Surfactant as a drug carrier

Drug delivery using a surfactant vehicle has the potential to prevent systemic side effects by delivering therapeutic agents directly to the respiratory system. The inherent chemical properties of surfactant allows it to readily distribute throughout the respiratory system. Therapeutic agents delivered by surfactant can primarily confer additional benefits but have potential to improve surfactant function. It is critically important that additional agents do not interefere with the innate surface tension lowering function of surfactant. Systemic evaluation through benchtop, translational and human trials are required to translate this potential technique into clinical practice

No association between CTNNBL1 and episodic memory performance

Polymorphisms in the gene encoding catenin-β-like 1 (CTNNBL1) were recently reported to be associated with verbal episodic memory performance—in particular, delayed verbal free recall assessed between 5 and 30 min after encoding—in a genome-wide association study on healthy young adults. To further examine the genetic effects of CTNNBL1, we tested for association between 455 single-nucleotide polymorphisms (SNPs) in or near CTNNBL1 and 14 measures of episodic memory performance from three different tasks in 1743 individuals. Probands were part of a population-based study of mentally healthy adult men and women, who were between 20 and 70 years old and were recruited as participants for the Berlin Aging Study II. Associations were assessed using linear regression analysis. Despite having sufficient power to detect the previously reported effect sizes, we found no evidence for statistically significant associations between the tested CTNNBL1 SNPs and any of the 14 measures of episodic memory. The previously reported effects of genetic polymorphisms in CTNNBL1 on episodic memory performance do not generalize to the broad range of tasks assessed in our cohort. If not altogether spurious, the effects may be limited to a very narrow phenotypic domain (that is, verbal delayed free recall between 5 and 30 min). More studies are needed to further clarify the role of CTNNBL1 in human memory

Pengaruh Intensitas Mengakses Twitter Duta Im3 terhadap Kepuasan Pengalaman Adopsi dan Kepuasan Pengalaman Adopsi terhadap Keputusan Penggunaan Program Im3

Nama : Diyan H Ayu KinasihNIM : D2C009029Judul : Pengaruh Intensitas Mengakses Twitter Duta IM3 terhadapKepuasan Pengalaman Adopsi dan Kepuasan PengalamanAdopsi terhadap Keputusan Penggunaan Program IM3ABSTRAKTwitter sebagai salah satu promotion tools yang digunakan oleh PTIndosat Tbk, diharapkan dapat memperkenalkan program-program serta eventyang dilakukan oleh Indosat. Melalui duta IM3 sebagai brand ambassador, Indosatmencoba meraih pasar anak muda dengan melakukan kegiatan promosi.Tipe penelitian ini adalah eksplanatory yang menjelaskan pengaruhintensitas mengakses twitter duta IM3 terhadap kepuasan pengalaman adopsiterhadap kepuasan pengalaman adopsi, dan kepuasan pengalaman adopsi terhadapkeputusan penggunaan program IM3. Teknik pengambilan sampling denganproporsional random sampling. Uji pengaruh antara variabel intensitasmengakses twitter duta IM3 (X1) terhadap kepuasan pengalaman adopsi (X2)menggunakan Uji Regresi Linier Sederhana sementara uji pengaruh variabelkepuasan pengalaman adopsi (X2) terhadap keputusan penggunaan program IM3(Y) menggunakan Uji Regresi Logistik Biner.Hasil penelitian ini menunjukkan terdapat intensitas mengakses twitterduta IM3 berpengaruh negatif terhadap kepuasan pengalaman adopsi dimanahanya 6,1% Perubahan pada variabel Kepuasan Pengalaman Adopsi (X2)disebabkan oleh variabel Intensitas Mengakses Twitter Duta IM3 (X1) sisanya93,9% dipengaruhi oleh variabel lain diluar model yang diajukan. Serta kepuasanpengalaman adopsi (X2) berpengaruh positif terhadap keputusan penggunaanprogram IM3 (Y) dengan taraf kepercayaan sebesar 95%. Twitter merupakanmedia sosial yang bersifat real time. Sifat real time ini dapat menjadi kelebihanyaitu twitter mampu memberikan informasi secara cepa, namun juga memberikankelemahan yaitu cepat berlalunya informasi Dalam penelitian ini, twitter duta IM3dirasa kurang memberikan pengaruh yang maksimal dalam kegiatan komunikasipemasaran. Masih rendahnya frekuensi responden terhadap jumlah tweet yangdilihat per harinya menjadi salah satu penyebabnya. Pada kepuasan pengalamanadopsi, untuk kategori persyaratan tarif sendiri masih terhitung rendah namunsecara keseluruhan sudah merasa puas terhadap program-program IM3. Padaakhirnya keputusan yang diambil dalam penelitian ini adalah memutuskan untuktetap menggunakan program IM3, yang paling mendominasi adalah besarnyakeinginan untuk tetap merekomendasikan program IM3 kepada orang lain.Kata kunci: komunikasi pemasaran, intensitas mengakses twitter duta im3,keputusan menggunakan program im3.Nama : Diyan H Ayu KinasihNIM : D2C009029Judul : The influence of Intensity of Accessing to Twitter IM3Ambassador against Satisfaction of The Adoption Experienceand Satisfaction of The Adoption Experience against TheDecision Use of IM3 ProgramsABSTRACTTwitter as one of promotion tools used by PT Indosat Tbk, is expected tointroduce programmes and events carried out by Indosat. Through AmbassadorIM3 Indosat as brand ambassador, trying to grab the youth market by conductingpromotional activities.This research type is explanatory which explains the influence ofintensity of accessing twitter IM3 ambassadors against satisfaction of the adoptionexperience, and satisfaction of the adoption experience against decision use ofIM3 program. Retrieval technique of sampling with proportional randomsampling. Test of influence of variable intensity access twitter ambassadors IM3(X 1) to the satisfaction of the adoption experience (X 2) using Simple Linearregression test while the test influences of variable satisfaction the experience ofadoption (x 2) against the decision use of IM3 programs (Y) using BinaryLogistic regression test.The results of this research indicate there is an intensity to access twitterambassadors IM3 effect negatively to the satisfaction of the adoption experiencewhere only 6.1% change in the variable Satisfaction of the adoption Experience(X 2) the variable Intensity caused by Accessing Twitter Ambassadors IM3 (X 1)rest 93,9% influenced by variables other than the model asked. As well assatisfaction of the adoption experience (X2) have a positive effect against thedecision of the IM3 program (Y) with 95% confidence level. Twitter is a socialmedia in real time. This real time can be an excess of twitter to provideinformation we have load, but also give a quick passage of the weakness of theinformation. In this study, twitter proved less IM3 Ambassadors providemaximum influence in the activity of marketing communications. Still the lowfrequency of respondents against the number of tweets viewed per day to be oneof the cause. On the adoption experience, satisfaction for its own costrequirements category still accounts for low but overall it feels satisfied towardsIM3 programs. Ultimately the decision taken in this research is decided to stay,using program im3 most dominate is the desire to remain im3 programrecommends to others.Keywords: marketing communications, intensity of accessing twitter im3ambassadors, decision of the use of im3 programs.I Latar BelakangBanyak operator seluler di Indonesia menjadikan persaingan pasarsemakin ketat. Masing-masing operator meluncurkan program-program tambahanyang menawarkan berbagai macam bonus seperti bonus sms, telepon, maupuninternet. Untuk memperkenalkan program-program tersebut tentu dibutuhkanbauran promosi seperti TVC, radio, flayer, billboard/Baliho, poster, event, maupunsponsorship.Dari hasil survey awareness yang dilakukan kepada masyarakat Bandungterhadap salah satu program Indosat yaitu 7 Hari 7 Malam, menunjukkan hasilbahwa responden mengetahui program tersebut dengan presentase 88%.Sementara responden yang memahami informasi yang didapat sebanyak 44%.Dan responden yang menggunakan program tersebut hanya 35% saja. Kurangnyainformasi dari Indosat inilah yang mengakibatkan responden tidak menggunakanprogram tersebut. Informasi disini berkaitan tentang cara pemakaian, berapanominal pulsa yang harus dipakai, serta apa kelebihan dan kekurangan dariprogram tersebut. Masyarakat Bandung mengetahui program tersebut mayoritasdari iklan televisi dan radio dengan presentase 86%, sementara sisanya mengakumengetahui program tersebut dari billboard/Baliho, event, maupunbanner(http://www.academia.edu/3519915/HASIL_SURVEY_AWARENESS_MASYARAKAT_BANDUNG_TERHADAP_PROMO_INDOSAT_7h7m).Dengan menggunakan sosial media twitter melalui akun pribadi duta IM3diharapkan mampu mempromosikan segala program maupun event Indosatkepada masyarakat.II Perumusan MasalahMenurut hasil survey terhadap salah satu program Indosat yaitu 7 hari 7malam yang dilakukan di Kota Bandung, menunjukkan bahwa mayoritasresponden sudah mengetahui adanya program 7 hari 7 malam, namun karenakurangnya pemahaman informasi tentang program 7 hari 7 malam sepertiinformasi mengenai cara pemakaian, berapa nominal pulsa yang harus digunakan,dan apa kelebihan-kekurangan dari program tersebut menjadikan masyarakatmemilih untuk tidak menggunakan program 7 hari 7 malam. Ketika ditanyaresponden mengetahui program tersebut darimana, responden mayoritasmenjawab dari iklan televisi dan radio. Kedua media iklan yang disebutkan olehresponden merupakan media iklan yang bersifat satu arah, dimana tidak terdapatumpan Balik atau feedback dari pengirim pesan.Keterbatasan informasi yang disampaikan serta komunikasi yang terjalinbersifat satu arah inilah yang menjadi awal mula terjadinya masalah. Awarenessmasyarakat mengenai produk memang sudah baik, namun dikarenakanketerbatasan informasi yang diberikan dari Indosat menjadikan masyarakatenggan untuk mencoba menggunakan program tertentu.Melihat keterbatasan tersebut, Indosat dengan menggunakan sosial mediatwitter melalui para duta IM3 melakukan kegiatan promosi mengenai setiapprogram-program terbaru yang dikeluarkan oleh Indosat. Duta IM3 yang dipilihdari anak-anak SMA inilah akan mendapat tugas sebagai ambassador, salesendorser, public influencer, community acquisition, indosat representatif.Kecenderungan konsumsi remaja menggunakan sosial media twitter inilah yangmenjadi alasan Indosat untuk menggerakkan duta IM3 melakukan promosi disosial media khususnya twitter. Dengan demikian, apakah ada pengaruh antaraintensitas mengakses twitter duta IM3 terhadap kepuasan pengalaman adopsi dankepuasan pengalamn adopsi terhadap keputusan penggunaan program IM3.III Tujuan PenelitianPenelitian ini bertujuan untuk mengetahui pengaruh antara intensitasmengakses twitter duta IM3 terhadap kepuasan pengalaman adopsi. Dan pengaruhantara kepuasan pengalaman adopsi terhadap keputusan penggunaan programIM3.IV HipotesisDalam penelitian ini dapat dirumuskan hipotesis sebagai berikut :1. Terdapat pengaruh positif antara intensitas mengakses twitter duta IM3(X1) terhadap kepuasan pengalaman adopsi (X2)2. Terdapat pengaruh positif antara kepuasan pengalaman adopsi (X2)terhadap keputusan penggunaan program IM3 (Y)V Landasan TeoriDalam penelitian ini, peneliti menggunakan 3 teori yang menjadi acuanatau dasar dalam pengerjaan penelitian ini yakni :Teori Difusi InovasiPada proses pengambilan keputusan inovasi, konsumen akan melaluibeberapa tahap yaitu pengetahuan, persuasi, keputusan, implementasi, dankonfirmasi (Shimp, 2003: 270).Low Involvement HierarchyLow involvement hierarchy menyebutkan bahwa tahapan Perubahansikap untuk produk low involvement yaitu penerima setelah menerima pesan yangdikomunikasikan atau tahap kognitif, penerima akan langsung melakukantindakan (behavior), dan baru setelah itu kemudian dipandang sebagai lewat dariingatan untuk perilaku untuk sikap Perubahan (afektif) (Belch, 2003 : 152).Teori Hierarki BelajarTeori hirarki belajar (The Learning Hierarchy Theory) (Liliweri, 1992 :90) menerangkan bahwa setiap informasi pertama-tama akan menerpa khalayakdan akibatnya terjadi Perubahan komponen kognitif dari khalayak tersebut.Perubahan itu meliputi kesadaran, perhatian, pemahaman khalayak terhadapproduk yang dipersuasifkan. Dengan kata lain, khalayak pertama-tama harusmemperhatikan, mengerti, dan paham tentang informasi.VI Metoda PenelitianTipe penelitian ini adalah penelitian eksplanatori, yaitu penelitian yangmenjelaskan hubungan kausal antara variabel-variabel yaitu intensitas mengaksestwitter duta IM3, kepuasan pengalaman adopsi, dan keputusan penggunaanprogram IM3.Dari total populasi 19511 follower duta IM3 Semarang, diambilsebanyak 100 responden sebagai sampel dengan teknik pengambilan sampelproporsional random sampling. Metode pengambilan sampel ini digunakanapabila populasi terdiri dari beberapa unit yang memiliki besar kecil yangberbeda. Dengan mengetahui jumlah setiap unit populasi yang ada, sampelkemudian diambil dari setiap unit secara berimbang berdasarkan besar kecilnyajumlah. Dari ukuran sampel 100, kemudian didistribusikan secara proporsionalmasing-masing ke dalam 10 unit duta IM3, yang disesuaikan dengan persentasejumlah total populasi yang dimiliki sampel. Kemudian tiap follower pada 10 unitduta IM3 diberi nomer terlebih dahulu, sesuai dengan jumlah anggota populasidan dilakukan pengundian.Teknik pengumpulan data yang digunakan adalah dengan mengajukanpertanyaan secara langsung atau wawancara terhadap responden mengenaipertanyaan-pertanyaan yang tertera pada kuesioner.VII PembahasanHasil penelitian ini menunjukkan terdapat intensitas mengakses twitterduta IM3 berpengaruh negatif terhadap kepuasan pengalaman adopsi dimanahanya 6,1% Perubahan pada variabel Kepuasan Pengalaman Adopsi (X2)disebabkan oleh variabel Intensitas Mengakses Twitter Duta IM3 (X1) sisanya93,9% dipengaruhi oleh variabel lain diluar model yang diajukan. Sehingga H1ditolak.Serta kepuasan pengalaman adopsi (X2) berpengaruh positif terhadapkeputusan penggunaan program IM3 (Y) dengan taraf kepercayaan sebesar 95%.Sehingga H2 diterima.Twitter merupakan media sosial yang bersifat real time. Sifat real timeini dapat menjadi kelebihan yaitu twitter mampu memberikan informasi secaracepa, namun juga memberikan kelemahan yaitu cepat berlalunya informasi Dalampenelitian ini, twitter duta IM3 dirasa kurang memberikan pengaruh yangmaksimal dalam kegiatan komunikasi pemasaran. Masih rendahnya frekuensiresponden terhadap jumlah tweet yang dilihat per harinya menjadi salah satupenyebabnya. Pada kepuasan pengalaman adopsi, untuk kategori persyaratan tarifsendiri masih terhitung rendah namun secara keseluruhan sudah merasa puasterhadap program-program IM3. Pada akhirnya keputusan yang diambil dalampenelitian ini adalah memutuskan untuk tetap menggunakan program IM3, yangpaling mendominasi adalah besarnya keinginan untuk tetap merekomendasikanprogram IM3 kepada orang lain.VIII KesimpulanBerdasarkan uraian pokok bahasan penelitian sebelumnya, maka dalambab ini berisi tentang kesimpulan atas hasil penelitian pengaruh intensitasmengakses twitter duta IM3 terhadap kepuasan pengalaman adopsi dan kepuasanpengalaman adopsi terhadap keputusan penggunaan program IM3 :1. Intensitas mengakses twitter duta IM3 berpengaruh negatif terhadap kepuasanpengalaman adopsi. Setiap kenaikan pada frekuensi dan durasi twittermenyebabkan penurunan pada kepuasan pengalaman adopsi.2. Kepuasan pengalaman adopsi berpengaruh positif terhadap keputusanpenggunaan program IM3. Tingkat kepuasan pengalaman adopsi membuatfollower twitter memutuskan untuk tetap menggunakan program Indosat.IX Saran1. Penggunaan twitter melalui akun pribadi duta IM3 dirasa masih kurangmemberikan pengaruh yang maksimal dalam aktifitas komunikasipemasaran, oleh karena itu penggunaan promotion tools lainnya perludipertimbangkan.2. Perlu adanya perencanaan dalam penggunaan sosial media dalam kegiatankomunikasi pemasaran, hal ini berkaitan dengan pemilihan waktu yangtepat untuk melakukan aktifitas dalam twitter. Para duta IM3 sebaiknyamemperhatikan waktu-waktu yang tergolong “premier” dimana pada jamjamtersebut mayoritas follower twitternya sedang mengakses twitter.3. Indosat perlu memperhatikan kembali ketentuan tarif yang dikenakanuntuk menggunakan program tertentu dengan melihat banyak respondenyang merasa kurang puas dengan persyaratan tarif program. Denganbegitu diharapkan masyarakat akan tetap menggunakan program IM3yang ditawarkan.DAFTAR PUSTAKABelch, George and Michael A Belch. (2003). Advertising and Promotion:AnIntegrated Marketing Communications Perspective (6th ed.). The McGraw-HillCompaniesDuden. (2003). Deutsche Grammatik. Manheim Leipzig Wein: DudenverlagFahmi, Abu Bakar. (2011). Mencerna Situs Jejaring Sosial. Jakarta: PT ElexMedia KomputindoKasali, Rhenald. (1995). Manajemen Periklanan. Jakarta: Pustaka Utama GrafitiSumartono. (2002). Terperangkap dalam Iklan:Meneropong Imbas Pesan IklanKomputer. Bandung: CV AlfabetaKotler, Philip. (1995). Manajemen Pemasaran Analysis Perencanaan danImplementasi. Jakarta: Salemba EmpatLiliweri, Alo. (1992). Dasar-Dasar Komunikasi Periklanan. Bandung: PT CitraAditya BaktiNisfiannoor, Muhammad. (2009). Pendekatan Statistika Modern untuk IlmuSosial. Jakarta: Salemba HumanikaRuslan, Rosadi. (2006). Metode Penelitian Public Relation dan Komunikasi.Jakarta: PT Raja Grafindo PersadaShimp A, Terence. (2003). Periklanan Promosi dan Aspek Tambahan KomunikasiPemasaran Terpadu (5th ed. Jilid 1). Jakarta: ErlanggaSugiarto, dkk. (2001). Teknik Sampling. Jakarta: Gramedia Pustaka UtamaSugiyono. (2007). Statistika untuk Penelitian. Bandung: CV AlfabetaTrihendradi,C. 2011. Langkah Mudah Melakukan Analisis Statistik MenggunakanSPSS 19. Yogyakarta : Penerbit AndiSumber Internet :Hasil Survey Top Brand Index. (2013). Dalam http://www.topbrandaward.com/top-brand-survey/survey-result/top-brand-index-2013/ Diunduh pada10 April 2013 pukul 10.30 WIBAdhima, Faza. (2013). Hasil Survey Awareness Masyarakat Bandung TerhadapPromo Indosat 7 Hari 7 Malam. Dalamhttp://www.academia.edu/3519915/HASIL_SURVEY_AWARENESS_MASYARAKAT_BANDUNG_TERHADAP_PROMO_INDOSAT_7h7m Diunduhpada 15 Mei 2013 pukul 13.00 WIBDela Permata Jadi Duta IM3 Queen 2012. (2012). Dalamhttp://www.tribunnews.com/2012/06/17/della-permata-jadi-duta-im3-queen-2012 Diunduh pada 15 Mei 2013 pukul 14.00 WIBHariyanti, Dini. (2011). Remaja, 64 Persen Pengguna Jejaring Sosial. Dalamhttp://www.jurnas.com/news/34328/Remaja,_64_Persen_Pengguna_Jejaring_Sosial_/2/Sosial_Budaya/Saintek Diunduh pada 16 Mei 2013 pukul 20.00 WIBhttps://twitter.com/search?q=%23DUTAIM3SASMG&src=hash Diunduh pada16 Mei 2013 pukul 21.30 WIBhttp://www.telkomsel.com/kartuas Diunduh pada 2 Agustus 2013 pukul 19.30WIBhttp://www.telkomsel.com/product/simpati/631-simPATI-Freedom.htmlDiunduh pada 2 Agusutus 2013 pukul 20.00 WIBhttp://www.telkomsel.com/promosimpati Diunduh pada 2 Agustus 2013 pukul21.00 WIBhttp://www.xl.co.id/id/internet/paket/hotrod Diunduh pada 21 Agustus 2013pukul 19.00http://www.xl.co.id/id/prabayar Diunduh pada 21 Agustus 2013 pukul 20.00http://www.xl.co.id/id/prabayar/perdana/xl-ku Diunduh pada 21 Agustus 2013pukul 20.30http://www.indosat.com/Personal/IM3_Update/IM3_Sekalee Diunduh pada 22Agustus 2013 pukul 15.00http://www.indosat.com/Personal/IM3_Update/IM3_SMS_SUKA_SUKADiunduh pada 22 Agustus 2013 pukul 15.30http://indosat.com/Personal/Personal/DOBEL_1000_BERKAH Diunduh pada22 Agustus 2013 pukul 17.00http://icity.indosat.com/t5/Events-Announcements/Terbaru-Dari-Indosat-Pulsa-Isi-Ulang-12000/td-p/78840 Diunduh pada 7 November 2013 pukul 19.00http://www.indosat.com/Personal/IM3_Update/IM3_Play Diunduh pada 7November 2013 pukul 19.30http://koran-Jakarta.com/index.php/detail/view01/113510 Diunduh pada 9 April2013 pukul 21.00http://www.indosat.com/Public_Relations/Press_Release_Photo_Gallery/INDOSAT_GELAR_IM3_MOBILE_ACADEMY_KE6 Diunduh pada 7 November 2013pukul 20.00Jurnal dan Skripsi :Raditya, C. (2012). Hubungan intensitas penggunaan situs jejaring sosial twitterdengan intensitas komunikasi interpersonal mahasiswa program studi ilmukomunikasi UPN FISIP “veteran” Yogyakarta. Skripsi. UPN VeteranYogyakarta.Kwon, Eun Sook and Yongjun Sung. (2011). Follow Me! Global MarketersTwitter Use. Journal of Interactive Advertising: 1-11Sari, Viranti Mustika. (2012). Pengaruh Eletronic Word of Mouth (eWOM) disocial media twitter terhadap minat beli konsumen: Studi pada RestoranHolycowsteak. Skripsi. Universitas IndonesiaSteyer, Alexandre, Renaud Garcia Bardidia, Pascale Quester. (2010). OnlineDiscussion Groups as Social Networks: An Empirical Investigation of Word ofMouth on The Internet. Journal of Interactive Adevertising: 1-

Multi-Parton Interactions at the LHC

We review the recent progress in the theoretical description and experimental observation of multiple parton interactions. Subjects covered include experimental measurements of minimum bias interactions and of the underlying event, models of soft physics implemented in Monte Carlo generators, developments in the theoretical description of multiple parton interactions and phenomenological studies of double parton scattering. This article stems from contributions presented at the Helmholtz Alliance workshop on "Multi-Parton Interactions at the LHC", DESY Hamburg, 13-15 September 2010.Comment: 68 page

Are social conflicts at work associated with depressive symptomatology? Results from the population-based LIFE-Adult-Study

Background Psychosocial stressors in the workplace can be detrimental to mental health. Conflicts at work, e.g. aggression, hostility or threats from coworkers, supervisors or customers, can be considered a psychosocial stressor, possibly increasing risk for depressive symptoms. Existing studies, however, differ in the assessment of social conflicts, i.e. as individual- or job-level characteristics. Here, we investigated the association between conflicts at work assessed as objective job characteristics, and depressive symptomatology, using data from a large population-based sample. Additionally, we investigated gender differences and the impact of personality traits and social resources. Methods We used data from the population-based LIFE-Adult-Study from Leipzig, Germany. Information on conflicts at work, assessed as job characteristics, were drawn from the Occupational Information Network, depressive symptoms were assessed via the Center for Epidemiological Studies Depression Scale. Multilevel linear regression models with individuals and occupations as levels of analysis were applied to investigate the association between conflicts at work and depressive symptoms. Results Our sample included 2164 employed adults (age: 18–65 years, mean: 49.3, SD: 7.9) in 65 occupations. No association between conflicts s at work and depressive symptomatology was found (men: b = − 0.14; p = 0.74, women: b = 0.17, p = 0.72). Risk for depression was mostly explained by individual-level factors like e.g. neuroticism or level of social resources. The model showed slightly higher explanatory power in the female subsample. Conclusion Conflicts at work, assessed as objective job characteristics, were not associated with depressive symptoms. Possible links between interpersonal conflict and impaired mental health might rather be explained by subjective perceptions of social stressors and individual coping styles

Increasing Respiratory Effort With 100% Oxygen During Resuscitation of Preterm Rabbits at Birth

Background: Spontaneous breathing is essential for successful non-invasive respiratory support delivered by a facemask at birth. As hypoxia is a potent inhibitor of spontaneous breathing, initiating respiratory support with a high fraction of inspired O2 may reduce the risk of hypoxia and increase respiratory effort at birth. Methods: Preterm rabbit kittens (29 days gestation, term ~32 days) were delivered and randomized to receive continuous positive airway pressure with either 21% (n = 12) or 100% O2 (n = 8) via a facemask. If apnea occurred, intermittent positive pressure ventilation (iPPV) was applied with either 21% or 100% O2 in kittens who started in 21% O2, and remained at 100% O2 for kittens who started the experiment in 100% O2. Respiratory rate (breaths per minute, bpm) and variability in inter-breath interval (%) were measured from esophageal pressure recordings and functional residual capacity (FRC) was measured from synchrotron phase-contrast X-ray images. Results: Initially, kittens receiving 21% O2 had a significantly lower respiratory rate and higher variability in inter-breath interval, indicating a less stable breathing pattern than kittens starting in 100% O2 [median (IQR) respiratory rate: 16 (4–28) vs. 38 (29–46) bpm, p = 0.001; variability in inter-breath interval: 33.3% (17.2–50.1%) vs. 27.5% (18.6–36.3%), p = 0.009]. Apnea that required iPPV, was more frequently observed in kittens in whom resuscitation was started with 21% compared to 100% O2 (11/12 vs. 1/8, p = 0.001). After recovering from apnea, respiratory rate was significantly lower and variability in inter-breath interval was significantly higher in kittens who received iPPV with 21% compared to 100% O2. FRC was not different between study groups at both timepoints. Conclusion: Initiating resuscitation with 100% O2 resulted in increased respiratory activity and stability, thereby reducing the risk of apnea and need for iPPV after birth. Further studies in human preterm infants are mandatory to confirm the benefit of this approach in terms of oxygenation. In addition, the ability to avoid hyperoxia after initiation of resuscitation with 100% oxygen, using a titration protocol based on oxygen saturation, needs to be clarified

Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial

Background Infections acquired in hospital are an important cause of morbidity and mortality in very preterm infants. Several small trials have suggested that supplementing the enteral diet of very preterm infants with lactoferrin, an antimicrobial protein processed from cow's milk, prevents infections and associated complications. The aim of this large randomised controlled trial was to collect data to enhance the validity and applicability of the evidence from previous trials to inform practice. Methods In this randomised placebo-controlled trial, we recruited very preterm infants born before 32 weeks' gestation in 37 UK hospitals and younger than 72 h at randomisation. Exclusion criteria were presence of a severe congenital anomaly, anticipated enteral fasting for longer than 14 days, or no realistic prospect of survival. Eligible infants were randomly assigned (1:1) to receive either enteral bovine lactoferrin (150 mg/kg per day; maximum 300 mg/day; lactoferrin group) or sucrose (same dose; control group) once daily until 34 weeks' postmenstrual age. Web-based randomisation minimised for recruitment site, gestation (completed weeks), sex, and single versus multifetal pregnancy. Parents, caregivers, and outcome assessors were unaware of group assignment. The primary outcome was microbiologically confirmed or clinically suspected late-onset infection (occurring >72 h after birth), which was assessed in all participants for whom primary outcome data was available by calculating the relative risk ratio with 95% CI between the two groups. The trial is registered with the International Standard Randomised Controlled Trial Number 88261002. Findings We recruited 2203 participants between May 7, 2014, and Sept 28, 2017, of whom 1099 were assigned to the lactoferrin group and 1104 to the control group. Four infants had consent withdrawn or unconfirmed, leaving 1098 infants in the lactoferrin group and 1101 in the sucrose group. Primary outcome data for 2182 infants (1093 [99·5%] of 1098 in the lactoferrin group and 1089 [99·0] of 1101 in the control group) were available for inclusion in the modified intention-to-treat analyses. 316 (29%) of 1093 infants in the intervention group acquired a late-onset infection versus 334 (31%) of 1089 in the control group. The risk ratio adjusted for minimisation factors was 0·95 (95% CI 0·86–1·04; p=0·233). During the trial there were 16 serious adverse events for infants in the lactoferrin group and 10 for infants in the control group. Two events in the lactoferrin group (one case of blood in stool and one death after intestinal perforation) were assessed as being possibly related to the trial intervention. Interpretation Enteral supplementation with bovine lactoferrin does not reduce the risk of late-onset infection in very preterm infants. These data do not support its routine use to prevent late-onset infection and associated morbidity or mortality in very preterm infants. Funding UK National Institute for Health Research Health Technology Assessment programme (10/57/49)

Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial

Background Infections acquired in hospital are an important cause of morbidity and mortality in very preterm infants. Several small trials have suggested that supplementing the enteral diet of very preterm infants with lactoferrin, an antimicrobial protein processed from cow's milk, prevents infections and associated complications. The aim of this large randomised controlled trial was to collect data to enhance the validity and applicability of the evidence from previous trials to inform practice. Methods In this randomised placebo-controlled trial, we recruited very preterm infants born before 32 weeks' gestation in 37 UK hospitals and younger than 72 h at randomisation. Exclusion criteria were presence of a severe congenital anomaly, anticipated enteral fasting for longer than 14 days, or no realistic prospect of survival. Eligible infants were randomly assigned (1:1) to receive either enteral bovine lactoferrin (150 mg/kg per day; maximum 300 mg/day; lactoferrin group) or sucrose (same dose; control group) once daily until 34 weeks' postmenstrual age. Web-based randomisation minimised for recruitment site, gestation (completed weeks), sex, and single versus multifetal pregnancy. Parents, caregivers, and outcome assessors were unaware of group assignment. The primary outcome was microbiologically confirmed or clinically suspected late-onset infection (occurring >72 h after birth), which was assessed in all participants for whom primary outcome data was available by calculating the relative risk ratio with 95% CI between the two groups. The trial is registered with the International Standard Randomised Controlled Trial Number 88261002. Findings We recruited 2203 participants between May 7, 2014, and Sept 28, 2017, of whom 1099 were assigned to the lactoferrin group and 1104 to the control group. Four infants had consent withdrawn or unconfirmed, leaving 1098 infants in the lactoferrin group and 1101 in the sucrose group. Primary outcome data for 2182 infants (1093 [99·5%] of 1098 in the lactoferrin group and 1089 [99·0] of 1101 in the control group) were available for inclusion in the modified intention-to-treat analyses. 316 (29%) of 1093 infants in the intervention group acquired a late-onset infection versus 334 (31%) of 1089 in the control group. The risk ratio adjusted for minimisation factors was 0·95 (95% CI 0·86–1·04; p=0·233). During the trial there were 16 serious adverse events for infants in the lactoferrin group and 10 for infants in the control group. Two events in the lactoferrin group (one case of blood in stool and one death after intestinal perforation) were assessed as being possibly related to the trial intervention. Interpretation Enteral supplementation with bovine lactoferrin does not reduce the risk of late-onset infection in very preterm infants. These data do not support its routine use to prevent late-onset infection and associated morbidity or mortality in very preterm infants. Funding UK National Institute for Health Research Health Technology Assessment programme (10/57/49)

Spontaneous breathing approach in mild congenital diaphragmatic hernia: A resuscitation algorithm

BackgroundInfants with a congenital diaphragmatic hernia (CDH) and expected mild pulmonary hypoplasia have an estimated survival rate of 90%. Current guidelines for delivery room management do not consider the individual patient's disease severity, but an individualized approach with spontaneous breathing instead of routine mechanical ventilation could be beneficial for the mildest cases. We developed a resuscitation algorithm for this individualized approach serving two purposes: improving the success rate by structuring the approach and providing a guideline for other centers.MethodsAn initial algorithm was discussed with all local stakeholders. Afterwards, the resulting algorithm was refined using input from international experts.ResultsEligible CDH infants: left-sided defect, observed to expected lung-to-head ratio ≥50%, gestational age at birth ≥37.0 weeks, and no major associated structural or genetic abnormalities. To facilitate fetal-to-neonatal transition, we propose to start stabilization with non-invasive respiratory support and to adjust this individually.ConclusionsInfants with mild CDH might benefit from an individualized approach for neonatal resuscitation. Herein, we present an algorithm that could serve as guidance for centers implementing this

The development and validation of a cerebral ultrasound scoring system for infants with hypoxic-ischaemic encephalopathy

BACKGROUND: Hypoxic-ischaemic encephalopathy (HIE) is an important cause of morbidity and mortality in neonates. When the gold standard MRI is not feasible, cerebral ultrasound (CUS) might offer an alternative. In this study, the association between a novel CUS scoring system and neurodevelopmental outcome in neonates with HIE was assessed. METHODS: (Near-)term infants with HIE and therapeutic hypothermia, a CUS on day 1 and day 3-7 after birth and available outcome data were retrospectively included in cohort I. CUS findings on day 1 and day 3-7 were related to adverse outcome in univariate and the CUS of day 3-7 also in multivariable logistic regression analyses. The resistance index, the sum of deep grey matter and of white matter involvement were included in multivariable logistic regression analyses. A comparable cohort from another hospital was used for validation (cohort II). RESULTS: Eighty-three infants were included in cohort I and 35 in cohort II. The final CUS scoring system contained the sum of white matter (OR = 2.6, 95% CI 1.5-4.7) and deep grey matter involvement (OR = 2.7, 95% CI 1.7-4.4). The CUS scoring system performed well in cohort I (AUC = 0.90) and II (AUC = 0.89). CONCLUSION: This validated CUS scoring system is associated with neurodevelopmental outcome in neonates with HIE