Search

In the present study, the applicability of electroporation (EP) has been investigated as a pretreatment method for enriching hydrogen producers and eliminating hydrogen consumers in anaerobic sludge (AS). Citrus wastewater was used as a feed source for biohydrogen production. Different treatment intensities (TI) of EP for 0.5 min (TI = 30 kWh/m3), 1 min (TI = 60 kWh/m3), and 2 min (TI = 120 kWh/m3) were employed to observe the effects of EP on the microbial community of AS. Furthermore, sonication with a probe, sonication in a bath, and heat-shock pretreatments were also conducted to compare the hydrogen yield with EP. The cell inactivation was evaluated and visualized using colony-forming units (CFU) and field emission scanning electron microscopy (FESEM), respectively. Among the different TIs, the TI of 60 kWh/m3 achieved higher methanogen inactivation with maximum hydrogen (896 mL) production compared to other EP pretreatments after 180 h of dark fermentation. In comparison with other pretreatments, the highest hydrogen production of 896 mL was achieved with EP treatment, followed by sonication with a probe (678 mL) and sonication in a bath (563 mL). The heat-shock pretreatment exhibited the lowest ultimate hydrogen production of 545 mL among the four different methods applied in this study. The outcome of this study suggests that EP is a promising technique for pretreating mixed cultures for the enhanced production of biohydrogen.

The health benefits of physical activity (PA) are well recognized, and PA levels vary in different populations. The study aimed to investigate PA levels and associated sociodemographic factors among people with hypertension in a rural area in Bangladesh. Baseline data were part of a cluster randomized controlled trial of 307 adults aged 30–75 years to study the effectiveness of PA and lifestyle changes in lowering blood pressure. The outcome variables were PA at work, commuter, recreation, metabolic equivalent task (MET)-minute per week and sitting time. Total 68 (22.1%) people participated in vigorous-intensity activity, 23 (7.5%) participated in moderate-intensity sports. Overall, 83% of people were physically active more than 600 MET-min. Women (OR 2.95, 95% CI, 1.36–6.39) compared to men, and people with no education (OR 4.47, 95% CI, 1.62–12.33) compared to people with secondary school certificates or above were less physically active. Of total PA, 63% were work-related, and 1% were recreation-related for women, and these figures were 55% and 3% for men. The study reports that vigorous-intensity PA is low, and recreation time is minimal. Routine PA, especially for women and people with low education levels, should be encouraged to increase PA to manage hypertension.

Background Malaria is a global pandemic that results in approximately 228 million cases globally; 3.5% of these cases are in Southeast Asian countries, including Indonesia. Following the World Health Organization (WHO) initiative, Indonesia is in the process of achieving malaria-free zone status by 2030. However, the eastern part of Indonesia, including the East Nusa Tenggara Province (ENTP), still has a disproportionately high rate of malaria. Objective The aims of this cross-sectional study are to determine the awareness and knowledge, attitude, and practice toward various aspects of malaria among rural adults and their associated factors, including sociodemographic factors and ethnicities; assess the gap between coverage of, access to, and use of long-lasting insecticide-treated nets (LLINs) among the households; estimate the prevalence of and factors associated with malaria in rural adults; and develop a risk prediction model for malaria. Methods A multistage cluster sampling procedure with a systematic random sampling procedure at cluster level 4 was applied to recruit 1503 adults aged 18 years or older from the ENTP. Each participant participated in a face-to-face interview to assess their awareness and knowledge, attitude, and practice toward aspects of malaria, practices of sleeping under LLINs, and history of malaria. Information on sociodemographic, environmental, and lifestyle factors was also documented. The proportion of knowledge, attitude, and practice toward aspects of malaria and their variations across different sociodemographic and ethnic groups will be analyzed using descriptive statistics and chi-square tests. Coverage and access to LLINs will be evaluated based on the WHO recommendations. Malaria risk factors will be analyzed using logistic regression. Multilevel logistic regression will be applied to estimate the risk score for malaria. Results Of the total participants, 99.46% (1495/1503) of rural adults from 49 villages in the ENTP participated in a face-to-face interview from October to December 2019. The study results are expected to be published in peer-reviewed journals. Conclusions The best malaria risk prediction model will be developed in this study. In this protocol, we developed a methodology to provide new evidence to guide health policy in supporting the ENTP government’s expectation to achieve the malaria-free rating by 2030. International Registered Report Identifier (IRRID) DERR1-10.2196/23545

Culture-based methods for the detection of Legionella pneumophila are prohibitively slow and frequently inadequate. The problem has been addressed with biosensing technology that employs a variety ...

IntroductionThe Indonesian roadmap to malaria elimination in 2009 indicated that the nation is progressing towards achieve malaria elimination by 2030. Currently, most of the districts in the Western part of Indonesia have eliminated malaria, however, none of the districts in East Nusa Tenggara Province (ENTP) have met set targets. This study aims to investigate the status of malaria awareness of rural adults in the ENTP.MethodsA cross-sectional study was conducted between October and December 2019 in high, moderate, and low malaria endemic settings (MES) in ENTP. 1495 participants recruited by multi-stage sampling method were interviewed using a validated questionnaire, after obtaining informed consent. A malaria awareness index was developed based on ten questions. Logistic regression method was applied to investigate the significance of associations of malaria awareness with the three malaria endemic settings.ResultsParticipants were between the age of 18 and 89 years old, 51.4% were female and 45.5% had completed primary education. Malaria awareness index was very low (48.8%, 95% confidence interval (CI): 45.2 – 52.4). Malaria awareness of rural adults residing in low endemic settings was three times higher compared to those were living in high endemic settings (Odds ratio (OR): 3.11, 95% CI: 2.40 – 4.03, p < 0.001) and the basic malaria knowledge for participants living in low malaria endemic setting was almost five times higher than that of in high endemic setting (OR: 4.66, 95% CI: 3.50 – 6.20, p < 0.001). Of total participants, 81.3% (95% CI: 79.1 – 83.5) were aware that malaria could be prevented and 75.1% (95% CI: 72.6 – 77.6) knew at least one prevention measure. Overall, the awareness of fever as the main symptom of malaria, mosquito bites as the transmission mode of malaria, and seeking treatment within 24 hours when suffering with malaria was poor, 37.9% (95% CI: 33.9 – 41.9), 59.1% (95% CI: 55.9 – 62.3), and 46.0% (95% CI: 42.3 – 49.7) respectively. The poor level of awareness was statistically significantly different amongst three MES, the level of awareness was the lowest in the high endemic setting.ConclusionMalaria awareness of rural adults needs to be improved to address Indonesia’s national roadmap to malaria elimination. Results indicate public health programs at a local government level should incorporate the malaria awareness index in their key strategic intervention packages to address local malaria awareness.

The detection of pathogenic bacteria using biosensing techniques could be a potential alternative to traditional culture based methods. However, the low specificity and sensitivity of conventional biosensors, critically related to the choice of bio-recognition elements, limit their practical applicability. Mammalian antibodies have been widely investigated as biorecognition ligands due to high specificity and technological advancement in antibody production. However, antibody-based biosensors are not considered as an efficient approach due to the batch-to-batch inconsistencies as well as low stability. In recent years, antimicrobial peptides (AMPs) have been increasingly investigated as ligands as they have demonstrated high stability and possessed multiple sites for capturing bacteria. The conjugation of chemo-selective groups with AMPs has allowed effective immobilization of peptides on biosensor surface. However, the specificity of AMPs is a major concern for consideration as an efficient ligand. In this article, we have reviewed the advances and concerns, particularly the selectivity of AMPs for specific detection of pathogenic bacteria. This review also focuses the state-of-the-art mechanisms, challenges and prospects for designing potential AMP conjugated biosensors. The application of AMP in different biosensing transducers such as electrochemical, optical and piezoelectric varieties has been widely discussed. We argue that this review would provide insights to design and construct AMP conjugated biosensors for the pathogenic bacteria detection.

Culture-based methods for the detection of Legionellapneumophila are prohibitively slow and frequently inadequate. The problem has been addressed with biosensing technology that employs a variety of ligands for the specific capture of bacteria. However, the limited success of the application of mammalian antibodies, aptamers, and nucleic acid-based probes for sensitive biosensing has generated growing interest in exploring alternative biosensing architectures, such as those based on antimicrobial peptides (AMP) that are known for their attractive therapeutic applications. We report on the successful employment of cysteine-modified warnericin RK AMP for the operation of a highly sensitive biosensor of L. pneumophila based on digital photocorrosion of GaAs/AlGaAs nanoheterostructures. The replacement of the relatively cumbersome procedure commonly applied for the attachment of antibodies to COOH-terminated mercaptohexadecanoic acid self-assembled monolayers has allowed for a significant reduction in the distance at which bacteria are immobilized above the biosensor surface. An important consequence of this approach is the attractive limit of detection of L. pneumophila estimated at 2 × 102 CFU/mL. The target bacteria were captured four times more efficiently than P. fluorescens, B. subtilis, and E. coli, which is highly promising for environmental monitoring.

BACKGROUND Malaria is a global pandemic that results in approximately 228 million cases globally; 3.5% of these cases are in Southeast Asian countries, including Indonesia. Following the World Health Organization (WHO) initiative, Indonesia is in the process of achieving malaria-free zone status by 2030. However, the eastern part of Indonesia, including the East Nusa Tenggara Province (ENTP), still has a disproportionately high rate of malaria. OBJECTIVE The aims of this cross-sectional study are to determine the awareness and knowledge, attitude, and practice toward various aspects of malaria among rural adults and their associated factors, including sociodemographic factors and ethnicities; assess the gap between coverage of, access to, and use of long-lasting insecticide-treated nets (LLINs) among the households; estimate the prevalence of and factors associated with malaria in rural adults; and develop a risk prediction model for malaria. METHODS A multistage cluster sampling procedure with a systematic random sampling procedure at cluster level 4 was applied to recruit 1503 adults aged 18 years or older from the ENTP. Each participant participated in a face-to-face interview to assess their awareness and knowledge, attitude, and practice toward aspects of malaria, practices of sleeping under LLINs, and history of malaria. Information on sociodemographic, environmental, and lifestyle factors was also documented. The proportion of knowledge, attitude, and practice toward aspects of malaria and their variations across different sociodemographic and ethnic groups will be analyzed using descriptive statistics and chi-square tests. Coverage and access to LLINs will be evaluated based on the WHO recommendations. Malaria risk factors will be analyzed using logistic regression. Multilevel logistic regression will be applied to estimate the risk score for malaria. RESULTS Of the total participants, 99.46% (1495/1503) of rural adults from 49 villages in the ENTP participated in a face-to-face interview from October to December 2019. The study results are expected to be published in peer-reviewed journals. CONCLUSIONS The best malaria risk prediction model will be developed in this study. In this protocol, we developed a methodology to provide new evidence to guide health policy in supporting the ENTP government’s expectation to achieve the malaria-free rating by 2030. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/23545

The present study embarked on investigating the photo-fermentative bio-H2 production kinetics and statistical optimization of operational parameters using immobilized inoculum from dark fermented palm oil mill effluent (DPOME). The statistical optimized values of initial pH, inoculum-substrate percentage (ISP), and light intensity were achieved by implicating the central composite design (CCD) under response surface methodology (RSM). The kinetic evaluation was conducted in terms of H2-yield with ISP ranged from 10 to 30%. The highest H2 production potential (P) and rate (Rmax) of 30.59 ml.H2/g-CODremoved and 0.514 ml h−1 respectively were achieved with reported lag phase (ρ) value of 32 h by using 20% of ISP. However, an observed Rmax of 0.746 with a ρ value of 39 h was attained at ISP of 15%. The quadratic model developed by using CCD was observed to display the significance value of < 00.5 of probability error. Additionally, observed values of correlation coefficient (R2), adequate precision (AP), and coefficient of variance (CV) for acquired H2-yield were 0.9219, 12.076, and 11.24 ml.H2/g-CODremoved, respectively. Under optimal conditions values (initial pH, 6.0; ISP, 20%; and light intensity, 350% W/m2), H2 yield of 147 ml.H2/g-CODremoved was achieved from DPOME, while reducing the COD value by 78 percentage. This statistical model is suggested to possess the regression, interaction, and quadratic terms as significant, so it can be deemed acceptable in terms of its achievable reproducibility.

Aims Endothelial dysfunction is a precursor to the development of symptomatic atherosclerosis. Retinal microvascular reactivity to flicker light stimulation is a marker of endothelial function and can be quantified in vivo. We sought to determine whether retinal microvascular endothelial dysfunction predicts long-term major adverse cardiovascular events (MACE). Methods and results In a single center prospective observational study, patients with coronary artery disease (CAD) or cardiovascular risk factors underwent dynamic retinal vessel assessment in response to flicker light stimulation and were followed up for MACE. Retinal microvascular endothelial dysfunction was quantified by measuring maximum flicker light-induced retinal arteriolar (FI-RAD) and venular dilatation (FI-RVD). In total, 252 patients underwent dynamic retinal vessel assessment and 242 (96%) had long-term follow-up. Of the 242 patients, 88 (36%) developed MACE over a median period of 8.6 years (IQR 6.0-9.1). After adjustment for traditional risk factors, patients within the lowest quintile of FI-RAD had the highest risk of MACE (OR 5.21; 95% CI 1.78, 15.28). Patients with lower FI-RAD were also more likely to die (OR 2.09; 95% CI 1.00, 4.40, per standard deviation decrease in FI-RAD). In Kaplan-Meier analysis, patients with FI-RAD responses below the cohort median of 1.4% exhibited reduced MACE-free survival (55.5 vs. 71.5%; log-rank p = 0.004). FI-RVD was not predictive of MACE. Conclusions Retinal arteriolar endothelial dysfunction is an independent predictor of MACE in patients with CAD or cardiovascular risk factors. Dynamic retinal vessel analysis may provide added benefit to traditional risk factors in stratifying patients at risk for cardiovascular events. Translational perspective Subclinical endothelial dysfunction precedes cardiovascular diseases and can be assessed non-invasively using the retinal microvascular network. Retinal arteriolar endothelial dysfunction is an independent predictor of MACE and all-cause mortality in patients with established coronary artery disease or cardiovascular risk factors. Validation studies and investigation into the lifestyle and pharmacological modifiability of endothelial dysfunction could enhance risk prediction and guide intensification of therapy.

An understanding of the inter-species relationships, especially their metabolic network in a mixed-culture system, is crucial to design an effective inoculum for enhancing the power generation of wastewater fed microbial fuel cell (MFC). In the present study, the influence of microbial mutualistic interactions on the power generation of palm oil mill effluent fed MFCs has been widely investigated by designing several co-culture and mixed culture inoculums. Among the different inoculum compositions, the highest power density of 14.8 W/m3 was achieved by Pseudomonas aeruginosa and Klebsiella variicola co-culture inoculum due to their synergistic relationships which were inter-linked via fermentation-based metabolites. Besides, the interaction of K. variicola and Bacillus cereus positively influenced the power generation resulting in a maximum power density of 11.8 W/m3 whereas the antagonistic relationship between B. cereus and P. aeruginosa resulted in a lower power generation of 1.9 W/m3. The microbial mutualistic interactions were investigated with polarization, cyclic voltammetry (CV), electrochemical impedance spectroscopy (EIS), as well as by using metabolite and biofilm analysis. It was observed that the synergism between bacteria enhanced power generation through the production of higher electron shuttling mediators and efficient biofilm formation as evidenced by polarization, CV and EIS analysis. In contrast, the antagonistic relationship resulted in production of cell inhibiting metabolites leading to the formation of ineffective biofilm. These findings demonstrate that the synergistic interaction between or within microorganisms is emergent in designing co-culture or mixed-culture inoculum for achieving maximum power generation in MFCs.

BackgroundThis investigation aims to validate the psychometric properties of the modified 19-item Bengali version World Health Organization Quality of Life (WHOQOL) instrument in a typical healthy rural population in Bangladesh.MethodThe cross-sectional investigation collected 300 adults aged 18–85 years from Narail, a rural district of Bangladesh using a multi-stage cluster random sampling technique. Face-to-face interviews were conducted between July and August 2018 using an Android phone installed with a mobile data collection application CommCare. SPSS version 25; IBM. and a Rasch analysis software RUMM2030 were used for analyses.ResultsResults showed good overall fit, as indicated by a significant item-trait interaction with Bonferroni correctedpvalues, for physical ($$ {\upchi}_{(20)}^2 $$χ202=32.13,p = 0.041), psychological ($$ {\upchi}_{(16)}^2 $$χ162=14.93,p = 0.529), social ($$ {\upchi}_{(16)}^2 $$χ162=12.62,p = 0.397), and environmental ($$ {\upchi}_{(20)}^2 $$χ202=22.01,p = 0.339) domains. Item fit residual (IFR) values for all domains were within the desired limits, indicating no deviation from the expected relationship between the individual items and the rest of the items of the scale. Person fit residual (PFR) values also showed no person misfit among the samples, indicating item threshold are suitable for Rasch analysis. Reliability of the three domains of the 19-item WHOQOL scale was very good as indicated by a person separation index (PSI) = 0.873 and Cronbach’s Alpha (CA) = 0.881 for physical domain, PSI = 0.739 and CA = 0.746 for psychological domain, and PSI = 0.753 and CA = 0.781 for environmental domain. The social domain (PSI = 0.650 and CA = 0.669) had below acceptable reliability. All items in each domain had ordered thresholds except one item of the environmental domain. All four domains of the 19-item WHOQOL scale showed unidimensionality and was free from local dependency. Each domain also showed similar functioning for adults and older adults, males and females, no education and at least primary level of education, low and high socio-economic conditions.ConclusionThe 19-item modified WHOQOL scale is confirmed as an efficient screening tool for measuring QoL among healthy rural Bangladeshi people. The scale could be implemented more widely. In particular, validations are required for diseases-specific population in Bangladesh to measure the Health Related Quality of life (HR-QoL) assessments for people suffering from chronic or other diseases.

ObjectivesThis investigation expected to validate the psychometric properties of the modified seven-item Kessler psychological distress scale (K7) for measuring psychological distress in healthy rural population of Bangladesh.DesignCross-sectional study.SettingNarail district, Bangladesh.ParticipantsA random sample of 300 adults of age 18–90 years were recruited. Face-to-face interviews were conducted between July and August 2018 using an Android phone installed with a mobile data collection application known as CommCare.Outcome measureValidation of the K7 was the major outcome. Sociodemographic factors were measured to assess for Differential Item Functioning to check if the tool functions equally in different factors. Rasch analysis was carried out for the validation of the K7 scale in the healthy rural population of Bangladesh. RUMM2030 was used for the analyses.ResultsResults showed good overall fit, as indicated by a non-significant item-trait interaction (χ2=44.54, df=28, p=0.0245) compared with a Bonferroni adjusted p value of 0.007. Both item fit (mean=0.30, SD 1.22) and person fit residuals (mean=–0.18, SD 0.85) showed perfect fit. Reliability was very good as indicated by a Person Separation Index=0.85 and Cronbach’s alpha=0.89. All individual items were ordered thresholds. The K7 scale showed adequate reliability, unidimensionality and was free from local dependency. The K7 scale also showed similar functioning for adults and older adults, males and females, no education and any level of education, and at least some financial instability versus no financial instability.ConclusionsValidation of K7 scale confirmed that the tool is suitable for measuring psychological distress among the rural Bangladeshi population. Further research should validate the K7 scale in different rural settings in Bangladesh to determine a valid cut-off score for assessment of severity levels of psychological distress. The K7 scale should also be tested in other developing countries where sociodemographic characteristics are similar to those of Bangladesh.

Purpose: This Australian study piloted a new measure of Orientation and Mobility to better understand the functional mobility of guide dog handlers with low vision or blindness. It is expected that this measure can be used to better match guide dogs to their handlers. Materials and methods: The new Orientation and Mobility Outcomes tool scores a client in Stable/Familiar and Dynamic/Unfamiliar conditions, also considering Travel-Related Wellbeing. Semi-structured interviews were conducted with 51 guide dog handlers, during which travel skills were co-rated with an interviewer. Results: A cluster analysis of the Orientation and Mobility Outcomes data identified four mobility styles: intrepid explorers, social navigators, independent roamers and homebodies. The differences between these clusters had more to do with mental mapping skills than level of vision, and different guide dog characteristics were needed to support the travel styles identified for each cluster. Conclusions: The results confirm the importance of the Orientation and Mobility Outcomes tool as a sensitive, person-centred measure of the impact of Orientation and Mobility and guide dog training. In particular, the four mobility clusters provide a new perspective on matching guide dogs with clients, also suggesting the need for a more personalised look at the guide dog training process.Implications for RehabilitationOrientation and Mobility Outcomes data seem precise enough to support and inform the process of matching guide dogs to handlers.Uniform results cannot be expected from guide dog mobility in handlers – age, stage of life, health and spatial cognition impact the competence and travel style of guide dog handlers, whereas vision is less important.Sharing the work of visual interpretation and decision making with a guide dog makes independent travel more possible.Valuable dog characteristics that are specific to handler requirements might be bred or trained from puppy raising onwards, creating a more diverse pool of dogs to draw upon. Orientation and Mobility Outcomes data seem precise enough to support and inform the process of matching guide dogs to handlers. Uniform results cannot be expected from guide dog mobility in handlers – age, stage of life, health and spatial cognition impact the competence and travel style of guide dog handlers, whereas vision is less important. Sharing the work of visual interpretation and decision making with a guide dog makes independent travel more possible. Valuable dog characteristics that are specific to handler requirements might be bred or trained from puppy raising onwards, creating a more diverse pool of dogs to draw upon.

Microalgal biofuels are considered as one of the most promising substitutes to the nonrenewable fossil fuels. However, the efficient recovery of microalgal lipids is emergent for the overall process economics and sustainability. The conventional lipid extraction technique entails direct use of organic solvents to liberate the intracellular lipids, thus making the extraction process more time-consuming and less eco-friendly. Furthermore, the efficiency of extraction process is affected by several problems, such as the rigid structure and composition of microalgal cell walls, the water content of biomass, the limited accessibility of lipids, the reduced mass transfer, and the formation of stable emulsions. Various modifications (e.g., use of green solvents, direct transesterification, pretreatment for disrupting microalgal cells, etc.) to conventional lipid extraction have been proposed to mitigate the problems associated with lipid extraction. Among them, the pretreatment approach (i.e., mechanical, chemical, biological cell disruption) in combination with solvent-based extraction would be a promising approach to address the problems during lipid extraction. Therefore, intensive research, review, and analysis are required to understand the challenges in lipid extraction and to develop a useful extraction process in terms of biomass status (dry/wet), solvent use, lipid yield, extraction time, and scalability. In this chapter, we have reviewed the composition and possible applications of microalgal lipids with the main challenges in their extraction process. Furthermore, the advantages and limitations of several pretreatment methods for cell disruption have been comprehensively discussed.

The depletion of nonrenewable energy sources drives the exploration for renewable energy sources as an alternation route of energy generation. Hence, in the past decade, research efforts have been employed to explore potential renewable energy sources utilizing waste biomass. Anaerobic digestion (AD) is considered as an efficient technique to treat different kinds of wastes such as agricultural, industrial, and food wastes to produce renewable energy. Until now, two predominant fermentation processes, namely submerge or liquid-state anaerobic fermentation (LSAF) and dry or solid-state anaerobic fermentation (SSAF) have been implemented to extract energy from waste biomass. Nowadays, SSAF is claimed to be more advantageous than LSAF for a number of reasons including its comparatively smaller reactor volume, lower energy requirements for heating, minimal material handling, and lower total parasitic energy loss. Due to its low moisture content, the digestate of SSAF can be used as fertilizer or pelletized fuel, which is much easier to handle than the effluent from LSAF. However, for enhancing the performance of dry AD processes, a suitable reactor needs to be designed so that the maximum amount of substrate could be fermented, to make the technology more economically viable. Therefore this chapter is aimed at discussing the different kinds of bioreactors along with their potential benefits, challenges, and limitations, which have been explored recently for biogas production through dry fermentation.

Microbial fuel cells (MFCs) are considered as promising technology to achieve simultaneous wastewater treatment and electricity generation. However, operational and technological developments are still required to make it as a sustainable technology. In the present study, response surface methodology (RSM) was used to evaluate the effects of substrate concentration, co-culture composition, pH and time on the performance of co-culture (Klebsiella variicola and Pseudomonas aeruginosa) inoculated double chamber MFC. From the statistical analysis, it can be seen that the performance of MFC was not influenced by the interaction between the initial COD and time, pH and time, pH and initial COD, time and initial COD. However, the interaction between the inoculum composition and time, pH and the inoculum composition, initial COD and inoculum composition significantly influenced the performance of MFC. Based on the RSM results, best performance (power density and COD removal efficiency) was obtained when the inoculum composition, initial COD, pH and time were about 1:1, 26.690 mg/L, 7.21 and 15.50 days, respectively. The predictions from the model were in close agreement with the experimental results suggesting that the proposed model could adequately represent the actual relationships between the independent variables generating electricity and the COD removal efficiency.

Biological hydrogen production through photo-fermentative process using dark fermented palm oil effluent (DPOME) is a cost effective and environmentally benign process. In this study, effect of various factors like light intensity, agitation rate and dilution of DPOME on the hydrogen productivity of Rhodopseudomanas palustris were investigated using batch system. Investigation methods like response surface methodology (RSM) and Box-Behnken design were employed to investigate the optimum conditions for enhanced photo-fermentative hydrogen production. The regression analysis suggested that hydrogen yield was well fitted by a quadratic polynomial equation (R2 = 0.92). The hydrogen production was investigated by varying the intensity levels of these three independent variables, in which all have significant influences on hydrogen yield. The set of 19 experimental runs were conducted to optimize these variables. The highest hydrogen yield of 3.07 ± 0.66 H2 yield mol-H2/mol-acetate was obtained under the optimum condition of light intensity 250 W/m2, agitation rate 200 rpm, and 30% dilution of DPOME. The experimentally obtained hydrogen yield found out to be in a good agreement with predicted yield which was about 2.80 mol-H2/mol-acetate. In short, results suggest that experimental strategy using RSM approach along with Box-Behnken design can be a promising approach to achieve enhanced biological hydrogen production.

The aim of the study was to investigate the feasibility of using irreversible electroporation (EP) as a microbial cell disruption technique to extract intracellular lipid within short time and in an eco-friendly manner. An EP circuit was designed and fabricated to obtain 4 kV with frequency of 100 Hz of square waves. The yeast cells of Lipomyces starkeyi (L. starkeyi) were treated by EP for 2-10 min where the distance between electrodes was maintained at 2, 4, and 6 cm. Colony forming units (CFU) were counted to observe the cell viability under the high voltage electric field. The forces of the pulsing electric field caused significant damage to the cell wall of L. starkeyi and the disruption of microbial cells was visualized by field emission scanning electron microscopic (FESEM) image. After breaking the cell wall, lipid was extracted and measured to assess the efficiency of EP over other techniques. The extent of cell inactivation was up to 95% when the electrodes were placed at the distance of 2 cm, which provided high treatment intensity (36.7 kWh m-3 ). At this condition, maximum lipid (63 mg g-1 ) was extracted when the biomass was treated for 10 min. During the comparison, EP could extract 31.88% lipid while the amount was 11.89% for ultrasonic and 16.8% for Fenton's reagent. The results recommend that the EP is a promising technique for lowering the time and solvent usage for lipid extraction from microbial biomass. © 2018 American Institute of Chemical Engineers Biotechnol. Prog., 34:838-845, 2018.

The interspecies interactions in microbial communities are very complex, rendering identification of synergistic or antagonistic relationships very difficult; however, understanding the mutualistic relationship between the microbes is exigent to gain deeper insight into their performance in wastewater fed microbial fuel cells (MFCs). In the present study, we aimed to explore the ecological networks between the microorganisms in a defined coculture system comprising with Pseudomonas aeruginosa (P. aeruginosa) and Klebsiella variicola (K. variicola). The coculture showed around 3 times higher current density in MFCs compared with either of these two bacteria alone. Metabolite analysis demonstrated that the fermentative metabolite (1,3-propanediol) produced by K. variicola stimulated the P. aeruginosa to produce a higher amount of pyocyanin through synergistic interactions, leading to the enhancement in the performance of coculture MFCs fed with palm oil mill effluent (POME). This study proves that the metab...

Although exogenous mediators can distinctly enhance the performance of yeast driven microbial fuel cell (MFC), the possibility of mediator’s toxicity, environmental risk, and cost are the main challenges facing toward its application in MFCs. Therefore, the use of naturally produced electron shuttles for unmediated yeast would be of great interest since it can solve most of the above-mentioned problems. The present study is to investigate the possibility of the use of electron shuttle producing bacteria Klebsiella pneumonia (K. pneumonia) to boost up the performance of yeast Lipomyces starkeyi (L. starkeyi) driven MFC. The MFCs inoculated with L. starkeyi and K. pneumoniae coculture achieved a maximum power density of 12.87 W/m3 which is about 3 and 6 times higher than that of MFC solely inoculated with pure yeast and bacteria, respectively, demonstrating that the yeast cells have successfully utilized the reduced electron shuttles excreted by the bacteria. The occurrence of the mutualistic interactions w...

Aim To identify the current roles of eye and health care workers in eye care delivery and investigate their potential roles in screening and detection for management of diabetic retinopathy (DR) through task sharing. Methods Purposive sampling of 24 participants including health administrators, members from non-government organizations and all available eye care workers in Takeo province were recruited. This cross sectional mixed method study comprised a survey and in-depth interviews. Data were collected from medical records at Caritas Takeo Eye Hospital (CTEH) and Kiri Vong District Referral Hospital Vision Centre, and a survey and interviews with participants were done to explore the potential roles for task sharing in DR management. Qualitative data were transcribed into a text program and then entered into N-Vivo (version 10) software for data management and analysis. Results From 2009 to 2012, a total of 105 178 patients were examined and 14 030 eye surgeries were performed in CTEH by three ophthalmologists supported by ophthalmic nurses in operating and eye examination for patients. Between January 2011 and September 2012, 151 patients (72 males) with retinal pathology including 125 (83%) with DR visited CTEH. In addition 170 patients with diabetes were referred to CTEH for eye examinations from Mo Po Tsyo screening programs for people with diabetes. Factors favouring task sharing included high demand for eye care services and scarcity of ophthalmologists. Conclusion Task sharing and team work for eye care services is functional. Participants favor the potential role of ophthalmic nurses in screening for DR through task sharing.

The discharge of palm oil mill effluent (POME) on arable land causes large amounts of environmental distress due to its high concentration of phenolic compounds and chemical oxygen demand (COD). The approach of simultaneous microbial oil production and wastewater treatment is an attractive option to combine renewable energy production and environmental resilience. This study aims to produce cost effective microbial lipids using the oleaginous yeast Lipomyces starkeyi through the bioremediation of POME. A moderately dilute solution (50%) of POME showed higher microbial growth and lipid accumulation and offered a significantly higher degree of bioremediation. A lipid content of 21.32% was achieved with 50% POME, whereas the value was 15.14% for 25% POME. Three different techniques including ultrasonic treatment, Fenton's reagent and Fenton's + ultrasonic were employed to extract lipids from microbial biomass, and the maximum lipid concentration was obtained using the Fenton's + ultrasonic treatment. The degree of bioremediation was evaluated by the calculating seed germination index (GI) values. Higher GI values were observed for the 25% and 50% dilutions compared to undiluted (100%) POME. This combined approach can be a potential alternative technology that integrates bioremediation of POME with microbial lipid production.

Introduction The 2009 Indonesian roadmap to malaria elimination indicated that the nation had been progressing towards achieving malaria elimination by 2030. Currently, most of the districts in the western part of Indonesia have eliminated malaria; however, none of the districts in the East Nusa Tenggara Province (ENTP) have met these set targets. This study aimed to investigate the status of malaria awareness of rural adults in the ENTP. Methods A community-based cross-sectional study was conducted between October and December 2019 in high, moderate, and low malaria-endemic settings (MESs) in the ENTP. After obtaining informed consent, data were collected using an interviewer-administered structure questionnaire among 1503 participants recruited by a multi-stage cluster sampling method. A malaria awareness index was developed based on ten questions. A binary logistic regression method was applied to investigate the significance of any association between malaria awareness and the different MESs. Results The participation rate of the study was 99.5%. Of this number, 51.4% were female and 45.5% had completed primary education. The malaria awareness index was significantly low (48.8%, 95% confidence interval [CI]: 45.2–52.4). Malaria awareness of rural adults residing in low endemic settings was two times higher than for those living in high endemic settings (adjusted odds ratio [AOR]: 2.41, 95% CI: 1.81–3.21) and the basic malaria knowledge of participants living in low malaria-endemic settings was almost four times higher than that in high endemic settings (AOR: 3.75, 95% CI: 2.75–5.11). Of the total participants, 81.3% (95% CI: 79.1–83.5) were aware that malaria could be prevented and 75.1% (95% CI: 72.6–77.6) knew at least one prevention measure. Overall, the awareness of fever as the main symptom of malaria, mosquito bites as the transmission mode of malaria, and seeking treatment within 24 hours of suffering from malaria was poor at 37.9% (95% CI: 33.9–41.9), 59.1% (95% CI: 55.9–62.3), and 46.0% (95% CI: 42.3–49.7), respectively. The poor level of awareness was significantly different amongst the three MESs, with the lowest levels of awareness in the high endemic setting. Conclusion Malaria awareness of rural adults needs to be improved to address Indonesia’s national roadmap for malaria elimination. Results indicated that public health programs at a local government level should incorporate the malaria awareness index in their key strategic intervention to address malaria awareness.

Biohydrogen production from different types of waste biomass using mixed culture inoculum has been an active research area in recent years. Several emerging techniques has been studied targeting to achieve higher efficiency and competitive hydrogen production through the dark fermentation. However, the production of biohydrogen from complex waste biomass meets the setback of lower final product yield due to the low substrate degradation rate. Besides, hydrogen consuming microbes in the mixed culture impede the rate of biohydrogen production. Thus, the waste biomass substrate and microbial inoculum are highly required to pretreat for enhancing system performance. With the aim to gain deeper insight into waste biomass and inoculum pretreatment techniques, this review compiles recently practiced pretreatment techniques with their limitations. The major challenges of these methods and few strategies to overcome these limitations with future directions are discussed in this review. Moreover, the efficiency of a potential nonconventional pretreatment technique such as electroporation (EP) over traditional techniques to degrade the complex waste biomass and reduce the load of hydrogen consuming microbes in the mixed culture consortium was reviewed. This review argued to provide a deeper insight to develop an efficient pretreatment technique by combining traditional techniques and EP for enhancing mixed culture driven biomass-based hydrogen production.

In the present work, the wild type Klebsiella variicola was investigated in double chamber microbial fuel cell (MFC) using palm oil mill effluent as substrate which achieved high power density (4.5 W/m3) and coulombic efficiency (63%) while maintaining the moderate chemical oxygen demand (COD) removal efficiency (58%). The effect of biofilm formation on power generation over time was also evaluated and found that an effective biofilm with the discrete distribution of single layer microorganisms can produce high power corresponding to low charge transfer resistance. The growth of biofilm in multilayers consisting of outnumbered dead cells in the vicinity of the electrode surface caused the polarization resistance and diffusion resistance resulting in a sharp drop in the current generation. The removal of multilayer biofilm from the anode surface positively influenced the cell performance which led to a rapid increase in current generation and thus revealed that effective biofilm predominated by live cells can be an emergent factor for achieving maximum performance in MFC.

Mutual interactions between microorganisms play a vital role in the formation of electroactive biofilms, which is a key element in the longevity and success of bioelectrochemical systems. The present study was intended to examine both the electrogenic properties of B. cereus and its ability to inhibit methanogenesis in microbial fuel cells (MFCs). The potential influence of the incorporation of B. cereus into anaerobic sludge (AS) on the electrochemical activity was assessed using cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS) analyses. The CV of MFCs with B. cereus showed a strong redox peak, suggesting that B. cereus has electrogenetic properties. Moreover, the incorporation of B. cereus into AS provided an enhancement in the power generation (4.83 W/m3) and the CE (22%) of the MFC compared to the corresponding values for an MFC inoculated solely with AS (1.82 W/m3, 12%). The increase in power generation could be due to the antimethanogenic property of B. cereus, which was evid...

In the present work, simultaneous power generation and wastewater treatment in the single chamber air cathode microbial fuel cell (MFC) have been enhanced by introducing wild-type Klebsiella variicola (K. variicola) as an efficient inoculum for the anode operated with palm oil mill effluent (POME). K. variicola was isolated from municipal wastewater (MWW) and identified using BIOLOG gene III analysis, PCR and sequencing. The performance of K. variicola in MFC was evaluated by polarization curve measurement, electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) analysis. The MFC with K. variicola achieved a maximum power density of about 1.7 W m−3 which is comparatively higher than most widely used anaerobic sludge (215 mW m−3) as an inoculum whereas COD removal efficiency is (43%) lower than anaerobic sludge (74%). Moreover, K. variicola has the ability to produce electron shuttles and to form biofilms on the electrode surface which helps to significantly reduce the anode charge transfer (Rct) resistance compared to the anaerobic sludge. These results revealed the potential of K. variicola to be used in MFC.

Anodic biofilm plays a crucial role in bioelectrochemical system to make it sustainable for long-term performance. However, the accumulation of dead cells over time within the anode biofilm can be particularly detrimental for current generation. In this study, the effect of ultrasound on anode biofilm thickness was investigated in microbial fuel cells (MFCs). Ultrasonic treatment was employed for different durations to evaluate its ability to control the thickness of the biofilm to maintain stable power generation. Cell viability count and field emission scanning electron microscopy (FESEM) analysis of the biofilms over time showed that the number of dead cells increased with the increase of biofilm thickness, and eventually exceeded the number of live cells by many-fold. Electrochemical impedance spectroscopy (EIS) analysis indicated that the high polarization resistance appeared due to the dead layer formation, and thus the catalytic efficiency was reduced in MFCs. The stable power generation was achiev...

Viable electroactive biofilm formation, allowing considerable conversion capacity and opportunities for extracellular electron transfer (EET) is essential for sustainable and long term stable power generation in microbial fuel cells (MFCs). However, over the time, the anodic biofilm can be particularly detrimental for electrogenesis due to the accumulation of more dead cells and that increases the charge transfer resistance as well as reduces the electrocatalytic efficiency. In this study, flow induced shear stresses (4.38, 9.34 and 14.92 mPa) were employed to revitalize the biofilm by removing the inert biomass for the maintenance of stable power in MFCs. Among them, the moderate shear stress (9.34 mPa) successfully reduced the thickness and thereby revitalized the biofilm within a short time. The field emission scanning electron microscopy (FESEM) and cell viability count analysis of the biofilms confirmed that the shear stress (9.34 mPa) reduced the dead cells accumulation in the biofilm. Moreover, this treatment significantly reduced the polarization resistance (68%) by dislodging nonconductive inert dead cells from the surface. Our results revealed that the application of shear stress could be an effective method to maintain the stable power generation by reducing the thickness and increasing the cell viability of the biofilm in the MFC.

High prevalence of blindness coupled with low public awareness of eye diseases is a severe problem in Pakistan. The objective of this study was to evaluate the awareness, attitude and practices related to common ocular problems and eye care use among general population of Punjab, Pakistan. Data were collected cross-sectionally, using random selection of participants from five districts of Punjab, Pakistan. A pre-tested questionnaire was used to collect the data from January to March 2017. The ordinal data were converted to interval--based data by Rasch analysis, which is termed as &ldquo, knowledge score&rdquo, and ranges from &minus, 3 to +3. Descriptive statistics, linear regression, binary logistic regression and chi square analysis were performed to evaluate the data. Of the 2073 people contacted, 96.4% (2019) responded the interviewer. The mean (SD) age was 39.9 (11.4) years, majority were males (64.8%) and only 3.1% were illiterate. The majority (68.1%) of respondents were aware that blindness can be prevented and are least aware of age-related macular degradation (31.4%). Multivariate analysis to knowledge scores demonstrated that male gender (&beta, = 0.53 95%CI = 0.39, 0.66, p &lt, 0.001), higher education (&beta, = 0.31 95%CI = 0.25, 0.37, p &lt, 0.001) were significantly associated with knowledge score. Eighty-two percent of our respondents had a positive attitude towards health-seeking behavior and those who had adequate income on most of occasions were 1.82 (AOR = 1.82 95%CI = 1.26, 2.62 p = 0.001) times more prone towards health-seeking behavior than those who had insufficient income. Out of all respondents, 21.5% had an eye examination at least once a year and this frequency was significantly higher in lower age, females, high education and high Socio Economic Status level (p &lt, 0.05). Among the general population of Pakistan, awareness about prevention of blindness and refractive error was optimum, while awareness of blindness causing eye conditions, like age-related macular degradation was low. Intensive improvements in the health literacy and public interventions&mdash, specifically in old age people, males and respondents with lower education&mdash, are urgently needed.

Background This study aimed to validate the psychometric properties of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) questionnaire for use in a rural district of Bangladesh. Methods This cross-sectional study recruited a multi-stage cluster random sample of 2425 participants from the rural district Narail of Bangladesh in May–July 2017. Rasch analysis was carried out using the sampled participants, as well as multiple validation random sub-samples of 300 participants, to validate four domains of the WHOQOL-BREF questionnaire: physical, psychological, social and environmental. Results The original WHOQOL-BREF appeared to be a poor fit for both sampled and sub-sampled group of participants in Narail district in all underlying domains: physical, psychological, social and environmental. Two items (sleep and work capacity) from the physical domain, two items (personal belief and negative feelings) from the psychological domain and three items (home environment, health care and transport) from the environment domain were excluded for goodness of fit of the Rasch model. The social domain exhibited reasonably reliable fitness while fulfilling all the assumptions of the Rasch model. A modified version of the WHOQOL-BREF questionnaire using five-items for the physical (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\upchi}_{(20)}^2 $$\end{document}χ202 = 36.47, p = 0.013, Person Separation Index (PSI) = 0.773), four-items for the psychological (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\upchi}_{(16)}^2 $$\end{document}χ162 = 28.30, p = 0.029, PSI = 0.708) and five-items for the environmental (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\upchi}_{(20)}^2 $$\end{document}χ202 = 36.97, p = 0.011, PSI = 0.804) domain was applied, which showed adequate internal consistency, reliability, unidimensionality, and similar functioning for different age-sex distributions. Conclusions The modified WHOQOL-BREF questionnaire translated into Bengali language appeared to be a valid tool for measuring quality of life in a typical rural district in Bangladesh. Despite some limitations of the modified WHOQOL-BREF questionnaire, further application of Rasch analysis using this version or an improved one in other representative rural areas of Bangladesh is recommended to assess the external validity of the outcomes of this study and to determine the efficacy of this tool to measure the quality of life at the national rural level. Electronic supplementary material The online version of this article (10.1186/s12913-019-4026-0) contains supplementary material, which is available to authorized users.

ObjectivesUtility of CT coronary angiography (CTA) and coronary artery calcium (CAC) scoring in risk stratification prior to non-cardiac surgery is unclear. Although current guidelines recommend stress testing in intermediate-high risk individuals, over one-third of perioperative major adverse cardiovascular events (MACE) occur in patients with a negative study. This systematic review and meta-analysis evaluates the value of CTA and CAC score in preoperative risk prognostication prior to non-cardiac surgery.MethodsMEDLINE, PubMed and EMBASE databases were searched for articles published up to June 2018. Summary ORs for degree of coronary artery disease (CAD) and perioperative MACE were pooled using a random-effects model.ResultsEleven studies were included. Two hundred and fifty-two (7.2%) MACE occurred in 3480 patients. Risk of perioperative MACE rose with the severity and extent of CAD on CTA (no CAD 2.0%; non-obstructive 4.1%; obstructive single-vessel 7.1%; obstructive multivessel 23.1%, pConclusionsSeverity and extent of CAD on CTA conferred incremental risk for perioperative MACE in patients undergoing non-cardiac surgery. The ‘rule-out’ capability of CTA is comparable to other non-invasive imaging modalities and offers a viable alternative for risk stratification of patients undergoing non-cardiac surgery.Trial registration numberCRD42018100883

Microbial oils are considered as alternative to vegetable oils or animal fats as biodiesel feedstock. Microalgae and oleaginous yeast are the main candidates of microbial oil producers' community. However, biodiesel synthesis from these sources is associated with high cost and process complexity. The traditional transesterification method includes several steps such as biomass drying, cell disruption, oil extraction and solvent recovery. Therefore, direct transesterification or in situ transesterification, which combines all the steps in a single reactor, has been suggested to make the process cost effective. Nevertheless, the process is not applicable for large-scale biodiesel production having some difficulties such as high water content of biomass that makes the reaction rate slower and hurdles of cell disruption makes the efficiency of oil extraction lower. Additionally, it requires high heating energy in the solvent extraction and recovery stage. To resolve these difficulties, this review suggests the application of antimicrobial peptides and high electric fields to foster the microbial cell wall disruption.

Assess the correlation between optical coherence tomography findings and change in vision for patients receiving "treat and extend" protocol ranibizumab for neovascular age-related macular degeneration.Optical coherence tomography analysis and best-corrected visual acuity (BCVA) change: mild = 5 to 9 letters, moderate = 10 to 14 letters, and severe ≥15 letters.A total of 103 eyes (99 patients, 63% female, 65-91 years) followed for 20.8 ± 4.9 months. By 12 months, there were 1.38 ± 0.59 instances of intraretinal fluid (IRF)/subretinal fluid recurrence on optical coherence tomography and 1.25 ± 1.00 instances of BCVA loss (≥5 letters) per patient. When BCVA was lost, IRF/subretinal fluid was present in 37.3% of cases. Occurrences of severe BCVA loss were less likely to recover vision than when BCVA loss was mild (5.9% vs. 75.6%, P = 0.001). New occurrence of IRF (33.9%) or subretinal fluid (29.6%) was more likely to lead to BCVA loss, compared with dry (16.6%) or persistent IRF (11.9%) or persistent subretinal fluid (14%, P0.001). With persistent fluid, any new loss of vision had a lower chance of recovery than when fluid was new in onset (64.3% vs. 85.3%, P = 0.04).During ranibizumab treatment, vision can decrease without signs of fluid. When fluid is present, IRF is associated with poorer vision. New occurrence of any fluid on optical coherence tomography is likely to lead to vision loss, but small amounts of persistent fluid can be tolerated without compromising vision.

Objectives: The purpose of this study were (i) to assess the knowledge, attitudes and practice (KAP) and impact of socioeconomic factors upon the prevalence of pre-diabetes and diabetes (ii) compute a diabetes risk score and (iii) estimate the undiagnosed prevalence of hypertension amongst a large adult population in rural Bangladesh. Methods/design: A sample of 3104 adults aged ?30 years were interviewed from a cluster sample of 18 villages in the Banshgram Union of the Narail District, Bangladesh. Each participant was interviewed using a semi-structured questionnaire that assessed participant knowledge, attitudes and practice (KAP) regarding diabetes, its risk factors, complications and management. Data on demographic details, education, socioeconomic status, medical history, dietary and lifestyle behavior was obtained. Fasting capillary glucose, blood pressure, presenting vision and anthropometric parameters were measured. Participants were stratified into those without diabetes, pre-diabetes, and diagnosed diabetes (known and newly diagnosed). The association of KAP components and other risk factors with diabetes status was assessed. Logistic regression analysis allowed for the development of a non-invasive risk-stratification tool to be developed and implemented for the rural Bangladeshi community. Multinomial logistic regression was applied to report the associations of risk factors with the severity of hypertension. Results and discussion: In Banshgram, over 95% people had not undergone any previous diabetes screening. Baseline demographics estimated the prevalence of diabetes in the sample was 3.2% (n=99). 47% of participants had no formal education. Whilst there is literature on the prevalence of diabetes in urban and semi-urban Bangladesh there is a paucity of evidence examining the impact of KAP of diabetes amongst the general community. We believe that the BPDES has developed a methodology to provide new evidence to guide health policy and targeted population-based interventions in these rural areas.Bangladesh Journal of Medical Science Vol.14(4) 2015 p.367-375

Background People with autism spectrum disorder (ASD) have an increased susceptibility for many chronic health conditions compared with their peers. An increasing number of adolescents are transitioning from pediatric to adult healthcare services. Thus, being able to access appropriate healthcare services that can not only address specific needs of the person but enable them to better manage healthcare conditions and decrease the development of preventable disease is necessary. A systematic review was conducted to identify barriers and enablers of healthcare access for autistic adults. Methods The studies included in the review were quantitative and qualitative and were published between 2003 and 2019. The participants for the review are considered to be adults (over 18 years of age) with a primary diagnosis of ASD. Results In total, 1290 studies were initially identified and 13 studies were included based on the inclusion and exclusion criteria outlined in a previous protocol paper. The analysis of these studies identified areas of concern to access appropriate healthcare, such as clinician knowledge, the environment, and life events. Conclusion Identifying the barriers to healthcare, highlights ways healthcare services can regulate scope of practice, the physical environment, and the process of managing health conditions, thus, autistic adults can strive for optimal health. This review contributes to peer-reviewed evidence for future research and up-to-date information when developing and piloting health interventions for autistic adults. Ethics and dissemination There are no human participants, data, or tissue being directly studied for the purposes of the review; therefore, ethics approval and consent to participate is not applicable. Registration and status PROSPERO 2018 CRD42018116093.

Detection of pathogenic Legionella pneumophila by culture-based methods is not efficient in predicting outbreaks of the Legionnaires’ disease. The main problem is the relatively slow time-to-result and the inability of some culture media to support the growth of viable bacteria. One strategy to alleviate these issues is developing biosensors functionalized with mammalian antibodies designed to capture bacteria. However, mammalian antibodies are known to suffer from batch-to-batch variations, as well as limited stability, which reduce the consistent utility of antibody-based biosensors. In an attempt to address this problem, we investigated antimicrobial peptides (AMPs) for capture of L. pneumophila with GaAs/AlGaAs biochips. The Fourier-transform infrared spectroscopy measurements revealed that the peptides were covalently immobilized on the 1-ethyl-3-(-3-dimethylaminopropyl) carbodiimide/N-hydroxysuccinimide activated −COOH terminals of mercaptohexadecanoic acid self-assembled monolayer functionalized GaAs surface. The efficiency of the specific interaction between the peptide and L. pneumophila, E. coli, B. subtilis and P. fluorescens was investigated with fluorescence microscopy and a digital photocorrosion GaAs/AlGaAs biosensor. We found that the warnericin RK peptides exhibited ∼5 times greater binding affinity towards L. pneumophila than to the other bacteria investigated. Furthermore, detection level as low as 103 CFU/mL was possible with the proposed biosensor architecture. We argue that a biosensor based on warnericin RK AMP peptides offers an attractive alternative solution in comparison to antibody-based devices towards detection of L. pneumophila.

The petrochemical wastewater (PCW) from acrylic acid plant possesses very high chemical oxygen demand (COD) due to presence of acrylic acid along with other organic acids. The treatment of PCW by conventional methods is energy intensive. The treatment of PCW with concurrent power generation by employing microbial fuel cell (MFC) could be a potential alternative solving the problem of energy and environment. The goal of the present paper is to evaluate the viability of treating the wastewater using anaerobic sludge as biocatalyst in a dual- chamber MFC for simultaneous power generation and wastewater treatment. This study demonstrates that anaerobic sludge (AS) could work as a biocatalyst producing maximum power density of 0.75 W/m3at current density and open circuit voltage (OCV) of 412 mA/m2 and 0.45 V respectively using PCW with an initial COD of 45,000 mg/L. The COD removal efficiency and the columbic efficiency (CE) were found 40% and 13.11%, respectively. The mechanism of electron transfer in the anode was analyzed by cyclic voltammetry (CV) and the resistances across the electrode/biofilm/solution interface were investigated by employing impedance spectroscopy (EIS). The current work proves the capability of the MFC for the treatment of acrylic acid plant PCW using anaerobic sludge (AS) as biocatalyst.

Background To assess the level of awareness, knowledge and help-seeking attitudes and behaviours in relation to mental health conditions (MHCs) and associations with socio-demographic characteristics of a rural district of Bangladesh. Methods We recruited 2425 adult samples (18–90 years) from a Cross-sectional study in Narial district of Bangladesh. Data on awareness, knowledge, help-seeking attitudes and practice in relation to six MHCs were collected. The MHCs were classified as common (depression, anxiety and drug addiction), and severe (psychosis, dementia and bipolar disorder). Associations of MHCs with socio-demographic characteristics were assessed using Chi-square tests. Rasch analysis was performed to transform the latent attribute (awareness) of MHCs from ordinal to interval scale. Multiple regression analysis was performed to determine how the socio-demographic characteristics contribute to the combined awareness score of MHCs. Results Of 2425 participants, 17 (0.7%) were cognizant of all the awareness construct of MHCs, and 1365 (56.28%) were not aware of any of MHCs. The prevalence of awareness of MHCs such as depression (8.5%), anxiety (6.2%), psychosis (3.5%), and bipolar disorder (3.3%), was found to be very low. Awareness was significantly lower in older adults, and in women. Higher levels of education (β 1.77, 95% confidence interval (CI): 1.58–1.97) associated with common MHCs and (β 0.81, 95% CI: 0.67–0.95) those associated with severe MHCs contributed significantly to increased awareness as opposed to having no or primary level of education. Availability of sufficient funds when applied to common MHCs (β 0.43, 95% CI: 0.26–0.61) and severe MHCs (β 0.25, 95% CI: 0.13–0.38) appeared to be more effective in boosting awareness compared to unstable financial situations. Almost 100% of the participants who were aware of the MHCs demonstrated positive attitudes towards seeking medical or psychological counselling. Conclusions Awareness of MHCs appeared to be very limited. However, knowledgeable participants were found to be very receptive to medical or psychological counselling. For improving awareness of MHCs need to conduct various intervention programs in particular those campaigns that focus on women, older adults, low SES and people up to the primary levels of education. Electronic supplementary material The online version of this article (10.1186/s12913-019-4385-6) contains supplementary material, which is available to authorized users.

Background: Low knowledge about diabetes risk factors coupled with high disease prevalence is common in low-resource countries. This study evaluated diabetes-related knowledge, attitudes, and practices in the general population in Punjab (Pakistan). Methods: A cross-sectional study was conducted in five districts in Punjab from January to March 2017. Data were collected from 2019 adults aged 18&ndash, 90 years through face-to-face interviews using a semi-structured questionnaire. The total knowledge score ranged from 0&ndash, 9, a score &ge, 6 was considered adequate diabetes awareness. Descriptive statistics, chi-square tests, and linear and binary logistic regression were used for the analyses. Results: Respondents&rsquo, mean age was 32.92 &plusmn, 11.4 years. In total, 85.9% of respondents had heard of diabetes, and 30.1% knew about the glucose tolerance test. We found 2.3% of respondents scored zero for diabetes knowledge, 11.3% scored 9, and 47.4% scored &ge, 6 (adequate awareness). Being female (&beta, = 0.37, 95% confidence interval [CI]: 0.16, 0.05, p = 0.001), socioeconomic status (&beta, = 0.24, 95% CI: 0.12, 0.36, p &lt, 0.001), being diabetic (&beta, = 0.82, 95% CI: 0.53, 1.10, 0.001), and higher education (&beta, = 0.25, 95% CI: 0.17, 0.33, 0.001) were significantly associated with knowledge score. Respondents with high socioeconomic status showed significantly higher positive attitudes compared with those with low socioeconomic status (adjusted odds ratio 1.57, 95% CI: 1.12, 2.24). Only 8.7% (30/343) of those diagnosed with diabetes had never undergone blood glucose screening since diagnosis. Conclusions: Knowledge of diabetes risk factors, management, and care is low in Pakistan&rsquo, s general population. Targeted public education programs should be instigated at a national level to increase understanding of diabetes prevention and treatment.

BackgroundPsychological distress including depression and anxiety are among the most serious causes of morbidity and mortality in Bangladesh. There has been no study in the rural area to report the prevalence of and risk factors for psychological distress. The aim of this study was to estimate the prevalence of and risk factors for psychological distress in a rural district in Bangladesh.MethodsA total of 2425 adults (1249 women) aged 18-90 years were selected from the Narail upazilla using multi-level cluster random sampling for a cross-sectional study. Psychological distress was assessed using the Kessler 10 items questionnaire. Participants' socio-demographic status, life style factors and health conditions were also collected. Odds ratios and 95% confidence intervals for binary outcomes and mean changes for continuous outcomes of psychological distress score were computed. Logistic regression and generalized linear model techniques were used for analytical purpose.ResultsThe overall prevalence of psychological distress was 52.5%. This proportion included 22.7% people rated as having mild psychological distress, 20.8% moderate and 9.0% severe. The prevalence of moderate (24.7% vs. 17.5%, pConclusionsIn this rural Bangladeshi community, the prevalence of psychological distress was high, especially among older women. Factors including lower level of education, inability to work, and living in semi-urban areas were associated with higher prevalence of psychological distress. Public health programmes should target people in high risk groups to reduce their psychological distress in Bangladesh.

Aim Diabetic retinopathy (DR) screening is one of the keys in successful diabetes care, but the participation in DR screening is sub-optimal. This study aims to assess the factors associated with participation in a DR screening program in a rural district of Bangladesh. Method 213 persons with diabetes identified in a population-based assessment of over 3000 persons ≥ 40 years were offered free of cost screening for DR. Awareness, attitudes and practice about diabetes and common eye diseases along with socio-demographic factors were assessed. Results 68 (32%) patients participated in the screening program. After multivariate adjustment, awareness related to diabetes causes eye disease (odds ratio (OR) 8.47, 95% confidence interval (CI) 3.95–18.18), awareness of DR (OR 5.15, 95% CI 1.89–14.01) and awareness of the possibility to prevent DR-related vision loss (OR 3.15, 95% CI 1.53–6.51) were associated with higher proportion of participation. Lack of confidence upon skills of ophthalmic assistants and fear of complications were barriers but socio-economic condition was not a barrier in attending the screening program. Conclusions The major factor associated with participation in DR screening is diabetes-related health literacy in rural Bangladesh. Public health promotion program should be designed to provide health education to increase participation in the screening program.

BACKGROUND: The number of adults with diabetes is increasing worldwide and also the number of people with diabetic retinopathy (DR), a major complication of diabetes. Task sharing in eye care for people with diabetes could address the shortage in the number of ophthalmologists and increase access to eye care services. This study investigated the opinion of eye care professionals for a checklist of tasks, which are involved in DR management, to be possibly shared by optometrists and mid-level eye and health care workers with ophthalmologists. METHODS: The study used a purposive sampling technique. All available eye and health care workers from five selected hospitals in two provinces in Pakistan were recruited. A cross-sectional survey was conducted to investigate the potential roles of various cadres in eye care delivery for people with diabetes. RESULTS: Ninety-six (79%) participants including doctors (n = 56), optometrists (n = 29), and mid-level eye care workers (n = 11) responded to the survey. Two-thirds of the participants suggested mid-level eye care workers, while 88.5% stated that lady health workers could provide education and health promotion to people with diabetes. Most of the participants (88.5%) suggested that optometrists could share the task of dilated ophthalmoscopy with ophthalmologists for detection of DR and make referrals to ophthalmologists if needed. Ophthalmologists remained the recommended cadre to undertake the eye examinations of patients with proliferative DR and diabetic macular edema. CONCLUSION: This research provided an insight on how task sharing in DR management can be implemented by optimizing the roles of eye care workers.

A microbial fuel cell (MFC) is a bioelectrochemical system that uses living microbes as biocatalyst to oxidize organic substrates as well as release electrons that can be harvested in an external circuit to produce electrical energy. In this study, a proteolytic biocatalyst, Bacillus cereus, has been employed for the first time in a microbial fuel cell (MFC). The wild type pure culture was isolated from municipal wastewater and identified using Biolog Gen III analysis. The MFCs were fueled with palm oil mill effluent (POME) and attained a maximum power density of about 3.88W/m3. The electrochemical behavior of the MFC was evaluated using a polarizationcurve, electrochemical impedance spectroscopy (EIS), and cyclic voltammetery (CV) analysis. The CV and EIS results suggest that the predominant electron transfer occurred through the electron shuttle mechanism. The electron shuttle mediators excreted by B. cereus significantly reduced the anode charge transfer resistance (52.95%). The FESEM result shows that B. cereus has the capability to form an effective biofilm on the anode electrode surface. These results revealed the electrocatalytic potentiality of B. cereus, making it a promising candidate to be used in MFCs. Therefore, this biocatalyst can be used to generate electricity through wastewater valorization.

Hypertension is mainly asymptomatic and remains undiagnosed until the disease progresses. The objective of the study was to determine the prevalence of and risk factors for hypertension in rural Bangladesh. Using a population-based cluster random sampling strategy, 3096 adults aged ⩾30 years were recruited from a rural district in Bangladesh. Data collected included two blood pressure (BP) measurements, fasting blood glucose, socio-demographic and anthropometric measurements. Hypertension was defined as systolic BP (SBP) ⩾140 mm Hg or diastolic BP (DBP) ⩾90 mm Hg or self-reported diagnosed hypertension. Logistic regression techniques were used for data analyses. The crude prevalence of hypertension was 40% (95% confidence interval (CI) 38–42%) of which 82% were previously undiagnosed. People from lower socio-economic status (SES) had a significantly higher percentage of undiagnosed hypertension compared with people with higher SES (P