Pediatric Trauma Recidivism: A Statewide Risk Factor Analysis of the Maryland Health Services Cost Review Commission (HSCRC)

BACKGROUND

National estimates suggest pediatric trauma recidivism is uncommon but are limited by short follow up and narrow ascertainment. We aimed to quantify the long-term frequency of trauma recidivism in a statewide pediatric population and identify risk factors for re-injury.

METHODS

The Maryland Health Services Cost Review Commission Dataset was queried for 0-19-year-old patients with emergency department or inpatient encounters for traumatic injuries between 2013 and 2019. We measured trauma recidivism by identifying patients with any subsequent presentation for a new traumatic injury. Univariate and multivariable regressions were used to estimate associations of patient and injury characteristics with any recidivism and inpatient recidivism.

RESULTS

Of 574,472 patients with at least one injury encounter, 29.6% experienced trauma recidivism. Age ≤2 years, public insurance, and self-inflicted injuries were associated with recidivism regardless of index treatment setting. Of those with index emergency department presentations 0.06% represented with an injury requiring inpatient admission; unique risk factors for ED-to-inpatient recidivism were age >10 years (aOR 1.61), cyclist (aOR 1.31) or burn (aOR 1.39) mechanisms, child abuse (aOR 1.27), and assault (aOR 1.43). Among patients with at least one inpatient encounter, 6.3% experienced another inpatient trauma admission, 3.4% of which were fatal. Unique risk factors for inpatient-to-inpatient recidivism were firearm (aOR 2.48) and motor vehicle/transportation (aOR 1.62) mechanisms of injury (all p < 0.05).

CONCLUSIONS

Pediatric trauma recidivism is more common and morbid than previously estimated, and risk factors for repeat injury differ by treatment setting. Demographic and injury characteristics may help develop and target setting-specific interventions.

LEVEL OF EVIDENCE

III (Retrospective Comparative Study).

Risk-based lung cancer screening performance in a universal healthcare setting

Globally, lung cancer is the leading cause of cancer death. Previous trials demonstrated that low-dose computed tomography lung cancer screening of high-risk individuals can reduce lung cancer mortality by 20% or more. Lung cancer screening has been approved by major guidelines in the United States, and over 4,000 sites offer screening. Adoption of lung screening outside the United States has, until recently, been slow. Between June 2017 and May 2019, the Ontario Lung Cancer Screening Pilot successfully recruited 7,768 individuals at high risk identified by using the PLCOm2012noRace lung cancer risk prediction model. In total, 4,451 participants were successfully screened, retained and provided with high-quality follow-up, including appropriate treatment. In the Ontario Lung Cancer Screening Pilot, the lung cancer detection rate and the proportion of early-stage cancers were 2.4% and 79.2%, respectively; serious harms were infrequent; and sensitivity to detect lung cancers was 95.3% or more. With abnormal scans defined as ones leading to diagnostic investigation, specificity was 95.5% (positive predictive value, 35.1%), and adherence to annual recall and early surveillance scans and clinical investigations were high (>85%). The Ontario Lung Cancer Screening Pilot provides insights into how a risk-based organized lung screening program can be implemented in a large, diverse, populous geographic area within a universal healthcare system.

Revolutionizing Atrial Fibrillation Treatment: The Robotic Convergent Plus Procedure

Atrial fibrillation (AF) is widely accepted to be the most common sustained arrhythmia, with an increasing incidence over time. This is thought to be due to the aging population across the world. AF occurs when abnormal electrical foci result in disorganization of atrial depolarization, though the exact pathophysiology leading to these abnormal foci is not well understood. A range of interventions exist for AF - pharmacological therapies (anti-arrhythmic or negative chronotropic medications), cardioversion, or ablations to interrupt the abnormal conduction pathways. Ablation may be via a catheter-based approach, via a surgical approach using the "Maze" procedure (Cox-Maze IV), or more recently, via a hybrid approach. This first involves a surgical epicardial ablation, with catheter-based endocardial ablation following a few weeks later to ensure durable transmural lesion sets via the "Convergent" procedure. We describe the use of the Da Vinci Xi™ robotic platform to improve the procedure, allowing continuous and improved visualization of the anatomy without the need for potentially harmful retraction of the atrial appendage or the back of the left atrium, as well as increased precision with our mapping tools and more complete ablation. Here, we highlight the advantages over a non-robotic (subxiphoid) Convergent procedure, while outlining the key operative steps in undertaking the "Robotic Convergent Plus" procedure using the Da Vinci Xi™ robotic surgical system.

Effectiveness of Community Pharmacy Diabetes and Hypertension Care Program: An Unexplored Opportunity for Community Pharmacists in Pakistan

Background: The effective management of patients diagnosed with both Diabetes as well as Hypertension is linked with administration of efficacious pharmacological therapy as well as improvement in adherence through counseling and other strategies. Being a part of primary healthcare team, community pharmacists can effectively provide patient care for chronic disease management. The objective of the study was to evaluate the impact of pharmacist counseling on blood pressure and blood glucose control among patients having both hypertension and diabetes attending community pharmacies in Pakistan. Method: A randomized, controlled, single-blind, pre-post-intervention study design was used. The respondents included patients diagnosed with diabetes mellitus (Type I or II) and hypertension visiting community pharmacies to purchase their regular medicine. A simple random sampling technique using the lottery method was used to select community pharmacies in groups A (intervention, n = 4) and group B (control, n = 4). The total number of patients was 40 in each group, while estimating a dropout rate of 25%. The patients in the intervention group received special counseling. Blood pressure and blood glucose were checked after every 15 days for 6 months. Prevalidated tools such as the hypertension knowledge level scale, the diabetes knowledge questionnaire 24, and a brief medication questionnaire was used. Data were coded and analyzed using SPSS 21. Wilcoxon test (p < 0.05) was used to compare pre-post intervention knowledge regarding the disease, while the Mann-Whitney test (p < 0.05) was used to find differences in medication adherence among control and intervention groups. Results: A significant improvement in mean knowledge scores of patients with diabetes (16.02 ±2.93 vs. 19.97 ±2.66) and hypertension (15.60 ±3.33 vs. 18.35 ±2.31) in the intervention group receiving counseling for 6 months than control group (p < 0.05) was noted. Furthermore, the fasting blood glucose levels (8.25 ±1.45) and systolic BP (130.10 ±6.89) were significantly controlled after 6 months in the intervention group. Conclusion: The current study results concluded that community pharmacists' counselling has a positive impact on blood glucose and blood pressure management among patients suffering with both diabetes and hypertension.

Factors Associated With Repeat Emergency Department Visits in a State-wide Cohort of Pediatric Patients With Mild Traumatic Brain Injury

OBJECTIVE

To describe demographic, injury, and clinical characteristics of pediatric patients treated in the ED for mild traumatic brain injury (mTBI), and to evaluate characteristics associated with mTBI-related return emergency department (ED) visit within 1 month of initial presentation.

METHODS

Retrospective cohort study from April 1, 2012, to September 30, 2017, of children 19 years or younger presenting to any Maryland ED for mTBI identified in the Maryland Health Services Cost Review Commission database using ICD-9/10 codes. Demographic, injury, and clinical characteristics of individuals were collected. The primary outcome was mTBI-related return ED visit within 4 weeks. Multiple logistic regression tested the associated of individual demographic, injury, and clinical characteristics with mTBI-related return ED visit.

RESULTS

There were 25,582 individuals who had an ED visit for mTBI, of which 717 (2.8%) returned to the ED within 4 weeks and 468 (1.8%) within 1 week with a mTBI-related diagnosis. In multivariable logistic regression analyses, public insurance (adjusted odds ratio [aOR], 1.44; 95% confidence interval [CI], 1.21-1.72) and female sex (aOR, 1.34; 95% CI, 1.15-1.56) were associated with increased odds of return to the ED within 4 weeks. Age younger than 2 years (aOR, 0.39; 95% CI, 0.21-0.72) was associated with decreased odds of return visit. There was a trend toward decreased odds of return patients receiving computed tomography head imaging (aOR, 0.86; 95% CI, 0.74-1.01).

CONCLUSIONS

Although return to the ED for mTBI-related complaints is uncommon, girls, older children, and publicly insured individuals may be at increased risk. Future targeted study may identify areas to improve access to appropriate longitudinal care and justify ED programs to better coordinate follow-up for mTBI.

Measuring the impact of the COVID-19 pandemic on organized cancer screening and diagnostic follow-up care in Ontario, Canada: A provincial, population-based study

It is essential to quantify the impacts of the COVID-19 pandemic on cancer screening, including for vulnerable sub-populations, to inform the development of evidence-based, targeted pandemic recovery strategies. We undertook a population-based retrospective observational study in Ontario, Canada to assess the impact of the pandemic on organized cancer screening and diagnostic services, and assess whether patterns of cancer screening service use and diagnostic delay differ across population sub-groups during the pandemic. Provincial health databases were used to identify age-eligible individuals who participated in one or more of Ontario's breast, cervical, colorectal, and lung cancer screening programs from January 1, 2019-December 31, 2020. Ontario's screening programs delivered 951,000 (-41%) fewer screening tests in 2020 than in 2019 and volumes for most programs remained more than 20% below historical levels by the end of 2020. A smaller percentage of cervical screening participants were older (50-59 and 60-69 years) during the pandemic when compared with 2019. Individuals in the oldest age groups and in lower-income neighborhoods were significantly more likely to experience diagnostic delay following an abnormal breast, cervical, or colorectal cancer screening test during the pandemic, and individuals with a high probability of living on a First Nation reserve were significantly more likely to experience diagnostic delay following an abnormal fecal test. Ongoing monitoring and management of backlogs must continue. Further evaluation is required to identify populations for whom access to cancer screening and diagnostic care has been disproportionately impacted and quantify impacts of these service disruptions on cancer incidence, stage, and mortality. This information is critical to pandemic recovery efforts that are aimed at achieving equitable and timely access to cancer screening-related care.

Green route to synthesize Zinc Oxide Nanoparticles using leaf extracts of Cassia fistula and Melia azadarach and their antibacterial potential

Development of plant based nanoparticles has many advantages over conventional physico-chemical methods and has various applications in medicine and biology. In present study, zinc oxide (ZnO) nanoparticles (NPs) were synthesized using leaf extracts of two medicinal plants Cassia fistula and Melia azadarach. 0.01 M zinc acetate dihydrate was used as a precursor in leaf extracts of respective plants for NPs synthesis. The structural and optical properties of NPs were investigated by X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, scanning electron microscope (SEM), ultraviolet-visible spectrophotometer (UV-Vis) and dynamic light scattering (DLS). The antibacterial potential of ZnO NPs was examined by paper disc diffusion method against two clinical strains of Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) based on the zone of inhibition and minimal inhibitory indices (MIC). Change in color of the reaction mixture from brown to white indicated the formation of ZnO NPs. UV peaks at 320 nm and 324 nm, and XRD pattern matching that of JCPDS card for ZnO confirmed the presence of pure ZnO NPs. FTIR further confirmed the presence of bioactive functional groups involved in the reduction of bulk zinc acetate to ZnO NPs. SEM analysis displayed the shape of NPs to be spherical whereas DLS showed their size range from 3 to 68 nm. The C. fistula and M. azadarach mediated ZnO NPs showed strong antimicrobial activity against clinical pathogens compared to standard drugs, suggesting that plant based synthesis of NPs can be an excellent strategy to develop versatile and eco-friendly biomedical products.

Emerging organizational parameters and their roles in implementation of organizational change

Purpose

The purpose of this paper is to investigate new emerging organizational parameters and their roles in successful change implementation. These organizational parameters are rarely investigated especially in the context of organizational change (OC) in private and public sector organizations.

Design/methodology/approach

In cumulative, 403 valid responses have been obtained randomly from public sector workers by using self-administered questionnaires.

Findings

The results reveal that knowledge sharing regarding incremental and radical changes can helpful for effective OC implementation. Findings highlight the significant role of emotional and social intelligence in managing resistance and bringing openness to change in these organizations. It is also found that social media has become an important emerging organizational parameter to foster effective communication and knowledge sharing during OC implementation. Apart from the direct effects, readiness to change has multiple effects coupled with emerging organizational parameters to implement change successfully.

Research limitations/implications

The results of the current study offer diversified implications for theory, practice and global society. The theoretical base is taken from the well-known theories of management (i.e. Lewin’s three-step model, field theory, intelligence theory, cost-effective theory, social exchange theory, social network theory and social penetration theory). Emerging organizational parameters that have a potential impact on effective change implementation are identified. The findings suggest that global organizations should have to initiate effective networking structure using social media applications and social intelligence skills to remain connected and get positive responses about change formulation and implementation decision.

Originality/value

A majority of studies have presented the research model on OC implementation in the context of developed countries, which form 30 percent of the world’s population, mostly the Americas and Europe. It is observed that a developing country, such as Pakistan, has a culture that is based on power distance, collectivism and more political influence as compared to developed countries. Triandis et al. (1980) argued that any theoretical contribution without considering the cultural aspect can lead to bias findings. There is limited research available in the world that is conducted to examine the interactive effects of readiness to change on the relationship between effective change implementation, knowledge sharing, intelligence and social media. These findings are useful to plan and execute OC using new emerging organizational parameters.

Exploring the sources and role of knowledge sharing to overcome the challenges of organizational change implementation

Purpose

In recent times, organizations and leaders are focusing on new strategies to increase the success rate of organizational change (OC) implementation. Therefore, this study aims to uncover the sources and role of knowledge sharing (KS) to overcome the challenges of OC implementation.

Design/methodology/approach

For this research, data have been gathered from respondents based on their key designations by using unstructured interview method. Thematic analysis was then performed using the NVivo 11-Plus software.

Findings

It has found that employees in public sector organizations are opposing OC because of ineffective communication, and a lower level of employee participation in decision-making and barriers of, for example, a cultural, social, structural and political nature. Therefore, this study suggests how KS can be used to overcome the challenges of OC implementation.

Research limitations/implications

KS has become necessary to ensure incremental and radical changes in the survival of dynamic businesses. The results are useful to enhance understanding regarding the role of KS in the context of OC among change leaders, researchers, academicians and policymakers.

Originality/value

The study provides meaningful and novel knowledge regarding role of KS to overcome the challenges of OC implementation. No prior research that contributes practical and theoretical knowledge in the perspective of KS and OC has been found, especially in the context of developing countries and Asian culture. Therefore, this investigation attempts to explore the role of KS and presented overarching conceptual framework in the real context of OC implementation.

Knowledge processes and firm performance: the mediating effect of employee creativity

Purpose

In current era, firms are facing difficulties in aligning their capabilities with the hallmarks of the knowledge-intensive economy. Notwithstanding the fact that employees’ creativity ensures competitive advantage through innovation, firms are unable to reap the required level of performance. The purpose of this paper is to investigate the linkage among knowledge processes, employee creativity and firm performance. Moreover, the current quantitative study measures the moderating effect of a knowledge-intensive culture on knowledge processes and employee creativity.

Design/methodology/approach

Surveys were conducted in eight services sector organizations operating in southern Punjab, Pakistan, and responses were obtained from 197 employees selected at random. To test the exposition using an empirical data analysis approach, three core hypotheses are drawn, and to test these hypotheses, multiple regression analyses, Preacher and Hayes (2004) mediation analysis and Aguinis (2004) guidelines were applied on 197 responses.

Findings

The results explain that knowledge processes have a positive impact on firm performance and employee creativity partially mediates their stated relationship. Moreover, a knowledge-intensive culture has a strengthening effect on the relationship between knowledge processes and employee creativity. In-depth investigation outlines that knowledge acquisition, sharing and application are more influencing processes to enhance firm performance. Furthermore, knowledge conversion and protection do not hold significant relevance with firm performance but are supportive elements for other processes.

Research limitations/implications

In order to have a sustained performance, firms have to initiate steps to promote employees’ creativity by deploying an optimal mix of knowledge processes and flourish a knowledge-intensive culture in routine organizational life. Moreover, knowledge processes are important to promote creative behavior in employees that will lead to incessant innovation and firm performance.

Originality/value

This study gives meaningful thoughts to unexplored areas in the field of knowledge management. First, the indirect effect of knowledge processes on firm performance through employees’ creativity. Second, the importance of knowledge processes to enhance employees’ creativity in the presence of a knowledge-intensive culture. This study gets together the dynamic constructs in the field of knowledge management, such as knowledge-intensive culture and employee creativity, and describes the linkage between knowledge processes and firm performance.

Investigating the antecedents of work disengagement in the workplace

Purpose

Organizations are keenly interested to find out the causes of work disengagement that are harmful to achieve desired level of performance. Antecedents and levels of work disengagement vary across organizations and sectors due to differences in organizational culture. Therefore, the purpose of this paper is to determine the antecedents of work disengagement in the public sector organizations.

Design/methodology/approach

The research data were obtained from 303 employees of the public sector organizations using the self-administered questionnaires and cluster sampling technique. The research model proposed in this study has been examined by using the regression analysis and Hayes’s (2013) guidelines for moderation.

Findings

It is found that work disengagement increases because of managers’ personal preferences, unfairness, above the rule practices, negative political influence, work overload, and a lack of accountability in the workplace. The results reveal a positive association among organizational injustice, organizational politics, work overload, and work disengagement. Moreover, it is also found that organizational injustice is a strongest predictor of work disengagement. Bureaucratic culture of the public sector organizations has a strong strengthening effect on above-stated relationships.

Research limitations/implications

The study has identified various practical implications related to top management, employees, union, and researchers. The study provides new avenues for senior managers of the services sector to eradicate the levels of work disengagement by improving fairness and perception of organizational politics in the workplace.

Originality/value

There is rare literature that investigates the link between work disengagement and organizational injustice, organizational politics, and work overload especially in the presence of interactive effects of a bureaucratic culture. Most of the studies on employee disengagement did not use the unbiased and significant sample size so their results cannot be generalized to larger population. Therefore, the current study has aimed to overcome the shortcomings of previous studies and brings a novel conceptual model on work disengagement.

A virus-derived short hairpin RNA confers resistance against sugarcane mosaic virus in transgenic sugarcane

RNA interference (RNAi) is commonly used to produce virus tolerant transgenic plants. The objective of the current study was to generate transgenic sugarcane plants expressing a short hairpin RNAs (shRNA) targeting the coat protein (CP) gene of sugarcane mosaic virus (SCMV). Based on multiple sequence alignment, including genomic sequences of four SCMV strains, a conserved region of ~ 456 bp coat protein (CP) gene was selected as target gene and amplified through polymerase chain reaction (PCR). Subsequently, siRNAs2 and siRNA4 were engineered as stable short hairpin (shRNA) transgenes of 110 bp with stem and loop sequences derived from microRNA (sof-MIR168a; an active regulatory miRNA in sugarcane). These transgenes were cloned in independent RNAi constructs under the control of the polyubiquitin promoter. The RNAi constructs were delivered into two sugarcane cultivars 'SPF-234 and NSG-311 in independent experiments using particle bombardment. Molecular identification through PCR and Southern blot revealed anti-SCMV positive transgenic lines. Upon mechanical inoculation of transgenic and non-transgenic sugarcane lines with SCMV, the degree of resistance was found variable among the two sugarcane cultivars. For sugarcane cultivar NSG-311, the mRNA expression of the CP-SCMV was reduced to 10% in shRNA2-transgenic lines and 80% in shRNA4-transgenic lines. In sugarcane cultivar SPF-234, the mRNA expression of the CP-SCMV was reduced to 20% in shRNA2-transgenic lines and 90% in shRNA4 transgenic lines, revealing that transgenic plants expressing shRNA4 were almost immune to SCMV infection.

Intersphincteric proctectomy for rectal mucocele in a Crohn's patient with anal stenosis. A case report and review of literature

In patients who have undergone a colonic resection with creation of an end colostomy, drainage of mucus secreted by the mucosa of the rectal stump may not be possible if there is an outlet obstruction. With an outlet obstruction, formation of a rectal mucocele occurs. A rectal mucocele is a rare condition which has only been reported sporadically in case reports. We present here the utility of an intersphincteric proctectomy for treatment of a rectal mucocele in a 47 year old male Crohn's patient resulting in negligible post-operative or long-term morbidities.

The impact of unfractionated heparin or bivalirudin on patients with stable coronary artery disease undergoing percutaneous coronary intervention

OBJECTIVES

To compare bleeding and clinical events of patients with stable angina or silent ischemia undergoing percutaneous coronary intervention (PCI) treated with unfractionated heparin (UFH) or bivalirudin.

BACKGROUND

Few direct comparisons between UFH monotherapy versus bivalirudin exist for patients with stable ischemic heart disease undergoing PCI.

METHODS

A prospective, investigator-initiated, single-center, single-blinded, randomized trial of UFH versus bivalirudin was conducted. The primary endpoint was all bleeding (major and minor) from index-hospitalization to 30 days post discharge. Secondary endpoints included major adverse cerebral and cardiovascular events (MACCE) and net adverse clinical events (NACE).

RESULTS

Two-hundred-sixty patients were randomized for treatment with either UFH (n = 123) (47%) or bivalirudin (n = 137) (53%) There were no significant differences in baseline clinical and angiographic characteristics between the two groups. Primary endpoint was similar in both groups (10.9% with bivalirudin vs 7.3% with UFH [P = 0.31]). Major bleeding rates were 5.8% and 2.4%, respectively (P = 0.17). There was a higher MACCE (3.5% vs 0%, P = 0.03) and NACE (8.8% vs 2.4%, P = 0.03) rate with bivalirudin compared to UFH, respectively. Bivalirudin had increased odds of NACE (OR = 3.65, 95% CI: 1.00-13.3.6). Death and stent thrombosis rates were low and similar in both groups. Radial access was associated with fewer bleeding events compared to femoral access but not statistically significant (P = 0.29).

CONCLUSIONS

Among patients with stable angina or silent ischemia, there was no difference between UFH and bivalirudin in bleeding rates up to 30-days post-PCI. MACCE and NACE were higher among the bivalirudin group. Radial access was associated with a numerically lower rate of bleeding compared with femoral access.

Exploring the challenges, trends and issues for knowledge sharing

Purpose

This study aims to explore the challenges to knowledge sharing (KS) in the context of public sector universities in developing countries. Furthermore, it explores why knowledge hoarding behaviour is flourishing even when employees are encouraged to share their knowledge in organisations and are rewarded for doing so.

Design/methodology/approach

Research data were collected from vice chancellor, registrar, professors, assistant professors and lecturers using an interview technique. They shared their knowledge, expertise, experiences and understanding about issues relating to KS practices in public universities. These interviews were thematically analysed using the NVivo 11-Plus software and different themes emerged.

Findings

The results reveal that hoard knowledge to gain power, authority, influence, promotion opportunities and employee favouritism negatively influence KS practices. Furthermore, an unsupportive culture and a poor linkage between KS and rewards negatively influence KS practices in public sector universities.

Research limitations/implications

The present study aids academic leadership in designing policies and strategies to enhance KS among faculty staff and to create a supportive KS culture. These results are useful for top management officials of public sector universities, especially in developing countries, and for policy makers, who can plan and execute effective policies to foster KS behaviour.

Originality/value

The originality can be viewed as a new window open towards the motivation of the university staff to hoard their knowledge instead of sharing it. This study gives the novel conceptual model based on why people do not share their knowledge and how KS practices can be fostered among the employees in public sector universities. Few studies have been conducted to explore KS issues in the real context of developing countries, and specifically in the Asian culture.

COTIP: Cotton TILLING Platform, a Resource for Plant Improvement and Reverse Genetic Studies

Cotton is cultivated worldwide for its white fiber, of which around 90% is tetraploid upland cotton (Gossypium hirsutum L.) carrying both A and D genome. Since centuries, yield increasing efforts for the cotton crop by conventional breeding approaches have caused an extensive erosion of natural genetic variability. Mutation based improvement strategies provide an effective way of creating new allelic variations. Targeting Induced Local Lesions IN Genomes (TILLING) provides a mutation based reverse genetic strategy to create and evaluate induced genetic variability at DNA level. Here, we report development and testing of TILLING populations of allotetraploid cotton (G. hirsutum) for functional genomic studies and mutation based enrichment of cotton genetic resources. Seed of two cotton cultivars "PB-899 and PB-900" were mutagenized with 0.3 and 0.2% (v/v) ethyl methanesulfonate, respectively. The phenotyping of M₁ and M₂ populations presented numerous mutants regarding the branching pattern, leaf morphology, disease resistance, photosynthetic lesions and flower sterility. Molecular screening for point mutations was performed by TILLING PCR aided CEL1 mismatch cleavage. To estimate the mutation frequency in the mutant genomes, five gene classes were TILLed in 8000 M₂ plants of each var. "PB-899" and "PB-900." These include actin (GhACT), Pectin Methyl Esterase (GhPME), sucrose synthase (GhSUS), resistance gene analog, and defense response gene (DRGs). The var. PB-899 was harboring 47% higher mutation induction rate than PB-900. The highest rate of mutation frequency was identified for NAC-TF5 (EU706348) of DRGs class, ranging from 1/58 kb in PB-899 to 1/105 kb in PB-900. The mutation screening assay revealed the presence of significant proportion of induced mutations in cotton TILLING populations such as 1/153 kb and 1/326 kb in var. "PB-899" and "PB-900," respectively. The establishment of a cotton TILLING platform (COTIP) and data obtained from the resource TILLING population suggest its effectiveness in widening the genetic bases of cotton for improvement and utilizing it for subsequent reverse genetic studies of various genes.

What’s organization knowledge management strategy for successful change implementation?

Purpose

In recent times, progression of technology and growing demands of customers have substantially influenced the services sector to introduce fast real-time mechanisms for providing up-to-mark services. To meet these requirements, organizations are going to change their end-user operating systems but success rate of change is very low. The purpose of this paper is to address one of the practitioners’ complaint “no one tells us how to do it” and uncovers the indirect effects of knowledge management (KM) strategies: personalization and codification, toward organizational change via organizational learning and change readiness. The current study also highlights how organizational learning and change readiness are helpful to reduce the detrimental effects of organizational change cynicism toward success of a change process.

Design/methodology/approach

Temporal research design is used to get the appropriate responses from the targeted population in two stages such as pre-change (Time-1) and post-change (Time-2). In cumulative, 206 responses have been obtained from the banking sector of Pakistan.

Findings

The results of the current study are very promising as it has been stated that KM strategies have an indirect effect on successful organizational change through organizational learning and change readiness. Moreover, change cynicism has a weakening effect on a change process and can be managed through effective learning orientation of employees and developing readiness for change in organizations.

Research limitations/implications

Change agents have to use an optimal mix of personalization and codification strategies to develop learning environment and readiness for change in organizations that are beneficial for implementing a change successfully. Moreover, change readiness and organizational learning in the context of change are equally beneficial to reduce organizational change cynicism as well.

Originality/value

This study is introducing a unique model to initiate a change with the help of KM strategies, organizational learning and readiness for change.

Improving health equity for First Nations, Inuit and Métis people: Ontario's Aboriginal Cancer Strategy II

Cancer incidence is increasing more rapidly and cancer survival is worse among Ontario's First Nations, Inuit and Métis (FNIM) populations than among other Ontarians. Cancer Care Ontario's Aboriginal Cancer Strategy II aims to reduce this health inequity and to improve the cancer journey and experience for FNIM people in Ontario. This comprehensive, multi-faceted strategy was developed and is being implemented with and for Aboriginal Peoples in Ontario in a way that honours the Aboriginal Path of Well-being.

Organizational learning through transformational leadership

Purpose

The transformation of firms from resource-based-view to knowledge-based-view has extended the importance of organizational learning. Thus, this study aims to develop an organizational learning model through transformational leadership with indirect effect of knowledge management process capability and interactive role of knowledge-intensive culture.

Design/methodology/approach

Different statistical analyses were done to check the direct, indirect and interactive effects on 204 valid responses.

Findings

The results are clearly depicting that transformational leadership has significant positive impact on organizational learning and knowledge management process capability, and partially mediates the relationship between transformational leadership and organizational learning. Additionally, knowledge-intensive culture has strengthened the relationship between transformational leadership and knowledge management process capability.

Originality/value

This is an overarching and unique conceptual model. After examining the importance of organizational learning in the context of innovative ability, competitive advantage, creativity and organizational performance, management has to initiate steps to induct transformational leaders, develop knowledge-intensive culture and introduce knowledge management processes to boost learning environment in organizations.

Organizational cynicism and its impact on privatization (evidence from federal government agency of Pakistan)

Purpose

– The aim of this study is to explore the impact of cynicism on the relationship among personality traits, organizational contextual factors and job outcomes. This study set up and examined the overarching model on resistance to change. Moreover, there were two models theoretically presented and investigated, i.e. direct and indirect models. This study was an attempt to explore and capture the causes of organizational cynicism against the change initiative.

Design/methodology/approach

– A case study research design was used in this study, and data were collected from 335 employees by using purposive sampling technique and structured questionnaire. While linear regression and Baron and Kenny’s (1986) tests were used to evaluate the direct and indirect models.

Findings

– Results highlighted the considerable positive relationship between dispositional resistance and employee’s turnover intention. Additionally, significant connection was also examined among organizational contextual factors and job outcomes, whereas interactive impact of behavioral resistance was found in the relation among dispositional resistance, organizational contextual factors and employee’s intent to quit. However, another dimension of organizational cynicism, i.e. cognitive resistance, could not influence the direct linear relationship between organizational context and continuance commitment.

Research limitations/implications

– Major limitations of this research were non-probability sampling technique, cross-sectional design, single organization and traditional data collection tool.

Practical implications

– Management can eradicate cynicism by providing social support and positive information, i.e. job security, wage award, medical benefits and promotion criteria, after implementing change. The management can clarify the objectives of that change by including employees in decision-making, reducing employee’s turnover intention. Organizational cynicism is a faith, which means that the change leaders have lack of integrity; when organizational cynicism mixes with negative cognitive process, it leads to a more destructive behavior against that change.

Originality/value

– This study contributed to the extensive knowledge of organizational cynicism. A conceptual model of resistance to change the model was unique in nature. There were rare studies conducted to check the impact of organizational cynicism on privatization, especially in the sub-continent. Therefore, it will add a good contribution in quality literature to understand the cynicism and its consequences for privatization.

Identification and characterization of plasma membrane aquaporins isolated from fiber cells of Calotropis procera

Calotropis procera, commonly known as "milkweed", possesses long seed trichomes for seed dispersal and has the ability to survive under harsh conditions such as drought and salinity. Aquaporins are water channel proteins expressed in all land plants, divided into five subfamilies plasma membrane intrinsic proteins (PIPs), tonoplast intrinsic proteins (TIPs), NOD26-like proteins (NIPs), small basic intrinsic proteins (SIPs), and the unfamiliar X intrinsic proteins (XIPs). PIPs constitute the largest group of water channel proteins that are involved in different developmental and regulatory mechanisms including water permeability, cell elongation, and stomata opening. Aquaporins are also involved in abiotic stress tolerance and cell expansion mechanisms, but their role in seed trichomes (fiber cells) has never been investigated. A large number of clones isolated from C. procera fiber cDNA library showed sequence homology to PIPs. Both expressed sequence tags (ESTs) and real-time polymerase chain reaction (PCR) studies revealed that the transcript abundance of this gene family in fiber cells of C. procera is greater than that of cotton. Full-length cDNAs of CpPIP1 and CpPIP2 were isolated from C. procera fiber cDNA library and used for constructing plant expression vectors under constitutive (2×35S) and trichome-specific (GhLTP3) promoters. Transgenic tobacco plants were developed via Agrobacterium-mediated transformation. The phenotypic characteristics of the plants were observed after confirming the integration of transgene in plants. It was observed that CpPIP2 expression cassette under 2×35S and GhLTP3 promoter enhanced the numbers of stem and leave trichomes. However, 2×35S::CpPIP2 has a more amplified effect on trichome density and length than GhLTP3::CpPIP2 and other PIP constructs. These findings imply the role of C. procera PIP aquaporins in fiber cell elongation. The PIPs-derived cell expansion mechanism may be exploited through transgenic approaches for improvement of fiber staple length in cotton and boosting of defense against sucking insects by enhancing plant pubescence.

Hyperventilation provokes symptoms of carpal tunnel syndrome

Hyperventilation causes respiratory alkalosis. The nervous system is more excitable in alkalosis. This phenomenon can be observed as paraesthesia in fingers and toes as well as around the lips in anxious patients breathing rapidly. We wanted to test this phenomenon on already irritable nerves like the median nerve in carpal tunnel syndrome (CTS). We deployed 50 patients who came in to the day case unit for carpal tunnel decompression with electro-physiologically proven diagnosis. We devised a test whereby patients were made to hyperventilate under prescribed conditions and repeated Phalen's test and Tinel's sign for comparison. These were compared with a control group chosen randomly among hospital staff. 86% patients had a positive result which was just behind Phalen's test in sensitivity. It was also 100% specific as there were no false positives. Hyperventilation is a phenomenon which provokes carpal tunnel syndrome. Its clinical value remains to be seen due to cumbersome method and probable patient non-compliance but it is a new discovery. It may be useful in other irritable-nerve-syndromes as a test to add to our available armament. It may be an additional factor or a primary reason for nocturnal paraesthesias in CTS patients.

Perforin-positive cytotoxic lymphocytes in pregnancy

OBJECTIVE

To investigate whether perforin-positive, cytotoxic lymphocytes are present in the first and second trimester as well as at term during normal gestation.

STUDY DESIGN

A monoclonal antibody raised against human perforin was used to detect perforin expression in mononuclear cells in first-trimester abortion, second-trimester preterm labor due to cervical incompetence and term placentas obtained after normal delivery. Fresh frozen tissue sections containing first- and second-trimester decidua and placental tissues as well as decidua of maternal and fetal surfaces of term placenta were stained using an immunoperoxidase method.

RESULTS

Occasional perforin-positive lymphocytes were present in stroma of chorionic villi of term placenta, while most were found in decidua and coagulated blood in maternal vessels and intervillous spaces. The majority of these lymphocytes were CD3-, CD2+ and CD56+. Quantitative comparison of decidual perforin-positive lymphocytes demonstrated a relative increase in these lymphocytes in decidua of second-trimester and term placentas.

CONCLUSION

The presence of perforin-positive cytotoxic lymphocytes in maternal blood and decidua during gestation suggests their roles in pregnancy.

3,4-Dichloroisocoumarin serine protease inhibitor induces DNA fragmentation and apoptosis in susceptible target cells

3,4-Dichloroisocoumarin (DCI) inhibition of serine proteases generates reactive intermediates that have been theorized to affect apoptosis. To examine this possibility various target cells were treated with different concentrations of DCI and assessed for intracellular nuclear DNA fragmentation and apoptosis. DCI treatment caused oligonucleosomal DNA fragmentation in cell lines expressing high levels of protease activity (LAK cells, NK-92, CTLL-2, L929, 3T3). This DNA breakdown characteristic of apoptosis occurred in a dose-dependent fashion within 4-6 hr of treatment and was confirmed by electron microscopy. In cell lines expressing low levels of protease activity (unstimulated human peripheral blood mononuclear (PBMN) cells, YAC-1 cells), DCI effectively inhibited protease activity without inducing oligonucleosomal DNA fragmentation. ZN2+ ions significantly inhibited DCI-induced DNA degradation. The mixture of DCI and BLT esterase active NK cell lysate triggered DNA fragmentation in isolated YAC-1 nuclei. Degree of DNA fragmentation in YAC-1 nuclei was proportional to the level of BLT esterase activity. Cell lysate protease activity, initially inhibited by DCI acylation, was restored by hydroxylamine deacylation, thus preventing DCI-mediated DNA fragmentation. Our results suggest that DCI treatment of cells expressing high levels of protease activity generates toxic levels of acyl-enzyme intermediates. These intermediates may trigger nuclear DNA breakdown and apoptosis by activating endogenous endonucleases. This effect may compromise the analysis of apoptosis in experimental systems using high concentrations of DCI for extended periods.