient. Specifically, it was argued that a “focused factory does a better job because repetition and concentration in one area allow its workforce and managers to become effective and experienced in the tasks required for success. A focused factory is more manageable and controllable than unfocused plants. Its problems are demanding but limited in scope”. A few studies have portrayed the impacts of the focused factory approach in healthcare environments, and they have reported that hospitals with more focused operations show improved operational performance (Clark and Huckman, Hyer et al., Kc and Terwiesch, McDermott and Stock). It is becoming apparent that hospitals benefit from economies of scale as they focus on fewer services, despite having to give up the advantages from economies of scope as they provide a narrower range of services. It has also been observed that hospitals increasingly do tend to have more focused operations (Eastaugh, Goldberger and Nallamothu). While the focused factory concept in healthcare has begun to be investigated in recent years, existing studies typically focus on just one or a small number of performance outcomes. In our study, we provide a more nuanced understanding of the effects of focused operations on a broader spectrum of quality variables. This allows us to test in which specific area of quality performance the focused factory approach is most effective. In addition, while outcomes of the focused factory have received research attention, the antecedents of the focused factory approach in a healthcare environment have been studied to a much lesser extent. Another area that is related to hospital performance is competition. The impact of competition on hospital performance has long been a point of discussion in medical and healthcare economics literature (Ginzberg, Miller, Mukamel et al., Porter and Teisberg, Rivers and Glover, Zwanziger and Melnick). The majority of past studies has focused on the impact of competition on cost, but not sufficiently on quality of care. As the object of competition shifts from price to non-price aspects (e.g. service availability, quality), we observe a nascent literature on competition in healthcare and its impact on quality performance. However, the results so far have not been consistent. For instance, Gaynor and Town ( find an association between competition and quality. In contrast, Ginzberg (1996) argues that the healthcare marketplace is different than other service industries, so that competition cannot necessarily be a driving force of quality improvement. Mukamel et al. (2001) do not find a significant association between hospital competition and risk-adjusted mortality. While the literature on focused factory in healthcare has demonstrated consistent results on improved quality of care, the impact of competition on quality is still not clear. Accordingly, in this essay, we explore competitive environment as a driving force of focused operations. Specifically, we test whether the focused factory approach is being used as a response to local competition. If so, it may serve to explain the increasing trend (Eastaugh, 2014) towards adoption of focused factory approach in healthcare. Using the Industrial Organization (IO) framework as the theoretical lens, we posit that a hospital’s decision to adopt focused operations is a part of its competitive response to regional competition. (Abstract shortened by ProQuest.)

Cas9-mediated gene editing corrects hereditary tyrosinemia in a mouse model. The combination of Cas9, guide RNA and repair template DNA can induce precise gene editing and the correction of genetic diseases in adult mammals. However, clinical implementation of this technology requires safe and effective delivery of all of these components into the nuclei of the target tissue. Here, we combine lipid nanoparticle–mediated delivery of Cas9 mRNA with adeno-associated viruses encoding a sgRNA and a repair template to induce repair of a disease gene in adult animals. We applied our delivery strategy to a mouse model of human hereditary tyrosinemia and show that the treatment generated fumarylacetoacetate hydrolase (Fah)-positive hepatocytes by correcting the causative Fah-splicing mutation. Treatment rescued disease symptoms such as weight loss and liver damage. The efficiency of correction was >6% of hepatocytes after a single application, suggesting potential utility of Cas9-based therapeutic genome editing for a range of diseases.

This study aimed to adapt and validate a Korean version of the Moral Identity Scale developed by Aquino and Reed. Intensive care unit (ICU) nurses face several moral conflict or challenging situations where they make difficult decisions related to the rationing of care or prioritization such as a shortage of medical supplies and staffing. To understand the reason behind choosing moral values over other values such as economic and personal ones by nurses during such times, conceptual research on moral identity is required. However, this has not been studied using empirical data analysis despite the increased significance of nurses’ moral identity. A secondary data analysis and a methodological design were employed. Data were collected from 207 ICU nurses. Exploratory and confirmatory factor analyses were used to test the construct validity. The results of exploratory factor analysis showed that the Eigenvalues ranged from 1.63 to 4.47 and comprised 52.17% of the total explained variance. Confirmatory factor analysis showed acceptable model fit indices (χ2 [p] = 28.822 [.051], df = 18, root mean square error of approximation = 0.076, goodness-of-fit index = 0.937, Tucker–Lewis index = 0.93, and comparative fit index = 0.955) and standardized factor loadings (0.45–0.82). As professionals, ICU nurses must protect and advocate for the patient according to their own moral identity. Therefore, the Korean version of the Moral Identity Scale is a valid and reliable instrument that can be used in nursing education programs for improving the moral identity of ICU nurses.

Cigarette smoking is one of the leading causes of preventable and premature death worldwide. Even worse, many people are generally exposed to passive smoking, which leads to several respiratory diseases and related mortalities. Considering, more than 7000 compounds are included in cigarettes, their combustion results intoxicants that have deleterious effects on health. However, there is a lack of research analyzing the effects of smoking and passive smoking on all-cause and disease-specific mortality through its chemical compounds including heavy metals. Thus, this study aimed to evaluate the effect of smoking and passive smoking on all-cause and disease-specific mortality mediated by cadmium, one of the representative smoking-related heavy metals using data from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 in the United States. We found that current smoking and passive smoking was related to increased risk of all-cause, CVD-related, and cancer-related mortality. Notably, passive smoking showed a synergistic effect with smoking status on the risk of mortality. In particular, current smokers with passive smoking had the highest risk of all-cause and disease-specific deaths. In addition, the accumulation of cadmium in the blood due to smoking and passive smoking mediates the increased risk of all-cause mortality. Further studies are needed to monitor and treat cadmium toxicity to improve smoking-related mortality rates.

As a candidate for a rapid detection of biomaterials, terahertz (THz) spectroscopy system can be considered with some advantage in non-destructive, label-free, and non-contact manner. Because protein-ligand binding energy is in the THz range, especially, most important conformational information in molecular interactions can be captured by THz electromagnetic wave. Based on the THz time-domain spectroscopy system, THz nano-metamaterial sensing chips were prepared for great enhancing of detection sensitivity. A metamaterial sensing chip was designed for increasing of absorption cross section of the target sample, related to the transmitted THz near field enhancement via the composition of metamaterial. The measured THz optical properties were then analyzed in terms of refractive index and absorption coefficient, and compared with simulation results. Also, virus quantification regarding various concentrations of the viruses was performed, showing a clear linearity. The proposed sensitive and selective THz detection method can provide abundant information of detected biomaterials to help deep understanding of fundamental optical characteristics of them, suggesting rapid diagnosis way especially useful for such dangerous and time-sensitive target biomaterials.