Contribution of ethnicity, area level deprivation and air pollution to paediatric intensive care unit admissions in the United Kingdom 2008-2021.

Background: There is emerging evidence on the impact of social and environmental determinants of health on paediatric intensive care unit (PICU) admissions and outcomes. We analysed UK paediatric intensive care data to explore disparities in the incidence of admission according to a child's ethnicity and the degree of deprivation and pollution in the child's residential area. Methods: Data were extracted on children <16 years admitted to UK PICUs between 1st January 2008 and 31st December 2021 from the Paediatric Intensive Care Audit Network (PICANet) database. Ethnicity was categorised as White, Asian, Black, Mixed or Other. Deprivation was quantified using the 'children in low-income families' measure and outdoor air pollution was characterised using mean annual PM2.5 level at local authority level, both divided into population-weighted quintiles. UK population estimates were used to calculate crude incidence of PICU admission. Incidence rate ratios were calculated using Poisson regression models. Findings: There were 245,099 admissions, of which 60.7% were unplanned. After adjusting for age and sex, Asian and Black children had higher relative incidence of unplanned PICU admission compared to White (IRR 1.29 [95% CI: 1.25-1.33] and 1.50 [95% CI: 1.44-1.56] respectively), but there was no evidence of increased incidence of planned admission. Children living in the most deprived quintile had 1.50 times the incidence of admission in the least deprived quintile (95% CI: 1.46-1.54). There were higher crude admission levels of children living in the most polluted quintile compared to the least (157.8 vs 113.6 admissions per 100,000 child years), but after adjustment for ethnicity, deprivation, age and sex there was no association between pollution and PICU admission (IRR 1.00 [95% CI: 1.00-1.00] per 1 µg/m3 increase). Interpretation: Ethnicity and deprivation impact the incidence of PICU admission. When restricting to unplanned respiratory admissions and ventilated patients only, increasing pollution level was associated with increased incidence of PICU admission. It is essential to act to reduce these observed disparities, further work is needed to understand mechanisms behind these findings and how they relate to outcomes. Funding: There was no direct funding for this project. HM was funded by an NIHR Academic Clinical Fellowship (ACF-2022-18-017).

Green human resource management practices to accomplish green competitive advantage: A moderated mediation model.

In present high-tech era, firms need to possess a variety of capabilities and resources to attain and sustain a competitive position in the market. The motivation for this study was to understand green competitive advantage through the application of Ability-Motivation-Opportunity theory and Natural-Resource-Based view. In a time-lagging longitudinal online survey related to small-and-medium-sized manufacturing enterprises, 223 professionals provided data according to their opinions. The structural and measurement model were designed for analyses. The results supported the model and verify the Green human resource management practices' influence on green competitive advantage, with partial mediation of green knowledge sharing and green innovation (green product innovation and green process innovation). The analyses revealed the positive highly significant moderation of green human capital, which is the novelty of the study. Green human capital is important to develop sustainable workforce who act as catalyst in achieving sustainable development goals. The report offers practical advice for small-medium manufacturing enterprises (SMMEs) aiming to attain a green competitive advantage. With the help of a green competitive advantage, the recommendations in this study can benefit SMMEs to develop a green human capital and to create innovative knowledge. As a result, it is a futuristic approach to dealing with the improved environmental conditions and developed a green human capital in this industrialized age.

Cardiac output monitoring in children: a review.

Cardiac output monitoring enables physiology-directed management of critically ill children and aids in the early detection of clinical deterioration. Multiple invasive techniques have been developed and have demonstrated ability to improve clinical outcomes. However, all require invasive arterial or venous catheters, with associated risks of infection, thrombosis and vascular injury. Non-invasive monitoring of cardiac output and fluid responsiveness in infants and children is an active area of interest and several proven techniques are available. Novel non-invasive cardiac output monitors offer a promising alternative to echocardiography and have proven their ability to influence clinical practice. Assessment of perfusion remains a challenge; however, technologies such as near-infrared spectroscopy and photoplethysmography may prove valuable clinical adjuncts in the future.

Online Customer Experience Leads to Loyalty via Customer Engagement: Moderating Role of Value Co-creation.

With the increasing growth of online shopping, businesses are intertwining to establish new shopping antecedents. Customer experience has steadily become the most important source of retailers' long-term competitive advantage via difference. To preserve long-term and sustained consumer loyalty, retailers must continually improve the customer experiences. This study presents a framework for online retailing in a digital environment called the Online Customer Experience-Engagement Context model in the presence of value co-creation (VCC). Data was gathered from 189 people who purchased products online. For additional analysis, testing the hypothesis, and model construction, SPSS 26 and Smart-PLS were used. The data was then evaluated further using descriptive statistics, path analysis, measurement, and structural model. The findings show that the online customer experience (measured as shopping environment, shopping procedure, staff service experience, and product experience) substantially influenced customer engagement, which improved customer loyalty. The VCC strengthened the link between online customer experience and customer engagement. It suggests that including consumers in co-creating a delightful online customer experience from time to time may be a valuable strategy for online retailers to increase customer engagement and loyalty. To create an overarching outcome, information integration theory (IIT), multi-attribute utility theory (MAUT), and the attitude-behavior-context theory (ABC) theories are converged to explain the proposed model in the study.

Brand Love: Role of Online Customer Experience, Value Co-creation, and Relationship Quality.

Customer experience is a source of retailers' long-term competitive advantage. This study has examined the relationship between online customer experience and brand love through the mechanism of relationship quality in the context of online shopping in Pakistan. The moderating effect of value co-creation on the relationship of online customer experience with relationship quality and brand love has also been examined. Data were collected from a purposive sampling of 189 online customers in an online survey. Results showed that online customer experience significantly impacts customer relationship quality, which leads to brand love. The relationship between online customer experience and relationship quality is found more robust at high levels of value co-creation. However, we observed a significant negative moderating effect of value co-creation on the direct relationship between online customer experience and brand love. It suggests that including customers in the value co-creation process and affording them a pleasurable online shopping experience may be an excellent way to enhance customer relationship quality and brand love. Theoretical and practical implications of these findings are discussed.

Epidemiology of Cardiopulmonary Resuscitation in Critically Ill Children Admitted to Pediatric Intensive Care Units Across England: A Multicenter Retrospective Cohort Study.

Background Cardiopulmonary arrests are a major contributor to mortality and morbidity in pediatric intensive care units (PICUs). Understanding the epidemiology and risk factors for CPR may inform national quality improvement initiatives. Methods and Results A retrospective cohort analysis using prospectively collected data from the Paediatric Intensive Care Audit Network database. The Paediatric Intensive Care Audit Network contains data on all PICU admissions in the United Kingdom. We identified children who received cardiopulmonary resuscitation (CPR) in 23 PICUs in England (2013-2017). Incidence rates of CPR and associated factors were analyzed. Logistic regression was used to estimate the size and precision of associations. Cumulative incidence of CPR was 2.2% for 68 114 admissions over 5 years with an incidence rate of 4.9 episodes/1000 bed days. Cardiovascular diagnosis (odds ratio [OR], 2.30; 95% CI, 2.02-2.61), age <1 year (OR, 1.84; 95% CI, 1.65-2.04), the Paediatric Index of Mortality 2 score on admission (OR, 1.045; 95% CI, 1.042-1.047) and longer length of stay (OR, 1.013; 95% CI, 1.012-1.014) were associated with increased odds of receiving CPR. We also found a higher risk of CPR associated with a history of preadmission cardiac arrest (OR, 20.69; [95% CI, 18.16-23.58) and for children with a cardiac condition admitted to a noncardiac PICU (OR, 2.75; 95% CI, 1.91-3.98). Children from Black (OR, 1.68; 95% CI, 1.36-2.07) and Asian (OR, 1.49; 95% CI, 1.28-1.74) racial/ethnic backgrounds were at higher risk of receiving CPR in PICU than White children. Conclusions Data from this first multicenter study from England provides a foundation for further research and evidence for benchmarking and quality improvement for prevention of cardiac arrests in PICU.

Understanding barriers for research involvement among paediatric trainees: a mixed methods study.

BACKGROUND: Child Health research is reported to be at worryingly low level by the Royal College of Paediatrics and Child Health. Recent survey showed that 54.5% of paediatric consultants in the United Kingdom do not do any research at all. We conducted a mixed methods study to understand barriers and facilitators for research involvement among paediatric trainees who are going to fill these consultant posts in the future. METHODS: A questionnaire based on a validated index for research and development was completed by 136 paediatric trainees within a region in the North of England (Yorkshire and Humber). Twelve semi-structured interviews were conducted with stratified purposive sampling. Descriptive statistics and Chi-Square test for independence were used for quantitative analysis. Thematic content analysis was done for interviews based on analysis method framework. RESULTS: 136 out of 396 trainees responded to the survey. There was a significant relationship between confidence in using research in practice and ability to understand research terminology. This was not related to research experience or training. Males were significantly more likely to have presented a research paper, know how research influences practice and have more confidence in using research in practice than females. There was no significant relationship between gender and research training or highest qualification. Time constraints and lack of academic culture were the most frequently mentioned barriers in the survey. Over-arching themes identified from the interviews were related to lack of academic culture, opportunities provided in current training scheme and constraints related to time availability along with workforce management. CONCLUSION: Paediatric research requires a supportive academic culture with more flexibility in training scheme and immediate attention to a pressing staffing crisis.