Factors influencing decision making in neonatology: inhaled nitric oxide in preterm infants.

ObjectiveWe studied decision making regarding inhaled nitric oxide (iNO) in preterm infants with Pulmonary Hypertension (PH).Study designWe asked members of the AAP-Society of Neonatal-Perinatal Medicine and Division-Chiefs to select from three management options- initiate iNO, engage parents in shared decision making or not consider iNO in an extremely preterm with PH followed by rating of factors influencing their decision.ResultsThree hundred and four respondents (9%) completed the survey; 36.5% chose to initiate iNO, 42% to engage parents, and 21.5% did not consider iNO. Provider's prior experience, safety, and patient-centered care were rated higher by those who initiated or offered iNO; lack of effectiveness and cost considerations by participants who did not chose iNO.ConclusionsMost neonatologists offer or initiate iNO therapy based on their individual experience. The minority who chose not to consider iNO placed higher value on lack of effectiveness and cost. These results demonstrate a tension between evidence and pathophysiology-based-therapy/personal experience

A Study to Assess the Effectiveness of E-Module on High-Alert Medications in Terms of Knowledge among Student Nurses in a Selected College of Nursing in Delhi

Introduction: Use of medications is central to modern healthcare, and nearly all patients visiting a hospitalwill receive one or more medicines during their hospital stay or upon discharge. Medication use is a complexprocess and includes intervention by several health personnel, for example, physicians, pharmacists,nurses and student nurses to ensure safety of the patient.1.High-alert medicines have been proven to besafe and effective when taken properly. But they can cause injury if a mistake happens while taking them.This means that it is vitally important to know about these medicines and take them exactly as intended.2Methodology: The research approach selected for the study was quantitative approach with pretestposttestdesign. Convenient sampling was used for the selection of 60 student nurses from Rufaida Collegeof Nursing to evaluate their knowledge on high-alert medications. The tool developed and used for datacollection was a structured knowledge questionnaire on high-alert medications to assess the knowledgeof student nurses on high-alert medications. E-module on high-alert medications was developed by theresearcher and administered to student nurses.Results: The present study revealed that the e-module was an effective method of teaching in nursing.The mean posttest knowledge score (44.03) was higher than the mean pretest knowledge score (30.23)with a mean difference of (13.8). It indicated gain in knowledge by the student nurses. The obtained meandifference was found to be statistically significant as evident from the ‘z’ value of 8.8193 at 0.05 level ofsignificance. There was no significant association between knowledge of student nurses on high-alertmedications with their selected demographic variables like age, educational qualification, percentage inclass attendance, marks obtained in previous exam, and area of domicile.Conclusion: E-module on high-alert medications was found to be effective in improving the knowledgeof student nurses on high-alert medications. There was significant difference found in the pretest andposttest mean scores of student nurses. It shows that the e-module on high-alert medications was effectivein enhancing the knowledge of student nurses on high-alert medications

Online Impulse Buying: Understanding the Interplay between Consumer Impulsiveness and Website Quality

With the proliferation of e-commerce, there is growing evidence that online impulse buying is an emerging phenomenon, which has been the focus of researchers from a variety of disciplines. This paper reports on two empirical studies that examine the interplay between a consumer’s inherent impulsiveness to buy and website quality. Specifically, consistent with past online impulse buying research, website quality manifests as an environmental cue that directly influences the likelihood that a consumer will experience an urge to buy impulsively. Further, highly impulsive consumers can be both positively and negatively influenced by varying degrees of website quality. Thus, while the objective quality of an e-commerce website is important, the inherent impulsiveness of a consumer is also a critical factor for understanding how and why individuals react impulsively to varying degrees of website quality. The implications of the results for both future research and the design of electronic commerce websites are discussed

A pilot study to assess compliance and impact of health warnings on tobacco products in the Udupi district of Karnataka State, India

Introduction: The Government of India has taken several steps to reduce tobacco use, including legislation in the Cigarettes and Other Tobacco Products Act (COTPA) requiring health warnings on tobacco products. This study assessed compliance with the legislation on warnings, and awareness of these warnings and their perceived impact in preventing tobacco uptake among college students in a district of Karnataka, India. Material and Methods: This study consisted of two components, pack collection and a survey. For the first, tobacco packs were obtained from all tobacco selling shops in an urban and a rural locality in the Karkala block of Udupi district. Empty cigarette packs were collected from shops, and full packs were purchased if empty packs were not available . The packs were collected to measure their dimensions, as per the Tobacco Pack Surveillance System guidelines, and assessed for compliance, as per COTPA. For the second component of the study, a questionnaire was distributed to each college student to fill in; this was done to assess awareness of the new warnings at the time of the pilot survey, knowledge of harms, and perceptions of the warnings in reducing tobacco uptake. Results: We collected 26 tobacco packs. Two (8%) packs had warnings that were the correct size (85% of the main display areas), 15 (58%) packs had clear and legible warnings, and 18 (69%) packs had warning messages in the appropriate language. In the student survey, 60% of males and 52% of females indicated that they would not start using any tobacco products on seeing the new warnings. Conclusions: Only a few studies other than our pilot study have assessed compliance with legislation on health warnings in low- or middle-income countries. Although health warnings were perceived as a deterrent to tobacco use among students, compliance with national legislation in this pilot study was found to be low

Usefulness of C-Reactive Protein as a Marker for Prediction of Future Coronary Events in the Asian Indian Population: Indian Atherosclerosis Research Study

Inflammation plays a pivotal role in all stages of atherosclerosis. Numerous inflammatory, lipid, and cytokines markers have been associated with coronary artery disease (CAD) risk but data directly comparing their predictive value are limited. Studies were carried to elucidate the role of high-sensitivity C-reactive protein (hsCRP), other inflammatory as well as lipid markers and their associations. Among 1021 subjects, comprising 774 CAD affected members from Indian Atherosclerosis Research Study (IARS), plasma hsCRP levels showed strong correlation with inflammatory markers, namely, IL6 (r = .373; P = <.0001), sPLA2 (r = .544; P = <.0001) as also with fibrinogen (r = .579; P = <.0001). Levels of hsCRP were higher among subjects affected by CAD who suffered a repeat coronary event as compared to those who remained event free and subjects in the top quartile of hsCRP (>3.58 mg/L) were found to have a fourfold higher risk. In conclusion, hsCRP appears to be an independent predictor of recurrent CAD events in Asian Indian population

eIF4A inhibitors suppress cell-cycle feedback response and acquired resistance to CDK4/6 inhibition in cancer

CDK4/6 inhibitors are FDA-approved drugs for estrogen receptor-positive (ER+) breast cancer and are being evaluated to treat other tumor types, including KRAS-mutant non-small cell lung cancer (NSCLC). However, their clinical utility is often limited by drug resistance. Here, we sought to better understand the resistant mechanisms and help devise potential strategies to overcome this challenge. We show that treatment with CDK4/6 inhibitors in both ER+ breast cancer and KRAS-mutant NSCLC cells induces feedback upregulation of cyclin D1, CDK4, and cyclin E1, mediating drug resistance. We demonstrate that rocaglates, which preferentially target translation of key cell-cycle regulators, effectively suppress this feedback upregulation induced by CDK4/6 inhibition. Consequently, combination treatment of CDK4/6 inhibitor palbociclib with the eukaryotic initiation factor (eIF) 4A inhibitor, CR-1-31-B, is synergistic in suppressing the growth of these cancer cells in vitro and in vivo Furthermore, ER+ breast cancer and KRAS-mutant NSCLC cells that acquired resistance to palbociclib after chronic drug exposure are also highly sensitive to this combination treatment strategy. Our findings reveal a novel strategy using eIF4A inhibitors to suppress cell-cycle feedback response and to overcome resistance to CDK4/6 inhibition in cancer.Accepted manuscrip

The role of ectonucleotidases CD39 and CD73 and adenosine signaling in solid organ transplantation

Extracellular adenosine is a potent immunomodulatory molecule that accumulates in states of inflammation. Nucleotides such as adenosine triphosphate and adenosine diphosphate are release from injured and necrotic cells and hydrolyzed to adenosine monophosphate and adenosine by the concerted action of the ectonucleotidases CD39 and CD73. Accumulating evidence suggest that purinergic signaling is involved in the inflammatory response that accompanies acute rejection and chronic allograft dysfunction. Modification of the purinergic pathway has been shown to alter graft survival in a number of solid organ transplant models and the response to ischemia&ndash;reperfusion injury (IRI). Furthermore, the purinergic pathway is intrinsically involved in B and T cell biology and function. Although T cells have traditionally been considered the orchestrators of acute allograft rejection, a role for B cells in chronic allograft loss is being increasingly appreciated. This review focuses on the role of the ectonucleotidases CD39 and CD73 and adenosine signaling in solid organ transplantation including the effects on IRI and T and B cell biology

Fake

Fakes, forgery, counterfeits, hoaxes, bullshit, frauds, knock offs—such terms speak, ostensibly, to the inverse of truth or the obverse of authenticity and sincerity. But what does the modern human obsession with fabrications and frauds tell us about ourselves? And what can anthropology tell us about this obsession? This timely book is the product of the first Annual Debate of Anthropological Keywords, a collaborative project between HAU, the American Ethnological Society, and L’Homme, held each year at the American Anthropological Association Meetings. The aim of the debate is reflect critically on keywords and terms that play a pivotal and timely role in discussions of different cultures and societies, and of the relations between them. This book, with multiple authors, explodes open our common sense notions of “novelty,” “originality,” and “truth,” questioning how cultures where deception and mistrust flourish seem to produce effective, albeit opaque, forms of sociality