Use of mechanical circulatory support in patients undergoing percutaneous coronary intervention: insights from the National Cardiovascular Data Registry.

BACKGROUND: Little is known about the contemporary use of intra-aortic balloon pump (IABP) and other mechanical circulatory support (O-MCS) devices in patients undergoing percutaneous coronary intervention (PCI) in the setting of cardiogenic shock. METHODS AND RESULTS: We identified 76 474 patients who underwent PCI in the setting of cardiogenic shock at one of 1429 National Cardiovascular Data Registry CathPCI participating hospitals from 2009 to 2013. Temporal trends and hospital-level variation in the use of IABP and O-MCS were evaluated. No mechanical circulatory support was used in 41 286 (54%) patients, 29 730 (39%) received IABP only, 2711 (3.5%) received O-MCS only, and 2747 (3.6%) received both IABP and O-MCS. At the start of the study period, 45% of patients undergoing PCI in the setting of cardiogenic shock received an IABP and 6.7% received O-MCS. The proportion of patients receiving IABP declined at an average rate of 0.3% per quarter, whereas the rate of O-MCS use was unchanged over the study period. The predicted probability of IABP use varied significantly by site (hospital median 42%, interquartile range 33% to 51%, range 8% to 85%). The probability of O-MCS use was <5% for half of hospitals and >20% in less than one-tenth of hospitals. CONCLUSIONS: In this large national registry, the use of IABP in the setting of PCI for cardiogenic shock decreased over time without a concurrent increase in O-MCS use. The probability of IABP and O-MCS use varied across hospitals, and the use of O-MCS was clustered at a small number of hospitals.

Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trial.

OBJECTIVES: In the context of acute hypoxemic respiratory failure (AHRF), ensuring effective preoxygenation and apneic oxygenation emerges as the pivotal approach ensuring for averting hypoxemic adverse events during endotracheal intubation. To investigate this, we conducted an open-label randomized controlled trial, aiming to assess the comparative effectiveness of nasopharyngeal high-flow oxygenation in conjunction with Bag-Valve-Mask (BVM) versus standard BVM preoxygenation in patients experiencing AHRF within the emergency department (ED). METHODS: This prospective single-center, open-labeled, randomized controlled trial enrolled patients aged 18 years and above requiring rapid sequence intubation due to AHRF in the ED. Participants were randomly assigned in a 1:1 ratio to either the intervention arm (involving nasopharyngeal high-flow oxygenation and BVM preoxygenation) or the control arm (involving BVM preoxygenation alone). RESULTS: A total of 76 participants were enrolled in the study, evenly distributed with 38 individuals in each arm. Median (interquartile range [IQR]) SpO2 at 0 min postintubation was 95.5 (80%-99%) versus 89 (76%-98%); z-score: 1.081, P = 0.279 in the intervention and control arm, respectively. The most common postintubation complications included hypoxia (intervention arm: 56.7% vs. control arm: 66.7%) and circulatory/hypoxic arrest (intervention arm: 39.5% vs. control arm: 44.7%). There were no adverse complications in 36.7% (n = 11) of patients in the intervention arm. Despite the best possible medical management, almost half (52.6%) of patients in the intervention arm and 47.4% of patients in the control arm succumbed to their illnesses in the ED. CONCLUSION: The primary outcome revealed no statistically significant difference between the two arms. However, patients in the intervention arm exhibited fewer intubation-related adverse effects.

Modeling teachers acceptance of learning management system in higher education during COVID-19 pandemic: A developing country perspective.

The ubiquity of the World Wide Web has provided massive opportunities to teachers and learners around the globe to share knowledge anytime anywhere via learning management system. Hence, considering the needs of the students; universities have arranged the facilities of the learning management system. This study is an empirical evaluation of university faculty members' intention to use a learning management system. We extended Davis's (1989) Technology Acceptance Model (TAM) to evaluate faculty members' intention to use learning management system amid COVID-19. Data were obtained from the faculty members of Pakistani universities through the convenience sampling technique and analyzed using PLS-SEM. The outcomes of the study revealed that perceived ease of using a learning management system, user-interface design, and faculty members' innovativeness have a favorable impact on their intention to use learning management system. Facilitating conditions positively influenced intention to use learning management system. However, the positive relationship between facilitating conditions and perceived ease of using the learning management system was insignificant. The results indicate that the extended TAM model has effectively predicted faculty members' intention to use the learning management system. The findings of the current study can be used for the training and development of faculty members by institutions and regulatory bodies in developing countries.

Green Initiatives and Environmental Concern Foster Environmental Sustainability: A Study Based on the Use of Reusable Drink Cups.

Unsustainable production and consumption have threatened human life and nature. Therefore, practitioners around the globe have paid attention to sustainability issues and adopted pro-environmental strategies to protect the environment. Using single-use cups contributes to environmental pollution. This study aims to understand university students' intention to use reusable drink cups in university campuses. This study has extended the theory of planned behavior (TPB) model by including moral norms, green university initiatives, environmental concerns, and moral norms. The purposive sampling technique has been employed to collect students' data from the twelve universities in Pakistan. Partial least square structural equation modeling (PLS-SEM) has been employed to test the hypothesized model. The study's results revealed that green university initiatives and norms significantly shape students' intention to use reusable cups. However, environmental concern has an insignificant impact on the perceived behavioral control. This study's results help higher education institutions to formulate strategies that create awareness among students and promote environmentally sustainable practices.

Understanding the role of corporate social responsibility and sustainable supply chain management in shaping the consumers' intention to use sharing platforms.

Sustainable supply chain management (SSCM) in sharing economy platforms supports resource management and achieves environmental sustainability. Corporate social responsibility (CSR) is an essential pillar of sustainability, but the link between CSR and SSCM has been missing in the literature. Therefore, the current study intends to examine the connection between CSR and SSCM practices in sharing economy-based platforms. This study has applied the means-end theory to understand customer intention in the sharing economy. The data of 379 respondents from five main cities of Pakistan have been collected through convenience sampling. Partial least square structural equation modeling (PLS-SEM) has been used to test the proposed conceptual model. The study results show that the corporate social responsibility approach adopted by the sharing economy platforms improves internal supply chain management that drives customers' intention to use sharing economy platforms. Green concern has a significant moderating effect on customers' tendency toward environmental issues and solutions. However, findings revealed that eco-design in the sustainable supply chain does not affect customer purchase intention in sharing economy platforms. The study findings provide practical implications to organizations focusing on sustainable supply chain management practices in the sharing economy.

A Serial-Mediation Model to Link Entrepreneurship Education and Green Entrepreneurial Behavior: Application of Resource-Based View and Flow Theory.

Eco-conscious behaviors have become a global imperative for entrepreneurs, as the consumer demand for products and services has become increasingly green. Hence, the purpose of this study is to identify the role of entrepreneurship education in environmental sustainability as measured by the launch of green ventures. This study also aims at extending the literature of resource-based view and flow theory by highlighting their application into the green venturing context. Data were collected from 420 Pakistani students having studied an entrepreneurship course in their university life by using the convenience sampling technique. The covariance based structural equation modeling (CB-SEM) was used to test the hypothesized relationships, and it was identified that entrepreneurship education evokes commitment to the environment, subsequently leading towards university green entrepreneurial support, environmental motivation, and green entrepreneurial behavior. University green entrepreneurial support also significantly influences green venturing; however, environmental motivation does not affect green entrepreneurial behavior. The findings of this study can be useful for policymakers in higher educational institutions, regulatory bodies, and diverse-government agencies dealing with UN sustainable development goals.

Safety and efficacy of thrombectomy in patients undergoing primary percutaneous coronary intervention for acute ST elevation MI: a meta-analysis of randomized controlled trials.

BACKGROUND: Clinical trials comparing thrombectomy devices with conventional percutaneous coronary interventions (PCI) in patients with acute ST elevation myocardial infarction (STEMI) have produced conflicting results. The objective of our study was to systematically evaluate currently available data comparing thrombectomy followed by PCI with conventional PCI alone in patients with acute STEMI. METHODS: Seventeen randomized trials (n = 3,909 patients) of thrombectomy versus PCI were included in this meta-analysis. We calculated the summary odds ratios for mortality, stroke, post procedural myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) grade flow, and post procedural ST segment resolution (STR) using random-effects and fixed-effects models. RESULTS: There was no difference in risk of 30-day mortality (44/1914 vs. 50/1907, OR 0.84, 95% CI 0.54-1.29, P = 0.42) among patients randomized to thrombectomy, compared with conventional PCI. Thrombectomy was associated with a significantly greater likelihood of TIMI 3 flow (1616/1826 vs. 1533/1806, OR 1.41, P = 0.007), MBG 3 (730/1526 vs. 486/1513, OR 2.42, P < 0.001), STR (923/1500 vs. 715/1494, OR 2.30, P < 0.001), and with a higher risk of stroke (14/1403 vs. 3/1413, OR 2.88, 95% CI 1.06-7.85, P = 0.04). Outcomes differed significantly between different device classes with a trend towards lower mortality with manual aspiration thrombectomy (MAT) (21/949 vs.36/953, OR 0.59, 95% CI 0.35-1.01, P = 0.05), whereas mechanical devices showed a trend towards higher mortality (20/416 vs.10/418, OR 2.07, 95% CI 0.95-4.48, P = 0.07). CONCLUSIONS: Thrombectomy devices appear to improve markers of myocardial perfusion in patients undergoing primary PCI, with no difference in overall 30-day mortality but an increased likelihood of stroke. The clinical benefits of thrombectomy appear to be influenced by the device type with a trend towards survival benefit with MAT and worsening outcome with mechanical devices.

Predicting eco-conscious consumer behavior using theory of planned behavior in Pakistan.

Sustainability of the environment has become pivotal in the modern world, and there have been enormous efforts by the world leaders and organizations to reduce the effects of hazardous production on the environment. This has led companies to implement pro-environment programs and work on sustainability to shift consumption from conventional products to green products. This study incorporates green trust, environmental concerns, and intrinsic religious orientation as a moderator into the theory of planned behavior. It aims to validate the theory of planned behavior and its extended form to predict Pakistani consumers' eco-conscious behavior, and simultaneously assess the moderating effect of intrinsic religious orientation on consumers' attitude towards green products. The data for the study was collected from 300 respondents through purposive sampling from Karachi, the metropolitan city of Pakistan. Structural equation model (SEM) was applied to test the proposed hypotheses. The results of SEM indicate that all paths in the model are significant, except the path from attitude towards green products to eco-conscious behavior. The results also indicate that intrinsic religious orientation has no moderating effect on the green trust and attitude towards green products. This study contributes to understand the effects of new constructs in the theory of planned behavior and their relationship with other variables in the model. It also provides theoretical and managerial implications to academics and marketing professionals for understanding and promoting eco-conscious consumer behavior.