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Wastewater treatment plants (WWTPs) are considered a significant microplastic discharge source. To evaluate the amount and characteristics of microplastics discharged from WWTPs in South Korea, we selected 22 municipal WWTPs nationally and investigated microplastics at each treatment stage. The mean microplastic removal efficiency by WWTPs was >99%, and most of the microplastics were removed by sedimentation with the second clarifier during wastewater treatment. Consequently, the microplastic removal efficiency of WWTPs did not significantly differ from that of the adopted wastewater treatment technology because a second clarifier was applied in most WWTPs. However, for WWTPs operating a tertiary treatment process, the removal efficiency was enhanced compared with that of WWTPs discharging after a second clarifier. Although the microplastic removal efficiency was high by WWTP, the discharge contribution to the water environment could not be ignored because of the amount of treated wastewater, resulting in an increase of 5.8-270.9 items/m3 of microplastics in the receiving water. The characteristics of microplastics in WWTPs, including their components, shape, and size, were also evaluated. The most detected components included polytetrafluoroethylene and polyester. Most microplastics detected were categorized as fragments and fibers, while other types were hardly detected. The size of more than 70% of the microplastics detected in WWTPs was under 300 µm, implying that the size of microplastics required to control in WWTPs was much smaller than the defined size of microplastics. An evaluation of the correlation between other pollution factors and microplastic abundance did not reveal positive correlations, and microplastic occurrence was not affected by changing seasons, which may need to be evaluated with further studies. Research should also be performed on the effect of influent sources on the level of microplastic abundance and fate of ultrafine plastics in WWTPs.
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Environmental Monitoring , Microplastics , Waste Disposal, Fluid , Wastewater , Water Pollutants, Chemical , Republic of Korea , Microplastics/analysis , Wastewater/chemistry , Water Pollutants, Chemical/analysis , Environmental Monitoring/methodsABSTRACT
Crack-free nanocellular graphenes are attractive materials with extraordinary mechanical and electrochemical properties, but their homogeneous synthesis on the centimeter scale is challenging. Here, a strong nanocellular graphene film achieved by the self-organization of carbon atoms using liquid metal dealloying and employing a defect-free amorphous precursor is reported. This study demonstrates that a Bi melt strongly catalyzes the self-structuring of graphene layers at low processing temperatures. The robust nanoarchitectured graphene displays a high-genus seamless framework and exhibits remarkable tensile strength (34.8 MPa) and high electrical conductivity (1.6 × 104 S m-1). This unique material has excellent potential for flexible and high-rate sodium-ion battery applications.
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Benign tumors or malignant neoplasms must be evaluated in patients with unilateral nasal cavity mass lesions. The 3 most prevalent unilateral benign mass lesions in such individuals are nasal polyps (NPs) and inverted papillomas (IPs). Although rare, it should be kept in mind that sinonasal hamartomas can be occasionally diagnosed as well. Among sinonasal hamartomas, respiratory epithelial adenomatoid hamartoma is more prevalent, with seromucinous hamartoma (SMH) being the second most common. Unlike NPs, sinonasal hamartomas are benign tumors with growth potential, which means it should not be undertreated and warrants surgical removal for treatment. However, sinonasal hamartomas do not have local invasion or malignant transformation potential like IPs; hence, it is vital not to overtreat them. Therefore, understanding the histopathology of SMH and thereby establishing proper surgical planning prior to the surgery remains crucial in such cases. Here, we present a successfully treated case of SMH with a distinctive radiographic, gross, and pathological clinical image of SMH.
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OBJECTIVE: The risk of rapid cognitive decline in Alzheimer's disease (AD) during the coronavirus disease 2019 (COVID-19) pandemic has been recognized. The purpose of this study was to investigate the cognitive decline in such patients during the COVID-19 pandemic by evaluating changes in their cognitive measure parameters before and after the pandemic. METHODS: This was a retrospective cohort study conducted in AD patients during their first visit and one-year regular follow-up for testing cognitive function at the Geriatric Psychiatry Clinic of Seoul St. Mary's Hospital. Changes in the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and Sum of Box for CDR (CDR-SB) scores were investigated. A time series analysis was performed to determine whether there was a significant difference in the MMSE, CDR, and CDR-SB scores of AD patients in pre- and post-COVID-19 periods. RESULTS: Overall, 130 AD patients aged 60 to 93 years were assessed. Their baseline mean MMSE score was 22.30 which had decreased to 21.08 at the one-year follow-up. Before November 2019, the average CDR differences for one year was 0.06, but after November 2019, it increased to 0.36 (p<0.001). Before November 2019, the average of the CDR-SB change value for one year was 1.69, but after November 2019, it increased to 3.00 (p<0.001). The difference in MMSE values for one year was not statistically significant. The time series analysis revealed a significant increase in the CDR and CDR-SB scores by approximately 0.47 (p=0.005) and 2.39 (p=0.002), before and after November 1, 2019, respectively. CONCLUSION: This study revealed that the COVID-19 pandemic and social distancing worsen cognitive function in AD patients rapidly. Exposure to the COVID-19 pandemic and social distancing for at least seven months worsen cognitive decline significantly. Therefore, in order to minimize the adverse effects of the cognitive decline in these patients, the period of social distancing should be minimized.
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OBJECTIVE: South Korea is one of the countries with a very fast aging rate, and the prevalence of dementia is rapidly increasing. However, there are relatively few studies pertaining to sociodemographic and physical health-related factors associated with dementia knowledge and dementia worry. METHODS: This was a cross-sectional survey of a community in Seocho-gu, Seoul, Republic of Korea. Overall, 1,869 adults aged 60 years participated. Participants completed an online interview or face-to-face interview. Survey data comprised self-report questions including dementia knowledge, dementia worry, demographic, psychological, exercise, and cognitive activities. We conducted logistic regression analysis. RESULTS: There was a significant positive association between dementia worry and knowledge. Family history of dementia, education, income, sleep problems, depressed mood and loss of volition, chronic diseases, and presence of a past job were associated with dementia knowledge or worry. Reading, art, or social cognitive activities had a significant positive association with dementia knowledge, and writing or musical cognitive activities had a negative association with dementia worry. CONCLUSION: We found that people with more dementia knowledge and less dementia worry engaged more in cognitive activities that could prevent dementia. Public education should be planned to improve dementia knowledge and reduce dementia worry.
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OBJECTIVE: Due to high cost of amyloid imaging, its use of amyloid imaging to confirm amyloid pathology is limited in clinical practice. It is of importance to develop a model to predict cerebral amyloid positivity using clinical data obtained from a memory clinic. METHODS: A total of 410 participants who had symptom of subjective cognitive decline and underwent amyloid PET and apolipoprotein ε (APOE) genotyping were retrospectively enrolled from January 2016 to January 2019. Models for cerebral amyloid positivity prediction were developed in all subjects, mild cognitive impairment (MCI) subjects, and Alzheimer's disease (AD) dementia subjects through multivariate logistic regression analysis. The performance of the models was assessed using receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) values. RESULTS: Age, sex, years of education, body mass index (BMI), APOE4, and mini mental state examination score (MMSE) were selected for the final model for all subjects. The AUC value of the ROC curve was 0.775. Age, sex, years of education, BMI, and APOE4 were selected for the final model for MCI subjects. The AUC value was 0.735. Age, sex, years of education, BMI, APOE4, MMSE, and history of hypertension were selected for the final model for AD dementia subjects. The AUC value was 0.845. CONCLUSION: This study found that models using clinical data can predict cerebral amyloid positivity according to cognitive status. These models can be useful as a screening tool predict cerebral amyloid deposition in cognitively impaired patients in a memory clinic.
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OBJECTIVES: We evaluated the usefulness of the standardized nasal provocation test (NPT) protocol recently published by the European Academy of Allergy and Clinical Immunology (EAACI) and compared the utility of several parameters for diagnosing allergic rhinitis (AR) caused by house dust mites (HDM). Subjective parameters were nasal and ocular symptoms measured using a visual analog scale (VAS), and objective parameters were peak nasal inspiratory flow (PNIF), minimal cross-sectional area (MCA), and total nasal volume (TNV). METHODS: Before and after spraying Dermatophagoides pteronyssinus (DP) allergen (1,000 AU/mL, 100 µL) into both nostrils of 13 patients with AR (AR group) and 22 patients with non-AR (NAR group), we used VAS scores to measure nasal symptoms (nasal obstruction, rhinorrhea, sneezing, and itching) and ocular symptoms and assessed PNIF, MCA, and TNV. RESULTS: The AR group had significantly worse symptoms than the NAR group 15 minutes after DP challenge (P<0.001). After 30 minutes, nasal obstruction and rhinorrhea remained worse in the AR group (P<0.001); a similar but less marked difference was seen for sneezing (P=0.012) and itching (P=0.039). Ocular symptoms, PNIF, MCA, and TNV differed between groups after both 15 and 30 minutes (P<0.05). The area under the receiver operating characteristic curve was higher for nasal obstruction (0.977), rhinorrhea (0.906), and TNV (0.979) than for sneezing (0.755), itching (0.673), and MCA (0.836). CONCLUSION: NPT performed according to the EAACI guidelines could help diagnose AR caused by HDM. TNV and VAS changes in nasal obstruction and rhinorrhea had higher diagnostic accuracy than other parameters.
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Surface functionalization is an effective approach to change the surface properties of a material to achieve a specific goal such as improving the biocompatibility of the material. Here, the surface of the commercial biomedical Ti-6Al-7Nb alloy was functionalized through synthesizing of a porous surface layer by liquid metal dealloying (LMD). During LMD, the Ti-6Al-7Nb alloy is immersed in liquid magnesium (Mg) and both materials react with each other. Particularly, aluminum (Al) is selectively dissolved from the Ti-6Al-7Nb alloy into liquid Mg while titanium (Ti) and niobium (Nb) diffuse along the metal/liquid interface to form a porous structure. We demonstrate that the porous surface layer in the Ti-6Al-7Nb alloy can be successfully tailored by LMD. Furthermore, the concentration of harmful Al in this porous layer is reduced by about 48% (from 5.62 ± 0.11 wt.% to 2.95 ± 0.05 wt.%) after 30 min of dealloying at 1150 K. The properties of the porous layer (e.g., layer thickness) can be tuned by varying the dealloying conditions. In-vitro tests suggest improved bone formation on the functionalized porous surface of the Ti-6Al-7Nb alloy.
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Controlling the feature sizes of 3D bicontinuous nanoporous (3DNP) materials is essential for their advanced applications in catalysis, sensing, energy systems, etc., requiring high specific surface area. However, the intrinsic coarsening of nanoporous materials naturally reduces their surface energy leading to the deterioration of physical properties over time, even at ambient temperatures. A novel 3DNP material beating the universal relationship of thermal coarsening is reported via high-entropy alloy (HEA) design. In newly developed TiVNbMoTa 3DNP HEAs, the nanoporous structure is constructed by very fine nanoscale ligaments of a solid-solution phase due to enhanced phase stability by maximizing the configuration entropy and suppressed surface diffusion. The smallest size of 3DNP HEA synthesized at 873 K is about 10 nm, which is one order of magnitude smaller than that of conventional porous materials. More importantly, the yield strength of ligament in 3DNP HEA approaches its theoretical strength of G/2π of the corresponding HEA alloy even after thermal exposure. This finding signifies the key benefit of high-entropy design in nanoporous materials-exceptional stability of size-related physical properties. This high-entropy strategy should thus open new opportunities for developing ultrastable nanomaterials against its environment.
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BACKGROUND: Early and late mild cognitive impairment (MCI) patients have been reported to have a distinctive prognosis of converting to Alzheimer's disease. OBJECTIVE: To evaluate the difference in gray matter volume and assess the association between cognitive function evaluated by comprehensive cognitive function test, and cortical thickness across healthy controls (HCs) (n = 37), early (n = 30), and late MCI patients (n = 35). METHODS: Differences in gray matter volume were evaluated by whole brain voxel-based morphometry across the groups. Multiple regression analysis was used to analyze group by memory performance interactions for the normalized gray matter volume. RESULTS: The early MCI group showed reduced gray matter volume in the right middle temporal gyrus in comparison to the HC group. The late MCI group displayed atrophy in the left parahippocampal gyrus in comparison to the HC group. Late MCI patients exhibited a decreased gray matter volume in the left fusiform gyrus in comparison to patients in the early MCI group (Monte Carlo simulation corrected p < 0.01, Tukey post hoc tests). Furthermore, there was a significant group (HC vs. early MCI) by memory performance interaction for the normalized cortical volume of the right middle temporal gyrus. Additionally, a significant group (early MCI vs. late MCI) by memory performance interaction was found for the normalized gray matter volume of the left fusiform gyrus (p < 0.001). CONCLUSION: Early and late MCI patients showed distinctive associations of gray matter volumes in compensatory brain regions with memory performances. The findings can contribute to a better understanding of the structural changes in compensatory brain regions to elucidate memory decline in the trajectory of the subdivided prodromal stages of the Alzheimer's disease (AD).
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OBJECTIVE: Cyanidin-3-glucoside (C3G), is a component of anthocyanin, have been considered to positively influence cognition and be beneficial for the prevention and treatment of dementia. We aimed to assess the safety and efficacy of cyanidin-3-glucoside-rich Oryza sativa L. (black rice) extract on cognitive function. METHODS: A 12-weeks double-blind randomized, placebo controlled trial assessed safety and cognitive outcomes in participants with subjective memory impairment (n=48) following consumption of 6 black rice extract capsules or a placebo. Cognitive function was assessed using the ADAS-cog and the CERAD-K. Subjective memory impairment also assessed. Safety was assessed by hematologic blood test, urine analysis, and participant reports of adverse events. RESULTS: There was significant improvement on subjective memory in intervention group. There was no statistically significant difference in objective cognitive outcomes following 12 weeks of consuming black rice extract. ADAS-cog scores, however, trended toward improvement in the intervention group compared to the placebo group. There was no adverse event. CONCLUSION: Although significant improvement in objective cognitive function was not proved, we found that C3G-rich Oryza sativa L. extract improves subjective memory in this study. Therefore the results may be informative of the possible effectiveness of the C3G-rich Oryza sativa L. on cognitive function.
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OBJECTIVE: No reports have investigated the influence of age at first or last childbirth on maternal mental health. The aim of this study was to determine whether there is an association between age at first or last childbirth and the mental health of premenopausal women. METHODS: The data used in this study were collected from the 2010 to 2012 Korea National Health and Nutrition Examination Surveys. A total of 3,370 premenopausal women were considered. The association between childbirth age and maternal mental health factors, including stress, depressed mood, and suicidal ideations were analyzed using multiple logistic regression analyses adjusted for confounding factors. RESULTS: After adjusting confounding factors, younger maternal age at first childbirth was found to be associated with an increase in the prevalence of maternal depressed mood and suicidal ideations. Also, older maternal age at last childbirth was related to an increase in maternal stress, depressed mood and suicidal ideations. CONCLUSION: Both younger first childbirth and older last childbirth maternal age may be risk factors for poor outcomes of premenopausal women's mental health. These data support the need for comprehensive mental health assessment for premenopausal women who either gave birth at an age too young or too old.
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OBJECTIVE: Alcohol drinking can cause various psychiatric and medical diseases. Although women generally consume less alcohol than men, they may be at a greater risk for alcohol-related psychological distress. The aim of the current study is to evaluate whether the association between alcohol consumption and psychological distress, including stress, depressed mood, and suicidal ideation and the risks of psychological distress differ based on gender. METHODS: The cross-sectional study included 31,657 participants (17,915 women and 13,742 men) from the 2010-2013 and 2015 Korea National Health and Nutrition Examination Survey. Alcohol drinking and Alcohol Use Disorders Identification Test (AUDIT) levels were assessed for evaluating the amount of alcohol intake and alcohol-related problems. Self-perception of stress, depressed mood, and suicidal ideation were assessed for evaluating psychological distress. Odds ratio and 95% confidence intervals for psychological distress were calculated using multiple logistic regression models. RESULTS: The risks of psychological distress were not significantly associated with drinking level in both sexes. However, the risks of psychological distress were associated with an increase in AUDIT levels, and there were gender differences in the psychological consequences of alcohol-related problems. The association was more drastic in women, and women showed a significant association even though the severity of drinking problem was low with the exception of stress perception. CONCLUSION: The risks of psychological distress were associated with the severity of alcohol-related problems and women were more likely to be susceptible. Therefore, it is recommended that women even at low-risk for problematic drinking should be screened for psychological distress.
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BACKGROUND: Previous research has separated spatial patterns of intra- and interregional intrinsic brain connectivity, as evaluated by regional homogeneity (ReHo) and functional connectivity (FC), respectively, in prodromal Alzheimer's disease (AD). Moreover, the intra- and interregional intrinsic brain connectivities have been demonstrated to have a significant relationship with each other. OBJECTIVE: To explore FCs from brain regions which display a difference in ReHo between an amnestic mild cognitive impairment (aMCI) group and healthy controls (HC) and to examine the relationship of intra- and interregional intrinsic brain connectivity to cognitive function in both groups. METHODS: Thirty-four subjects with aMCI and 38 HC underwent 3T MRI scanning and a battery of neuropsychological tests. RESULTS: The aMCI group exhibited significantly higher ReHo in the left putamen and lower ReHo in the left inferior temporal gyrus than the HC. Furthermore, both groups showed a distinctive functional connectivity pattern seeded from 2 regions of interest which exhibited significant ReHo differences between the groups. In the HC group, only ReHo exhibited significant associations with memory performance, but in the aMCI group, only FC seeded from the left inferior temporal gyrus showed significant correlations with memory performance. CONCLUSIONS: By approaching both intra- and interregional intrinsic brain activities in the early stages of AD, the findings of this research provide insights into the early pathogenesis of AD as related to memory performance.
Subject(s)
Alzheimer Disease/diagnosis , Cognitive Dysfunction/diagnosis , Connectome/methods , Memory/physiology , Aged , Brain Mapping/methods , Female , Humans , Magnetic Resonance Imaging/methods , Male , Memory and Learning Tests , Neuropsychological Tests , Prodromal Symptoms , Putamen/diagnostic imaging , Temporal Lobe/diagnostic imagingABSTRACT
In this work, the mechanical characteristics of high-entropy alloy Co20Cr26Fe20Mn20Ni14 with low-stacking fault energy processed by cryogenic and room temperature high-pressure torsion (HPT) were studied. X-ray diffraction, scanning electron microscopy (SEM), and transmission electron microscopy (TEM) analyses were performed to identify the phase and microstructure variation and the mechanical properties characterized by Vickers hardness measurements and tensile testing. Cryogenic HPT was found to result in a lower mechanical strength of alloy Co20Cr26Fe20Mn20Ni14 than room temperature HPT. Microstructure analysis by SEM and TEM was conducted to shed light on the microstructural changes in the alloy Co20Cr26Fe20Mn20Ni14 caused by HPT processing. Electron microscopy data provided evidence of a deformation-induced phase transformation in the alloy processed by cryogenic HPT. Unusual softening phenomena induced by cryogenic HPT were characterized by analyzing the dislocation density as determined from X-Ray diffraction peak broadening.
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The room-temperature tensile strength, toughness, and high-temperature creep strength of 2000, 6000, and 7000 series aluminum alloys can be improved significantly by dispersing up to 1 wt% carbon nanotubes (CNTs) into the alloys without sacrificing tensile ductility, electrical conductivity, or thermal conductivity. CNTs act like forest dislocations, except mobile dislocations cannot annihilate with them. Dislocations cannot climb over 1D CNTs unlike 0D dispersoids/precipitates. Also, unlike 2D grain boundaries, even if some debonding happens along 1D CNT/alloy interface, it will be less damaging because fracture intrinsically favors 2D percolating flaws. Good intragranular dispersion of these 1D strengtheners is critical for comprehensive enhancement of composite properties, which entails change of wetting properties and encapsulation of CNTs inside Al grains via surface diffusion-driven cold welding. In situ transmission electron microscopy demonstrates liquid-like envelopment of CNTs into Al nanoparticles by cold welding.
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Introduction: Mild cognitive impairment (MCI) is a prodromal stage of dementia. The association of body mass index (BMI) and progression to Alzheimer's disease (AD) in MCI subjects according to age, sex, and cognitive intervention remains unknown. We investigated the relationship between BMI and the risk of progression to AD in subjects with MCI, as well as the effect of BMI on progression to AD depending on age, sex, cognitive intervention, and chronic diseases. Methods: Three hundred and eighty-eight MCI subjects were followed for 36.3 ± 18.4 months, prospectively. They underwent neuropsychological testing more than twice during the follow-up period. The MCI subjects were categorized into underweight, normal weight, overweight, and obese subgroups. The associations between baseline BMI and progression to AD over the follow-up period were estimated using Cox proportional hazard regression models. Data were analyzed after stratification by age, sex, cognitive intervention, and chronic diseases. Results: After adjustment for the covariates, the underweight MCI group had a higher risk of progression to AD [hazard ratio (HR): 2.38, 95% confidence interval (CI): 1.17-4.82] relative to the normal weight group. After stratifying by age, sex, cognitive intervention, and chronic diseases, this effect remained significant among females (HR: 3.15, 95% CI: 1.40-7.10), the older elderly ≥75 years old (HR: 3.52, 95% CI: 1.42-8.72), the non-intervention group (HR: 3.06, 95%CI: 1.18-7.91), and the hypertensive group (HR: 4.71, 95% CI: 1.17-18.99). Conclusion: These data indicate that underweight could be a useful marker for identifying individuals at increased risk for AD in MCI subjects. This association is even stronger in females, older elderly subjects, the non-cognitive intervention group, and the hypertensive group.
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OBJECTIVE: Previous research has indicated that there are potential associations between education and total hippocampal volume in the trajectory of Alzheimer's disease (AD). However, the correlation between education and hippocampal subfield volumes in the progression of AD has yet to be understood. This study examined the relationship between education, which is a standard proxy for cognitive reserve, and hippocampal subfield volumes in healthy and amnestic mild cognitive impairment (aMCI) groups. SUBJECTS AND METHODS: Thirty-eight subjects with aMCI and 39 healthy control subjects underwent 3 T magnetic resonance imaging, and hippocampal subfield volumes were measured by automated segmentation. Multiple linear regression analysis was used to determine the association between education and hippocampal subfield volumes. RESULTS: Education had a significant negative correlation with the left parasubiculum, presubiculum, and subiculum volumes in the aMCI group. In addition, multiple subfield volumes including left parasubiculum, left/right presubiculum, left cornus ammonis (CA)3, and left CA4 showed a significant correlation with the neuropsychological test scores in the control group and aMCI group. CONCLUSION: These findings contribute to a better understanding of the association between education, hippocampal subfield volumes, and amnestic cognitive functions in the early phase of AD.
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OBJECTIVE: Although the diagnosis and treatment of cancer is associated with psychosocial distress, routine distress screening is difficult in hospitalized oncology settings. We developed a consecutive screening program for psychosocial distress to promote psychiatric treatment of cancer patients and evaluated the feasibility of our program by Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS). METHODS: Among 777 cancer inpatients recruited from the Catholic Comprehensive Institute of Seoul St. Mary's Hospital, 499 agreed to complete primary distress screening through DT. We conducted secondary distress screening through HADS in 229 patients who had high scores of DT. RESULTS: Of the 499 participants, 270 patients with low scores of DT were included in the distress education program. 229 patients with high scores of DT received secondary distress screening through HADS. Among 115 patients with low scores of HADS, 111 patients received distress management. Among 114 patients with high scores in the secondary distress screening, 38 patients received psychiatric consultation service whereas 76 patients refused psychiatric consultation. CONCLUSION: Using consecutive screening for psychosocial distress appeared to be feasible in an inpatient oncology setting. Nevertheless, the low participation rate of psychiatric consultation service in cancer patients with high distress level should be improved.
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The current study aimed to investigate the association between mental health status and bone mineral density (BMD) using data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008-2010. We enrolled 15,876 South Korean participants (4,010 postmenopausal females, 4,836 premenopausal females, and 7,016 males, all aged 20 years or older). BMD was measured using dual-energy radiography absorptiometry at the femoral neck (NK), lumbar spine (LSP), and total femur (TFM). Mental health status data were obtained from a self-report questionnaire that assessed psychological stress, depressed mood, and suicidal ideation. Psychological stress was negatively correlated with BMD in the LSP, NK, and TFM for the male group. Depressed mood was associated with lower BMD in the LSP, NK and TFM for the premenopausal female group, and in the LSP for the male group. Suicidal ideation was associated with lower BMD in the NK and TFM for the male group. Mental health problems were associated with lower BMD, especially in premenopausal females and males. Future investigations should focus on the shared pathophysiology between mental health problems and BMD, and the interrelationship between increased BMD and recovery from mental health problems.