Evolution of self-employed physician production: Cohort, career-course, and feminization effects.

Burnout syndrome, manifested as emotional exhaustion, depersonalization, and reduced personal accomplishment, constitutes a critical issue for the nursing profession, especially during the COVID-19 pandemic. This study aimed to conduct a comprehensive bibliometric review to analyze the patterns and trends in scientific production on burnout syndrome in nursing during the 2020–2024 period. The research was carried out using a quantitative approach, with the Scopus database serving as the main source. The bibliometric analysis tools Bibliometrix and VOSviewer were applied to process and analyze a total of 1593 documents related to the central theme. The results demonstrate an exponential increase in publications starting in 2020, reaching their peak in 2022 and subsequently showing a slight decrease. The United States is positioned as the most prolific country and the one with the largest international collaboration network. The International Journal of Environmental Research and Public Health and PLOS ONE were identified as the leading journals for dissemination. Keyword analysis highlights the centrality of terms such as “COVID-19″ and “anxiety,” and the emergence of topics like “work engagement” and “depersonalization.” The disciplines of Medicine and Nursing predominate, although key contributions from the social sciences and psychology were also identified, with seminal authors such as Maslach and Stamm maintaining their conceptual relevance. The bibliometric analysis offers an integral view of the scientific development on burnout syndrome during the pandemic, highlighting the thematic density and opportunities for future research. The need for a more comprehensive and interdisciplinary approach to the problem is emphasized. Nonetheless, the exclusive use of the Scopus database is identified as a methodological limitation, suggesting the inclusion of other bibliographic sources in subsequent studies to achieve a broader view of the field of study.

Accumulation patterns of polychlorinated alkanes in an Arctic marine food web.

Robotic technologies are increasingly explored in acute and emergency surgical contexts, offering potential advantages in precision, minimally invasive access, and perioperative management. Despite rapid growth, research addressing robotic acute care surgery (RACS) remains dispersed across specialties, methodological designs, and geographic regions. A comprehensive, data-driven synthesis of its intellectual structure, collaboration patterns, and thematic evolution has not been systematically undertaken. This study aimed to map global research activity in RACS, identify leading contributors, characterize dominant and emerging themes, and delineate conceptual transitions within the field. A bibliometric analysis was conducted using Scopus-indexed publications (1997-2025). Descriptive, collaboration, and thematic analyses were performed using Bibliometrix, VOSviewer, and CiteSpace to evaluate productivity trends, knowledge networks, thematic development, and emerging research fronts. A total of 1,172 publications demonstrated sustained growth, particularly after 2020. The United States, China, and Italy emerged as leading contributors, with Europe and North America accounting for the majority of productivity and citation impact. Collaboration networks revealed concentrated institutional hubs with relatively limited transnational integration. Bradford's Law identified a small core of specialized surgical journals responsible for approximately one-third of total output. Keyword co-occurrence analysis highlighted central themes around robot-assisted surgery, minimally invasive techniques, and perioperative outcomes, with bridging roles played by laparoscopy and comparative study designs. Thematic evolution analysis suggested a gradual shift from technology-focused foundations toward outcome-oriented evaluation, cost analysis, and acute-context applications. CiteSpace identified active research fronts in emergency surgery, risk assessment, propensity score matching, and randomized controlled trials, indicating increasing methodological sophistication. Research intersecting robotic surgery and acute care contexts has expanded substantially over the past decade, with growing emphasis on outcomes, comparative effectiveness, and economic evaluation. This study provides a structured intellectual and thematic framework, identifies gaps in international collaboration and high-level evidence generation, and outlines strategic directions for future multicenter and methodologically rigorous investigations.

Monitoring changes in disposable e-cigarette attributes is crucial for youth health and market regulations. Online stores are a major purchasing channel for U.S. youth. This study compares trends in product attributes of disposables between 2022 and 2024 using our unique data scraped from online stores. We obtained product-level information by scraping websites of online vape stores from our 2022 study that remained in business in 2024, and we examined changes in product attributes including sales prices and standardized prices, product size (mL volume and puff counts), consumer ratings and reviews, nicotine dimensions (concentration, free-base/nicotine salt, tobacco-derived/synthetic), battery capacity, and flavor mentions in description texts. Unique product listings significantly increased from 1638 in 2022 to 8339 in 2024. Sales price per unit and standardized price (per mL or per puff) declined, while product size in terms of mL volume and puff counts increased dramatically. The proportion of products with nicotine salt or synthetic nicotine claims decreased, and 5% nicotine level remained dominant. Fruits, sweets and menthol were the most prevalent flavor mentions in both years, though the percentage of products declined from 97% to 79%, 69% to 19% and 59% to 15%, respectively. Disposable e-cigarettes available in the online market have become more diverse, more affordable, and larger in size, especially in puff counts. High nicotine concentration (5%) persists, and fruity flavors remain prevalent. These trends raise public health concerns and require effective market regulations.

Oil palm cultivation offers a potential solution to reduce India's dependence on edible oil imports. This study investigates the profitability, water usage, and production trends of oil palm in central and south Gujarat, with a specific focus on unexplored areas. A purposive sampling technique was employed to select 60 oil palm cultivators in consultation with the Department of Horticulture. This targeted approach ensured data collection from representative farmers actively involved in cultivation. The analysis reveals promising profitability with a net return of Rs. 1,88,012.70 per hectare per year. Economic viability is further supported by a Net Present Value (NPV) of Rs. 39,137.25 at 12 percent discount rate, a Benefit-Cost Ratio (BCR) of 1.64, and an Internal Rate of Return (IRR) of 26.70 percent. Payback period is estimated at 6 years. However, a major concern is the high water consumption, averaging 376.75 liters per day per tree. While water productivity is 0.88 kg/m3, sustainable water management practices are crucial for responsible cultivation. The study demonstrates that oil palm, with intercropping for the first three years, can be a profitable venture. However, water management strategies are essential for long-term sustainability.

Abstract Forests are one of the most important terrestrial carbon sinks, but are increasingly under pressure due to drought, heat and the occurrence of extreme events. There are opposing longer term trends for European forest growth reported, and severe drought and disturbance events additionally impact forest ecosystems, so that the overall trend of forest productivity is uncertain. Thirty years of harmonized forest monitoring at 18 forest sites along an altitudinal gradient in Switzerland provides a good basis for assessing the effects of climate change on forest conditions. We found a decreasing trend of forest productivity (basal area index and net carbon uptake by growth), particularly pronounced since 2015 across all altitudinal ranges, age classes and species, which could not solely be attributed to stand density and ageing of the forest, but also to soil water availability and nitrogen deposition. The growth rate of trees, as well as the ingrowth rate, were hereby the most important factors explaining the overall forest productivity. At a given stand density, forest productivity was lower in recent years compared to earlier decades. Overall, our results indicate a decreasing stand‐level growth trend irrespective of site conditions and stand structure. This 30‐year declining trend can be partly attributed to water and nitrogen availability, and points to a decreasing growth capacity of the forest sites that is the long‐term potential of a site to sustain tree growth. The pivotal role of water availability for sustainable forest production and the long‐term effect of drought years on forest vitality urges us to rethink the adaptability of forests in view of the increasing frequency of drought and heat periods predicted for the future. Read the free Plain Language Summary for this article on the Journal blog.

Inadequate sludge treatment poses a significant risk of environmental pollution. To reduce pollution, utilizing waste sludge as an energy source offers a sustainable solution to mitigate pollution. Since sludges contain abundant organics, they are expected to produce more valuable organics, such as volatile fatty acids (VFAs). Although sludge fermentation has been widely studied, direct yields of VFA production from different sludge types are still limited, particularly for sludge materials originating from Finnish wastewater treatment plants. In this study, laboratory-scale bioreactors were built to examine VFA production from digester feed sludge, digested sludge, and ammonia removal sludge, which were collected from local wastewater treatment plants. Among the tested substrates, digested feed sludge resulted in the highest VFA yield, reaching 171.6 ± 6.3mg/g volatile solids after 11 days of incubation, which indicated its superior potential for VFA generation. In contrast, bioreactors fed with digested sludge or ammonia removal sludge showed no clear increasing trend in VFA production. The addition of sawdust led to lower overall VFA yields, approximately half of those obtained with digested feed sludge alone, and increasing the sludge proportion did not result in further yield enhancement. Acetic acid was the dominant VFA in all bioreactors, accounting for 61.2-97.9% of total VFAs. Microbial community analysis indicated the prevalence of phyla Bacillota and Pseudomonadota, with Lactobacillus being relatively abundant in bioreactors exhibiting higher VFA production. These findings suggest that sludge type plays an important role in determining VFA production performance and may support more informed selection of sludge substrates for VFA-oriented sludge valorisation.

BACKGROUND: Research productivity and impact are essential indicators of institutional performance; however, the University of Zambia (UNZA) School of Medicine lacks a systematic bibliometric appraisal. Benchmarking faculty-level output and impact provides evidence to guide strategic investments, faculty development, and resource allocation. OBJECTIVE: To investigate and analyse research productivity and impact among faculty members of the UNZA School of Medicine and determine whether these matrices differ between basic science and clinical departments. METHODS: We conducted a retrospective bibliometric study of the academic staff listed on the 2025 UNZA School of Medicine roster with publications indexed in Google Scholar. For each faculty member, we extracted publication counts, citations, H-index, mean citations per paper, and covariates (department and sex). Data were de identified. Descriptive statistics (medians, IQRs, and time-series plots) were used to characterise productivity and impact trends. Group comparisons between clinical and basic sciences were performed using the Mann–Whitney U test for continuous variables and categorical variables. Multivariable regression analysis identified independent predictors of productivity and impact after adjusting for academic position and department. RESULTS: Among 80 faculty members (65% clinical, 35% basic sciences), there were 2,185 publications since 1998, with a median of 12 papers per lecturer (IQR 4–38). Scholarly impact was reflected in a median of 173 citations (IQR 38–382) and an H index of 4.5 (IQR 2–11). Regression analyses showed that affiliation with the clinical sciences department was associated with greater publication output (β = 22.2, p = 0.03), independent of academic position, although citation counts did not differ significantly by department. Citation trends demonstrated a sharp rise after 2015, approaching 4,000 by 2025. Professors consistently held the highest average citations until 2023, when lecturers surpassed them. CONCLUSION: Research productivity and impact at UNZA, School of Medicine have risen sharply since 2015, with clinical sciences affiliation associated with higher publication output and growing citation visibility across ranks, underscoring the expanding institutional research strength.

Agriculture plays a significant role in Odisha’s rural economic development. In 2018 Odisha government introduced an innovative program known as the KALIA Scheme. Providing direct income support, the scheme aims to enhance farmers’ income in agricultural sector. To assess agricultural performance the study examines trends in paddy production and yield over the periods 2013-14 to 2022-23. The study based on secondary data, data collected from various sources such as the Odisha Economic Survey 2019-20, government reports, and existing literature. The discussion highlights that paddy production and yield exhibit an overall increasing trend; fluctuations persist year to year. While the scheme has contributed to increasing agricultural production, external factors such as climatic variability and structural factors affect outcomes. After implementation of the scheme, it reflects more stability in agricultural performance. The study concludes that while the KALIA Scheme has contributed to inclusive agricultural development by strengthening agricultural productivity, sustainable growth requires more development in irrigation, technological adoption, and risk mitigation strategies.

Objectives: To establish a data-driven framework for deciding when a large, single-specialty orthopedic group practice should hire a new surgeon, based on longitudinal physician productivity and patient access data as primary decision triggers. Design: Retrospective, observational, single-practice benchmarking study with narrative synthesis of strategic, operational, and governance considerations. Setting: Large, single-specialty orthopedic group practice. Methods: Work relative value unit (wRVU) output was collected from internal practice records for six mid-to-late career surgeons over five years (2019–2023). New patient wait times were tracked monthly and compared to established access benchmarks (14-day optimal threshold; 21-day patient leakage threshold) derived from Merritt Hawkins, MGMA, and AAOS survey data. External benchmarks served as comparison points for regional productivity and access standards. Revenue data for one newly hired surgeon and one concurrently declining senior partner were also extracted from internal financial records over a five-year period (2012–2016) to construct the revenue crossover curve illustrated in Figure 1. Results: The mean wRVU output per surgeon decreased from 15,877 in 2019 to 13,406 in 2023, representing a 15.6% decline and a total practice-wide productivity loss of 14,824 wRVUs — roughly equivalent to one full-time surgeon FTE. New patient wait times consistently exceeded the 14-day optimal benchmark and neared or exceeded the 21-day patient leakage threshold despite operational efforts such as APP expansion, extended hours, and schedule optimization. The revenue trajectory of a newly hired surgeon crossed that of a concurrently declining senior partner within approximately two years, demonstrating that a well-timed hire can offset senior partner productivity decline without net revenue loss to the practice. These findings contributed to the practice’s decision to hire 7 new surgeons. Five core decision triggers are proposed: patient access metrics, physician productivity trends, APP utilization limits, financial readiness, and strategic alignment. Conclusions: Recruitment decisions based on quantitative productivity and access thresholds—rather than partner consensus or reactive needs—are associated with sustained practice growth and competitive positioning. A governance-driven, data-informed hiring framework that includes wRVU trajectory, new patient wait time monitoring, APP saturation signals, and financial modeling offers a reproducible and objective decision-making structure for orthopedic group practices managing workforce planning. Level of Evidence: Level 4: Retrospective Observational Benchmarking Study Key Words: Physician recruitment, orthopedic workforce, private practice management, healthcare economics

Import refusal trends of FSIS-regulated products: Meat and poultry

Disentangling the effects of FPAR, CO2, and climate on terrestrial vegetation productivity trends over two decades (2001–2023)

Dyes worldwide are drawing attention to the health risks they pose, thereby beckoning radical change toward better alternatives. Synthetic dyes are large, complex molecules that are resistant to biodegradation, leading to various environmental issues. The trend in natural products has been toward natural dyes, particularly those derived from flowering parts, such as the flowers of Clitoria ternatea, which produce blue colors due to anthocyanins. This research aims to extract anthocyanins from Clitoria ternatea using two solvents: distilled water and ethanol. The most efficient solvent for the extraction of natural dyes from Clitoria ternatea was determined by focusing on two key parameters: extraction time and pH. The total anthocyanin content was determined using UV-Vis spectroscopy; the presence of functional groups was analyzed by Fourier Transform Infrared Spectroscopy (FTIR); and the color attributes of Clitoria ternatea were assessed using a chroma meter. The results showed that distilled water consistently yielded higher anthocyanin content than ethanol, with the highest value at 60 minutes of extraction. FTIR analysis confirmed the presence of key functional groups associated with anthocyanins, while color analysis indicated that higher anthocyanin content corresponded to darker and more intense blue coloration. These findings demonstrate that distilled water is a more effective and environmentally friendly solvent for anthocyanin extraction. The information presented may serve as a basis for further research on the extraction of natural dyes, advancing the process and enabling the creation of new natural products.

The exponential growth in plastic production since the mid-twentieth century has led to the pervasive presence of micro- and nanoplastics (MNPs) across ecosystems and human exposure pathways, coinciding with a rising global burden of neurological disorders. Increasing evidence demonstrates that MNPs are not confined to peripheral tissues but can accumulate even in the human brain, raising concerns about their potential contribution to neurological disease. This structured review synthesizes global trends in plastic production, environmental MNP burden, and human exposure, together with emerging data on brain accumulation, entry pathways, neurotoxic mechanisms, and key translational challenges. We present evidence showing that MNPs may cross brain barriers via multiple routes, including the blood-brain barrier, blood-cerebrospinal fluid barrier, olfactory, and circumventricular pathways, particularly under conditions of barrier vulnerability. Experimental studies reveal that once in neural tissue, MNPs may disrupt synaptic function, mitochondrial homeostasis, autophagy, and redox balance, while activating neuroinflammatory and gut-brain axis-mediated pathways. These mechanisms intersect with disease-relevant processes implicated in multiple neurological disorders whose global prevalence and societal burden have sharply increased over recent decades, including stroke, Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, mood disorders, and neurodevelopmental conditions. Despite growing mechanistic plausibility, translational and human epidemiological evidence remains limited by methodological heterogeneity, a lack of standardized detection methods, and the absence of longitudinal clinical data/studies. We highlight critical analytical and translational gaps, public health implications, and priorities for longitudinal, biomarker‑driven studies needed to rigorously test whether MNPs may contribute to population‑level risk of neurological disease.

ABSTRACT This review aims to identify patterns in knowledge production on sustainability within Arab educational institutions. It seeks to highlight gaps and opportunities for further research and to guide efforts to develop more sustainable education systems across Arab societies. This focus is especially relevant given the unprecedented educational developments in the region. The review used systematic methods to examine English-language articles and book chapters published between 2000 and 2024 on sustainability in educational institutions. Relevant sources were identified through keyword searches in the Scopus, ERIC, and Google Scholar databases. A dataset of 130 eligible articles was compiled and analysed using descriptive statistics and content analysis. The study explored trends in knowledge production, including publication volume and growth over time, geographical distribution, study types, topical coverage, and research methods. The results revealed patterns typical of educational research in Arab societies, including a steady increase, uneven geographical distribution, imbalances in study types, reliance on quantitative methods, and a dominance of descriptive and simple correlation analyses. The study's findings offer useful insights and suggest directions for future policy and research, including greater investment in local capacity to support context-specific research, the development of relevant research agendas, fostering interdisciplinary collaboration, and strengthening regional research networks.

ABSTRACT This study analyzes the evolution of crop production in Antioquia from 2006 to 2022, revealing a shift toward agroindustrial models geared for export, marked by an increase in crops such as avocado, cacao, and oil palm tree, and a significant decline in staple foods like maize and beans. This trend reflects a productive reconfiguration that threatens regional food security and agro-biodiversity. Through time series and correlation analysis, patterns of crop substitution are identified. These findings deepen the understanding of the influence of national and international trade-oriented policies and highlight the urgent need to strengthen sustainable agricultural models aimed at guaranteeing the human right to adequate food.

Vanilla (Vanilla planifolia Jacks. ex Andrews) is a tropical orchid of high economic value, with an annual production of 8000 to 10,000 t and a market exceeding 800 million USD in over 40 countries. In vitro propagation has strengthened the innovation, production, and conservation of this species. Bibliometrics, as a quantitative approach, systematically examines the patterns, dynamics, and evolutionary trends of scientific production. A systematic search was conducted in Scopus and Web of Science until December 2025, using the terms “vanilla” and “micropropagation”. A total of 53 documents were identified in Scopus (1997–2025) and 39 in Web of Science (2000–2025). The evaluated indicators included: year of publication, country of origin, language, areas, main categories, document typology, authorship, and keyword distribution. VOSviewer was used for keyword analysis to identify author collaboration networks and emerging trends. The years with the most information were 2024 and 2025, with Mexico and India standing out prominently. The main thematic areas were Agricultural and Biological Sciences, and the role of researcher Ramírez-Mosqueda was highlighted. The keywords with the highest correlation and impact were bioreactors, vanillin, and cryopreservation. This bibliometric study provides a comprehensive perspective on scientific production related to vanilla micropropagation. The results highlight the multidisciplinary nature of biotechnology applied to this crop, integrating contributions from various areas of knowledge for the benefit of the main actors in the value chain.

Abstract. Soils across sub-Saharan Africa are exposed to extensive degradation processes, which can reduce their ability to produce crops and support livestock. While there has been a significant research effort focussing on soil degradation in sub-Saharan croplands, less research effort had been directed towards grasslands. Here, we tested the effectiveness of remote sensing to classify the soil degradation status of smallholder grazing lands. Focussing on grasslands used by smallholders in the districts of Nyando and Kuresoi in Western Kenya, we first used remote sensing (RS) to classify grasslands as productive grazing lands, grazing lands that followed a variable trend in vegetation productivity (transition), and unstable and unproductive (degraded) grazing lands. We then tested how this classification related to measured soil parameters indicative of soil degradation. We then used this classification, which was based on a temporal analysis of Normalised Difference Vegetation Index (NDVI), Enhanced Vegetation Index (EVI) and Normalised Difference Water Index (NDWI) between 2013 and 2018, to identify 90 field sites across the two districts, which we then sampled and analysed for a range of physical, chemical and biological soil properties. Only soil microbial biomass carbon (C) showed consistent alignment with the RS classification, although there was some overlap with other soil parameters at one or other of the study areas. To group the sites using the soil variables, which we split by study area and into stable (those that are slow to change) and transient (those that change rapidly in response to a changing pedological environment), K-means clustering was undertaken. Two sets of clusters were produced for each district for the stable and transient variables. For the stable variables, at Kuresoi one of these clusters included sites with higher levels of C, nitrogen (N), phosphorus (P) and pH, that aligned well with the RS classification, with seven out of 10 productive sites being assigned to this cluster. At Nyando one of the stable variable clusters included sites with high soil C and N, but low pH and relatively low soil bulk density, and corresponded to 12 out of the 16 productive sites. For the transient variables, agreement between the clusters and the remote sensing classification was poor indicating a lack of utility for degradation assessment. Overall, our results suggest that while the use of RS methods for classifying degraded grasslands and the soils supporting them does have significant advantages in terms of time and costs over field survey, supplementing these methods with a limited set of soil parameters related to nutrient cycling, such as microbial biomass C, soil P, percent C and N, and soil pH, could enhance our ability to identify degraded soils and target restoration efforts.

Understanding how protons influence heterogeneous electrocatalytic CO2 reduction on electrode surfaces is critical for advancing energy-efficient carbon conversion technologies. Here, we show that on Ag, Au, and Zn surfaces, a concerted proton-electron transfer (CPET) pathway enables CO2-to-CO conversion at up to ∼400mV lower overpotential than commonly proposed cation-stabilized mechanisms, which dominate reactivity at higher overpotentials. Using both positively charged and neutral proton donors, we show that CPET operates at low overpotentials but is limited by the rate of proton supply. Kinetic isotope effect measurements and infrared adsorption spectroscopy support the involvement of protons in the rate-determining step. Furthermore, our data shed light on the complex competition for proton donors between CO2 reduction, carbonate acidification, and hydrogen evolution, explaining commonly reported product trends. Our findings suggest that enhancing proton flux and suppressing the hydrogen evolution reaction can further promote CPET-based CO2 reduction, offering a pathway to more efficient electrocatalytic processes.