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Over recent years, the Human Resource Information System (HRIS) has gained tremendous impetus in industry. Still, the literature states that most information system failures result from employee resistance and subsequent opposition behaviour. To address the gap in the literature, this study has targeted employees' technological symbolic adoption to analyze employee resistance behaviour. As employees' technological symbolic adoption occurs much before their actual technology adoption. Symbolic adoption means users' mental evaluation of the technology used for their work. This study has taken the perspective of HRIS symbolic adoption and identifies its antecedents and outcome factors, i.e., technology adoption factors and work-related outcomes. Thus, this study investigates the relationship between technology adoption factors (performance expectancy, effort expectancy, social influence, and information quality) and work-related outcomes (work-life balance, engagement, and creativity). Furthermore, this study examines the mediating effect of HRIS symbolic adoption between the above-stated factors. 415 HRIS end-users from the HR department of small-to-medium-sized organizations were recruited to collect data. This paper offers a theoretical and practical contribution, extending the line of research on the end user's symbolic adoption domain, and helping small and medium-size organizations to better understand end-users' technological adoption factors. In light of this study's findings, HR practitioners and management should focus on effective HRIS interventions in small and medium-sized organizations to stay ahead with engaged, creative, and balanced employees.

Byline: B. Bajaj, S. Shrestha The French physician Augustine Marie Morvan first used the term 'la choree fibrillare' to describe a syndrome characterized by peripheral nerve hyperexcitability, dysautonomia, insomnia and [...]

Introduction: Postural instability and gait difficulty are the major contributors to disability in patients with Parkinson's disease (PD) and are least responsive to dopaminergic therapies. Transcranial direct current stimulation (tDCS) of the brain is reported to improve locomotor function in patients with PD. Aims and Objectives: (1) To determine the effect of bilateral anodal tDCS on locomotor function by measuring the change in timed up and go (TUG) test scores in patients with PD immediately after tDCS. (2) To estimate the association of the effect of bilateral anodal tDCS on executive function and that on locomotor function by measuring the relation between the Stroop test scores and the TUG test scores. Study Design: Randomized triple-blind sham-controlled crossover study. Methods: A total of 30 patients with PD diagnosed using the Movement Disorder Society clinical diagnostic criteria for PD, belonging to H&Y stages 2--4, fulfilling the inclusion and exclusion terms were included in the study. Patients were randomized to receive the "real" or the "sham" tDCS stimulation in the first session and a week later the other type of stimulation, i.e., sham or real, was given. The gait of all the patients was assessed using the TUG test performed immediately before and after the "real" as well as the "sham" sessions. The Stroop test was also performed before and after each stimulation session. Results: The mean age [±standard deviation (SD)] of the study participants was 61.1 (±10.9) years, with two-thirds of them being males and one-third being females. Patients showed statistically significant improvement in the averaged TUG tests scores post the "real" stimulation compared to the "sham" stimulation session (p < 0.05). Statistically significant improvement in Stroop test scores (incongruent) was observed after the "real" stimulation. Conclusions: Locomotor function of patients with PD improves immediately following bilateral anodal tDCS, and the improvement in locomotor function has a positive correlation with improvement in executive function. Area of Research: Clinical aspects [ABSTRACT FROM AUTHOR]

Gabapentin is a new gamma aminobutyric acid (GABA) analogue that has anticonvulsant activity Preliminary results are promising with gabapentin for the treatment of refractory anxiety disorders. In a supplementary role in several behavioral disorders, especially in acute mania, it has produced significant beneficial results. In this study, the anxiolytic activity of gabapentin was examined in mice. There was a significant decrease in time spent in the central square, an increase in the crossings, and an increase in rearing in the open field with the low-dose gabapentin (10 and 30 mg/kg), implying anxiolysis. Furthermore, potentiation of diazepam with gabapentin was also reported. On screening the gabapentin for learning and memory with passive avoidance response, there was significant prolongation of step-down latency, decrease in step-down error, and decrease in the total time spent by the mice in the shock zone at 10 and 100 mg/kg of gabapentin. Gabapentin was not associated with any adverse effect on the memory of mice. The lack of effect of gabapentin on memory, exhibiting anxiolytic activity at a low dose, the lack of cognition deficits, lack of drug interaction, alleviating the requirement for plasma monitoring, and its freedom from dependence or abuse liability suggest the potential advantage of gabapentin over the exiting anxiolytics. [ABSTRACT FROM AUTHOR]

A 42 year old male patient presented with sudden onset painless drooping of right shoulder while lifting himself up with his right arm from squatting position. He was diagnosed to have fracture of spine of right scapula. Neurological examination of the patient revealed patient's inability to abduct the right arm and mild weakness of handgrip without associated wasting or fasciculations. Impairment of pain sensation in right half of face, right cervical and upper thoracic dermatomes (T1-T4), and absence of deep tendon reflexes in right upper limb with brisk deep tendon reflexes in lower limbs were discovered on examination. The patient's cervico-dorsal Magnetic Resonance Imaging confirmed a syrinx extending from cervico-medullary junction to the upper thoracic segments. The patient did not have any obvious features suggestive of charcot's arthropathy on clinical and radiological examination. The case highlights the importance of detailed neurological examination and unusual presentation of fracture of spine of scapula in a patient harbouring cervico-dorsal syrinx. [ABSTRACT FROM AUTHOR]

The postpericardiotomy syndrome may occur as a complication of temporary and permanent pacing. Physicians involved in procedures which may be complicated by this condition therefore need to be aware of its diagnosis and management. [ABSTRACT FROM AUTHOR]

An abstract of the article∣Cabergoline and the Risk of Cardiac Valve Regurgitation: A Serial Echocardiography Study,∣by V. Gontu, S. Burn, B. Bajaj and N. Bajaj is presented.

Patients with vitamin B12 deficiency are known to present with neuropsychiatric manifestations. Autoimmune origin of vitamin B12 deficiency due to pernicious anemia is relatively less common in Asians compared to certain western populations. Other autoimmune disorders including autoimmune thyroiditis may be associated with pernicious anemia. The coexistent hypovitaminosis B12 and hypothyroidism presenting with multiple level neuraxis involvement is relatively rare. Our patient, a 50 year old previously healthy male started becoming impulsive, irrational, and socially indiscreet around 4 months prior to presentation. He started talking to 'ghosts' and insisted that his house is haunted by 'spirits'. He was started on antipstchotics for his abnormal behaviour by psychiatrist only to worsen further. He was noted to have ataxic gait more prominent in the dark. He could hardly walk or feed himself without assistance. He had difficulty writing with his hand and had troublesome paraesthesias in extremities. When he presented to Neurology, he had MMSE score of 14/28. He had marked sensory ataxia, pseudoathetosis, normal motor power with exaggerated deep tendon reflexes and extensor plantars. Investigations revealed macrocytic hypochromic anemia with severely low vitamin B12 levels and hypothyroidism. Patient had positive antinuclear antibody, thyroid peroxidase and antiparietal cell antibodies. Elisa for HIV and routine blood tests including LFT, KFT were within normal limits. There was subclinical evidence of peripheral neuropathy. MRI Brain revealed cerebral atrophy and EEG showed background beta activity. Patient was started on 1000 microgam / d of parenteral vit B12 alongwith gradually escalating dose of I thyroxin. Patient showed significant signs of cognitive improvement within one week of treatment and reached MMSE score of 28/30 after 2 weeks. [ABSTRACT FROM AUTHOR]

Background: Herpes simplex virus (HSV) has rarely been reported as a cause of acute polyneuritis cranialis. Aim: To report the clinical features and outcome in a case of polyneuritis cranialis following reactivation of HSV 1 infection. Case: A 21 year old female, presented with acute onset difficulty in closing her left eye, deafness in left ear, electric shock like pain in her left face and left sided loss of taste sensation without hyperacusis, tinnitus, vertigo or ear discharge. Two weeks back, she had fever with vesicular eruptions in the oral cavity, which improved over one week. Patient had history of vesicular eruptions in her oral cavity two years back also. On examination, no vesicular rash was evident in oral cavity, external ear and tympanic membrane. Patient had left 7th infranuclear palsy and sensorineural deafness. There was no facial sensory loss. Left corneal reflex, with contralateral consensual response, was absent. Serum IgM and IgG for HSV1 antibodies were positive. CSF showed 16 lymphocytes/cmm, sugar 49 mg % (blood sugar: 99 mg %), protein 11 mg%, and positive PCR for HSV1 DNA. MRI brain showed enlargement of left cranial nerve V, VII and VIII complex with contrast enhancement. Audiometry and BAER were unrecordable from left ear. Left facial nerve conduction study showed decreased CMAP amplitude. Patient received intravenous acyclovir 30mg/kg/day for 10 days. Pain improved within 3 days and by 4 months, she made complete recovery with normal responses on repeat BAER and facial nerve conduction study. Conclusion: Reactivation of HSV 1 infection can present as polyneuritis cranialis. High index of suspicion and early treatment results in satisfactory outcome. [ABSTRACT FROM AUTHOR]

Purpose: To determine the dose-dependent effect of adjuvant radiotherapy on survival for pediatric intracranial ependymomas and explore patient and disease characteristics that experience survival benefit from higher doses., Methods: Data was accessed from the National Cancer Database. Inclusion criteria was comprised of a diagnosis of non-metastatic intracranial ependymoma, World Health Organization (WHO) grade 2 or 3, surgical resection, adjuvant radiotherapy between 4500-6300 cGy, and non-missing survivorship data. Crude and adjusted Cox proportional hazard ratios (HRs) were calculated to estimate the associations of patient, tumor, and treatment characteristics with overall survival (OS). Kaplan-Meier (KM) estimations were used to visualize survival curves for dosing for the general cohort and by subgroups (age, resection extent, and grade)., Results: Of the 1154 patients who met inclusion criteria, 405 received ≤ 5400 cGy and 749 received > 5400 cGy. We found no difference in OS crude (0.95, 95% CI 0.72-1.06) or adjusted (0.88, 95% CI 0.46-1.69) HR for those receiving ≤ 5400 cGy. KM curves showed no difference in OS for dosing for the general cohort based on age, surgical extent, and grade. However, there was better OS in those with WHO grade 2 tumors compared to grade 3 regardless of dose received., Conclusions: There was no difference in OS between patients who received ≤ 5400 cGy compared to > 5400 cGy. We found improved OS in those with grade 2 tumors compared to grade 3, however there was no difference in OS based on dose received by tumor grade, age, or resection extent. Limitations in data available prevent exploring other outcomes or toxicity., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: In resource-limited facilities, the greatest number of unfavorable maternal-fetal outcomes at referral hospitals is chronicled from emergency obstetric referrals of critically ill patients from lower health facilities. An efficient obstetric referral system is thus necessitated for improving maternal health. Referral practices have not been optimized effectively till date, owing to paucity of a detailed profile of referred women and indigenous barriers encountered during implementation process., Materials and Methods: This five-year retrospective audit was conducted in the Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi from September 2018 to 2023, in which records of all critically ill obstetric women referred were reviewed. The primary outcomes included were proportion and pattern of patients being referred, while secondary outcomes included demographic variables, referring hospital, reason and number of steps in referral, duration of hospital stay and fetomaternal outcome. The data were recorded on a predesigned case proforma and analyzed using the SPSSv23 version of software, after application of appropriate statistical tests., Results: The referral rate to obstetric intensive care unit (ICU) ranged from 39 to 47% in last 5 years; hypertensive disorder of pregnancy (31%) being the foremost cause of the referrals. Around 2/3rd women were transferred without escort (70%) or prior communication (90.6%) and referral slips were incomplete in half the admissions., Conclusion: Ensuring emergency obstetric care (EmOC) at various levels by up-gradation of health infrastructure would go a long way in improving fetomaternal health outcomes. There is need of standardized referral slips tailor-made to each state and contextualized protocols for early recognition of complications and effective communication between referral centers., How to Cite This Article: Marwah S, Suri J, Shikha T, Sharma P, Bharti R, Mann M, et al . Referral Audit of Critically Ill Obstetric Patients: A Five-year Review from a Tertiary Care Health Facility in India. Indian J Crit Care Med 2024;28(8):734-740., Competing Interests: Source of support: Nil Conflict of interest: NoneConflict of interest: None, (Copyright © 2024; The Author(s).)

Site-one protease (S1P) conducts the first of two cleavage events in the Golgi to activate Sterol regulatory element binding proteins (SREBPs) and upregulate lipogenic transcription. S1P is also required for a wide array of additional signaling pathways. A zymogen serine protease, S1P matures through autoproteolysis of two pro-domains, with one cleavage event in the endoplasmic reticulum (ER) and the other in the Golgi. We recently identified the SREBP regulating gene, (SPRING), which enhances S1P maturation and is necessary for SREBP signaling. Here, we report the cryo-EM structures of S1P and S1P-SPRING at sub-2.5 Å resolution. SPRING activates S1P by dislodging its inhibitory pro-domain and stabilizing intra-domain contacts. Functionally, SPRING licenses S1P to cleave its cognate substrate, SREBP2. Our findings reveal an activation mechanism for S1P and provide insights into how spatial control of S1P activity underpins cholesterol homeostasis., (© 2024. The Author(s).)