Browse publications by year: 2023

Fulltext Career Satisfaction of Malaysian Dentists With Expanded Roles at a Specialist Clinic

Malek AA, Radzi NAM, Musa MFC

Int Dent J, 2023 Aug;73(4):574-579.
PMID: 36513555 DOI: 10.1016/j.identj.2022.11.010

OBJECTIVES: Public dentists interested in postgraduate studies were required to complete clinical attachments at the Malaysian Ministry of Health (MOH) Dental Specialist Clinic (DSC). This cross-sectional quantitative study aimed to explore career satisfaction (CS) and barriers perceived by Malaysian dentists at Malaysia's MOH DSC.
METHODS: A total of 208 dentists from DSC nationwide completed an online questionnaire in June 2022. Demographic data and information on dentists' expanded roles were retrieved. Responses on dentists' satisfaction and perceived barriers were collected using a 5-point ordinal scale. Mann-Whitney U and Kruskal-Wallis tests were used to compare the mean rank differences for CS. Factors influencing CS were analysed using multiple logistic regression (MLR) (P < .05).
RESULTS: The mean age of the respondents was 32.68 ± 2.48 years. Almost half (49.0%) of the respondents were attached to a non-hospital-based clinic. The majority (72.0%) of them were permanently attached to the DSC. About half of the dentists (51.0%) strongly agreed that they received no financial incentives for their expanded role at the MOH DSC. Dentists attached at a non-hospital-based clinic (P = .046), working with more than 15 years of experience (P = .013), and having 12 to 18 months' duration of attachment (P = .014) were more satisfied. MLR analysis revealed that non-Malay respondents (odds ratio [OR], 1.54; P = .035) and those who applied for scholarships more than 3 times (OR, 1.85; P = .050) were more satisfied. In contrast, more than 19 months at the DSC decreased CS (OR, 0.44; P = .029).
CONCLUSIONS: Despite having a similar organisational structure, DSC dentists had different satisfaction levels. Dentists' ethnicity, duration of attachment, and frequency of applying for scholarships influenced their CS. Future career advancement plans in the MOH should consider these important influencing factors to ensure the delivery of quality health care from their personnel.

MeSH terms: Adult; Attitude of Health Personnel*; Cross-Sectional Studies; Dentists; Humans; Job Satisfaction*; Personal Satisfaction; Surveys and Questionnaires; Practice Patterns, Dentists'
The Potential Cardiovascular Benefits of COVID-19 Vaccination: Lessons from Influenza and Emerging Evidence

Kow CS, Ramachandram DS, Hasan SS

Cardiovasc Drugs Ther, 2023 Jul 08.
PMID: 37421485 DOI: 10.1007/s10557-023-07485-6
Biosensors for the detection of lung cancer biomarkers: A review on biomarkers, transducing techniques and recent graphene-based implementations

Lin LP, Tan MTT

Biosens Bioelectron, 2023 Oct 01;237:115492.
PMID: 37421797 DOI: 10.1016/j.bios.2023.115492

Lung cancer remains the leading cause of cancer-related death. In addition to chest X-rays and computerised tomography, the detection of cancer biomarkers serves as an emerging diagnostic tool for lung cancer. This review explores biomarkers including the rat sarcoma gene, the tumour protein 53 gene, the epidermal growth factor receptor, the neuron-specific enolase, the cytokeratin-19 fragment 21-1 and carcinoembryonic antigen as potential indicators of lung cancer. Biosensors, which utilise various transduction techniques, present a promising solution for the detection of lung cancer biomarkers. Therefore, this review also explores the working principles and recent implementations of transducers in the detection of lung cancer biomarkers. The transducing techniques explored include optical techniques, electrochemical techniques and mass-based techniques for detecting biomarkers and cancer-related volatile organic compounds. Graphene has outstanding properties in terms of charge transfer, surface area, thermal conductivity and optical characteristics, on top of allowing easy incorporation of other nanomaterials. Exploiting the collective merits of both graphene and biosensor is an emerging trend, as evidenced by the growing number of studies on graphene-based biosensors for the detection of lung cancer biomarkers. This work provides a comprehensive review of these studies, including information on modification schemes, nanomaterials, amplification strategies, real sample applications, and sensor performance. The paper concludes with a discussion of the challenges and future outlook of lung cancer biosensors, including scalable graphene synthesis, multi-biomarker detection, portability, miniaturisation, financial support, and commercialisation.

MeSH terms: Humans; Lung; Biomarkers, Tumor; Biomarkers; Electrochemical Techniques/methods
The importance of getting the ethics right in a pandemic treaty

Schaefer GO, Atuire CA, Kaur S, Parker M, Persad G, Smith MJ, et al.

Lancet Infect Dis, 2023 Nov;23(11):e489-e496.
PMID: 37421968 DOI: 10.1016/S1473-3099(23)00364-X

The COVID-19 pandemic revealed numerous weaknesses in pandemic preparedness and response, including underfunding, inadequate surveillance, and inequitable distribution of countermeasures. To overcome these weaknesses for future pandemics, WHO released a zero draft of a pandemic treaty in February, 2023, and subsequently a revised bureau's text in May, 2023. COVID-19 made clear that pandemic prevention, preparedness, and response reflect choices and value judgements. These decisions are therefore not a purely scientific or technical exercise, but are fundamentally grounded in ethics. The latest treaty draft reflects these ethical considerations by including a section entitled Guiding Principles and Approaches. Most of these principles are ethical-they establish core values that undergird the treaty. Unfortunately, the treaty draft's set of principles are numerous, overlapping, and show inadequate coherence and consistency. We propose two improvements to this section of the draft pandemic treaty. First, key guiding ethical principles should be clearer and more precise than they currently are. Second, the link between ethical principles and policy implementation should be clearly established and define boundaries on acceptable interpretation, ensuring that signatories abide by these principles.
Toxicity assessment of microplastic (MPs); a threat to the ecosystem

Bostan N, Ilyas N, Akhtar N, Mehmood S, Saman RU, Sayyed RZ, et al.

Environ Res, 2023 Oct 01;234:116523.
PMID: 37422115 DOI: 10.1016/j.envres.2023.116523

Plastic is now considered part and parcel of daily life due to its extensive usage. Microplastic (MP) pollution is becoming a growing worry and has been ranked as the second most critical scientific problem in the realm of ecology and the environment. Microplastics are smaller in size than the plastic and are more harmful to biotic and as well as abiotic environments. The toxicity of microplastic depends upon its shape and size and increases with an increase in its adsorption capacity and their toxicity. The reason behind their harmful nature is their small size and their large surface area-to-volume ratio. Microplastic can get inside fruits, vegetables, seeds, roots, culms, and leaves. Hence microplastic enters into the food chain. There are different entry points for microplastic to enter into the food chain. Such sources can include polluted food, beverages, spices, plastic toys, and household (packing, cooking, etc.). The concentration of microplastic in terrestrial environments is increasing day by day. Microplastic causes the destruction of soil structure; destroys soil microbiota, cause depletion of nutrients in the soil, and their absorption by plants decreases plant growth. Apart from other environmental problems caused by microplastic, human health is also badly affected by microplastic pollution present in the terrestrial environment. The presence of microplastics in the human body has been confirmed. Microplastic enters into the body of humans in different possible ways. According to their way of entering the body, microplastics cause different diseases in humans. MPs also cause negative effects on the human endocrine system. At the ecosystem level, the impacts of microplastic are interconnected and can disrupt ecological processes. Although recently different papers have been published on several aspects of the microplastic present in the terrestrial environment but there is no complete overview that focus on the interrelationship of MPs in plants, and soil and their effect on higher animals like a human. This review provides a completely detailed overview of existing knowledge about sources, occurrences, transport, and effects of microplastic on the food chain and soil quality and their ecotoxicological effects on plants and humans.

MeSH terms: Animals; Environmental Monitoring; Environmental Pollution; Humans; Plants; Plastics/toxicity; Soil; Ecosystem
Oral and Gut Microbiota Dysbiosis is Associated with Mucositis Severity in Autologous Hematopoietic Stem Cell Transplantation: Evidence from an Asian Population

Wong SP, Er YX, Tan SM, Lee SC, Rajasuriar R, Lim YAL

Transplant Cell Ther, 2023 Oct;29(10):633.e1-633.e13.
PMID: 37422196 DOI: 10.1016/j.jtct.2023.06.016

Mucositis is a debilitating complication of hematopoietic stem cell transplantation (HSCT). It is unclear how changes in the composition of microbiota, which are modulated by geographical location and ethnicity, may influence immune regulation leading to the development of mucositis, and the study of both oral and gut microbiota in a single population of autologous HSCT in the Asian region is lacking. The present study aimed to characterize the oral and gut microbiota changes, and the impact on both oral and lower gastrointestinal (GI) mucositis, with associated temporal changes in a population of adult recipients of autologous HSCT. Autologous HSCT recipients age ≥18 years were recruited from Hospital Ampang, Malaysia, between April 2019 and December 2020. Mucositis assessments were conducted daily, and blood, saliva, and fecal samples were collected prior to conditioning, on day 0, and at 7 days and 6 months post-transplantation. Longitudinal differences in alpha diversity and beta diversity were determined using the Wilcoxon signed-rank test and permutational multivariate analysis of variance, respectively. Changes in relative abundances of bacteria across time points were assessed using the microbiome multivariate analysis by linear models function. The combined longitudinal effects of clinical, inflammatory, and microbiota variables on mucositis severity were measured using the generalized estimating equation. Among the 96 patients analyzed, oral mucositis and diarrhea (representing lower GI mucositis) occurred in 58.3% and 95.8%, respectively. Alpha and beta diversities were significantly different between sample types (P < .001) and across time points, with alpha diversity reaching statistical significance at day 0 in fecal samples (P < .001) and at day +7 in saliva samples (P < .001). Diversities normalized to baseline by 6 months post-transplantation. Significant microbiota, clinical, and immunologic factors were associated with increasing mucositis grades. Increasing relative abundances of saliva Paludibacter, Leuconostoc, and Proteus were associated with higher oral mucositis grades, whereas increasing relative abundances of fecal Rothia and Parabacteroides were associated with higher GI mucositis grades. Meanwhile, increasing relative abundances of saliva Lactococcus and Acidaminococcus and fecal Bifidobacterium were associated with protective effects against worsening oral and GI mucositis grades, respectively. This study provides real-world evidence and insights into the dysbiosis of the microbiota in patients exposed to conditioning regimen during HSCT. Independent of clinical and immunologic factors, we demonstrated significant associations between relative bacteria abundances with the increasing severity of oral and lower GI mucositis. Our findings offer a potential rationale to consider the inclusion of preventive and restorative measures targeting oral and lower GI dysbiosis as interventional strategies to ameliorate mucositis outcome in HSCT recipients.
Immunotherapies for the prevention and treatment of Staphylococcus aureus infections: updates and challenges

Chung PY

Pathog Dis, 2023 Jan 17;81.
PMID: 37422444 DOI: 10.1093/femspd/ftad016

Staphylococcus aureus is the leading cause of hospital-acquired infections and can cause a wide range of diseases from mild skin infections to invasive diseases including deep surgical site infections, life-threatening bacteremia, and sepsis. This pathogen remains a challenge to manage due to its ability to rapidly develop resistance to antibiotic treatment and to form biofilms. Despite the current infection control measures which involve mainly antibiotics, the burden of infection remains high. The 'omics' approaches have not led to the discovery of novel antibacterials at a pace sufficient to cope with the emergence of multidrug-resistant and biofilm-forming S. aureus, Hence, new strategies for anti-infective therapies need to be explored urgently. One promising strategy is harnessing the immune response to enhance the protective antimicrobial immunity in the host. This review discusses the potential of monoclonal antibodies and vaccines as alternatives to treat and manage infections caused by planktonic and biofilms of S. aureus.

MeSH terms: Anti-Bacterial Agents/therapeutic use; Humans; Immunotherapy; Staphylococcus aureus/physiology; Biofilms; Methicillin-Resistant Staphylococcus aureus*
Fulltext Extreme precipitation patterns in the Asia-Pacific region and its correlation with El Niño-Southern Oscillation (ENSO)

An D, Eggeling J, Zhang L, He H, Sapkota A, Wang YC, et al.

Sci Rep, 2023 Jul 08;13(1):11068.
PMID: 37422491 DOI: 10.1038/s41598-023-38317-0

In the Asia-Pacific region (APR), extreme precipitation is one of the most critical climate stressors, affecting 60% of the population and adding pressure to governance, economic, environmental, and public health challenges. In this study, we analyzed extreme precipitation spatiotemporal trends in APR using 11 different indices and revealed the dominant factors governing precipitation amount by attributing its variability to precipitation frequency and intensity. We further investigated how these extreme precipitation indices are influenced by El Niño-Southern Oscillation (ENSO) at a seasonal scale. The analysis covered 465 ERA5 (the fifth-generation atmospheric reanalysis of the European Center for Medium-Range Weather Forecasts) study locations over eight countries and regions during 1990-2019. Results revealed a general decrease indicated by the extreme precipitation indices (e.g., the annual total amount of wet-day precipitation, average intensity of wet-day precipitation), particularly in central-eastern China, Bangladesh, eastern India, Peninsular Malaysia and Indonesia. We observed that the seasonal variability of the amount of wet-day precipitation in most locations in China and India are dominated by precipitation intensity in June-August (JJA), and by precipitation frequency in December-February (DJF). Locations in Malaysia and Indonesia are mostly dominated by precipitation intensity in March-May (MAM) and DJF. During ENSO positive phase, significant negative anomalies in seasonal precipitation indices (amount of wet-day precipitation, number of wet days and intensity of wet-day precipitation) were observed in Indonesia, while opposite results were observed for ENSO negative phase. These findings revealing patterns and drivers for extreme precipitation in APR may inform climate change adaptation and disaster risk reduction strategies in the study region.

MeSH terms: Asia; China; Disasters*; Weather; El Nino-Southern Oscillation*
Barriers to effective implementation of end-of-life vehicle management in Indonesia

Sitinjak C, Simic V, Ismail R, Bacanin N, Musselwhite C

Environ Sci Pollut Res Int, 2023 Aug;30(37):87286-87299.
PMID: 37422560 DOI: 10.1007/s11356-023-28554-1

Effective end-of-life vehicle (ELV) management is crucial for minimizing the environmental and health impacts of Indonesia's growing automotive industry. However, proper ELV management has received limited attention. To bridge this gap, we conducted a qualitative study to identify barriers to effective ELV management in Indonesia's automotive sector. Through in-depth interviews with key stakeholders and a strengths, weaknesses, opportunities, and threats analysis, we identified internal and external factors influencing ELV management. Our findings reveal major barriers, including inadequate government regulation and enforcement, insufficient infrastructure and technology, low education and awareness, and a lack of financial incentives. We also identified internal factors such as limited infrastructure, inadequate strategic planning, and challenges in waste management and cost collection methods. Based on these findings, we recommend a comprehensive and integrated approach to ELV management involving enhanced coordination among government, industry, and stakeholders. The government should enforce regulations and provide financial incentives to encourage proper ELV management practices. Industry players should invest in technology and infrastructure to support effective ELV treatment. By addressing these barriers and implementing our recommendations, policymakers can develop sustainable ELV management policies and decisions in Indonesia's fast-paced automotive sector. Our study contributes valuable insights to guide the development of effective strategies for ELV management and sustainability in Indonesia.

MeSH terms: Indonesia; Industry; Technology; Waste Management*
Fulltext Mental distress and substance use among rural Black South African youth who are not in employment, education or training (NEET)

Mngoma NF, Ayonrinde OA

Int J Soc Psychiatry, 2023 May;69(3):532-542.
PMID: 35903872 DOI: 10.1177/00207640221114252

BACKGROUND: South Africa (SA) has one of the highest rates of youth unemployment and youth who are not in employment, education or training (NEET), even higher among Black South Africans. SA's NEET rates are 3 times those of UK; 5.4 times of Germany; 1.3 times of Brazil; and 2.5 times of Malaysia. Given that youths between 15 and 24 years of age make up 24% of the total population, these are significant challenges for the economy and further fuel the cyclical, pervasive and enduring nature of poverty. We hypothesised that rural youth who are NEET would have a greater prevalence of mental disorders and higher rates of substance use compared to their non-NEET counterparts. The objective of the study is to determine the differences in rates of psychological distress and substance use between NEET and non-NEET rural African 14- to 24-year-old young men.
METHODS: The study took place in a remote and rural district municipality in KwaZulu-Natal, South Africa. We divided the district's five sub-municipalities into two clusters (large and small) and randomly selected one from each cluster for inclusion in the study. We further randomly selected wards from each sub-municipality and then rural settlements from each ward, for inclusion in the study. We recruited young men as part of a larger study to explore sociocultural factors important in gender-based violence in rural SA. We compared 15- to 19-year old and 20- to 24-year old youth NEET and non-NEET on rates of psychological distress symptoms (depression, anxiety, suicidal thoughts, hopelessness and worthlessness) and substance misuse (including alcohol, cannabis, other recreational drugs) using a Multivariate Analysis of Variance (MANOVA) statistics at p

MeSH terms: Adolescent; Adult; Employment; Female; Humans; Male; South Africa/epidemiology; Unemployment; Young Adult
Correction to: Circular economy of medical waste: novel intelligent medical waste management framework based on extension linear Diophantine fuzzy FDOSM and neural network approach

Chew X, Khaw KW, Alnoor A, Ferasso M, Al Halbusi H, Muhsen YR

Environ Sci Pollut Res Int, 2023 May;30(24):66428.
PMID: 37097584 DOI: 10.1007/s11356-023-27165-0
Fulltext A Paradoxical Phenomenon: Hemichorea-Hemiballismus Resolution After Stroke in Moyamoya Disease

Por CY, Lim TT, Chee YC, Raymond AA

J Clin Neurol, 2023 Jul;19(4):410-412.
PMID: 37417437 DOI: 10.3988/jcn.2023.0009
Fulltext A Rare Case of Late- Onset Task-Specific Jaw Tremor

Lau YH, Ong TL, Joseph JP, Mawardi AS

J Clin Neurol, 2023 Jul;19(4):416-418.
PMID: 37417439 DOI: 10.3988/jcn.2022.0202
Diagnostic approaches for dengue infection

Thergarajan G, Sekaran SD

Expert Rev Mol Diagn, 2023;23(8):643-651.
PMID: 37417532 DOI: 10.1080/14737159.2023.2234815

INTRODUCTION: Every year, a significant rise in dengue incidence observed is responsible for 10% of fever episodes in children and adolescents in endemic countries. Considering that the symptoms of dengue are similar to those of many other viruses, early diagnosis of the disease has long been difficult, and lack of sensitive diagnostic tools may be another factor contributing to a rise in dengue incidence.
AREAS COVERED: This review will highlight dengue diagnostics strategies and discuss other possible targets for dengue diagnosis. Understanding the dynamics of the immune response and how it affects viral infection has enabled informed diagnosis. As more technologies emerge, precise assays that include some clinical markers need to be included.
EXPERT OPINION: Future diagnostic strategies will require the use both viral and clinical markers in a serial manner with the use of artificial intelligence technology to determine from the first point of illness to better determine severity status and management. A definitive endpoint is not in the horizon as the disease as well as the virus is constantly evolving and hence many developed assays need to be constantly changing some of their reagents periodically as newer genotypes and probably too serotypes emerge.

MeSH terms: Adolescent; Antibodies, Viral; Artificial Intelligence; Child; Enzyme-Linked Immunosorbent Assay; Humans; Sensitivity and Specificity; Biomarkers; Early Diagnosis
Fulltext The evidence for repurposing anti-epileptic drugs to target cancer

Aroosa M, Malik JA, Ahmed S, Bender O, Ahemad N, Anwar S

Mol Biol Rep, 2023 Sep;50(9):7667-7680.
PMID: 37418080 DOI: 10.1007/s11033-023-08568-1

Antiepileptic drugs are versatile drugs with the potential to be used in functional drug formulations with drug repurposing approaches. In the present review, we investigated the anticancer properties of antiepileptic drugs and interlinked cancer and epileptic pathways. Our focus was primarily on those drugs that have entered clinical trials with positive results and those that provided good results in preclinical studies. Many contributing factors make cancer therapy fail, like drug resistance, tumor heterogeneity, and cost; exploring all alternatives for efficient treatment is important. It is crucial to find new drug targets to find out new antitumor molecules from the already clinically validated and approved drugs utilizing drug repurposing methods. The advancements in genomics, proteomics, and other computational approaches speed up drug repurposing. This review summarizes the potential of antiepileptic drugs in different cancers and tumor progression in the brain. Valproic acid, oxcarbazepine, lacosamide, lamotrigine, and levetiracetam are the drugs that showed potential beneficial outcomes against different cancers. Antiepileptic drugs might be a good option for adjuvant cancer therapy, but there is a need to investigate further their efficacy in cancer therapy clinical trials.

MeSH terms: Animals; Humans; Signal Transduction; Drug Resistance, Neoplasm; Cell Proliferation/drug effects
Fulltext The Gut Microbiota: a Novel Player in the Pathogenesis of Uterine Fibroids

K VK, Bhat RG, Rao BK, R AP

Reprod Sci, 2023 Dec;30(12):3443-3455.
PMID: 37418220 DOI: 10.1007/s43032-023-01289-7

Uterine fibroid is a common gynecological disorder that affects women of reproductive age and has emerged as a major public health concern. The symptoms have a negative influence on both their physical health and quality of life. The cost of treatment has a significant impact on the disease's burden. Even though its origin is uncertain, estrogen is thought to be a key player in fibroid pathophysiology. Many theories, including those based on genetic and environmental factors, explain what causes hyper-estrogenic condition in fibroid patients. One such possibility that is currently being explored is the hypothesis that an altered gut microbiome can contribute to the development of diseases characterized by estrogen dominance. Gut dysbiosis is often a "hot area" in the health sciences. According to a recent study, uterine fibroid patients have altered gut microbiome. A variety of risk factors influence both fibroid development and gut homeostasis. Diet, lifestyle, physical activity, and environmental contaminants have an impact on estrogen and the gut flora. A better understanding of uterine fibroids' pathophysiology is required to develop effective preventative and treatment options. A few ways by which the gut microbiota contributes to UF include estrogen, impaired immune function, inflammation, and altered gut metabolites. Therefore, in the future, while treating fibroid patients, various strategies to deal with changes in the gut flora may be advantageous. For developing suggestions for clinical diagnosis and therapy, we reviewed the literature on the relationship between uterine fibroids and the gut microbiota.

MeSH terms: Gastrointestinal Microbiome*; Estrogens/therapeutic use; Female; Humans; Quality of Life
Pineapple wastewater as co-substrate in treating real alkaline, non-biodegradable textile wastewater using biogranulation technology

Nuid M, Aris A, Krishnen R, Chelliapan S, Muda K

J Environ Manage, 2023 Oct 15;344:118501.
PMID: 37418913 DOI: 10.1016/j.jenvman.2023.118501

This study was to develop biogranules using a sequencing batch reactor (SBR) and to evaluate the effect of pineapple wastewater (PW) as a co-substrate for treating real textile wastewater (RTW). The biogranular system cycle was 24 h (2 stages of phase), with an anaerobic phase (17.8 h) followed by an aerobic phase (5.8 h) for every stage of the phase. The concentration of pineapple wastewater was the main factor studied in influencing COD and color removal efficiency. Pineapple wastewater with different concentrations (7, 5, 4, 3, and 0% v/v) makes a total volume of 3 L and causes the OLRs to vary from 2.90 to 0.23 kg COD/m3day. The system achieved 55% of average color removal and 88% of average COD removal at 7%v/v PW concentration during treatment. With the addition of PW, the removal increased significantly. The experiment on the treatment of RTW without any added nutrients proved the importance of co-substrate in dye degradation.

MeSH terms: Industrial Waste/analysis; Textile Industry; Textiles; Waste Disposal, Fluid; Bioreactors; Ananas*; Waste Water*
Carbon rich media for luminescence-based surface dosimetry and study of associated surface defects

Lam SE, Bradley DA, Mat Nawi SN, Khandaker MU, Abdul Sani SF

Appl Radiat Isot, 2023 Sep;199:110920.
PMID: 37419002 DOI: 10.1016/j.apradiso.2023.110920

The present study continues research into the utilisation of carbonaceous media for medical radiation dosimetry, focusing on the effects of surface area-to-volume ratio and carbon content on structural interaction alterations and dosimetric properties in sheet- and bead-type graphitic materials (with the respective carbon content of ∼98 wt% and ∼90 wt%). Using 60Co gamma-rays and doses from 0.5 Gy to 20 Gy, the study has been made of the response of commercially available graphite in the form of 0.1 mm, 0.2 mm, 0.3 mm and 0.5 mm thick sheets, also of activated carbon beads. Confocal Raman and photoluminescence spectroscopy have been employed, examining radiation-induced structural interaction alterations. Dose-dependent variation in the Raman intensity ratio ID/IG relates to the varying dominance of defect generation and dose-driven defect annealing. Of the various thickness graphite sheets, the 0.1 mm thick medium possesses the greatest surface area-to-volume ratio. Perhaps unsurprisingly, it also exhibits the greatest thermoluminescence (TL) yield compared to that of the other carbonaceous sheet foils used herein. Moreover, the second greatest mass-normalised TL yield has been observed to be that of the porous beads, reflected in the greater defect density (ID/IG > 2) when compared to the other media, due in part to their inherent feature of large internal surface area. Considering the challenge posed in matching skin thickness with skin dose, the near tissue equivalent graphite sheets show particular promise as a skin dosimeter, sensitive as a function of depth.
Cost-Effectiveness of Glucose-Lowering Therapies as Add-on to Standard Care for People With Type 2 Diabetes in Malaysia

Sim R, Chong CW, Loganadan NK, Saidoung P, Adam NL, Hussein Z, et al.

Value Health Reg Issues, 2023 Nov;38:9-17.
PMID: 37419012 DOI: 10.1016/j.vhri.2023.05.006

OBJECTIVES: This study aims to evaluate the cost-effectiveness of various glucose-lowering therapies as add-on to standard care for people with type 2 diabetes (T2D) in Malaysia.
METHODS: A state-transition microsimulation model was developed to compare the clinical and economic outcomes of 4 treatments: standard care, dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors (SGLT2is), and glucagon-like peptide-1 receptor agonists. Cost-effectiveness was assessed from a healthcare provider's perspective over a lifetime horizon with 3% discount rate in a hypothetical cohort of people with T2D. Data input were informed from literature and local data when available. Outcome measures include costs, quality-adjusted life-years, incremental cost-effectiveness ratios, and net monetary benefits. Univariate and probabilistic sensitivity analyses were performed to assess uncertainties.
RESULTS: Over a lifetime horizon, the costs to treat a person with T2D ranged from RM 12 494 to RM 41 250, whereas the QALYs gains ranged from 6.155 to 6.731, depending on the treatment. Based upon a willingness-to-pay threshold of RM 29 080 per QALY, we identified SGLT2i as the most cost-effective glucose-lowering treatment, as add-on to standard care over patient's lifetime, with the net monetary benefit of RM 176 173 and incremental cost-effectiveness ratios of RM 12 279 per QALY gained. The intervention also added 0.577 QALYs and 0.809 LYs compared with standard care. Cost-effectiveness acceptability curve showed that SGLT2i had the highest probability of being cost-effective in Malaysia across varying willingness-to-pay threshold. The results were robust to various sensitivity analyses.
CONCLUSIONS: SGLT2i was found to be the most cost-effective intervention to mitigate diabetes-related complications.

MeSH terms: Cost-Benefit Analysis; Diabetes Mellitus, Type 2*; Glucose/therapeutic use; Humans; Malaysia
Fulltext A framework for determining the life cycle GHG emissions of fossil marine fuels in countries reliant on imported energy through maritime transportation: A case study of South Korea

Ha S, Jeong B, Jang H, Park C, Ku B

Sci Total Environ, 2023 Nov 01;897:165366.
PMID: 37419370 DOI: 10.1016/j.scitotenv.2023.165366

This research was motivated to address limitations in the current lifecycle assessment frameworks with the absence of proper guidelines for developing default lifecycle values of energies in consideration of supply chain activities and maritime transportation. Given this, it aims to evaluate the level of life cycle GHG emissions of heavy fuel oil, LNG, LPG and methanol as marine fuels produced and supplied in energy import-dependent countries, using South Korea as a case study. The analysis clearly shows that the impact of international shipping on Well-to-Tank (WtT) GHG emissions for energy carriers would be subject to several factors: propulsion system types, the quantify of energy transported, and the routes and distances of voyages. For instance, transportation emissions from LNG carriers for LNG fuel vary significantly depending on the country of import, ranging from 2.26 g CO2 eq./MJ (representing 12.2 % of Well-to-Tank (WtT) emissions for Malaysia) to 5.97 g CO2 eq./MJ (representing 33.3 % of WtT emissions for Qatar). As a preliminary study, an enhancement on the quality of the input/inventory data is imperative for obtaining a reliability of results. Nevertheless, the comparative analysis of different fuels and life stages provides valuable insights for stakeholders to develop effective policies and energy refueling plans for reducing life cycle GHG emissions from marine fuels. These findings could also enhance the current regulatory framework and provide meaningful lifecycle carbon footprints of marine fuels for energy importing countries. The study results also strongly suggest that default values of GHG emission for different countries relying on energy imports via international maritime transport should be further developed in consideration of the impact of regional differences, such as distance, from the importing country for successful arrival of LCA application on marine industry.

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