Improving Scalability of copper recovery in saline microbial fuel cells with microtubular polypyrrole-based cathodic electrocatalysts.

Microbial fuel cells (MFC) are emerging energy-efficient systems for copper (Cu) electrowinning from waste streams by coupling it with anodic oxidation of organics in wastewater. However, there is a lack of research examining scalable electrocatalysts for Cu electrowinning at low cathodic overpotentials in highly saline catholytes often found in e-waste leachates. The challenge of developing resilient anodic biofilms that withstand the antagonistic effects of ions migrating from catholytes in saline MFC also needs to be addressed. In this study, polypyrrole (PPy) cathodic electrocatalysts were developed and coupled with a robust halophilic anodic biofilm in MFC to improve the kinetics of Cu electrowinning from acidic chloride-based catholytes. Electrochemical characterisation of these cathodes revealed shuttling of electrons by redox-active PPy via the formation of intermediate Cu+-complexes as an energy-efficient pathway for producing metallic Cu. High power densities ranging from 0.63 ± 0.17 to 0.73 ± 0.05 W m-2 were achieved with undoped-PPy and phytic acid doped-PPy cathodes with simultaneous recovery of ∼97% Cu. These electrocatalysts also exhibited low charge transfer resistance (3-8 mΩ m2) that met the requisites for scalable cathodes in MFC. However, a decrease in the efficiency of PPy cathodes was observed over 5 d due to competing reactions at their interfaces, including re-oxidation of deposited Cu and cathodic corrosion, with further studies suggested to enhance their corrosion resistance. Nonetheless, integrating PPy electrocatalysts for Cu electrowinning in saline MFC has advanced its outlooks as an energy-efficient downstream process for urban mining of Cu from e-waste.

Causes, risks and care circumstances associated with death in older adults diagnosed with HIV in a tertiary centre in Malaysia.

BACKGROUND: A substantial number of older adults succumb soon after HIV diagnosis despite ART. We explored the causes, risk factors and circumstances before death among older adults acquring HIV. METHODS: We recruited individuals newly diagnosed at our centre from 2016-2020 and analysed data of those who died. Patients were stratified to older (≥50 years) or younger (<50 years) based on their age at diagnosis and attributes were compared. The Cox proportional multivariable model was used to identify factors associated with all-cause mortality. RESULTS: Among 75 deaths reported, the majority of deaths were AIDS-related and late presentation was common in both age groups. The majority of deaths occurred in the first 12 months after care presentation and over two-thirds in both groups disengaged from care prior to death. Older age remained an independent factor associated with death after adjusting for confounders including opportunistic infections, late presentation to care, ART initiation and chronic comorbidities at presentation. CONCLUSION: Most causes of death in our setting were AIDS-related and associated with late care presentation both in young and older individuals, although older age at diagnosis remained an independent risk factor. Our findings highlight the urgent need to encourage prompt ART initiation following diagnosis, especially in older adults.

Development of a dental diet-tracking mobile app for improved caries-related dietary behaviours: Key features and pilot evaluation of quality.

Objective: Diet significantly contributes to dental decay (caries) yet monitoring and modifying patients' diets is a challenge for many dental practitioners. While many oral health and diet-tracking mHealth apps are available, few focus on the dietary risk factors for caries. This study aims to present the development and key features of a dental-specific mobile app for diet monitoring and dietary behaviour change to prevent caries, and pilot data from initial user evaluation. Methods: A mobile app incorporating a novel photo recognition algorithm and a localised database of 208,718 images for food item identification was developed. The design and development process were iterative and incorporated several behaviour change techniques commonly used in mHealth. Pilot evaluation of app quality was assessed using the end-user version of the Mobile Application Rating Scale (uMARS). Results: User feedback from the beta-testing of the prototype app spurred the improvement of the photo recognition algorithm and addition of more user-centric features. Other key features of the final app include real-time prompts to drive actionable behaviour change, goal setting, comprehensive oral health education modules, and visual metrics for caries-related dietary factors (sugar intake, meal frequency, etc.). The final app scored an overall mean (standard deviation) of 3.6 (0.5) out of 5 on the uMARS scale. Conclusion: We developed a novel diet-tracking mobile app tailored for oral health, addressing a gap in the mHealth landscape. Pilot user evaluations indicated good app quality, suggesting its potential as a useful clinical tool for dentists and empowering patients for self-monitoring and behavioural management.

Scaling up of dual-chamber microbial electrochemical systems - An appraisal using systems design approach.

Impetus to minimise the energy and carbon footprints of evolving wastewater resource recovery facilities has promoted the development of microbial electrochemical systems (MES) as an emerging energy-neutral and sustainable platform technology. Using separators in dual-chamber MES to isolate anodic and cathodic environments creates endless opportunities for its myriad applications. Nevertheless, the high internal resistance and the complex interdependencies among various system factors have challenged its scale-up. This critical review employed a systems approach to examine the complex interdependencies and practical issues surrounding the implementation and scalability of dual-chamber MES, where the anodic and cathodic reactions are mutually appraised to improve the overall system efficiency. The robustness and stability of anodic biofilms in large-volume MES is dependent on its inoculum source, antecedent history and enrichment strategies. The composition and anode-respiring activity of these biofilms are modulated by the anolyte composition, while their performance demands a delicate balance between the electrode size, macrostructure and the availability of substrates, buffers and nutrients when using real wastewater as anolyte. Additionally, the catholyte governed the reduction environment and associated energy consumption of MES with scalable electrocatalysts needed to enhance the sluggish reaction kinetics for energy-efficient resource recovery. A comprehensive assessment of the dual-chamber reactor configuration revealed that the tubular, spiral-wound, or plug-in modular MES configurations are suitable for pilot-scale, where it could be designed more effectively using efficient electrode macrostructure, suitable membranes and bespoke strategies for continuous operation to maximise their performance. It is anticipated that the critical and analytical understanding gained through this review will support the continuous development and scaling-up of dual-chamber MES for prospective energy-neutral treatment of wastewater and simultaneous circular management of highly relevant environmental resources.

Biochemical trade-offs and opportunities of commercialized microalgae cultivation under increasing carbon dioxide.

Microalgae's exceptional photosynthetic prowess, CO2 adaptation, and high-value bioproduct accumulation make them prime candidates for microorganism-based biorefineries. However, most microalgae research emphasizes downstream processes and applications rather than fundamental biomass and biochemical balances and kinetic under the influence of greenhouse gases such as CO2. Therefore, three distinctly different microalgae species were cultivated under 0% to 20% CO2 treatments to examine their biochemical responses, biomass production and metabolite accumulations. Using a machine learning approach, it was found that Chlorella sorokiniana showed a positive relationship between biomass and chl a, chl b, carotenoids, and carbohydrates under increasing CO2 treatments, while Chlamydomonas angulosa too displayed positive relationships between biomass and all studied biochemical contents, with minimal trade-offs. Meanwhile, Nostoc sp. exhibited a negative correlation between biomass and lipid contents under increasing CO2 treatment. The study showed the potential of Chlorella, Chlamydomonas and Nostoc for commercialization in biorefineries and carbon capture systems where their trade-offs were identified for different CO2 treatments and could be prioritized based on commercial objectives. This study highlighted the importance of understanding trade-offs between biomass production and biochemical yields for informed decision-making in microalgae cultivation, in the direction of mass carbon capture for climate change mitigation.

Addressing the overlooked: Integrating oral healthcare in a geriatric care system: Insights from Singapore.

Oral health of the older population has long been overlooked in global healthcare agenda. Limited access to oral healthcare for dependent older adults results in poor oral health, negatively impacting their quality of life, nutrition and overall well-being. Especially for nations experiencing rapid ageing population, efforts must be urgently made to integrate oral healthcare services into the current healthcare system and policy. Singapore stands out as one of the most rapidly ageing nations in Southeast Asia, achieving remarkable progress in the healthcare field, as well as advancements in social modernization and economic growth. It now faces the growing burden of the dependent older population and is required to respond to the complex challenges associated with providing holistic eldercare services and ensuring the well-being of its ageing population. This narrative review offers an overview of Singapore's current healthcare policy and system development for the older population, with a specific focus on oral healthcare. The goal is to shed light on this underexplored area, highlighting the challenges that need to be tackled to improve the accessibility of oral health services for dependent older adults.

Psychosocial risk factors and cognitive decline in people living with HIV: results from the Malaysian HIV and aging (MHIVA) study.

HIV-associated mortality has improved with the advent of antiretroviral therapy, yet neurocognitive decline persists. We assessed the association between psychosocial risk factors and cognitive function among Malaysian PLWH. Data of virally suppressed PLWH (n = 331) on stable ART, from the Malaysian HIV and Aging study was assessed. Psychosocial factors were assessed using the Lubben Social Network Scale-6 (social isolation) and Depression Anxiety Stress Scale-21 (DASS-21). The Montreal Cognitive Assessment (MoCA) with normative standards for the Malaysian population was used to determine cognitive function. Linear and logistic regression were used to assess the associations between cognition, and psychosocial risk factors. Median age of participants was 43.8 years (IQR 37.7-51.0). Participants were predominantly male (82.8%), with secondary education or higher (85.2%). Participants were on ART for 5.7 years (IQR 3.0-9.7), with a mean MoCA score of 24.6 (±3.7). Social isolation was found in 34.6% of participants, and severe depression, severe stress, and severe anxiety in 10.6%, 15.4%, and 6.0% respectively. After adjusting for demographic, clinical, and HIV parameters, MoCA scores were significantly associated with severe stress (ß = -0.11, p = 0.02) and having marginal friendship ties (ß = -0.13, p = 0.03). Social isolation and severe stress are associated with neurocognitive impairment in PLWH.

Factors associated with reduced function and quality of life among adult people with HIV with depression and substance use in the Asia-Pacific region.

BACKGROUND: Depression and substance use (SU) disorders are prevalent among people with HIV (PWH) and impact health outcomes despite successful antiretroviral therapy (ART). We explored quality of life, functional ability and associated factors among PWH screened positive for depression and/or SU. METHODS: This cross-sectional study recruited adult PWH during routine follow-up at five HIV clinical sites in the Asia-Pacific region. Participants were screened for depression using Patient Health Questionnaire-9 and SU using Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Quality of life (QoL) was assessed with WHOQOL-HIV BREF and functional ability with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Factors associated with mean QoL and disability scores were analysed using linear regression. RESULTS: Of 864 PWH enrolled, 753 screened positive for depression or SU. The median (interquartile range, IQR) age was 38 (31-47) years and 97% were on ART. Overall mean WHOQOL-HIV BREF and WHODAS scores indicated greater impairment with increasing depressive symptom severity and SU risk. In multivariate analysis, PWH reporting previous trauma/stress (difference = 2.7, 95% confidence interval [CI] 1.5-3.9, P  < 0.001) and past mental health diagnosis (difference = 5.0, 95% CI 2.9-7.1, P  < 0.001) were associated with greater disability and poorer QoL scores across multiple domains ( P < 0.01 for all). Higher CD4 T-cell counts was also associated with better QoL scores and functional ability. CONCLUSION: PWH with depression/SU experienced poorer QoL and function despite routine engagement in HIV care. Efforts to integrate mental health services and interventions addressing disability into HIV management should be prioritized in the region.

Poor HIV-Related Outcomes in Older Adults Newly Diagnosed With HIV: A 4-Year Retrospective Analysis From a Single Site in Asia.

BACKGROUND: In resource-limited settings, HIV-related services are often targeted to younger key populations, although increasing reports have found that adults ≥50 years now account for among the highest increase in new HIV diagnosis. We assessed the proportion of new HIV infections among older adults (≥50 years) and compared their sociodemographics, risk behaviors, and HIV-related outcomes to newly diagnosed younger adults (<50 years). METHODS: This retrospective analysis included all new HIV diagnosis from 2016 to 2019 at the University of Malaya Medical Centre, Malaysia. Trends of HIV diagnosis was assessed using join point regression analysis, and characteristics between the older and younger adults were compared using χ 2 test or Mann-Whitney U test. Kaplan-Meier analysis and log-rank test were used to compare the survival probability in both age groups. RESULTS: From a total of 594 new HIV diagnosis between 2016 and 2019, 11.5% (N = 68) were among older adults with an annual percent increase of 5.50%. Older adults were more likely ethnic Indians ( P < 0.001), acquired HIV through heterosexual contact ( P = 0.001), had late presentation to care ( P = 0.003), and multimorbidity ( P < 0.001). Immunological responses after 12 months on antiretroviral therapy were comparable in both the groups. Older adults had a higher probability of death compared with younger adults (adjusted hazard ratio 1.81, 95% confidence interval: 1.02 to 3.23, P = 0.043) after adjusting for sex, mode of HIV transmission, late presentation to care, antiretroviral therapy initiation, and multimorbidity. CONCLUSION: Older adults diagnosed with HIV were associated with late care presentation and increased mortality. There is an urgent need to enhance uptake of HIV testing and linkage to care among older individuals in our setting.

Clinical application of adjustable traction skin stretchers in repair of wounds at the lower leg, foot and ankle / 中华创伤骨科杂志

Objective:To evaluate the clinical effects of adjustable traction skin stretchers used in repair of wounds at the lower leg, foot and ankle.Methods:A retrospective study was performed to analyze the clinical data of 56 patients who had been treated for skin defects at the lower leg, foot and ankle from August 2016 to September 2022 at The First Affiliated Hospital of Zhengzhou University, Honghui Hospital, Affiliated to Xi'an Jiaotong University Medical College, The First Affiliated Hospital of Henan Polytechnic University, and Yunnan Zhongde Orthopedic Hospital. There were 35 males and 21 females, aged (39.9±18.7) years. There were 43 traumatic wounds, 3 burns, 6 inflammatory wounds, 3 relief incisions due to osteofascial compartment syndrome, and 1 scar. The areas of skin defect ranged from 2.5 cm × 2.0 cm to 20.0 cm × 10.0 cm. The duration of wounds was (8.6±7.8) d. All the wounds were repaired with adjustable traction skin stretchers. The row-hook type of skin stretchers was used in 28 cases, the single-rod type in 20 cases, the single-rod type combined with an external fixator in 5 cases, and a combination of the row-hook type and the single-rod type in 3 cases.The time for wound traction closure, color of wound skin margin, skin swelling around the wound, functional recovery of affected limb and complications were recorded.Results:The time from skin stretching to wound closure was (7.8±3.8) d in the 56 patients. The color of wound skin edge after stretching was normal in 16 cases, dark red in 38 cases, and dark in 2 cases; the skin swelling around the wound was degree 1 in 21 cases, degree 2 in 33 cases, and degree 3 in 2 cases. The 56 patients were followed up for (8.9±4.1) months. Primary wound closure was achieved in 48 patients, and secondary wound closure in 8 patients after repair with an autologous skin graft. Partial skin necrosis occurred due to tension blisters after skin stretching in 2 patients, one of whom was repaired with an autologous skin graft and the other of whom by dressing change. Deep bone infection recurred in 2 patients whose wounds healed after their bone defects were repaired using Ilizarov technique of bone transfer. In the 56 patients, the muscle strength of the lower extremity beyond the wound was recovered to normal, and the range of motion of the joints adjacent to the wound also recovered to normal.Conclusion:In repair of wounds at the lower leg, foot and ankle, adjustable traction skin stretchers can lead to fine clinical effects and limited complications, because the stretchers can control the tension of skin digitally and precisely.

Pathogenesis of chronic heart failure in rats based on ferroptosis-mediated oxidative stress and intervention effect of Shenfu Injection / 中国中药杂志

This study aims to investigate the pathogenesis of chronic heart failure based on ferroptosis-mediated oxidative stress and predict the targets of Shenfu Injection in treating chronic heart failure. A rat model of chronic heart failure was established by the isoproterenol induction method. According to the random number table method, the modeled rats were assigned into three groups: a model group, a Shenfu Injection group, and a ferrostatin-1(ferroptosis inhibitor) group. In addition, a normal group was designed. After 15 days of intervention, the cardiac mass index and left ventricular mass index were determined. Echocardiography was employed to eva-luate the cardiac function. Hematoxylin-eosin staining and Masson staining were employed to reveal the pathological changes and fibrosis of the heart, and Prussian blue staining to detect the aggregation of iron ions in the myocardial tissue. Transmission electron microscopy was employed to observe the mitochondrion ultrastructure in the myocardial tissue. Colorimetry was adopted to measure the levels of iron metabolism, lipid peroxidation, and antioxidant indicators. Flow cytometry was employed to measure the content of lipid-reactive oxygen species(ROS) and the fluorescence intensity of ROS. Western blot and RT-qPCR were employed to determine the protein and mRNA levels, respectively, of ferroptosis-related factors in the myocardial tissue. The results showed that the rats in the model group had reduced cardiac function, elevated levels of total iron and Fe~(2+), lowered level of glutathione(GSH), increased malondialdehyde(MDA), decreased superoxide dismutase(SOD) and glutathione peroxidase(GSH-Px), and rising levels of ROS and lipid-ROS. In addition, the model group showed fibrous tissue hyperplasia with inflammatory cell infiltration and myocardial fibrosis, iron ion aggregation, and characteristic mitochondrial changes specific for iron death. Moreover, the model group showcased upregulated protein and mRNA levels of p53 and COX2 and downregulated protein and mRNA levels of GPX4, FTH1, SLC7A11, and Nrf2 in the myocardial tissue. The intervention with Shenfu Injection significantly improved the cardiac function, recovered the iron metabolism, lipid peroxidation, and antioxidant indicators, decreased iron deposition, improved mitochondrial structure and function, and alleviated inflammatory cell infiltration and fibrosis. Furthermore, Shenfu Injection downregulated the mRNA and protein levels of p53 and COX2 and upregulated the mRNA and protein levels of GPX4, FTH1, SLC7A11, and Nrf2 in the myocardial tissue. Shenfu Injection can improve the cardiac function by regulating iron metabolism, inhibiting ferroptosis, and reducing oxidative stress injury.

Prevalence and Risks of Depression and Substance Use Among Adults Living with HIV in the Asia-Pacific Region.

Despite the mental health and substance use burden among people living with HIV (PLHIV) in the Asia-Pacific, data on their associations with HIV clinical outcomes are limited. This cross-sectional study of PLHIV at five sites assessed depression and substance use using PHQ-9 and ASSIST. Among 864 participants, 88% were male, median age was 39 years, 97% were on ART, 67% had an HIV viral load available and < 1000 copies/mL, 19% had moderate-to-severe depressive symptoms, and 80% had ever used at least one substance. Younger age, lower income, and suboptimal ART adherence were associated with moderate-to-severe depressive symptoms. Moderate-to-high risk substance use, found in 62% of users, was associated with younger age, being male, previous stressors, and suboptimal adherence. Our findings highlight the need for improved access to mental health and substance use services in HIV clinical settings.

Data-driven and validated dimensional analysis for rational scale-up of a dual-chamber microbial fuel cell system for water-energy nexus exploitation.

Mathematical modelling of microbial fuel cells (MFC) facilitates their scale-up by maintaining dimensionless parameters across reactor volumes for consistent performance. This study developed data-driven correlations to predict areal power density for a batch-fed dual-chamber MFC using hybridised first-principle mechanistic model and Buckingham's Pi theorem. The established correlations were validated using experimentally-derived data for pre-enriched electroactive biofilm from mixed cultures. The biochemical model parameters are infilled with stoichiometric and thermodynamics estimations. Results showed that the correlations using logistic kinetics (Nash-Sutcliffe Efficiency, NSE = 0.59) outperformed Monod kinetics (NSE = 0.52) as the latter was not suitable for representing the first-order biochemical kinetics under limited substrate conditions. Sensitivity analysis on varying pH and bicarbonate concentration improved model predictions by ± 50%, though relative absolute error was ± 20% due to inherent error of estimated biochemical parameters. The application of hybridised approach for modelling MFC provides renewed perspectives for their rational design and scale-up applications.

Catalysing electrowinning of copper from E-waste: A critical review.

Smart technologies and digitalisation have increased the consumption of scarce metals that threaten the sustainability of intricated industries. Additionally, the growing streams of waste electrical and electronic equipment (e-waste) are significant hazards to public health and the environment. Thus, there is an escalating need to recover metals from e-waste for sustainable management of metal resources. Hydrometallurgical processing of e-waste, involving copper (Cu) leaching and its subsequent recovery from pregnant leach solution (PLS) via electrowinning, has emerged as an efficient strategy to close the recycling loop. Electrowinning from PLS demonstrated higher Cu recovery efficiency and operational feasibility with a lower reagent use and lesser waste generation. Nevertheless, multiple issues challenged its practical implementation, including selective recovery of Cu from PLS containing mixed metals and high energy consumption. This review (1) identifies the factors affecting Cu electrowinning from PLS; (2) evaluates the composition of lixiviants influencing Cu electrowinning; (3) appraises various catalysts developed for enhancing Cu electrodeposition; and (4) reviews coupled systems that minimised process energy consumption. From the literature review, electrocatalysts are prospective candidates for improving Cu electrowinning as they reduced the cathodic reduction overpotentials, enhanced surface reaction kinetics and increased current efficiency. Other catalysts, including bioelectrocatalysts and photoelectrocatalysts, are applicable for dilute electrolytes with further investigations required to validate their feasibility. The coupled systems, including slurry electrolysis, bioelectrochemical systems and coupled redox fuel cells, minimise process energy requirements by systematically coupling the cathodic reduction reaction with suitable anodic oxidation reactions having thermodynamically low overpotentials. Among these systems, slurry electrolysis utilising a single-step processing of e-waste is feasible for commericalisation though operational challenges must be addressed to improve its sustainability. The other systems require further studies to improve their scalability. It provides an important direction for energy-efficient Cu electrowinning from PLS, ultimately promoting a circular economy for the scarce metal resources.

Distinctive correlations between cell concentration and cell size to microalgae biomass under increasing carbon dioxide.

Carbon capture and storage (CCS) via microalgae cultivations is getting renewed interest as climate change mitigation effort, owing to its excellent photosynthetic and CO2 fixation capability. Microalgae growth is monitored based on their biomass, cell concentrations and cell sizes. The key parametric relationships on microalgae growth under CO2 are absent in previous studies and this inadequacy hampers the design and scale-up of microalgae-based CCS. In this study, three representative microalgae species, Chlorella, Nostoc and Chlamydomonas, were investigated for establishing key correlations of cell concentrations and sizes towards their biomass fluctuations under CO2 influences of 0% to 20% volume ratios (v/v). This revealed that Chlorella and Chlamydomonas cell concentrations significantly contributed towards increasing biomass concentration under CO2 elevations. Chlorella and Nostoc cell sizes were enhanced at 20% (v/v). These findings provided new perspectives on growth responses under increasing CO2 treatment, opening new avenues on CCS schemes engineering designs and biochemical production.

Comparing the efficacy of tocilizumab with corticosteroid therapy in treating COVID-19 patients: a systematic review and meta-analysis.

PURPOSE: Tocilizumab has shown equivocal outcomes in reducing mortality in COVID-19. The corticosteroids appear to be an affordable alternative to tocilizumab. This study aims to estimate the efficacy of tocilizumab and the corticosteroids particularly dexamethasone and methylprednisolone and to identify possible determinants of their efficacy. METHODS: Five electronic databases were searched for studies involving tocilizumab, dexamethasone, and methylprednisolone in treating COVID-19. We included case-control and randomized or partially randomized trials. Meta-regression for patient baseline characteristics, co-medications, and tocilizumab dose regimens was performed to identify contributing factors to drug efficacy. RESULTS: Thirteen randomized controlled trials (RCTs) and twenty-four case-control studies were included in our meta-analysis involving 18,702 patients. Meta-analysis among the RCTs showed that a summary estimate favoring mortality reduction (OR 0.71, 95%CI 0.55 - 0.92) contributed mainly by tocilizumab and dexamethasone. Among case-control studies, meta-analysis showed mortality reduction (OR 0.52, 95%CI 0.36 - 0.75) contributed by tocilizumab and tocilizumab-methylprednisolone combination. Methylprednisolone alone did not reduce mortality except for one study involving high dose pulse therapy. Meta-analysis also found that all three drugs did not significantly reduce mechanical ventilation (OR 0.72, 95%CI 0.32 - 1.60). CONCLUSION: Tocilizumab and dexamethasone emerge as viable options in reducing mortality in severe COVID-19 patients. A tocilizumab-corticosteroid combination strategy may improve therapeutic outcome in cases where single therapy fails.

Functional Dentition, Chronic Periodontal Disease and Frailty in Older Adults-A Narrative Review.

BACKGROUND: The likelihood of experiencing the impact of chronic disease rises with age, and cumulative functional deficits over time increase the risk of frailty in older adults. The exact causes of frailty are not clear, and research is needed to identify appropriate intervention measures to reduce risk of developing frailty in old age. OBJECTIVE: To review the evidence on the relationship between frailty, dental status and chronic periodontitis and to determine if improvements in oral health of older adults can contribute to reversal of frailty. RESULTS: The oral cavity is the entry point to the gastro-intestinal tract, and natural teeth facilitate efficient mastication of food prior to swallowing and subsequent digestion. The loss of natural teeth, which is gradual and cumulative over the life course, is associated with diminished nutritional intake, especially in older adults. Furthermore, chronic periodontitis has been postulated as a risk factor for frailty. The evidence supporting a strong relationship between oral health status and frailty is not clearcut. Cross sectional studies suggest an association with missing teeth and chronic periodontal inflammation. However, there are very few longitudinal studies and accordingly, it is not currently possible to claim a causal relationship. As yet, there is no evidence to suggest that improvements in oral health contribute to reversal of frailty. CONCLUSION: Longitudinal studies with robust designs are required to better inform the relationship across functional dentition, chronic periodontitis and frailty in older adults.

Exploring the factors related to adolescent health literacy, health-promoting lifestyle profile, and health status.

BACKGROUND: Health literacy has been concerned a key factor for determining the use of health information and promoting health. The study aimed to explore adolescent health literacy, health-promoting lifestyle profile, and health status and related factors. METHODS: A cross-sectional study design was used; 918 first year junior college students were recruited in Taiwan. The measurements were the Chinese Health Literacy Survey Questionnaire (HLS-C-Q), the Chinese Health-Promoting Lifestyle Profile (HPLP-S), and the Health Status Questionnaire. RESULTS: The mean score for health literacy was 36.15 (±6.21), with 30.17% of the participants having insufficient or problematic health literacy. Further, 19.9% of participants were obese and 11.2% experienced emotional instability. Health literacy and health-promoting lifestyle profile showed significant positive and negative correlations with perceived health status and depression, respectively (p < 0.05). An exercise frequency of ≥3 times/week was a predictor of health literacy, health-promoting lifestyle profile, and emotional stability. CONCLUSIONS: Adolescent health literacy, health-promoting lifestyle profile, and health status require careful consideration. In adolescents, developing regular exercise may increase health literacy, thereby developing healthy lifestyle profiles and ameliorating obesity and depression-related issues.

Delayed HIV testing and treatment seeking, and associated support needs among people living with HIV in Malaysia: a qualitative study.

Background By the end of 2017, an estimated 83% of people living with HIV in Malaysia knew their serostatus. However, the Ministry of Health reported a high proportion of those newly diagnosed had low CD4 counts <200 cells/µL, indicating late presentation for testing may be pervasive. METHODS: A qualitative study was conducted to explore the context and experiences of people at risk of HIV infection testing and seeking treatment later in the course of their infection. Participants recruited (n = 20) were HIV positive, aged >18 years who fit the description of late presentation (World Health Organization defined as CD4 cell count <350 cells/µL). Semi-structured interviews were conducted, and a framework approach was used to interrogate the data. RESULTS: Many participants perceived themselves at low risk of HIV infection and did not undergo routine voluntary testing; rather, they were diagnosed when seeking treatment for serious illness or as part of mandatory employment-related testing. Perceived lack of confidentiality and potential discriminatory behaviour at public health facilities were significant deterrents to testing. Participants were satisfied with HIV treatment, but rarely sought psychosocial support in order to 'protect' their privacy. CONCLUSION: Unless drivers of HIV infection are effectively addressed, including stigmatising and discriminatory practices, and low health literacy, the occurrence of late presentation will persist. Their collective impact will not only jeopardise efforts to improve the treatment cascade, but may also impact engagement with other biomedical prevention and care technologies.

Alkaline earth atom doping-induced changes in the electronic and magnetic properties of graphene: a density functional theory study.

Density functional theory was used to investigate the effects of doping alkaline earth metal atoms (beryllium, magnesium, calcium and strontium) on graphene. Electron transfer from the dopant atom to the graphene substrate was observed and was further probed by a combined electron localization function/non-covalent interaction (ELF/NCI) approach. This approach demonstrates that predominantly ionic bonding occurs between the alkaline earth dopants and the substrate, with beryllium doping having a variant characteristic as a consequence of electronegativity equalization attributed to its lower atomic number relative to carbon. The ionic bonding induces spin-polarized electronic structures and lower workfunctions for Mg-, Ca-, and Sr-doped graphene systems as compared to the pristine graphene. However, due to its variant bonding characteristic, Be-doped graphene exhibits non-spin-polarized p-type semiconductor behavior, which is consistent with previous works, and an increase in workfunction relative to pristine graphene. Dirac half-metal-like behavior was predicted for magnesium doped graphene while calcium doped and strontium doped graphene were predicted to have bipolar magnetic semiconductor behavior. These changes in the electronic and magnetic properties of alkaline earth doped graphene may be of importance for spintronic and other electronic device applications.