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The global high prevalence of COVID-19 is a major challenge for health professionals and patients. SARS-CoV-2 virus mutate predominantly in the spike proteins, whilst the other key viral components remain stable. Previous studies have shown that the human oral cavity can potentially act as reservoir of the SARS-CoV-2 virus. COVID-19 can cause severe oral mucosa lesions and is likely to be connected with poor periodontal conditions. However, the consequence of SARS-CoV-2 viral infection on human oral health has not been systematically examined. In this research, we aimed to study the pathogenicity of SARS-CoV-2 viral components on human periodontal tissues and cells. We found that by exposing to SARS-CoV-2, especially to the viral envelope and membrane proteins, the human periodontal fibroblasts could develop fibrotic pathogenic phenotypes, including hyperproliferation that was concomitant induced together with increased apoptosis and senescence. The fibrotic degeneration was mediated by a down-regulation of mitochondrial β-oxidation in the fibroblasts. Fatty acid β-oxidation inhibitor, etomoxir treatment could mirror the same pathological consequence on the cells, similar to SARS-CoV-2 infection. Our results therefore provide novel mechanistic insights into how SARS-CoV-2 infection can affect human periodontal health at the cell and molecular level with potential new therapeutic targets for COVID-19 induced fibrosis.

BackgroundsVaccination remains one of the most effective ways to protect populations from COVID-19 infection, severe conditions, and death. This study aims to examine whether the gain/loss-framing of information, provision of subsidized pre-vaccination physician consultation, and cash incentives can improve COVID-19 acceptance amongst adults.MethodsA survey experiment was conducted within a broader cross-sectional survey of people aged 18–64 years in Hong Kong, China. The participants were randomly assigned to one of the eight groups derived from full-factorial design of the three strategies with stratification by age and sex. The vaccine acceptance rate was compared between people with and without any of the strategies. The heterogeneous effects of these strategies were identified for those with different perceptions of the pandemics and vaccine in multiple logistic regressions.ResultsThe survey experiment collected 1,000 valid responses. It found that loss-framed information and provision of subsidized physician consultation to assess suitability to be vaccinated, can improve vaccine acceptance, while cash incentives did not make a difference. The improvement effect of loss-framing information and physician consultation is stronger among those with higher perceived infection risk and severity of condition, as well as unvaccinated people with lower confidence in vaccine safety.ConclusionsThe findings indicated that individualized loss-framing messages and equitable provision of subsidized pre-vaccination physician consultations can be incorporated in efforts to promote vaccine acceptance and vaccination roll-out speed. However, it remains inconclusive whether and how universal cash incentives may be deployed to support vaccination promotion.

IntroductionHealth literacy (HL) refers to an individual's ability to process and use health information to make health-related decisions. However, previous HL scales did not fully cover all aspects of this concept. This study aimed to develop a comprehensive Hong Kong HL scale (HLS-HK) and evaluate its psychometric properties among Chinese adults.MethodsA scale of 31-item covering Nutbeam's framework, namely functional and interactive HL (FHL and IHL), and critical HL (CHL) within three subdomains: critical appraisal of information, understanding of social determinants of health, and actions to address social determinants of health, was developed based on previous literature review and Delphi survey. Cognitive interviews were performed to examine all items' face validity in terms of three aspects: comprehensiveness, clarity, and acceptability. A cross-sectional survey was conducted to investigate the scale's psychometric properties, including its internal consistency reliability, factorial structure validity, convergent validity, and predictive validity.ResultsNine interviewees participated in the cognitive interviews in October 2021. Based on the input from respondents, two items were deleted, two items were combined, and several items' wording was revised. The other items were clear and readable. Finally, 28 items remained. A total of 433 adults completed the questionnaire survey between December 2021 and February 2022. After excluding one item with low inter-item correlations, the scale's internal consistency reliability was acceptable, with a Cronbach's alpha of 0.89. Exploratory factor analysis produced a five-factor model, as shown in the original theoretical framework. These factors accounted for 53% of the total variance. Confirmatory factor analysis confirmed that the fit indices for this model were acceptable (comparative fit index = 0.91, root mean square error of approximation = 0.06, and root mean square residual = 0.06). The scale is also significantly correlated with theoretically selected variables, including education and self-rated health.ConclusionThe HLS-HK is a valid and reliable tool for evaluating HL. Compared with existing tools, this scale extended the operationalization of FHL, IHL, and CHL and fully operationalized the CHL via three subdomains. It can be used to understand the difficulties and barriers that people may encounter when they use health-related information and services.

Context In December 2020, the US Food and Drug Administration approved a 68Ga-labeled prostate-specific membrane antigen ligand (68Ga-PSMA-11) for positron emission tomography (PET) in patients with suspected prostate cancer (PCa) metastasis who are candidates for initial definitive therapy. 68Ga-PSMA PET is increasingly performed for these patients and is usually combined with computed tomography (CT). In recent years, 68Ga-PSMA PET has been combined with high-resolution magnetic resonance imaging (MRI), which is beneficial for T staging and may further enhance the staging of primary PCa. Objective To compare the diagnostic accuracy of 68Ga-PSMA PET/MRI with 68Ga-PSMA PET/CT for staging of primary PCa. Evidence acquisition A comprehensive literature search was performed using Embase, PubMed/Medline, Web of Science, Cochrane Library, and Google Scholar up to June 24, 2021 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the QUADAS-2 tool. Evidence synthesis The search identified 2632 articles, of which 27 were included. The diagnostic accuracy of 68Ga-PSMA PET/MRI, measured as the pooled natural logarithm of diagnostic odds ratio (lnDOR), was 2.27 (95% confidence interval [CI] 1.21-3.32) for detection of extracapsular extension (ECE), 3.50 (95% CI 2.14-4.86) for seminal vesicle invasion (SVI), and 4.73 (95% CI 2.93-6.52) for lymph node metastasis (LNM). For 68Ga-PSMA PET/CT, the analysis showed lnDOR of 2.45 (95% CI 0.75-4.14), 2.94 (95% CI 2.26-3.63), and 2.42 (95% CI 2.07-2.78) for detection of ECE, SVI, and LNM, respectively. The overall risk of bias and applicability concerns were assessed as moderate and low, respectively. Conclusions 68Ga-PSMA PET/MRI shows high diagnostic accuracy equivalent to that of 68Ga-PSMA PET/CT for detection of ECE, SVI, and LNM in staging of PCa. There is an urgent need for direct comparison of the two diagnostic tests in future research. Patient summary The use of radioactively labeled molecules that bind to prostate-specific membrane antigen (68Ga-PSMA) for positron emission tomography (PET) scans combined with either computed tomography (CT) or magnetic resonance imaging (MRI) is increasing for prostate cancer diagnosis. There is a need for direct comparison of the two tests to demonstrate the benefit of 68Ga-PSMA PET/MRI for determining tumor stage in prostate cancer. Take home message After the recent US Food and Drug Administration approval of 68Ga-labeled prostate-specific membrane antigen ligand (68Ga-PSMA) positron emission tomography (PET) for staging of primary prostate cancer (PCa), it is expected that the use of this imaging modality will increase rapidly. Our review of the literature shows that 68Ga-PSMA PET/magnetic resonance imaging has high diagnostic accuracy equivalent to that of 68Ga-PSMA PET/computed tomography in primary PCa staging. There is an urgent need for direct head-to-head comparison of the two diagnostic tests in future research.

Technological developments have brought profound challenges to design education. To understand how design educators adapt to new technological directions, this article examines student feedback from advertising design courses that apply blended learning approaches. This study identified three blended learning strategies conducive to meaningful learning: timely and meaningful feedback; engagement with real world tasks; and support from expert tutors. This article also discusses potential resistance and challenges in implementing instruction in blended technological environments.

We present the synthesis and characterization of an efficient and low cost solar-driven electrolyzer consisting of Earth-abundant materials. The trimetallic NiFeMo electrocatalyst takes the shape of nanometer-sized flakes anchored to a fully carbon-based current collector comprising a nitrogen-doped carbon nanotube network, which in turn is grown on a carbon fiber paper support. This catalyst electrode contains solely Earth-abundant materials, and the carbon fiber support renders it effective despite a low metal content. Notably, a bifunctional catalyst–electrode pair exhibits a low total overpotential of 450 mV to drive a full water-splitting reaction at a current density of 10 mA cm–2 and a measured hydrogen Faradaic efficiency of ∼100%. We combine the catalyst–electrode pair with solution-processed perovskite solar cells to form a lightweight solar-driven water-splitting device with a high peak solar-to-fuel conversion efficiency of 13.8%. Originally included in thesis in manuscript form.

El estudio tiene como objetivos reconocer la eficacia de los distintos dispositivos de liberación lenta de flúor, en especial, los llamados “perlas de vidrio” y poder verificar su eficacia en los tratamientos preventivos de lesiones causadas por caries. Se busca poder distinguir algún dispositivo que beneficie a los distintos tratamientos. La metodología de investigación fue por ensayos aleatorizados y clínicos usando bases de datos. Con ayuda de los distintos ensayos revisados, se pudo concluir la gran efectividad con la que cuentan los dispositivos de vidrio de liberación lenta de flúor en pacientes con un deficiente conocimiento sobre las lesiones cariosas, convirtiéndose en un tratamiento preventivo y efectivo a largo plazo.

Objectives: To examine the level of resilience among the frontline healthcare workers (HCWs) in four different Southeast Asian jurisdictions and identify the potential factors that may enhance healthcare workers resilience.Methods: An online cross-sectional survey was carried out among 3,048 eligible healthcare workers in Hong Kong, Nepal, Vietnam, and Taiwan from May 2021 to July 2022, and information on individual resilience, socio-demographic characteristics, organizational supports, and personal exposures were collected. A binary logistic regression model was used to identify the factors that were associated with a high resilience level.Results: The resilience score was the highest among healthcare workers of Vietnam, followed by Taiwan and Hong Kong, with Nepal scoring the lowest. Participants with old age, part-time work, higher education level, more satisfaction with workplace policy, better organizational supports, and fewer COVID-specific worries were associated with higher resilience. Healthcare workers who were satisfied with the overall organizational policy support had an OR of 1.48 (95% CI: 1.25–1.76) for a high resilience level.Conclusion: Implementing satisfying organizational policies and establishing supportive work environments for frontline healthcare workers can increase individual resilience and organizational stability.

Diabetic corneal neuropathy (DCN) is a common complication of diabetes mellitus (DM). However, there are very limited therapeutic options. We investigated the effects of a peroxisome proliferator-activated receptor-alpha (PPAR)-α agonist, fenofibrate, on thirty patients (60 eyes) with type II DM. On in-vivo confocal microscopy evaluation, there was significant stimulation of corneal nerve regeneration and a reduction in nerve edema after 30 days of oral fenofibrate treatment, evidenced by the significant improvement in corneal nerve fiber density (CNFD) and corneal nerve fiber width, respectively. Corneal epithelial cells morphology also significantly improved in its cell circularity. Upon clinical examination, fenofibrate significantly improved patients’ neuropathic ocular surface status by increasing tear break-up time along with a reduction of corneal and conjunctival punctate keratopathy. Tear substance P (SP) concentrations significantly increased after treatment, suggesting an amelioration of ocular surface neuroinflammation. The changes in tear SP concentrations was also significantly associated with the improvement in CNFD. Quantitative proteomic analysis demonstrated that fenofibrate significantly upregulated and modulated the neurotrophin signalling pathway, linolenic acid, cholesterol and fat metabolism. Complement cascades, neutrophil reactions, and platelet activation were also significantly suppressed. Our results showed that fenofibrate could potentially be a novel treatment for patients with DCN.

Integrated Part Load Value (IPLV) has been adopted worldwide as a simple metric for regulating and evaluating chiller performance. There is no exception for Hong Kong. However, the weighting factors and working temperatures for the derivation of IPLV were developed for the US. They may not be appropriate for use in other countries/regions with different operating conditions. Europe and China therefore have developed their own formula but the formulation is based on simulations and details cannot be found in literature. This study adopts a carefully-designed methodology to develop a Hong Kong specific IPLV. The development was based on actual operating characteristics of 20 Grade A office buildings in Hong Kong. Representativeness of the 20 office buildings was verified by statistical analysis. Through in-situ measurements and site surveys, hour-by-hour operating data of the studied buildings were collected. Monte Carlo analysis and ASHRAE's bin method were employed to examine the massive volume of operating data. Regression analysis was employed to formulate the Hong Kong specific IPLV. The formulated IPLV was validated. It gives the highest weighting to 75% capacity (0.682), followed in descending order are 50% capacity (0.257), 25% capacity (0.049) and 100% capacity (0.012). In determining the working temperatures, a mathematical model to enable quick estimation of entering condenser water temperature for water-cooled chillers was developed. The results and methodology adopted in this study will be useful for reference of manufacturers, policy makers and researchers in searching for a reliable metric for performance evaluation of chillers should simulation is not practical.

Background The evolving pandemic of coronavirus disease 2019 (COVID-19) has become a severe threat to public health, and the workplace presents high risks in terms of spreading the disease. Few studies have focused on the relationship between workplace policy and individual behaviours. This study aimed to identify inequalities of workplace policy across occupation groups, examine the relationship of workplace guidelines and measures with employees’ behaviours regarding COVID-19 prevention. Methods A cross-sectional online survey using a structured questionnaire was conducted to gather employees’ access to workplace guidelines and measures as well as their personal protection behaviours. Statistical associations between these two factors in different occupations were examined using multiple ordinal logistic regressions. Results A total of 1048 valid responses across five occupational groups were analysed. Manual labourers reported lower availability of workplace guidelines and measures (76.9% vs. 89.9% for all, P = 0.003). Employees with available workplace guidelines and measures had higher compliance of hand hygiene, wearing masks, and social distancing, and this association was more significant among managers/administrators and manual labourers. Conclusions Protection of the quantity and quality of employment is important. Awareness about the disease and its prevention among employers and administrators should be promoted, and resources should be allocated to publish guidelines and implement measures in the workplace during the pandemic. Both work-from-home arrangement and other policies and responses for those who cannot work from home including guidelines encouraging the health behaviours, information transparency, and provision of infection control materials by employers should be established to reduce inequality. Manual labourers may require specific attention regarding accessibility of relevant information and availability of medical benefits and compensation for income loss due to the sickness, given their poorer experience of workplace policy and the nature of their work. Further studies are needed to test the effectiveness of specific workplace policies on COVID-19 prevention.

Chronic infections with the hepatitis B and C viruses have significant worldwide health and economic impacts. Previous treatments for hepatitis C such as interferon and ribavirin therapy were ineffective and poorly tolerated by patients. The introduction of directly acting curative antiviral therapy for hepatitis C and the wider use of nucleos(t)ide analogues for suppression of chronic Hepatitis B infection have resulted in many positive developments. Decreasing the prevalence of hepatitis B and C have concurrently reduced transmission rates and hence, the number of new infections. Antiviral treatments have decreased the rates of liver decompensation and as a result, lowered hospitalisation and mortality rates for both chronic hepatitis B and C infection. The quality of life of chronically infected patients has also been improved significantly by modern treatment. Antiviral therapy has stopped the progression of liver disease to cirrhosis in certain patient cohorts and prevented ongoing hepatocellular damage in patients with existing cirrhosis. Longer term benefits of antiviral therapy include a reduced risk of developing hepatocellular carcinoma and decreased number of patients requiring liver transplantation. This review article assesses the literature and summarises the impact of modern antiviral therapy of chronic hepatitis B and C on clinical outcomes from liver disease.

Ammonia production via the electrochemical N2 reduction reaction (NRR) at ambient conditions is highly desired as an alternative to the Haber-Bosch process, but remains a great challenge due to the low efficiency and selectivity caused by the competing hydrogen evolution reaction (HER). Herein we investigate the effect of availabilities of reactants (protons, electrons and N2) on NRR using a FeOx-coated carbon fiber paper cathode in various electrochemical configurations. NRR is found viable only under the conditions of low proton- and high N2 availabilities, which are achieved using 0.12 vol% water in LiClO4-ethyl acetate electrolyte and gaseous N2 supplied to the membrane-electrode assembly cathode. This results in an NRR rate of 29 ± 19 pmolNH3 s−1 cm−2 at a Faradaic efficiency of 70 ± 24% at the applied potential of −0.1 V vs. NHE. Other conditions (high proton-, or low N2-availability, or both) yield a lower or negligible amount of ammonia due to the competing HER. Our work shows that promoting NRR by suppressing the HER requires optimization of the operational variables, which serves as a complementary strategy to the development of NRR catalysts.