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Objective. This study aimed to evaluate the correlation between occupational noise-induced hearing loss (ONIHL) and noise exposure in different positions within manufacturing facilities that primarily produce electronic devices, wooden furniture and hardware machinery in southern China and to investigate the practical application of the risk assessment model. Methods. Noise exposure data were collected from 115 workers in 10 manufacturing industries in southern China through on-site investigation. Subsequently, sample testing was conducted in accordance with Chinese standards. The 31 job positions investigated were classified into two similar exposure groups (SEGs). The occupational health risk assessment (OHRA) model was used to evaluate the risks of ONIHL in various job positions. Results. More than half of the positions in both groups had noise levels exceeding 85 dB. In both SEGs, male workers exhibited similar risk patterns of acquiring hearing impairment, with a more pronounced and earlier risk of hearing loss compared to female workers. Age was also found to be a risk factor for hearing impairments. Conclusion. The ORHA model demonstrated a positive correlation between noise exposure levels and NIHL. This model can help employers assess job management with noise exposure and take measures to implement an effective risk management system.

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Focusing on the research scenario that integrates value-based healthcare objectives with the pharmaceutical group purchasing model, this study delineates value-based healthcare objectives in pharmaceutical group purchasing from three perspectives: drug sales price, drug quality, and service level. We construct a three-level pharmaceutical group purchasing supply chain consisting of drug manufacturers, medical institutions, and non-profit drug group purchasing organisations. Under centralised and decentralised decision-making, we introduce cost-sharing contracts and "cost-sharing-quantity-discount" contracts to analyse the impact of factors such as drug sales price, quality, and sensitivity of the service level. The study found that: (1) Compared with centralised decision-making, the optimal drug quality and service level in decentralised decision-making and the optimal profits of drug manufacturers and medical institutions will decrease. However, the optimal drug sales price in decentralised decision-making always deviates from that in centralised decision-making, leading to higher or lower drug sales prices. (2) The incorporation of value-based healthcare objectives in the pharmaceutical group purchasing through cost-sharing contracts depends on changes in the proportion of drug quality costs borne by medical institutions. If the proportion is too high, medical institutions will suffer greater losses because they bear too much of the cost. (3) Under certain conditions, cost-sharing contracts can improve supply chain efficiency but cannot achieve supply chain coordination, while the combination of "cost-sharing-quantity-discount" contracts can achieve supply chain coordination in pharmaceutical group purchasing.

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OBJECTIVE: To understand the use of alternative payment models to address the reimbursement challenges of cell and gene therapies (CGT) in the U.S.A.. METHODS: A literature search focused on CGT reimbursement in the U.S. market was conducted to identify information gaps and inform survey development. U.S. developers (n = 100) and payers (n = 195) were invited to complete an online survey between June and August 2022. RESULTS: The overall response rate was 16%; payer respondents represented 98 plans covering 338 million lives. Most developers (81%) and payers (84%) had implemented or were planning to implement at least one alternative payment model. Payers pursued these models to 'reduce product performance uncertainties' (81%), 'align therapy costs with benefits' (58%), and 'manage actuarial uncertainty' (54%). Developers aimed to 'streamline patient access' (92%) and 'mitigate budget impact' (77%). Common perceived barriers included increased administrative burden (developers 79% and payers 67%), defining performance measures (developers 71%, payers 83%) and addressing patient mobility (developers 71% and payers 63%). Both parties expressed a willingness to use real-world evidence for contract adjudication. CONCLUSION: Although limited by the number of participants, this survey indicates early discussions coupled with understanding motivations are essential for developing contracts that appeal to both parties and ensure patient access.

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Objective:To perform acceptance test and performance assessment for Siemens Biograph Vision 600 positron-emission tomography/computed tomography(PET/CT)according to the national health industry standard WS 817-2023.Methods:Spatial resolution,sensitivity,scatter fraction,count loss and random coincidence,correction accuracy of count loss and random coincidence,time-of-flight(TOF)resolution of the PET component within the PET/CT system were tested through the measurement program(NU2-2018)of National Electrical Manufacturers Association(NEMA),which was installed inside of the equipment,in accordance with the requirement of national health industry standard WS 817-2023.The PET/CT registration accuracy was measured through Gantry_offset acquisition program that was built into the equipment.Results:The transversely and axially spatial resolutions of Biograph Vision 600 PET/CT were respectively 3.69 mm and 4.10 mm at 1 cm away from the center of visual field,and were respectively 4.26 mm and 4.89 mm at 10 cm away from the center of visual field,and were respectively 4.68 mm and 4.89 mm at 20 cm away from the center of visual field.The sensitivity of 10 cm away from center and radial of visual field were respectively 16.12 kcps/MBq and 16.00 kcps/MBq.The peak value of noise equivalent count rate(NECR)was 281.60 kcps,and the corresponding radioactivity concentration of peak value was 30.69 kBq/ml.The NECR peak value,scatter fraction and maximum value of the error of relative count rate were respectively 38.17% and 4.0%.The TOF resolution was 209.87 ps when the radioactivity concentration was 5.3 kBq/mL.The registration accuracy values of Biograph Vision 600 PET/CT were 0.347 mm,-0.226 mm and 3.659 mm at the directions of x,y and z axis.Conclusion:It is feasible to perform the acceptance test according to the WS 817-2023 standard through uses the NEMA NU2-2018 standard measurement program that is installed inside of the equipment.The performance indicators can meet requirement of standard as the current national standard GB/T 18988.1-2013 and the health industry standard WS 817-2023 that will being implemented in the test of Biograph Vision 600 PET/CT,which can pass acceptance.

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Introduction: Product guarantees are known to the manufacturing industry, however warranties have been rare in Orthopaedic surgery. Over the last 10 years, select manufacturers of implants have instituted warranties of varying scope, length, and reimbursement. This phenomenon prompted us to investigate the landscape of warranties in Orthopaedics and compare that to other medical industries to better inform their impact on patient care. Methods: We conducted a systematic review of patient access material of over 120 Orthopaedic manufacturers including that of the Top 25 grossing companies of 2022 to identify the prevalence and scope of these warranties. Results: We identified eight companies that offer a warranty on implants. The expiration time for the implant warranties ranged from one year to lifetime. The scope of the warranties ranged from coverage of a one-time component replacement to outcome-based guarantees that cover any complications and revisions that may result from the surgery. Discussion: While the use of warranties remains uncommon in orthopaedics, their utility is expanding and evolving. Contemporary warranties appear to have a focus on enhancing product-marketability and improving quality-control.

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The FDA initiated a cross-sectional, statistically based sampling and testing study to characterize the quality of marketed alcohol-based hand sanitizer (ABHS) by evaluating the alcohol content and impurities present in ABHS products manufactured by establishments that registered with the FDA during March-April 2020. A stratified sampling design divided the population of manufacturers into independent groups based on each establishment's level of experience with FDA oversight and its geographic location. ABHS products were collected and analyzed by spatially offset Raman spectroscopy and gas chromatography with mass spectrometry (GC-MS). The GC-MS results for 310 products, from 196 newly registered domestic manufacturers, showed that 71.6% (± 5.7%) of these manufacturers had violative products. In 104 (33.5%) cases, the alcohol content did not meet label claim assay specifications but still fell within CDC efficacy ranges. Ethanol ABHS products failed more often overall (assay and impurities) (84.3%) and for impurities (84.3%), than isopropanol ABHS products (11.2% and 6.2%, respectively). Differences in test results across active ingredients were statistically significant. Ethanol ABHS products often (63.5% of cases) failed due to the presence of acetal or acetaldehyde, particularly in products with pH ≤ 6. Other impurities were also detected in several ABHS products, suggesting the use of low-grade alcohol in the manufacture of these products. Evidence was insufficient to conclude that having experience manufacturing FDA-regulated products, or lack thereof, influenced product-level violative results. This study highlights the importance of sourcing and testing active pharmaceutical ingredients to produce quality drug products.

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The UK National Centre for the Replacement, Refinement, and Reduction of Animals in Research (NC3Rs) is reviewing World Health Organization (WHO) manuals, guidelines and recommendations for vaccines and biotherapeutics to identify the extent to which animal-based testing methods are described. The aim is to recommend where updates to these documents can lead to an increased and more harmonised adoption of 3Rs principles (i.e. Replacement, Reduction and Refinement of animal tests) in the quality control and batch release testing requirements for vaccines and biotherapeutics. Improved adoption of 3Rs principles and non-animal testing strategies will help to reduce the delays and costs associated with product release testing. Developing recommendations that are widely applicable by both the manufacturers and national regulatory authorities for vaccines and biological therapeutics globally requires a detailed understanding of how different organisations view the opportunities and barriers to better integration of the 3Rs. To facilitate this, we developed and distributed a survey aimed at individuals who work for national regulatory authorities (NRAs) and/or national control laboratories (NCLs). In this paper, we present the key findings from this survey and how these will help inform the recommendations for wider integration of 3Rs approaches by WHO in their guidance documents applicable to the quality control and batch release testing of vaccines and biotherapeutics.

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During the development of an oral solid form of a drug substance, a thorough understanding of the critical material attributes is necessary, as the physical properties of the active pharmaceutical ingredient (API) can profoundly influence the drug product's manufacturability, critical quality attributes, and bioavailability. The objective of this study was to validate the manufacturing process of the drug Linezolid from three different sources at both the pilot and industrial scale and to identify differences in critical material attributes between the API manufacturers. Furthermore, the scalability factor between the pilot and industrial scale and the suitability of a process for direct compression were also evaluated. In the present study, the different sources of API were characterized by SeDeM methodology, particle size distribution, and scanning electron microscopy determinations. The statistical analysis revealed that no statistically significant differences were found for any of the parameters under study for the same API source analyzed on both scales. On the other hand, for most of the parameters evaluated, statistical differences were observed between the different sources. It was concluded that SeDeM was able to successfully validate the API manufacturing process, assess scalability, and distinguish between sources. Therefore, it could be highly valuable in the formulation phase to select the best API source.

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PURPOSE: Device manufacturers and technicians (MaTs) of augmentative and alternative communication (AAC) systems play key roles in the design and successful uptake of communication devices. This study aims to investigate MaT perspectives on AAC device design and effective use. MATERIALS AND METHODS: To investigate their perspectives, a focus group of MaTs within Canada was conducted. Reflexive thematic analysis was used to analyze data. FINDINGS: Three major themes resulted from analysis, which reflect MaT's views: AAC hardware and software flexibility, AAC knowledge and implementation, and social good versus financial resources. CONCLUSIONS: This study provides insights into the complexities faced by MaTs in balancing technical support of system end-users and the financial resources necessary for that support. These insights indicate a need for increased financial resources and the expansion of individuals who qualify for AAC system candidacy. MaTs suggest that an increase in resources and candidacy could lead to more successful AAC implementation and a greater understanding of AAC for all stakeholders.

Augmentative and Alternative Communication (AAC):• AAC technology provides individuals with communication disabilities a form of alternative communication.• The success of AAC systems is dependent on multiple factors including AAC stakeholders, system design, and system implementation.• This study explores AAC manufacturers and technicians perspectives on how to make AAC systems as effective and widely accessible as possible.

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INTRODUCTION: Verification of blood collection tubes is essential for clinical laboratories. The aim of this study was to assess performance of candidate tubes from four alternative suppliers for routine diagnostic haematology testing during an impending global shortage of blood collection tubes. METHODS: A multicentre verification study was performed in Cape Town, South Africa. Blood from 300 healthy volunteers was collected into K2 EDTA and sodium citrate tubes of BD Vacutainer® comparator tubes and one of four candidate tubes (Vacucare, Vacuette®, V-TUBE™ and Vacutest®). A technical verification was performed, which included tube physical properties and safety. Routine haematology testing was performed for clinical verification. RESULTS: Vacucare tubes did not have a fill-line indicator, Vacuette® tubes had external blood contamination on the caps post-venesection and Vacutest® tubes had hard rubber stoppers. K2 EDTA tubes of Vacuette®, Vacucare and Vacutest® performed similarly to the comparator. Unacceptable constant bias was seen for PT in Vacucare (95% CI -2.38 to -0.10), Vacutest® (95% CI -1.91 to -0.49) and Vacuette® (95% CI 0.10-1.84) tubes and for aPTT in Vacuette® (95% CI 0.22-2.00) and V-TUBE™ (95% CI -2.88 to -0.44). Unacceptable %bias was seen for aPTT in Vacucare (95% CI 2.78-4.59) and Vacutest® tubes (95% CI 2.53-3.82; desirable ±2.30), and in V-TUBE™ for mean cell volume (95% CI 1.15-1.47, desirable ±0.95%) and mean cell haemoglobin concentration (95% CI -1.65 to -0.93, desirable ±0.43%). CONCLUSION: Blood collection tubes introduce variability to routine haematology results. We recommend that laboratories use one brand of tube. Verification of new candidate tubes should be performed to ensure consistency and reliable reporting of results.

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This study aims to develop an Excel programming model to formulate feed for Nile tilapia (Oreochromis niloticus), mainly for small- and medium-sized fish feed manufacturers. The model allows users to formulate the least costly balanced diet of Nile tilapia species, giving them the ability to choose a specific ingredient in the formulation according to the realities of the local environment: space-temporary availability of ingredients, prices and nutritional quality. Computer programming of a database of 25 locally available feed components was carried out using the Excel Solver Add-in and Excel IF mathematical functions to incorporate/delete specific ingredients in real time in accordance with user objectives. The theoretical characteristics of the least-cost balanced diets performed were within the margin of the nutrients requirement of the target fish size with protein levels of 35 per cent (fry diet: $1.07/kg), 32 per cent (fingerlings diet: $0.48/kg), 29 per cent (growth diet: $0.43/kg) and 27.12 per cent (final diet: $0.39/kg). The digestible energy of these diets was between 3016.5 ± 93.8 kcal. In addition, the model shows that an increase in soya meal prices by 75 per cent led the local feed industry to rely on imported fish meals, as the number included reached 52.28 per cent. However, the cost of the diet margin did not vary significantly. Nevertheless, it would be important to test the balanced diet developed with the model before production and scaling.

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BACKGROUND: Labels are a key element of the marketing strategies of infant formula companies, and often include text or images that idealize their use, undermining efforts to promote breastfeeding. RESEARCH AIMS: To evaluate the prevalence of marketing cues that idealize infant formula on labels of products commercialized in Uruguay and to assess changes after a periodic monitoring of compliance with the International Code of Marketing of Breast-Milk Substitutes (IC). METHOD: This study is a descriptive, observational, and longitudinal assessment of the information included on infant formula labels. The first data collection was in 2019, as part of a periodic assessment to monitor the marketing of human-milk substitutes. In 2021, the same products were purchased to evaluate changes in their labels. Thirty-eight products were identified in 2019, of which 33 were still available in 2021. All information available on the labels was analyzed through content analysis. RESULTS: Most products included at least one textual or visual marketing cue idealizing infant formula in both 2019 (n = 30, 91%) and 2021 (n = 29, 88%). This represents a violation of both the IC and national regulations. References to nutritional composition were the most frequent marketing cue, followed by references to child growth and development. No relevant changes were observed after the periodic assessment conducted by the Uruguayan government. CONCLUSIONS: Monitoring compliance with the IC per se cannot be expected to trigger changes in the marketing strategies of infant formula companies. More explicit regulations and strong enforcement mechanisms are needed to end the inappropriate marketing practices on infant formula labels.

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In 2019, China proposed the weight of consumption responsibility (WCR) policy for renewable energy. This study first analyzes the interaction between the electricity market and the green certificate market and establishes a two-market equilibrium model with multiple subjects. Secondly, a system dynamics model of the development decision of the new energy manufacturers (NEMs) under the interaction of the two markets is established. Finally, taking Henan province as an example, the development trend of NEMs is simulated, and sensitivity analysis is conducted to explore the key influencing factors for the development of NEMs. The results show that the electricity market and the green certificate market interact with each other mainly through the price of electricity and the price of green certificates, thus evolving the trading behavior of trading subjects. By 2035, for every 0.25% increase in non-hydropower WCR in Henan province, the annual added new energy installation will be around 1200 MW. In the current scenario, the policy of certificate multiplier will be detrimental to the overall development of NEMs, and a conservative investment strategy and accelerated technology improvements are more beneficial to NEMs. Carbon emission peaking and carbon neutrality policies can also accelerate the growth of new energy installations.

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OBJECTIVES: In 2017, the government of Ukraine introduced the new Affordable Medicines Program (AMP) for outpatient prescription medicines reimbursement. Despite the evident program implementation benefits, it is highly important to examine the AMP framework to reveal its current tendencies, strengths, and shortcomings that might be useful to support further development and improvement of reimbursement models. This study aimed to evaluate how the pricing strategies applied by the AMP framework might affect the potential to provide patients with affordable medicines. METHODS: The AMP framework has been evaluated by several parameters characterizing the pricing mechanisms, pharmaceutical manufacturers, the scope of medicines covered by the program, and consumption volumes. The data were collected from official government databases and open sources. The statistics assessment was applied. RESULTS: In 2017 to 2021, the AMP demonstrated extensive growth of the number of medicines covered, consumption volumes, and the scope of international nonproprietary names reimbursed. The pricing limits used by the AMP framework proportionally were correlated with the number of manufacturers involved. At the same time, the number of medicines containing reimbursed international nonproprietary names but not being covered by the program has been decreasing. CONCLUSIONS: The AMP framework significantly influences the pharmaceutical market and the potential to provide patients with a wider scope of essential medicines while effectively managing government and patients' healthcare spending. There is a need for the AMP re-evaluation tool enabling timely diagnosing of its shortcomings, assessing the effectiveness and helping to implement its targeted development according to pharmaceutical market tendencies and achievement of desirable patient's health outcomes.

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Canadian regulations require food business operators (FBOs) to implement preventive controls to manage allergens and ensure their accurate declaration. However, the use of precautionary allergen labelling (PAL) is voluntary and competent authorities provide limited guidance on its use. The objective of this study was to present an overview of Canadian FBOs' current allergen management practices, including the mechanisms used to evaluate the need for PAL in finished products, and to investigate potential areas for improvement. Canadian FBOs were invited to answer an online survey of 48 questions covering allergen management practices and perceptions. Eighty-four full survey responses (margin of error of 9% at a 90% confidence level) were obtained. Differences in responses to multiple choice questions per company size were determined using chi-square and Fisher's exact tests. Kruskal-Wallis tests were used to analyse responses to rating or forced ranking questions. Survey respondents' allergen management practices were based on a combination of recognized best practices, third-party quality systems' standards, and regulatory requirements. Concerning practices related to the criteria used to reach PAL decisions were noted, which could be addressed with increased awareness and use of risk-based approaches and a clearer regulatory policy. Analytical testing applicability and interpretation, access to information on unintentional allergen presence in raw materials, and clarity on the expectations related to the current regulatory framework on food allergens and its enforcement, were identified as challenges faced by Canadian FBOs. The results of this survey and its analysis could be used by regulators - to inform potential policy changes, by FBOs - to map industry practices, and by allergic consumers - to better understand how manufacturers manage allergens in their operations.

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Despite three decades of proven safety and effectiveness of hydroxyurea in modifying sickle cell disease (SCD), its accessibility is limited in Sub-Saharan Africa, which shares 75% of the world's SCD burden. Therefore, it is time to explore the barriers and facilitators for manufacturing and importation of hydroxyurea for SCD in Tanzania. This was qualitative research that employed a case study approach. Purposive sampling followed by an in-depth interview (IDI) using a semi-structured questionnaire aspired by data saturation enabled us to gather data from 10 participants. The study participants were people with more than three years of experience in pharmaceuticals importation, manufacturing, and regulation. The audio-recorded data were verbatim transcribed and analyzed using thematic analysis. Two themes were generated. The first comprised barriers for importation and manufacturing of hydroxyurea with sub-themes such as inadequate awareness of SCD and hydroxyurea, limited market, and investment viability. The second comprised opportunities for importation and manufacturing of hydroxyurea with sub-themes such as awareness of activities performed by medicines regulatory authority and basic knowledge on SCD and hydroxyurea. Inadequate understanding of SCD, hydroxyurea, and orphan drug regulation are major issues that aggravate the concern for limited market and investment viability. Existing opportunities are a starting point towards increasing the availability of hydroxyurea.

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Background: In the manufacturing industry, work-family conflict (WFC) is related to working hour characteristics. Earlier studies on the relationship between working hour characteristics and WFC in the manufacturing industry have been limited to some regions in Korea. No study has addressed the data on a national scale. Thus, this study investigated the impact of weekly working hours, weekend work, and shift work on WFC using national-scale data. Methods: This study was based on the fifth Korean Working Conditions Survey of 5,432 manufacturers. WFC consists of 5 variables; WFC1 "kept worrying about work"; WFC2 "felt too tired after work"; WFC3 "work prevented time for family"; WFC4 "difficult to concentrate on work"; WFC5 "family responsibilities prevented time for work". As WFC refers to the inter-role conflict between the need for paid work and family work, WFC has been measured in two directions, work to family conflict (WTFC: WFC1, 2, 3) and family to work conflict (FTWC: WFC4, 5). With these WFC variables, we conducted multiple logistic analyses to study how working hours, weekend work, and shift work impact WFC. Results: Korean manufacturers' prolonged working hours increased all aspects of WFCs. Odds ratios (ORs) of WFCs based on working hours (reference of under 40 hours) of 41-52, 53-60, over 61 were 1.247, 1.611, 2.279 (WFC1); 1.111, 2.561, 6.442 (WFC2); 1.219, 3.495, 8.327 (WFC3); 1.076, 2.019, 2.656 (WFC4); and 1.166, 1.592, 1.946 (WFC5), respectively. Shift-work in the WFC2 model showed a significantly higher OR of 1.390. Weekend work 'only on Saturday' had significant ORs with WFC2 (1.323) and WFC3 (1.552). Conclusions: An increase in working hours leads to the spending of less time attending to problems between work and family, causing both WTFC and FTWC to increase. As weekends, evenings, and nighttime are considered to be family-friendly to people, working on weekends and shift-work were highly correlated to WTFC.

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Cross reactivity with high molecular weight complexes of prolactin known as macroprolactin is a common cause of positive interference in assays for serum prolactin. All prolactin assays currently available are affected with 5-25% of results indicating hyperprolactinaemia falsely elevated due to macroprolactinaemia - hyperprolactinaemia due to macroprolactin with normal concentrations of bioactive monomeric prolactin. Macroprolactinaemia has no pathological significance but, if it is not recognised as the cause, the apparent hyperprolactinaemia can lead to clinical confusion, unnecessary further investigations, inappropriate treatment and waste of healthcare resources. Macroprolactinaemia cannot be distinguished from true hyperprolactinaemia on clinical grounds alone but can be detected by a simple laboratory test based on the precipitation of macroprolactin with polyethylene glycol. Laboratory screening of all cases of hyperprolactinaemia to exclude macroprolactinaemia has been advised as best practice but has not been implemented universally and reports of clinical confusion caused by macroprolactinaemia continue to appear in the literature. Information provided by manufacturers to users of assays for prolactin regarding interference by macroprolactin is absent or inadequate and does not comply with the European Union Regulation covering in vitro diagnostic medical devices (IVDR). As the IVDR is implemented notified bodies should insist that manufacturers of assays for serum prolactin comply with the regulations by informing users that macroprolactin is a source of interference which may have untoward clinical consequences and by providing an estimate of the magnitude of the interference and a means of detecting macroprolactinaemia. Laboratories should institute a policy for excluding macroprolactinaemia in all cases of hyperprolactinaemia.

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OBJECTIVE: To assess the effect of safety claims and warnings on perceptions of consumer chemical products. BACKGROUND: Manufacturers have two contradictory objectives: to increase sales by emphasizing the positive aspects of a product and to protect consumers from hazards of the product. One of the strategies that some manufactures have devised to achieve these goals is to use anti-warnings. Safety claims placed on consumer chemical products were examined to determine if anti-warnings influenced product perceptions. METHOD: Two experiments were conducted. In Experiment 1, three consumer chemical products with manipulated safety claims were presented to 300 participants, who completed a survey to rate their perceptions of the products. In Experiment 2, the same products with the safety claims and added warnings were presented to 600 participants and were rated using the same measurements as Experiment 1. RESULTS: Safety claims on product labels decreased perceived hazards compared to no safety claims on products in both Experiments 1 and 2. In Experiment 2, added warnings raised the perceived hazards. CONCLUSION: The use of safety claims on consumer chemical products had an effect on product perceptions by decreasing hazard perceptions. The addition of strong warnings on product labels mitigated this effect. APPLICATION: This research provides empirical evidence suggesting that the use of safety claims decreased hazard perceptions of potentially hazardous consumer chemical products and can serve as a possible form of anti-warnings.

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A perennial question for the pharmaceutical industry has been excessive drug prices. To alleviate patients' burden of expensive medical bills and increase the affordability of medicines, China adopted the Two-Invoice System (TIS) in drug procurement for public medical institutions in 2017. In this paper, we study the impact of the TIS on pharmaceutical manufacturers' selling expenses. Using a Difference-in-Differences (DID) methodology and a sample of the A-share pharmaceutical manufacturing firms listed on the Shanghai Stock Exchange and Shenzhen Stock Exchange from the years 2014 to 2020, we find that the TIS leads to a significant increase in pharmaceutical manufacturers' selling expenses but gradually weakens over time. In addition, we further explore whether the impact of the TIS on pharmaceutical manufacturers' selling expenses is affected by the pharmaceutical manufacturers' previous drug circulation mode. The results indicate that the TIS could significantly increase the pharmaceutical manufacturers' selling expenses in the agency mode group. However, there is no evidence to support the TIS having the same effect in the direct sales office model group.

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