Impact of pollution prevention strategies on environment sustainability: role of environmental management accounting and environmental proactivity

Environmental sustainability involves meeting current needs without compromising the abilities of future generations. Practical steps must be taken to prevent pollution, decrease waste, and utilize resources. This study investigates the predictors of environmental sustainability in SMEs, focusing on the role of environmental management accounting and environmental proactivity in linking pollution prevention strategies to environmental sustainability using the natural resource-based view theory. This study surveyed 308 Pakistani SMEs employees and tested the data using SPSS v28 and AMOS v26. The results show that pollution control initiatives increased the usage of environmental management accounting, which in turn had a positive impact on environmental sustainability. The study also finds that environmental proactivity is significantly moderate and that environmental management accounting mediates these associations. To the best of our knowledge, this study is unique in that it is the first to provide sustainable implications based on the current framework. This study highlights the importance of implementing pollution prevention strategies, integrating environmental management accounting practices, and fostering environmental proactivity to enhance environmental sustainability performance in SMEs in Pakistan, ultimately leading to improved business competitiveness, positive environmental impacts, and a sustainable future. SMEs can focus on implementing proactive pollution prevention strategies such as waste reduction, energy conservation, and resource optimization. By adopting a proactive approach to pollution prevention, SMEs can reduce their environmental impact and enhance their sustainability performance.

Disruption of hippocampal neuronal circuit function depends upon behavioral state in the APP/PS1 mouse model of Alzheimer's disease

The Alzheimer's disease-associated peptide amyloid-beta (Aβ) has been associated with neuronal hyperactivity under anesthesia, but clinical trials of anticonvulsants or neural system suppressors have, so far, failed to improve symptoms in AD. Using simultaneous hippocampal calcium imaging and electrophysiology in freely moving mice expressing human Aβ, here we show that Aβ aggregates perturbed neural systems in a state-dependent fashion, driving neuronal hyperactivity in exploratory behavior and slow wave sleep (SWS), yet suppressing activity in quiet wakefulness (QW) and REM sleep. In exploratory behavior and REM sleep, Aβ impaired hippocampal theta-gamma phase-amplitude coupling and altered neuronal synchronization with theta. In SWS, Aβ reduced cortical slow oscillation (SO) power, the coordination of hippocampal sharp wave-ripples with both the SO and thalamocortical spindles, and the coordination of calcium transients with the sharp wave-ripple. Physostigmine improved Aβ-associated hyperactivity in exploratory behavior and hypoactivity in QW and expanded the range of gamma that coupled with theta phase, but exacerbated hypoactivity in exploratory behavior. Together, these findings show that the effects of Aβ alone on hippocampal circuit function are profoundly state dependent and suggest a reformulation of therapeutic strategies aimed at Aβ induced hyperexcitability.

Abstract TP112: Racial Differences In Palliative Care Utilization And Impact On Inpatient Mortality Length Stay And Costs Among Patients With Ischemic Stroke

Background and Purpose: Palliative is increasingly used in critically ill patients which has lead to shorter length of stays, higher inpatient mortality and lower utilization of aggressive treatment. We performed analysis to evaluate trends in utilization of palliative care among patients with Ischemic Stroke and its effect on in-hospital outcomes over a 10-year period.

Methods: We obtained data for patients admitted to hospitals in the United States from 2009 to 2018 with a primary diagnosis of Ischemic stroke (IS) using a large national database. We determined the overall and among different races, rate of utilization of palliative care in patients with IS and associated in-hospital outcomes consisting of mean hospital charges, mean length of stay and in-hospital mortality.

Results: Out of 5525248 patients admitted with primary diagnosis of IS, palliative care was used in 150301 (2.72%). There was a 1.05-fold utilization of PC (1.69% in 2009 vs 1.78% in 2018; p<0.001) from 2009 till 2018. Similarly, there were 1.003, 1.4, 1.04 and 1.05-folds increase in utilization of PC among different races: whites, blacks, hispanics and others respectively, p<0.001. Overall rates of PC utilization among different races: whites, blacks, hispanics and others were: 3.0%, 1.6%, 2.03% and 2.69%, p<0.001 respectively. The length of hospitalization remained significantly higher (6.0±7.4 versus 3.8±5.2, p<0.001) in patients undergoing PC compared those who did not. The cost of hospitalization remained significantly higher ($55068 ± 84630 versus $ 40148 ± 53479, p<0.001) in patients undergoing PC compared with those who did not. Patients with PC utilization had significantly higher (42.9% versus 1.56%, p<0.001) in-hospital mortality compared ones with out.

Conclusions: Between 2009 and 2018, there has been a significant increase in utilization of PC among patients with IS along with longer length of stay and higher hospital charges. Patients with PC had significantly in-hospital morality. The findings in this IS population are paradoxical to what has been seen in other critical illnesses which may be related to differences in natural history.

Abstract TP130: Racial Differences In Palliative Care Utilization And Impact On Inpatient Mortality Length Stay And Costs Among Patients With Intracerebral Hemorrhage

Background and Purpose: Palliative is increasingly used in critically ill patients which has lead to shorter length of stays, higher inpatient mortality and lower utilization of aggressive treatment. We performed analysis to evaluate trends in utilization of palliative care among patients with subarachnoid hemorrhage and its effect on in-hospital outcomes over a 10-year period.

Methods: We obtained data for patients admitted to hospitals in the United States from 2009 to 2018 with a primary diagnosis of intracerebral hemorrhage (ICH) using a large national database. We determined the overall and among different races, rate of utilization of palliative care in patients with ICH and associated in-hospital outcomes consisting of mean hospital charges, mean length of stay and in-hospital mortality.

Results: Out of 711787 patients admitted with primary diagnosis of ICH, palliative care was used in 105354 (14.8%). There was a 2.5-fold increase in utilization of PC (8.9% in 2009 vs 22.9% in 2018; p<0.001). Similarly, there were 2.4, 2.6, 3.7 and 2.4-folds increase in utilization of PC among different races: whites, blacks, hispanics and others respectively, p<0.001. Overall rates of PC utilization among different races: whites, blacks, hispanics and others were: 17.4%, 9.8%, 10.1% and 12.2%, p<0.001 respectively. The length of hospitalization remained significantly lower (4.8±7.8 versus 7.7±10.8, p<0.001) in patients undergoing PC compared with those who did not. The cost of hospitalization remained significantly lower ($54736 ± 94502 versus $ 79426 ± 124617, p<0.001) in patients undergoing PC compared with those who did not. Patients with PC utilization had significantly higher (64.9% versus 13.7%, p<0.001) in-hospital mortality compared ones with out.

Conclusions: Between 2009 and 2018, there has been a significant increase in utilization of PC among patients with ICH along with shorter length of stay and lower hospital charges. ICH patients with PC had significantly higher in-hospital mortality.

Abstract WP132: National Trends In Utilization And Outcomes Of Acute Ischemic Stroke And Intracerebral Hemorrhage Patients Undergoing Gastrostomy Tube Placement

Background and Purpose: Persistent dysphagia requiring gastrostomy tube placement continues to be a major issue for stroke patients. We performed analysis to evaluate trends in utilization of gastrostomy tube placement and associated rates of death among acute ischemic stroke (IS) and intracerebral hemorrhage (ICH) patients over a 10-year period.

Methods: We obtained data for patients admitted to hospitals in United States from 2009 to 2018 with a primary diagnosis of IS or ICH using a large national database. We determined rate and pattern of utilization and associated in-hospital outcomes of gastrostomy tube placement among IS and ICH patients.

Results: A total of 50551 (7.05%) and 136922 (2.45%) patients underwent gastrostomy tube placement among the 716777and 5567538patients admitted with ICH and IS, respectively. There was a 3.2-fold decrease in patients who gastrostomy tube placement among patients with IS (2.3% in 2009 vs 0.7% in 2018; P<0.001), and by a 1.5-fold decrease for those with ICH (7.8% in 2009 vs 5.3% in 2018; P<0.001). The rates of in-hospital mortality among patients undergoing gastrostomy tube placement remained unchanged throughout the 10 years for patients with IS (5.2% in 2009 vs 4.9% in 2018; p = 0.54) but decreased by fold for those with ICH (7.58% in 2009 vs 2.7% in 2010; p = 0.01). The length of hospitalization remained significantly higher in patients undergoing gastrostomy tube placement compared with those who did not for both patients with IS (16.2 ±15.7versus 3.6±4.3, p<.0001) and those with ICH (24.4±22.1 versus 6.0±7.5, p<.0001). The cost of hospitalization remained significantly higher in patients undergoing gastrostomy tube placement compared with those who did not for both patients with IS ($140563± 172413 versus $ 37950.2± 45101.6, p<.0001) and those with ICH ($254519± 251973 versus $ 62133.3± 90833.9, p<.0001).

Conclusions: Between 2009 and 2018, there has been a significant reduction in the proportion of IS and ICH patients who underwent gastrostomy tube placement. However, the length and cost of hospitalization remained significantly higher among patients who underwent gastrostomy tube placement.

Abstract TMP7: Racial Differences In Palliative Care Utilization And Impact On Inpatient Mortality Length Stay And Costs Among Patients With Subarachnoid Hemorrhage

Background and Purpose: Palliative is increasingly used in critically ill patients which has lead to shorter length of stays, higher inpatient mortality and lower utilization of aggressive treatment. We performed analysis to evaluate trends in utilization of palliative care among patients with subarachnoid hemorrhage and its effect on in-hospital outcomes over a 10-year period.

Methods: We obtained data for patients admitted to hospitals in the United States from 2009 to 2018 with a primary diagnosis of subarachnoid hemorrhage (SAH) using a large national database. We determined the overall and sub racial rate of utilization of palliative care in patients with SAH and associated in-hospital outcomes consisting of mean hospital charges, mean length of stay and in-hospital mortality.

Results: Out of 199928 patients admitted with primary diagnosis of SAH, palliative care was used in 20490 (10.2%). There was a 2.2-fold increase in utilization of PC (6.5%% in 2009 vs 14.4% in 2018; p<0.001). Similarly, there were 1.7, 2.9, 3.2- and 4.6-folds increase in utilization of PC among different races: whites, blacks, hispanics and others respectively, p<0.001. Overall rates of PC utilization among among different races: whites, blacks, hispanics and others were: 11.8%, 6.9%, 7.5% and 10.0%, p<0.001 respectively. The length of hospitalization remained significantly lower in patients undergoing PC compared with those who did not. (6.5±9.9 versus 11.6±12.6, p<0.001). The cost of hospitalization remained significantly lower in patients undergoing PC compared with those who did not. ($120526 ± 193412 versus $ 185116 ± 219434, p<0.001). Patients with PC utilization had significantly higher (72.7% versus 13.6%, p<0.001) in-hospital mortality compared ones with out.

Conclusions: Between 2009 and 2018, there has been a significant increase in utilization of PC among patients with SAH along with shorter length of stay and lower hospital charges. SAH patients with PC had significantly higher in-hospital mortality.

Asymmetric relationship of environmental degradation and economic growth with tourism demand in Pakistan: evidence from non-linear ARDL and causality estimation

The purpose of this study is to assess the asymmetric associations of environmental degradation and economic growth with Pakistan's tourism demand. To fulfil this purpose, "non-linear autoregressive distributed lag" (NARDL) modelling was performed on the time series data collected from Pakistan for 26 years. The unit root test, co-integration test, long-run estimation and NARDL estimations were applied to the data to generate findings. The present study revealed that there exist the significant asymmetric associations between environmental degradation and tourism demand. It has also indicated that there exist the significant asymmetric associations between economic growth and tourism demand. It is found through the non-linear ARDL estimation results that the increase or decrease in economic growth leads towards the increase of the tourism demand of Pakistan. It means that any change (either positive or negative) in economic growth is followed by the increase of the tourism demand. Results further indicate that the increase in environmental degradation in Pakistan causes its tourism demand to reduce while the negative change in the environmental degradation does not cause any significant effect on tourism demand. However, this relationship becomes significant in the long run as the negative change in environmental degradation caused significant inverse effect on tourism demand in long run. The current study tends to be theoretically significant and practically beneficial for Pakistan's policymakers. It will help them realize the role of economic growth of the country and environmental degradation in shaping Pakistan's tourism demand and thus help them develop and implement better policies for the growth of the tourism sector.

Cholinergic modulation of hippocampal calcium activity across the sleep-wake cycle

Calcium is a critical second messenger in neurons that contributes to learning and memory, but how the coordination of action potentials of neuronal ensembles with the hippocampal local field potential (LFP) is reflected in dynamic calcium activity remains unclear. Here, we recorded hippocampal calcium activity with endoscopic imaging of the genetically encoded fluorophore GCaMP6 with concomitant LFP in freely behaving mice. Dynamic calcium activity was greater in exploratory behavior and REM sleep than in quiet wakefulness and slow wave sleep, behavioral states that differ with respect to theta and septal cholinergic activity, and modulated at sharp wave ripples (SWRs). Chemogenetic activation of septal cholinergic neurons expressing the excitatory hM3Dq DREADD increased calcium activity and reduced SWRs. Furthermore, inhibition of muscarinic acetylcholine receptors (mAChRs) reduced calcium activity while increasing SWRs. These results demonstrate that hippocampal dynamic calcium activity depends on behavioral and theta state as well as endogenous mAChR activation.