Exercise Prescription Practices Among Mental Health Professionals on College Campuses: Testing the Information-Motivation-Behavioral Skills Model.

BACKGROUND: The co-occurrence of physical inactivity and poor mental health in the college student population can lead to chronic health issues that have negative short-term effects (e.g., academic success). Poor mental health is associated with long-term conditions (e.g., obesity, serious mental illness) that are linked to premature mortality. The purpose of this study was to examine the information-motivation-behavioral (IMB) skills model and evaluate its ability to explain the variance in the use of exercise prescription in mental health treatment. METHOD: Mental health professionals (MHPs) (n = 255) were recruited from college counseling centers in the USA. Structural equation modeling was used to examine the relationship between the predictor variables of information (exercise knowledge and benefits of exercise), motivation (personal beliefs, perceived barriers, and organizational support), and behavioral skills (self-efficacy), and the outcome variable of exercise prescription (i.e., brief counseling and referral for exercise). RESULTS: The predictors accounted for 23% of the variance in exercise prescription (p = .001). Organizational support had a significant direct effect on exercise prescription (ß = 0.27, p = .05). Personal beliefs (ß = 0.96, p = .05) and organizational support (ß = 0.31, p = .04) had significant direct effects on self-efficacy for prescribing exercise. MHP personal exercise behavior was associated with exercise prescription. CONCLUSION: MHPs may be willing to support physical activity promotion and exercise prescription, but organizational structures are critical to enhance and sustain the delivery of this adjunctive therapy. The personal exercise history of MHPs may be an important consideration for behavior change interventions. The development and validation of scales are important considerations for future intervention study design.

Utilising BC observations to estimate CO contributions from fossil fuel and biomass burning in the Central Himalayan region.

The Himalayan region is adversely affected by the increasing anthropogenic emissions from the adjacent Indo-Gangetic plain. However, source apportionment studies for the Himalayan region that are crucial for estimating CO concentration, are grossly insufficient, to say the least. It is in this context that our study reported here assumes significance. This study utilizes five years (2014-2018) of ground-based observations of eBC and multiple linear regression framework (MLR) to estimate CO and segregate its fossil fuel and biomass emission fractions at a high-altitude (1958 m) site in the Central Himalayas. The results show that MERRA2 always underestimates the observed CO; MOPITT has a high monthly difference ranging from -32% to +57% while WRF-Chem simulations underestimate CO from February to June and overestimate in other months. In contrast, CO estimated from MLR replicates diurnal and monthly variations and estimates CO with an r2 > 0.8 for 2014-2017. The CO predicted during 2018 closely follows the observed variations, and its mixing ratios lie within ±17% of the observed CO. The results reveal a unimodal diurnal variation of CO, COff (ff: fossil fuel) and CObb (bb: biomass burning) governed by the boundary layer evolution and upslope winds. COff has a higher diurnal amplitude (39.1-67.8 ppb) than CObb (5.7-33.5 ppb). Overall, COff is the major contributor (27%) in CO after its background fraction (58%). CObb fraction reaches a maximum (28%) during spring, a period of increased agricultural and forest fires in Northern India. In comparison, WRF-Chem tracer runs underestimate CObb (-38% to -98%) while they overestimate the anthropogenic CO during monsoon. This study thus attempts to address the lack of continuous CO monitoring and the need to segregate its fossil fuel and biomass sources, specifically over the Central Himalayas, by employing a methodology that utilizes the existing network of eBC observations.

Exercise Promotion Practices among Mental Health Professionals: A Scoping Review.

Mental health professionals (MHPs) have a unique opportunity to integrate PA and exercise promotion into clinical care. This scoping review employed the information-motivation-behavioral Skills (IMB) model to examine the exercise promotion practices of MHP. An electronic search of four major databases from 2007 to August 2020 was conducted and results were reported using PRISMA. Seventeen studies were included where the variables of interest were knowledge, attitudes, and beliefs regarding exercise promotion. MHP expressed a need for additional training and the integration of exercise specialists to care for the physical health of patients. Practitioners need additional education to understand the guidelines for exercise prescription for individuals with SMI and the role exercise could have in improving the quality of life for their patients. Findings were conceptualized utilizing the IMB model to inform future quantitative measures and health behavior interventions.

Differential Free Intracellular Calcium Release by Class II Antiarrhythmics in Cancer Cell Lines.

Class II antiarrhythmics or ß-blockers are antisympathetic nervous system agents that act by blocking ß-adrenoceptors. Despite their common clinical use, little is known about the effects of ß-blockers on free intracellular calcium (Ca2+ i), an important cytosolic second messenger and a key regulator of cell function. We investigated the role of four chemical analogs, commonly prescribed ß-blockers (atenolol, metoprolol, propranolol, and sotalol), on Ca2+ i release and whole-cell currents in mammalian cancer cells (PC3 prostate cancer and MCF7 breast cancer cell lines). We discovered that only propranolol activated free Ca2+ i release with distinct kinetics, whereas atenolol, metoprolol, and sotalol did not. The propranolol-induced Ca2+ i release was significantly inhibited by the chelation of extracellular calcium with ethylene glycol tetraacetic acid (EGTA) and by dantrolene, an inhibitor of the endoplasmic reticulum (ER) ryanodine receptor channels, and it was completely abolished by 2-aminoethoxydiphenyl borate, an inhibitor of the ER inositol-1,4,5-trisphosphate (IP3) receptor channels. Exhaustion of ER stores with 4-chloro-m-cresol, a ryanodine receptor activator, or thapsigargin, a sarco/ER Ca2+ ATPase inhibitor, precluded the propranolol-induced Ca2+ i release. Finally, preincubation of cells with sotalol or timolol, nonselective blockers of ß-adrenoceptors, also reduced the Ca2+ i release activated by propranolol. Our results show that different ß-blockers have differential effects on whole-cell currents and free Ca2+ i release and that propranolol activates store-operated Ca2+ i release via a mechanism that involves calcium-induced calcium release and putative downstream transducers such as IP3 The differential action of class II antiarrhythmics on Ca2+ i release may have implications on the pharmacology of these drugs.

Anomalous variations of VLF sub-ionospheric signal and Mesospheric Ozone prior to 2015 Gorkha Nepal Earthquake.

The subject of pre-earthquake ionospheric signatures has always been contentious and debatable. Some of the previous reports have documented unforeseen and unusual variations in some of the atmospheric and ionospheric parameters well before an earthquake. Here, we analyze the ionospheric response from the Indian Subcontinent to Nepal Gorkha Earthquakes occurred between April and May 2015, which were the most powerful and disastrous natural calamities in past ~80 years over the Himalayan region left ~9000 causalities and more than ~20000 people injured with the property damage of the order of several billion dollars. In view of severe earthquakes occurrences, their prior information on the shorter time scales are warranted for mitigation of associated disasters. Here, we report for the first time, a case which shows a strong link in anomalous variations between VLF sub-ionospheric signal and mesospheric ozone prior to both April 25, 2015 (Mw = 7.8) earthquake and its biggest aftershock on May 12, 2015 (Mw = 7.3). Observations show an unusual variation in VLF signals amplitude /shift in terminator time (TT) strongly linked with positive (negative) mesospheric ozone anomaly in D-region altitudes prior to the Gorkha Nepal earthquakes. It is surmised that simultaneous continuous observations of both VLF waves and mesospheric ozone can be considered as an important tool to identify the prior earthquake signatures in the vicinity of the extremely earthquake-prone zone such as Himalayan region. In this context, the current report opens up a new dimension in lithosphere-atmosphere-ionosphere coupling during the earthquake preparation processes itself.

Chemical characterization of rainwater at a high-altitude site "Nainital" in the central Himalayas, India.

The present study investigates the chemical composition of rainwater (RW) from a high-altitude site "Nainital" (1958 m above msl) in the central Himalaya region, to understand the influence of local, regional, and long-range transport of pollutants. A total of 55 (2 in pre-monsoon and 53 in monsoon) RW samples were collected during the study period (June-September 2012) and were analyzed for major anions and cations using an ion chromatograph. The pH of precipitation events ranged from 4.95 to 6.50 (average 5.6 ± 0.3) was observed during the monsoon period (near to the acidic), whereas during the pre-monsoon, the pH was 6.25 ± 0.49 (alkaline) over the study region; it is due the mixture of anthropogenic as well as the natural chemical constituents. The average ionic concentration (sum of measured chemical constituents) was ∼3 times higher during the pre-monsoon (986 ± 101 µeq/1) compared to that in the monsoon season (373 ± 37 µeq/1). This is mainly due to the presence of more natural aerosols in the pre-monsoon season which is also reflected in the pH of rainwater (average 6.25 ± 0.50) as well as ionic concentration. The chemical composition suggests that Ca2+ was the major contributor (34%) among cations, followed by Na+ (10%), K+ (8%), and Mg2+ (9%), whereas Cl-, NO3-, and SO42- contributed ∼13, 11, and 9%, respectively, among anions. The average ratio of acidic species (SO42-/NO3-) is 1.56, suggesting 61 and 39% contribution of SO42- and NO3-, respectively, which is very close to the estimated contribution of H2SO4 (60-70%) and HNO3 (30-40%) in the precipitation samples. Neutralization factors for Ca2+, Mg2+, and NH4+ in RW at Nainital are 4.94, 1.21, and 0.37, respectively, indicating their crucial role in neutralization of acidic species. The non-sea-salt (NSS) contribution to total Ca2+, K+, and Mg2+ is estimated to be ∼98, 97, and 74%, respectively, suggesting the dominance of crustal sources for cations. In contrast, the NSS contribution to the total Cl- and SO42- is 16 and 69% indicating their anthropogenic origin, respectively. Principle component analysis also suggests that the first factor (i.e., natural sources, mainly dust, and sea-salts) accounts for ∼33% variance, whereas the second factor (i.e., fossil fuel and biomass burning) accounts for ∼18% variance of the measured ionic composition. The remaining contributions are attributed to the mixed emission sources and transport of pollutants from Indo-Gangetic Plain (IGP) and western parts of India. The results of the present study reveal a significant contribution of crustal and anthropogenic sources in the RW and neutralization processes in the central Himalaya.

Organic and inorganic components of aerosols over the central Himalayas: winter and summer variations in stable carbon and nitrogen isotopic composition.

The aerosol samples were collected from a high elevation mountain site, Nainital, in India (1958 m asl) during September 2006 to June 2007 and were analyzed for water-soluble inorganic species, total carbon, nitrogen, and their isotopic composition (δ(13)C and δ(15)N, respectively). The chemical and isotopic composition of aerosols revealed significant anthropogenic influence over this remote free-troposphere site. The amount of total carbon and nitrogen and their isotopic composition suggest a considerable contribution of biomass burning to the aerosols during winter. On the other hand, fossil fuel combustion sources are found to be dominant during summer. The carbon aerosol in winter is characterized by greater isotope ratios (av. -24.0‰), mostly originated from biomass burning of C4 plants. On the contrary, the aerosols in summer showed smaller δ(13)C values (-26.0‰), indicating that they are originated from vascular plants (mostly of C3 plants). The secondary ions (i.e., SO4 (2-), NH4 (+), and NO3 (-)) were abundant due to the atmospheric reactions during long-range transport in both seasons. The water-soluble organic and inorganic compositions revealed that they are aged in winter but comparatively fresh in summer. This study validates that the pollutants generated from far distant sources could reach high altitudes over the Himalayan region under favorable meteorological conditions.

Seasonal, interannual, and long-term variabilities in biomass burning activity over South Asia.

The seasonal, interannual, and long-term variations in biomass burning activity and related emissions are not well studied over South Asia. In this regard, active fire location retrievals from the Moderate Resolution Imaging Spectroradiometer (MODIS), the retrievals of aerosol optical depth (AOD) from MODIS Terra, and tropospheric column NO2 from Ozone Monitoring Instrument (OMI) are used to understand the effects of biomass burning on the tropospheric pollution loadings over South Asia during 2003-2013. Biomass burning emission estimates from Global Fire Emission Database (GFED) and Global Fire Assimilation System (GFAS) are also used to quantify uncertainties and regional discrepancies in the emissions of carbon monoxide (CO), nitrogen oxide (NOx), and black carbon (BC) due to biomass burning in South Asia. In the Asian continent, the frequency of fire activity is highest over Southeast Asia, followed by South Asia and East Asia. The biomass burning activity in South Asia shows a distinct seasonal cycle that peaks during February-May with some differences among four (north, central, northeast, and south) regions in India. The annual biomass burning activity in north, central, and south regions shows an increasing tendency, particularly after 2008, while a decrease is seen in northeast region during 2003-2013. The increase in fire counts over the north and central regions contributes 24 % of the net enhancement in fire counts over South Asia. MODIS AOD and OMI tropospheric column NO2 retrievals are classified into high and low fire activity periods and show that biomass burning leads to significant enhancement in tropospheric pollution loading over both the cropland and forest regions. The enhancement is much higher (110-176 %) over the forest region compared to the cropland (34-62 %) region. Further efforts are required to understand the implications of biomass burning on the regional air quality and climate of South Asia.

Survival and complications of beta-thalassemia in Lebanon: a decade's experience of centralized care.

beta-Thalassemia major is a debilitating disease with a considerable incidence in Lebanon (around 2-3% carriership). The present article describes our experience to this day with 214 patients, emphasizing the survival of beta-thalassemia major and development of complications among patients with different parameters. Fifteen deaths were reported. The most common cause of death was heart failure (60%). Patients with a ferritin level of 3,000 ng/ml showed better survival than those with a level >3,000 ng/ml (p < 0.006). In addition, patients with a ferritin level of 1,500 ng/ml showed less complication-free survival than those with a level >1,500 ng/ml (p < 0.024). High level of ferritin (1,500 ng/ml) is associated with increased risk of heart failure. Overall and complication-free survival were statistically different among patients classified according to birth cohort or ferritin level. The Chronic Care Center, a multidisciplinary center located in the suburbs of Beirut, led to an increase in complication-free as well as overall survival. Although patients are being diagnosed earlier and chelation therapy is being initiated at an earlier age, complications due to iron overload still persist. The introduction of new oral iron chelators and better iron overload quantitation methods will most likely modify this picture, and a follow-up study will examine their impact.

[Biological analysis of workers in the food sector in north Lebanon]. / Analyses biologiques réalisées chez des travailleurs dans le secteur alimentaire au nord du Liban.

We investigated the prevalence of bacterial and parasitic infections among workers in a pastry factory in North Lebanon in 2004. We found 39% of the workers (n = 196) had nasal carriage of Staphylococcus aureus. Resistance of S. aureus isolates was 98.7% to penicillin G, 24.7% to fusidic acid, 14.3% to pefloxacine and tetracycline, 11.7% to erythromycin, 6.5% to oxacillin and amoxicillin-clavulanate. Salmonella typhi was not found in any of the workers. Prevalence of intestinal parasites was 57.8% (n = 308). Amoebae comprised 72.5% (68.3% Entamoeba coli, 15.5% E. histolytica), followed by flagellates (18.0 %) (37.5% Dientamoeba fragilis, 31.3% Giardia lamblia) and nematodes (7.8%) (only Ascaris lumbricoides). The tuberculin test was positive in 16.3% of the workers (n = 301).

[Biological analysis of workers in the food sector in north Lebanon]

We investigated the prevalence of bacterial and parasitic infections among workers in a pastry factory in North Lebanon in 2004. We found 39% of the workers [n = 196] had nasal carriage of Staphylococcus aureus. Resistance of S. aureus isolates was 98.7% to penicillin G, 24.7% to fusidic acid, 14.3% to pefloxacine and tetracycline, 11.7% to erythromycin, 6.5% to oxacillin and amoxicillin-clavulanate. Salmonella typhi was not found in any of the workers. Prevalence of intestinal parasites was 57.8% [n = 308]. Amoebae comprised 72.5% [68.3% Entamoeba coli, 15.5% E. histolytica], followed by flagellates [18.0 %] [37.5% Dientamoeba fragilis, 31.3% Giardia lamblia] and nematodes [7.8%] [only Ascaris lumbricoides]. The tuberculin test was positive in 16.3% of the workers [n = 301]

Effectiveness of local anaesthesia (clonidine and fentanyl) infiltration for post-submucosal resection pain relief: a randomized, double-blinded clinical trial.

BACKGROUND: Submucosal resection is accompanied by significant post-operative pain and discomfort. The aim of this randomized, double-blinded clinical trial was to study the efficacy of a local block anaesthetic, delivered after induction of general anaesthesia, in reducing post-operative pain. METHODS: Patients aged 16 years and over who were scheduled for elective submucosal resection were randomly assigned to receive either standardized general anaesthesia, general anaesthesia with local anaesthetic infiltration or general anaesthesia with placebo infiltration. Haemodynamic stability, intra-operative blood loss, post-operative pain (over a seven day follow-up period), analgesics consumption, hospital stay, and the patient's and surgeon's levels of satisfaction were assessed. RESULTS: We found significantly lower results for pack removal pain score, volume of intra-operative blood loss, number of patients suffering from headache, altered dental sensation or nasal pain, number of patients who consumed analgesics, and length of hospital stay, comparing the infiltration group with the general anaesthesia and placebo groups (p<0.05). CONCLUSION: This clinical trial showed that infiltration with the local anaesthetics fentanyl and clonidine substantially reduced post-operative pain and shortened patients' hospital stay.

Pre-incisional infiltration for pediatric tonsillectomy: a randomized double-blind clinical trial.

OBJECTIVE: Tonsillectomy is frequently associated with post-operative pain of considerable duration. The aim of the current study is to corroborate our previous observational data by conducting a prospective double-blind placebo-controlled randomized clinical trial to determine the potential effect of pre-incision infiltration of local anesthesia on post-operative pain after tonsillectomy. DESIGN: Randomized double-blind controlled clinical trial. SETTING: Tertiary care facility in Beirut, Lebanon. PATIENTS: Ninety patients who underwent tonsillectomy allocated evenly in three groups. INTERVENTIONS: Pre-incision infiltration of 1.5 local anesthetic mixture in each tonsil was performed in conjunction with general anesthesia (infiltration, n=30). Pre-incision infiltration of 1.5 ml of 0.9% of normal saline was applied with general anesthesia (placebo, n=30). GA received only general anesthesia. OUTCOME MEASURES: Post-operative pain at rest, eating soft diet, jaw opening at 0, 6, 12, and once daily for the 10-day follow-up period, hemodynamic stability, hospital stay, parent and surgeon satisfaction, ear pain and analgesics consumption were assessed. RESULTS: Hemodynamic stability was maintained during pre, per and post-operation. 93.1% of infiltration group left the hospital the same day compared to 60% in placebo groups and 41.4% in general anesthesia group (p=0.001). Surgeon's satisfaction was significantly higher in infiltration group compared to placebo and general anesthesia groups (p=0.001). Parent's satisfaction was significantly higher in infiltration group (89.65%) compared to general anesthesia group (13.8%) and placebo group (36.7%) (p=0.001). The average pain scores at rest, on jaw opening and when eating soft diet were significantly lower in infiltration group compared to placebo group and general anesthesia group (p<0.05). Analgesic consumption in placebo and general anesthesia groups were significantly higher compared to infiltration group (p<0.05). CONCLUSION: This modified pre-incision infiltration of anesthetic mixture combined with general anesthesia reduces significantly post-tonsillectomy pain in children and provides a more rapid return to normal activity compared to general anesthesia alone or in combination with a placebo infiltration.

Distance between the skin and the thoracic paravertebral space.

A fundamental requirement for the safe and effective performance of paravertebral blockade is reliable estimates of the depth from skin to paravertebral space at different thoracic levels. This distance was assessed using a nerve stimulator guided paravertebral blockade technique in 527 separate blocks in 186 patients scheduled for various surgical procedures on the trunk. The median skin-paravertebral depth was 55.0 mm. The skin-paravertebral distance at upper (T1-3) and lower (T9-12) thoracic levels were significantly greater than mid-thoracic levels (T4-8) (p < 0.05). Body mass index significantly influences this depth at upper and lower thoracic levels (p < 0.001) but not in the mid-thoracic region.

Modified infiltration technique in tonsillectomy: expanded case report of 25 children.

OBJECTIVE: To introduce a modified infiltration technique of anesthetic mixture in order to reduce post-tonsillectomy pain based on histo-anatomic observations and tonsil's innervation detection. DESIGN: Histo-anatomic, expanded case report. SETTING: Tertiary care facility in Beirut, Lebanon. PATIENTS: One hundred and seven patients who underwent tonsillectomy allocated in three groups. INTERVENTIONS: Histo-anatomic observations were studied in 62 patients (group I). Nerve-stimulator detection was performed in group II (20 children). An expanded case report of 25 children (group III) was conducted using a modified infiltration technique based on the findings of the histo-anatomic observations and nerve detection. OUTCOME MEASURES: Post-operative pain at 0, 6, 12h and once daily for the 10-day follow-up period, hemodynamic stability, hospital stay, patient satisfaction and analgesics consumption were assessed. RESULTS: The nerve-stimulator confirmed the histo-anatomic findings by strong contractions of the superior constrictor muscle, soft palate and uvula when the needle is mainly in the middle part of the peritonsillar area where the glossopharyngeal nerve branches predominate. No visual analogue scale median exceeded 1 for any child at any predetermined time interval, only three children (12%) required opoiods during the follow-up period. All children (100%) were discharged the same day, only 4% of parents were unsatisfied. Hemodynamic stability was maintained during pre- and post-operation. CONCLUSION: This modified technique with minimal volume of anesthetic mixture seems to reduce post-operative pain in tonsillectomy patients; a randomized double-blinded prospective study was designed based on the findings in this initial series of children.

General anaesthesia combined with bilateral paravertebral blockade (T5-6) vs. general anaesthesia for laparoscopic cholecystectomy: a prospective, randomized clinical trial.

BACKGROUND AND OBJECTIVE: The efficiency of bilateral paravertebral blockade combined with general anaesthesia (active) vs. general anaesthesia alone (control) in reducing postoperative pain following laparoscopic cholecystectomy was evaluated using a prospective randomized study design. METHODS: Patients were randomly assigned to either group. Nerve-stimulator guided paravertebral blockade at the T5-6 level was performed with a local anaesthetic mixture (0.30 mL kg(-1)). Twenty millilitres of the mixture contained lidocaine 2% 6 mL; lidocaine 2% 6 mL with epinephrine 1/200 000; bupivacaine 0.5% 5 mL; fentanyl 1 mL (50 microg mL(-1)) and clonidine 2 mL (150 microg mL(-1)). Postoperative pain and consumption of opioids were assessed during the first 72 h. RESULTS: Two-times 30 patients were analysed. Patient characteristics data, and pre- and peroperative variables were similar in both groups. Mean pain scores visual analogue scale were significantly less with active compared with control (P < 0.05) at 6h (1.56 +/- 1.58 vs. 4.78 +/- 1.67), at 12 h (1.52 +/- 1.58 vs. 3.81 +/- 1.63), at 24 h (1.16 +/- 1.34 vs. 2.71 +/- 1.50), at 36h (0.68 +/- 1.02 vs. 2.29 +/- 1.41), at 48h (0.60 +/- 1.04 vs. 1.61 +/- 1.33) and at 72 h (0.40 +/- 0.86 vs. 1.19 +/- 1.16). The number of patients consuming supplemental analgesics was significantly less (P < 0.05) with active compared with control, at 6 h (6 vs. 29), at 12 h (2 vs. 26), at 24 h (1 vs. 23) and at 36 h (2 vs. 15). More patients were free from nausea (P < 0.05) with active compared with control at 6 h (23 vs. 9) and at 12 h (29 vs. 19). CONCLUSION: When used as a complement to general anaesthesia, bilateral nerve-stimulator guided paravertebral blockade with lidocaine, bupivacaine, fentanyl and clonidine may improve postoperative pain relief.