Factors associated with pediatric trauma patients leaving against medical advice.

BACKGROUND: Discharge against medical advice (AMA) leads to worse patient outcomes, increased readmission rates, and higher cost. However, AMA discharge has received limited study, particularly in pediatric trauma patients. Our objective was to explore the risk factors associated with leaving AMA in pediatric trauma patients. METHODS: We performed a retrospective analysis on pediatric trauma patients from 2017 to 2019 using the National Trauma Data Bank. We examined patient characteristics including age (<18 years), race, sex, Glasgow Coma Scale, trauma type, primary payment methods, and Abbreviated Injury Scale. Multiple Logistic Regression models were utilized to determine characteristics associated with leaving AMA. RESULTS: Of the 224,196 pediatric patients included in the study, 238 left AMA (0.1%). Our study showed black pediatric trauma patients were more likely to leave AMA compared to nonblack patients (OR 1.987, 95% CI 1.501 to 2.631). Patients with self-pay coverage were more likely to leave AMA than those with other insurance coverages (OR 1.759, 95% CI 1.183 to 2.614). Blunt trauma patients were more likely to leave AMA than those with penetrating trauma (OR 1.683, 95% CI 1.216 to 2.330). Every one-year increase in age led to 15% increase in odds of AMA discharge (OR 1.150, 95% CI 1.115 to 1.186). Pediatric patients with severe abdominal injuries were less likely to leave AMA compared to those with mild abdominal injuries (OR 0.271, 95% CI 0.111 to 0.657). Patients with severe lower extremity injury were less likely to leave AMA compared to those with mild lower extremity injuries (OR 0.258, 95% CI 0.127 to 0.522). CONCLUSION: Race, insurance, injury type, and age play a role in AMA discharge of pediatric trauma patients. Black pediatric trauma patients have ∼ double the AMA discharge rate of nonblack patients. AMA discharge remains relevant, and addressing racial and socioeconomic factors provide opportunities for future interventions in pediatric trauma care. LEVEL OF EVIDENCE: III, retrospective study.

Inhibition of NF-κB DNA Binding Suppresses Myeloma Growth via Intracellular Redox and Tumor Microenvironment Modulation.

Multiple myeloma is a plasma cell malignancy that is still largely incurable, despite considerable progress in recent years. NF-κB is a well-established therapeutic target in multiple myeloma, but none of the currently available treatment options offer direct, specific pharmacologic targeting of NF-κB transcriptional activity. Thus, we designed a novel direct NF-κB inhibitor (IT848) as a drug candidate with strong potential for clinical translation and conducted comprehensive in vitro and in vivo mechanistic studies in multiple myeloma cell lines, primary multiple myeloma cells, xenograft models, and immunocompetent mouse models of multiple myeloma. Here, we show that IT848 inhibits NF-κB activity through inhibition of DNA binding of all five NF-κB subunits. IT848 treatment of multiple myeloma cell lines and patient samples inhibited proliferation and induced caspase-dependent and independent apoptosis. In addition to direct NF-κB inhibitory effects, IT848 treatment altered the redox homeostasis of multiple myeloma cells through depletion of the reduced glutathione pool, selectively inducing oxidative stress in multiple myeloma but not in healthy cells. Multiple myeloma xenograft studies confirmed the efficacy of IT848 as single agent and in combination with bortezomib. Furthermore, IT848 significantly improved survival when combined with programmed death protein 1 inhibition, and correlative immune studies revealed that this clinical benefit was associated with suppression of regulatory T-cell infiltration of the bone marrow microenvironment. In conclusion, IT848 is a potent direct NF-κB inhibitor and inducer of oxidative stress specifically in tumor cells, displaying significant activity against multiple myeloma cells in vitro and in vivo, both as monotherapy as well as in combination with bortezomib or immune checkpoint blockade.

Leadership empowering behaviour as a predictor of employees' psychological well-being: Evidence from a cross-sectional study among secondary school teachers in Kohat Division, Pakistan.

In this technologically developed scenario, many organizations in developing countries including Pakistan have expanded the enthusiasm for understanding and creating an encouraging administrative and managerial environment. Numerous organizations are struggling for structural changes by deserting the old-fashioned organizational management style and implementing an empowering leadership where leaders give more authority to subordinates in decision making and responsibilities with the aim to increase organizational productivity. Therefore, the study examined the leadership empowering behaviour as a predictor of employees' psychological well-being of the educational institutions at secondary level in Kohat Division, Pakistan. A total sample of 564 secondary school teachers (male n = 379; female n = 185) was carefully chosen through a stratified random sampling technique. In this study, a non-experimental predictive correlational design was adopted. In order to collect data from the participants, two different standardized research tools i.e., the Leader Empowering Behaviour Questionnaire and Ryff's Psychological Well-being Scale were used. After the collection of data, it was analyzed on the basis of mean, standard deviation, Pearson's product-moment correlation, and multiple linear regression model. In conclusion, the study confirmed a significant positive correlation between leadership empowering behaviour and employees' psychological well-being. Leadership empowering behaviours predict employees' psychological well-being positively. Therefore, it was recommended that empowering behaviour might be adopted by the school leaders to improve the employees' psychological well-being for better organizational productivity.

Correlating Emotional Intelligence With Job Satisfaction: Evidence From a Cross-Sectional Study Among Secondary School Heads in Khyber Pakhtunkhwa, Pakistan.

Emotional intelligence is extremely indispensable in functioning leadership positions as leaders wish everybody to fulfill his/her responsibilities and obligations effectively while job satisfaction has a direct association with the productivity and efficiency of an organization and also to individuals' success. Therefore, this cross-sectional study examined the relationship between emotional intelligence and job satisfaction among secondary schools heads in Khyber Pakhtunkhwa. For this investigation, a total of 402 out of 884 secondary school heads were taken as a sample using a multistage sampling technique. The study was correlative, descriptive, and quantitative in nature, and survey research designed was used for collecting information from the participants. Statistical tools, i.e. mean, standard deviation, Pearson's product-moment correlation, multiple linear regression, and analysis of variance, were applied. The findings showed that there was a moderate positive correlation between emotional intelligence and job satisfaction. Additionally, there was a moderate positive correlation between all the subdimensions of emotional intelligence and job satisfaction except emotional stability, where the correlation was also positive and the effect size weak. Furthermore, five dimensions of emotional intelligence such as managing relations, emotional stability, self-development, integrity, and altruistic behavior were found significant predictors of job satisfaction. Therefore, it is imperative to concentrate on those practices that promote emotional intelligence among secondary school heads.

Association between emotional intelligence and academic success among undergraduates: A cross-sectional study in KUST, Pakistan.

The study investigated the association between emotional intelligence and academic success among undergraduates of Kohat University of Science & Technology (KUST), Pakistan. A sample of 186 students who were enrolled during the semester Fall 2015 to Spring 2018 was selected through a random sampling technique. A cross-sectional, descriptive and correlational research methods were employed in this study. A standardized tool "Emotional Intelligence Scale" was employed for the collection of information from the undergraduates. Cumulative Grade Point Average (CGPA) of the students was considered as academic success. Data were collected through personal visits. Statistical tools i.e., simple percentage, mean, standard deviation, ANOVA, Pearson's product-moment correlation and multiple linear regression were employed to reach the desired research outcomes. The findings revealed that there was a strong positive relationship (r = 0.880) between emotional intelligence and academic success among undergraduate students. The multiple linear regression analysis showed that self-development (Beta = 0.296), emotional stability (Beta = 0.197), managing relations (Beta = 0.170), altruistic behaviour (Beta = 0.145), and commitment (Beta = 0.117) predict academic success of undergraduates positively. The findings suggest that the emotional intelligence of the undergraduate students may be further improved so that their academic performance may further be enhanced.

Relationship between perceived occupational stress and psychological well-being among secondary school heads in Khyber Pakhtunkhwa, Pakistan.

The purpose of the study was to examine the relationship between perceived occupational stress and psychological well-being among secondary school heads in Khyber Pakhtunkhwa. A sample of 402 secondary school heads (male n = 260, female n = 142) was selected through multistage sampling technique. A descriptive, quantitative and correlative research design was used. For gathering information from the participants, two standardized tools i.e., "Occupational Stress Index (OSI)" and "Ryff's Psychological Wellbeing Scale (RPWB)" were used for measuring perceived occupational stress and psychological well-being respectively. For statistical analysis, mean, standard deviation, Pearson's product-moment correlation and multiple regression were employed. The findings revealed that there is a strong negative correlation between perceived occupational stress and psychological well-being. Furthermore, moderate negative correlation was found between all the sub-scales of perceived occupational stress and psychological well-being. All the subscales of occupational stress except low status were found significant predictors and have negative effect on psychological well-being of secondary school heads. So, it was suggested that Elementary & Secondary Education Department Khyber Pakhtunkhwa should have a collaboration with policy makers to formulate a comprehensive strategy for stress reduction management for secondary school heads so that they may develop good psychological well-being and perform their duties effectively.

Using a multipronged approach to implement organizational performance improvements.

Efforts to improve organizational performance sometimes fail. One way to increase the likelihood of a successful implementation is to adopt a multipronged approach. This article describes a multipronged approach for change management and performance improvement. The approach combines a systems implementation process with sensitivity to the human side of change. Tactics to defuse resistance are also discussed. The approach assists leaders assigned to coordinate performance improvements.

A computer program to estimate the parameters of covariate dependent higher order Markov model.

This paper presents a computer program developed in S-plus to estimate the parameters of covariate dependent higher order Markov Chain and related tests. The program can be applied for two states Markov Chain with any order and any number of covariates depending on the PC capabilities. The program provides the maximum likelihood estimates of the parameters, together with their estimated standard error, t-value and significance level. It also produces the test results for likelihood ratio and model chi-square. To illustrate the program we have used a longitudinal data set on maternal morbidity of rural women in Bangladesh. The occurrences of haemorrhage, convulsion, or fits at different follow-ups were used as outcome variable. Economic status, wanted pregnancy, ages at marriage, and education of women were used as covariates.