Nevin Manimala

J Air Waste Manag Assoc. 2022 Sep 19. doi: 10.1080/10962247.2022.2126558. Online ahead of print.

ABSTRACT

In order to get well understanding of the production trend of plastic waste in Chengdu, as well as its compositions and environmental impacts, based on the statistical data from 2005 to 2019, the back propagation (BP) neural network model was used to predict the production amount of plastic waste in Chengdu. Compositions of plastic waste were analyzed by sampling. In addition, inhale particles and greenhouse gas emissions (GHGs) from plastic waste incineration, bisphenol A (BPA) from plastic waste landfill were evaluated. Results indicated that, (1) economic development, urban construction level, residents’ consumption ability and plastic waste production were positively correlated to different degrees. (2) The production of plastic waste in Chengdu in 2025 and 2030 will reach 865.3 and 931 kiloton (Kt) respectively. (3) High density polyethylene (HDPE) and polypropylene (PP) are the two main components of plastic waste in Chengdu, accounted for 40.17% and 24.96%, respectively. (4) Different degrees of environmental impacts occurred during plastic waste incineration and landfill, taking the year of 2019 as an example, the incineration of plastic waste in Chengdu produced 2874.82-4711.73 tons of inhalable particulate matter (PM) and emitted 725.4-867.4 Kt of CO₂, about 65.02-910.27 kg of bisphenol A (BPA) leached from sanitary landfill. (5) positive policies and measures from the beginning to the end-of-life of plastics should be carried out in the future, which will improve plastic waste management level in Chengdu, and mitigate the side-impacts from plastic waste treatment and disposal.

PMID:36121689 | DOI:10.1080/10962247.2022.2126558

JAMA Netw Open. 2022 Sep 1;5(9):e2231903. doi: 10.1001/jamanetworkopen.2022.31903.

ABSTRACT

IMPORTANCE: The prevalence of obesity has increased substantially among emerging adults, yet no previous large-scale behavioral weight loss trials have been conducted among this age group.

OBJECTIVE: To test the effect of 2 theory-based motivational enhancements on weight loss within a primarily digital lifestyle intervention designed for emerging adults.

DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical trial conducted at an academic medical research center, 382 participants aged 18 to 25 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45 were enrolled between February 2, 2016, and February 6, 2019. Data collection was completed February 8, 2020. Analysis was performed on an intention-to-treat basis.

INTERVENTIONS: Participants were randomized to 1 of 3 groups: developmentally adapted behavioral weight loss (aBWL), aBWL plus behavioral economics (aBWL + BE), or aBWL plus self-determination theory (aBWL + SDT). All groups received a 6-month intervention with 1 group session, 1 individual session, and a digital platform (digital tools for self-monitoring, weekly lessons, tailored feedback, text messages, and optional social media). The aBWL + BE group received modest financial incentives for self-monitoring and weight loss; the aBWL + SDT group received optional experiential classes. Coaching and message framing varied by group.

MAIN OUTCOMES AND MEASURES: The primary outcome was mean (SE) weight change (in kilograms) at 6 months. Secondary outcomes included proportion of participants achieving weight loss of 5% or more, percentage weight change, waist circumference, body composition, and blood pressure.

RESULTS: Among the 382 participants (mean [SD] age, 21.9 [2.2] years), 316 (82.7%) were female, mean (SD) BMI was 33.5 (4.9), 222 (58.1%) were of underrepresented race and/or ethnicity, and 320 (83.8%) were retained at the primary end point. There was a significant time effect for mean (SE) weight loss (-3.22 [0.55] kg in the aBWL group; -3.47 [0.55] kg in the aBWL + BE group; and -3.40 [0.53] kg in the aBWL + SDT group; all P < .001), but no between-group differences were observed (aBWL vs aBWL + BE: difference, -0.25 kg [95% CI, -1.79 to 1.29 kg]; P = .75; aBWL vs aBWL + SDT: difference, -0.18 kg [95% CI, -1.67 to 1.31 kg]; P = .81; and aBWL + SDT vs aBWL + BE: difference, 0.07 kg [95% CI, -1.45 to 1.59 kg]; P = .93). The proportion of participants achieving a weight loss of 5% or more was 40.0% in the aBWL group (50 of 125), 39.8% in the aBWL + BE group (51 of 128), and 44.2% in the aBWL + SDT group (57 of 129), which was not statistically different across groups (aBWL vs aBWL + BE, P = .89; aBWL vs aBWL + SDT, P = .45; aBWL + SDT vs aBWL + BE, P = .54). Parallel findings were observed for all secondary outcomes-clinically and statistically significant improvements with no differences between groups.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, all interventions produced clinically significant benefit, but neither of the motivational enhancements promoted greater reductions in adiposity compared with the developmentally adapted standard group. Continued efforts are needed to optimize lifestyle interventions for this high-risk population and determine which intervention works best for specific individuals based on sociodemographic and/or psychosocial characteristics.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02736981.

PMID:36121656 | DOI:10.1001/jamanetworkopen.2022.31903

JAMA Netw Open. 2022 Sep 1;5(9):e2231917. doi: 10.1001/jamanetworkopen.2022.31917.

ABSTRACT

IMPORTANCE: Health care workers (HCWs) have been experiencing substantial stress and burnout, and evidence-based mitigation strategies are needed. Transcendental Meditation (TM) is a mantra meditation practice with potential efficacy in reducing stress.

OBJECTIVE: To assess the efficacy of TM practice in reducing stress among HCWs over a 3-month period.

DESIGN, SETTING, AND PARTICIPANTS: This single-center open-label randomized clinical trial was conducted among HCWs at an academic medical center from November 19, 2020, to August 31, 2021. Inclusion criteria comprised a score of 6 points or greater on the Subjective Units of Distress Scale and an increase of 5% or greater in baseline heart rate or an increase of 33% or greater in galvanic skin response after exposure to a stressful script. Exclusion criteria included the use of antipsychotic or β blocker medications, current suicidal ideation, or previous TM training. Of 213 HCWs who participated in prescreening, 95 attended in-person visits, resulting in 80 eligible participants who were randomized to receive a TM intervention (TM group) or usual treatment (control group).

INTERVENTIONS: The TM group practiced TM for 20 minutes twice daily over a 3-month period. The control group received usual treatment, which consisted of access to wellness resources.

MAIN OUTCOMES AND MEASURES: The primary outcome was change in acute psychological distress measured by the Global Severity Index. Secondary outcomes included changes in burnout (measured by the Maslach Burnout Inventory), insomnia (measured by the Insomnia Severity Index), and anxiety (measured by the Generalized Anxiety Disorder-7 scale).

RESULTS: Among 80 participants, 66 (82.5%) were women, with a mean (SD) age of 40 (11) years. One participant (1.3%) was American Indian or Alaska Native, 5 (6.3%) were Asian, 12 (15.0%) were Black, 59 (73.8%) were White, and 3 (3.8%) were of unknown or unreported race; 4 participants (5.0%) were Hispanic, and 76 (95.0%) were non-Hispanic. A total of 41 participants were randomized to the TM group, and 39 were randomized to the control group. Participants in the TM group did not show a statistically significant decrease in psychological distress on the Global Severity Index compared with those in the control group (-5.6 points vs -3.8 points; between-group difference, -1.8 points; 95% CI, -4.2 to 0.6 points; P = .13). Compared with the control group, the TM group had significantly greater reductions in the secondary end points of emotional exhaustion (Maslach Burnout Inventory subscore: -8.0 points vs -2.6 points; between-group difference, -5.4 points; 95% CI, -9.2 to -1.6 points; P = .006), insomnia (Insomnia Severity Scale score: -4.1 points vs -1.9 points; between-group difference, -2.2 points; 95% CI, -4.4 to 0 points; P = .05), and anxiety (Generalized Anxiety Disorder-7 score: -3.1 points vs -0.9 points; between-group difference, -2.2 points; 95% CI, -3.8 to -0.5; P = .01) at 3 months. A total of 38 participants (92.7%) in the TM group adhered to home practice.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, TM practice among HCWs over a 3-month period did not result in a statistically significant reduction in the primary outcome of acute psychological distress compared with usual treatment but significantly improved the secondary outcomes of burnout, anxiety, and insomnia. These findings suggest that TM may be a safe and effective strategy to alleviate chronic stress among HCWs.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04632368.

PMID:36121655 | DOI:10.1001/jamanetworkopen.2022.31917

JAMA Netw Open. 2022 Sep 1;5(9):e2231973. doi: 10.1001/jamanetworkopen.2022.31973.

ABSTRACT

IMPORTANCE: For some patients receiving warfarin, adding aspirin (acetylsalicylic acid) increases bleeding risk with unclear treatment benefit. Reducing excess aspirin use could be associated with improved clinical outcomes.

OBJECTIVE: To assess changes in aspirin use, bleeding, and thrombosis event rates among patients treated with warfarin.

DESIGN, SETTING, AND PARTICIPANTS: This pre-post observational quality improvement study was conducted from January 1, 2010, to December 31, 2019, at a 6-center quality improvement collaborative in Michigan among 6738 adults taking warfarin for atrial fibrillation and/or venous thromboembolism without an apparent indication for concomitant aspirin. Statistical analysis was conducted from November 26, 2020, to June 14, 2021.

INTERVENTION: Primary care professionals for patients taking aspirin were asked whether an ongoing combination aspirin and warfarin treatment was indicated. If not, then aspirin was discontinued with the approval of the managing clinician.

MAIN OUTCOMES AND MEASURES: Outcomes were assessed before and after intervention for the primary analysis and before and after 24 months before the intervention (when rates of aspirin use first began to decrease) for the secondary analysis. Outcomes included the rate of aspirin use, bleeding, and thrombotic outcomes. An interrupted time series analysis assessed cumulative monthly event rates over time.

RESULTS: A total of 6738 patients treated with warfarin (3160 men [46.9%]; mean [SD] age, 62.8 [16.2] years) were followed up for a median of 6.7 months (IQR, 3.2-19.3 months). Aspirin use decreased slightly from a baseline mean use of 29.4% (95% CI, 28.9%-29.9%) to 27.1% (95% CI, 26.1%-28.0%) during the 24 months before the intervention (P < .001 for slope before and after 24 months before the intervention) with an accelerated decrease after the intervention (mean aspirin use, 15.7%; 95% CI, 14.8%-16.8%; P = .001 for slope before and after intervention). In the primary analysis, the intervention was associated with a significant decrease in major bleeding events per month (preintervention, 0.31%; 95% CI, 0.27%-0.34%; postintervention, 0.21%; 95% CI, 0.14%-0.28%; P = .03 for difference in slope before and after intervention). No change was observed in mean percentage of patients having a thrombotic event from before to after the intervention (0.21% vs 0.24%; P = .34 for difference in slope). In the secondary analysis, reducing aspirin use (starting 24 months before the intervention) was associated with decreases in mean percentage of patients having any bleeding event (2.3% vs 1.5%; P = .02 for change in slope before and after 24 months before the intervention), mean percentage of patients having a major bleeding event (0.31% vs 0.25%; P = .001 for change in slope before and after 24 months before the intervention), and mean percentage of patients with an emergency department visit for bleeding (0.99% vs 0.67%; P = .04 for change in slope before and after 24 months before the intervention), with no change in mean percentage of patients with a thrombotic event (0.20% vs 0.23%; P = .36 for change in slope before and after 24 months before the intervention).

CONCLUSIONS AND RELEVANCE: This quality improvement intervention was associated with an acceleration of a preexisting decrease in aspirin use among patients taking warfarin for atrial fibrillation and/or venous thromboembolism without a clear indication for aspirin therapy. Reductions in aspirin use were associated with reduced bleeding. This study suggests that an anticoagulation clinic-based aspirin deimplementation intervention can improve guideline-concordant aspirin use.

PMID:36121653 | DOI:10.1001/jamanetworkopen.2022.31973

Environ Sci Pollut Res Int. 2022 Sep 19. doi: 10.1007/s11356-022-22734-1. Online ahead of print.

ABSTRACT

Fastest growing population, rapid urbanization, and growth in the disciplines of science and technology cause continually development in the amount and diversity of solid waste. In modern world, evaluation of an appropriate solid waste disposal method (SWDM) can be referred as multi-criteria decision-making (MCDM) problem due to involvement of several conflicting quantitative and qualitative sustainability indicators. The imprecision and ambiguity are usually arisen in SWDM assessment problem, and the q-rung orthopair fuzzy set (q-ROFS) has been recognized as one of the adaptable and valuable ways to tackle the complex uncertain information arisen in realistic problems. In the context of q-ROFSs, entropy is a significant measure for depicting fuzziness and uncertain information of q-ROFS and the discrimination measure is generally used to quantify the distance between two q-ROFSs by evaluating the amount of their discrimination. Thus, the aim of this study is to propose a novel integrated framework based on multi-attribute multi-objective optimization with the ratio analysis (MULTIMOORA) method with q-rung orthopair fuzzy information (q-ROFI). In this approach, an integrated weighting process is presented by combining objective and subjective weights of criteria with q-ROFI. Inspired by the q-rung orthopair fuzzy entropy and discrimination measure, objective weights of criteria are estimated by entropy and discrimination measure-based model. Whereas, the subjective weights are derived based on aggregation operator and the score function under q-ROFS environment. In this respect, novel entropy and discrimination measure are proposed for q-ROFSs. Furthermore, to display the feasibility and usefulness of the introduced approach, a case study related to SWD method selection is presented under q-ROFS perspective. Finally, comparison and sensitivity investigation are presented to confirm the robustness and solidity of the introduced approach.

PMID:36121629 | DOI:10.1007/s11356-022-22734-1

Jpn J Radiol. 2022 Sep 19. doi: 10.1007/s11604-022-01336-4. Online ahead of print.

ABSTRACT

PURPOSE: The present study aims to investigate the occurrence and severity of HRCT abnormalities in symptomatic never-smokers, passively exposed to cigarette smoke.

MATERIALS AND METHODS: A total of 135 never-smokers with respiratory symptoms, without underlying lung disease, underwent paired inspiratory-expiratory HRCT and completed the secondhand smoking (SHS) exposure scale questionnaire. Individuals passively exposed to tobacco consisted the secondhand smoking group (SHS group) (n = 68); the remaining 67 controls were never exposed to SHS. Statistical analysis was performed using the Kolmogorov-Smirnov, x² and Pearson Point-Biserial correlation tests. P < 0.05 was statistically significant.

RESULTS: HRCT findings in SHS group included bronchial wall thickening (98.5%), mild cylindrical bronchiectasis (44%), ground-glass opacities (17.6%), and mosaic attenuation pattern (53%). Air trapping occurred in 65% of expiratory scans. Differences in occurrence of findings between SHS group participants and controls were statistically significant (p < 0.0001). There was significant correlation between exposure to tobacco smoke in hours/day and in number of cigarettes/day and the presence of mosaic attenuation pattern, ground-glass opacities, cylindrical bronchiectasis and air trapping, respectively (p < 0.05). Cumulative SHS exposure in years was also strongly correlated with the presence of ground-glass opacities, mosaic attenuation pattern, cylindrical bronchiectasis, and air trapping, as well as with the frequency of respiratory symptoms (p < 0.05).

CONCLUSION: HRCT findings attributed to SHS are mostly related to airway involvement and are correlated with the duration and grade of exposure to environmental tobacco smoke. SHS followed by lifestyle adjustments should be considered in symptomatic non-smokers with such HRCT findings.

PMID:36121625 | DOI:10.1007/s11604-022-01336-4

Drugs. 2022 Sep 19. doi: 10.1007/s40265-022-01769-1. Online ahead of print.

ABSTRACT

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disorder involving loss of upper and lower motor neurons, with most cases ending in death within 3-5 years of onset. Several molecular and cellular pathways have been identified to cause ALS; however, treatments to stop or reverse disease progression are yet to be found. Riluzole, a neuroprotective agent offering only a modest survival benefit, has long been the sole disease-modifying therapy for ALS. Edaravone, which demonstrated statistically significant slowing of ALS disease progression, is gaining approval in an increasing number of countries since its first approval in 2015. Sodium phenylbutyrate and taurursodiol (PB-TURSO) was conditionally approved in Canada in 2022, having shown significant slowing of disease progression and prolonged survival. Most clinical trials have focused on testing small molecules affecting common cellular pathways in ALS: targeting glutamatergic, apoptotic, inflammatory, and oxidative stress mechanisms among others. More recently, clinical trials utilizing stem cell transplantation and other biologics have emerged. This rich and ever-growing pipeline of investigational products, along with innovative clinical trial designs, collaborative trial networks, and an engaged ALS community’, provide renewed hope to finding a cure for ALS. This article reviews existing ALS therapies and the current clinical drug development pipeline.

PMID:36121612 | DOI:10.1007/s40265-022-01769-1

Photochem Photobiol Sci. 2022 Sep 19. doi: 10.1007/s43630-022-00303-2. Online ahead of print.

ABSTRACT

In the current study, the application of fluorescence spectroscopy along with the advanced statistical technique and confocal microscopy was investigated for the early detection of stripe rust infection in wheat grown under field conditions. The indigenously developed Fluorosensor fitted with LED, emitting monochromatic light was used that covered comparatively larger leaf area for recording fluorescence data thus presenting more reliable current status of the leaf. The examined leaf samples covered the entire range of stripe rust disease infection from no visible symptoms to the complete disease prevalence. The molecular changes were also assessed in the leaves as the disease progresses. The emission spectra mainly produce two fluorescence emission classes, namely the blue-green fluorescence (400-600 nm range) and chlorophyll fluorescence (650-800 nm range). The chlorophyll fluorescence region showed lower chlorophyll bands both at 685 and 735 nm in the asymptomatic (early diseased) and symptomatic (diseased) leaf samples than the healthy ones as a result of partial deactivation of PSII reaction centers. The 735 nm chlorophyll fluorescence band was either slight or completely absent in the leaf samples with lower to higher disease incidence and thus differentiate between the healthy and the infected leaf samples. The Hydroxycinnamic acids (caffeic and sinapic acids) showed decreasing trend, whereas the ferulic acid increased with the rise in disease infection. Peak broadening/shifting has been observed in case of ferulic acid and carotenes/carotenoids, with the increase in the disease intensity. While using the LEDs (365 nm), the peak broadening and the decline in the chlorophyll fluorescence bands could be used for the early prediction of stripe rust disease in wheat crop. The PLSR statistical techniques discriminated well between the healthy and the diseased samples, thus showed promise in early disease detection. Confocal microscopy confirmed the early prevalence of stripe rust disease infection in a susceptible variety at a stage when the disease is not detectable visually. It is inferred that fluorescence emission spectroscopy along with the chemometrics aided in the effective and timely diagnosis of plant diseases and the detected signatures provide the basis for remote sensing.

PMID:36121603 | DOI:10.1007/s43630-022-00303-2

Arch Sex Behav. 2022 Sep 19. doi: 10.1007/s10508-022-02384-7. Online ahead of print.

ABSTRACT

Sensation seeking (SS)-the seeking of novel and intense sensations or experiences and the willingness to take risks for the sake of such experiences-has been shown to be related to various risky sexual behaviors (RSBs) in areas such as multiple sexual partners, condom use, and sexual initiation. The aims of the current meta-analysis were to examine (1) how SS relates to specific RSBs in adolescents and (2) how the overall relationship between SS and RSB differs across sex, race, and age. Overall, a total of 40 studies met the inclusion criteria for our meta-analysis examining the relationship between SS and RSB, contributing 102 effect sizes. RSB variables included unprotected sex; multiple sexual partners; hazardous sexual activity; sexual initiation; virginity status; and history of sexually transmitted disease (STD) diagnosis. Moderating effects of sex, race, and age were also examined. The overall mean effect size of the correlational relationship between adolescent SS and RSB was statistically significant, as were the mean effect sizes of the relationships between SS and RSB subgroups, except for history of STD diagnosis. Race and age did not significantly moderate the overall relationship between SS and RSB; however, results indicated that SS and RSB relations were stronger in females compared to males. Our findings suggest that adolescents with elevations in SS tendencies tend to engage in more RSBs compared to their peers with lower levels of SS, increasing their risk of unplanned pregnancy and STD acquisition.

PMID:36121585 | DOI:10.1007/s10508-022-02384-7

Int Urol Nephrol. 2022 Sep 19. doi: 10.1007/s11255-022-03318-x. Online ahead of print.

ABSTRACT

PURPOSE: Concomitant kidney diseases raise the mortality rate due to the SARS-CoV-2 virus as an independent factor. Although a qualitative PCR test’s result is sufficient for diagnosis, Cycle threshold value may present relevant information to the physicians in providing faster treatment in patients with chronic conditions, including kidney diseases, to prevent morbidity and subsequent mortality. Thus, the present study was conducted to determine the relationship between the Cycle threshold value and clinical outcomes in renal patients with the coronavirus 2019.

METHODS: This retrospective study was conducted on renal patients with the coronavirus 2019 infection admitted to Labbafinejad Hospital in Tehran, the capital of Iran, within a period of one year, from late February 2020 to February 2021. Data were collected per the prepared checklist. Cycle threshold values were measured by performing PCR on nasopharynx and oropharynx swab samples of patients.

RESULTS: According to the adjusted analysis, having high viral load increased the odds of in-hospital mortality (aOR = 11.65, 95% CI 3.93-34.54), ICU admission (aOR = 5.49, 95% CI 2.16-13.97), and invasive ventilation (aOR = 7.18, 95% CI 2.61-19.74). Having high viral load also increased the odds of O₂ therapy (aOR = 3.08, 95% CI 0.79-12.01), although the difference was not statistically significant (P = 0.105).

CONCLUSION: Cycle threshold value was a significant predictor of mortality in renal patients. Nevertheless, further studies are required on how to render optimal use of the Cycle threshold value, given that the quality of the test sample and the different groups of patients under study affect the effectiveness of this marker in predicting disease severity.

PMID:36121573 | DOI:10.1007/s11255-022-03318-x