Displaying publications 1 - 20 of 45 in total

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  1. Yeo RYZ, Chin BH, Hil Me MF, Chia JF, Pham HT, Othman AR, et al.
    ACS Biomater Sci Eng, 2023 Nov 13;9(11):6034-6044.
    PMID: 37846081 DOI: 10.1021/acsbiomaterials.3c00453
    Electrogenic microorganisms serve as important biocatalysts for microbial electrochemical sensors (MESes). The electrical signal produced is based on the rate of electron transfer between the microbes and electrodes, which represents the biotoxicity of water. However, existing MESes require complex and sophisticated fabrication methods. Here, several low-cost and rapid surface modification strategies (carbon powder-coated, flame-oxidized, and acid-bleached) have been demonstrated and studied for biosensing purposes. Surface-modified MESe bioanodes were successfully applied to detect multiple model pollutants including sodium acetate, ethanol, thinner, and palm oil mill effluent under three different testing sequences, namely, pollutant incremental, pollutant dumping, and water dilution tests. The carbon powder-coated bioanode showed the most responsive signal profile for all the three tests, which is in line with the average roughness values (Ra) when tested with atomic force microscopy. The carbon powder-coated electrode possessed a Ra value of 0.844, while flame-oxidized, acid-bleached, and control samples recorded 0.323, 0.336, and 0.264, respectively. The higher roughness was caused by the carbon coating and provided adhesive sites for microbial attachment and growth. The accuracy of MESe was also verified by correlating with chemical oxygen demand (COD) results. Similar to the sensitivity test, the carbon powder-coated bioanode obtained the highest R2 value of 0.9754 when correlated with COD results, indicating a high potential of replacing conventional water quality analysis methods. The reported work is of great significance to showcase facile surface modification techniques for MESes, which are cost-effective and sustainable while retaining the biocompatibility toward the microbial community with carbon-based coatings.
  2. Kim BH, Lim SS, Daud WR, Gadd GM, Chang IS
    Bioresour Technol, 2015 Aug;190:395-401.
    PMID: 25976915 DOI: 10.1016/j.biortech.2015.04.084
    The cathode reaction is one of the most important limiting factors in bioelectrochemical systems even with precious metal catalysts. Since aerobic bacteria have a much higher affinity for oxygen than any known abiotic cathode catalysts, the performance of a microbial fuel cell can be improved through the use of electrochemically-active oxygen-reducing bacteria acting as the cathode catalyst. These consume electrons available from the electrode to reduce the electron acceptors present, probably conserving energy for growth. Anaerobic bacteria reduce protons to hydrogen in microbial electrolysis cells (MECs). These aerobic and anaerobic bacterial activities resemble those catalyzing microbially-influenced corrosion (MIC). Sulfate-reducing bacteria and homoacetogens have been identified in MEC biocathodes. For sustainable operation, microbes in a biocathode should conserve energy during such electron-consuming reactions probably by similar mechanisms as those occurring in MIC. A novel hypothesis is proposed here which explains how energy can be conserved by microbes in MEC biocathodes.
  3. Lim SS, Yu EH, Daud WRW, Kim BH, Scott K
    Bioresour Technol, 2017 Aug;238:313-324.
    PMID: 28454006 DOI: 10.1016/j.biortech.2017.03.127
    The bioanode is important for a microbial electrolysis cell (MEC) and its robustness to maintain its catalytic activity affects the performance of the whole system. Bioanodes enriched at a potential of +0.2V (vs. standard hydrogen electrode) were able to sustain their oxidation activity when the anode potential was varied from -0.3 up to +1.0V. Chronoamperometric test revealed that the bioanode produced peak current density of 0.36A/m(2) and 0.37A/m(2) at applied potential 0 and +0.6V, respectively. Meanwhile hydrogen production at the biocathode was proportional to the applied potential, in the range from -0.5 to -1.0V. The highest production rate was 7.4L H2/(m(2) cathode area)/day at -1.0V cathode potential. A limited current output at the bioanode could halt the biocathode capability to generate hydrogen. Therefore maximum applied potential that can be applied to the biocathode was calculated as -0.84V without overloading the bioanode.
  4. Ooi J, Lee LY, Hiew BYZ, Thangalazhy-Gopakumar S, Lim SS, Gan S
    Bioresour Technol, 2017 Dec;245(Pt A):656-664.
    PMID: 28917100 DOI: 10.1016/j.biortech.2017.08.153
    In this study, AB113 dye was successfully sequestered using a novel adsorbent made of mixed fish scales (MFS). The influence of adsorbent dosage, initial pH, temperature, initial concentration and contact time on the adsorption performance was investigated. The surface chemistry and morphology of the adsorbent were examined by FTIR, TGA and SEM. Amides, phosphate and carbonate groups were evidently responsible for the high affinity of MFS towards the dye. The adsorption equilibrium and kinetic were well described by Langmuir and pseudo-second-order models, respectively. The maximum adsorption capacities of MFS were 145.3-157.3mg/g at 30-50°C. The adsorption of AB113 dye onto the adsorbent was exothermic and spontaneous as reflected by the negative enthalpy and Gibbs energy changes. The results support MFS asa potential adsorbent for AB113 dye removal.
  5. Nuge T, Liu X, Tshai KY, Lim SS, Nordin N, Hoque ME, et al.
    PMID: 33826152 DOI: 10.1002/bab.2162
    Despite a lot of intensive research on cells-scaffolds interaction, focused are mainly on the capacity of construct scaffolds to regulate cell mobility, migration and cytotoxicity. The effect of the scaffold's topographical and material properties on the expression of biologically active compounds from stem cells is not well understood. In this study, the influence of cellulose acetate (CA) on the electrospinnability of gelatin and the roles of gelatin-cellulose acetate (Ge-CA) on modulating the release of biologically active compounds from amniotic fluid stem cells (AFSCs) is emphasized. It was found that the presence of a small amount of CA could provide a better microenvironment that mimics AFSCs' niche. However, a large amount of CA exhibited no significant effect on AFSCs migration and infiltration. Further study on the effect of surface topography and mechanical properties on AFSCs showed that the tailored microenvironment provided by the Ge-CA scaffolds had transduced physical cues to biomolecules released into the culture media. It was found that the AFSCs seeded on electrospun scaffolds with less CA proportions has profound effects on the secretion of metabolic compounds compared to those with higher CA contained and gelatin coating. The enhanced secretion of biologically active molecules by the AFSCs on the electrospun scaffolds was proven by the accelerated wound closure on the injured human dermal fibroblast (HDF) model. The rapid HDF cell migration could be anticipated due to a higher level of paracrine factors in AFSCs media. Our study demonstrates that the fibrous topography and mechanical properties of the scaffold is a key material property that modulates the high expression of biologically active compounds from the AFSCs. The discovery elucidates a new aspect of material functions and scaffolds material-AFSCs interaction for regulating biomolecules release to promote tissue regeneration/repair. To the best of our knowledge, this is the first report describing the scaffolds material-AFSCs interaction and the efficacy of scratch assays on quantifying the cell migration in response to the AFSCs metabolic products. This article is protected by copyright. All rights reserved.
  6. Chew KW, Khoo KS, Foo HT, Chia SR, Walvekar R, Lim SS
    Chemosphere, 2020 Dec 15;268:129322.
    PMID: 33359993 DOI: 10.1016/j.chemosphere.2020.129322
    With the rapid urbanisation happening around the world followed by the massive demand for clean energy resources, green cities play a pivotal role in building a sustainable future for the people. The continuing depletion of natural resources has led to the development of renewable energy with algae as the promising source. The high growth rate of microalgae and their strong bio-fixation ability to convert CO2 into O2 have been gaining attention globally and intensive research has been conducted regarding the microalgae benefits. The focus on potential of microalgae in contributing to the development of green cities is rising. The advantage of microalgae is their ability to gather energy from sunlight and carbon dioxide, followed by transforming the nutrients into biomass and oxygen. This leads to the creation of green cities through algae cultivation as waste and renewable materials can be put to good use. The challenges that arise when using algae and the future prospect in terms of SDGs and economy will also be covered in this review. The future of green cities can be enhanced with the adaptation of algae as the source of renewable plants to create a better outlook of an algae green city.
  7. Lim SS, Fontmorin JM, Ikhmal Salehmin MN, Feng Y, Scott K, Yu EH
    Chemosphere, 2022 Feb;288(Pt 2):132548.
    PMID: 34653487 DOI: 10.1016/j.chemosphere.2021.132548
    A microbial electrolysis cell (MEC) fully catalysed by microorganisms is an attractive technology because it incorporates the state-of-the-art concept of converting organic waste to hydrogen with less external energy input than conventional electrolysers. In this work, the impact of the anode feed mode on the production of hydrogen by the biocathode was studied. In the first part, three feed modes and MEC performance in terms of hydrogen production were evaluated. The results showed the highest hydrogen production under the continuous mode (14.6 ± 0.4), followed by the fed-batch (12.7 ± 0.4) and batch (0 L m-2 cathode day-1) modes. On one hand, the continuous mode only increased by 15% even though the hydraulic retention time (HRT) (2.78 h) was lower than the fed-batch mode (HRT 5 h). A total replacement (fed-batch) rather than a constant mix of existing anolyte and fresh medium (continuous) was preferable. On the other hand, no hydrogen was produced in batch mode due to the extensive HRT (24 h) and bioanode starvation. In the second part, the fed-batch mode was further evaluated using a chronoamperometry method under a range of applied cell voltages of 0.3-1.6 V. Based on the potential evolution at the electrodes, three main regions were identified depending on the applied cell voltages: the cathode activation (<0.8 V), transition (0.8-1.1 V), and anode limitation (>1.1 V) regions. The maximum hydrogen production recorded was 12.1 ± 2.1 L m-2 cathode day-1 at 1.0 V applied voltage when the oxidation and reduction reactions at the anode and cathode were optimal (2.38 ± 0.61 A m-2). Microbial community analysis of the biocathode revealed that Alpha-, and Deltaproteobacteria were dominant in the samples with >70% abundance. At the genus level, Desulfovibrio sp. was the most abundant in the samples, showing that these microbes may be responsible for hydrogen evolution.
  8. Lam YF, Lee LY, Chua SJ, Lim SS, Gan S
    Ecotoxicol Environ Saf, 2016 May;127:61-70.
    PMID: 26802563 DOI: 10.1016/j.ecoenv.2016.01.003
    Lansium domesticum peel (LDP), a waste material generated from the fruit consumption, was evaluated as a biosorbent for nickel removal from aqueous media. The effects of dosage, contact time, initial pH, initial concentration and temperature on the biosorption process were investigated in batch experiments. Equilibrium data were fitted by the Langmuir, Freundlich, Temkin and Dubinin-Radushkevich models using nonlinear regression method with the best-fit model evaluated based on coefficient of determination (R(2)) and Chi-square (χ(2)). The best-fit isotherm was found to be the Langmuir model exhibiting R(2) very close to unity (0.997-0.999), smallest χ(2) (0.0138-0.0562) and largest biosorption capacity (10.1mg/g) at 30°C. Kinetic studies showed that the initial nickel removal was rapid with the equilibrium state established within 30min. Pseudo-second-order model was the best-fit kinetic model indicating the chemisorption nature of the biosorption process. Further data analysis by the intraparticle diffusion model revealed the involvement of several rate-controlling steps such as boundary layer and intraparticle diffusion. Thermodynamically, the process was exothermic, spontaneous and feasible. Regeneration studies indicated that LDP biosorbent could be regenerated using hydrochloric acid solution with up to 85% efficiency. The present investigation proved that LDP having no economic value can be used as an alternative eco-friendly biosorbent for remediation of nickel contaminated water.
  9. Me MFH, Ang WL, Othman AR, Mohammad AW, Nasharuddin AAA, Aris AM, et al.
    Environ Monit Assess, 2024 Mar 14;196(4):366.
    PMID: 38483639 DOI: 10.1007/s10661-024-12526-0
    Bioelectrochemical sensors for environment monitoring have the potential to provide facility operators with real-time data, allowing for better and more timely decision-making regarding water and wastewater treatment. To assess the robustness and sensitivity of the Sentry™ biosensor in local conditions, it was tested in Malaysia using domestically available wastewater. The study objectives included (1) enrich the biosensor locally, (2) operate and test the biosensor with local domestic wastewater, and (3) determine the biosensor's responsiveness to model pollutants through pollutant spike and immersion test as well as response to absence of wastewater. Lab-scale operation shows the biosensor was successfully enriched with (1) local University Kebangsaan Malaysia's, microbial community strain collection and (2) local municipal wastewater microflora, operated for more than 50 days with a stable yet responsive carbon consumption rate (CCR) signal. Meanwhile, two independent biosensors were also enriched and operated in Indah Water Research Centre's crude sewage holding tank, showing a stable response to the wastewater. Next, a pilot scale setup was constructed to test the enriched biosensors for the spiked-pollutant test. The biosensors showed a proportional CCR response (pollutant presence detected) towards several organic compounds in the sewage, including ethanol, chicken blood, and dilution of tested sewage but less to curry powder, methanol, and isopropanol. Conversely, there was no significant response (pollutant presence not detected) towards hexane, Congo red, engine oil, and paint, which may be due to their non-biodegradability and/or insoluble nature. Additionally, the biosensors were exposed to air for 6 h to assess their robustness towards aerobic shock with a positive result. Overall, the study suggested that the biosensor could be a powerful monitoring tool, given its responsiveness towards organic compounds in sewage under normal conditions.
  10. Soh EYS, Lim SS, Chew KW, Phuang XW, Ho VMV, Chu KYH, et al.
    Environ Res, 2021 Nov 13.
    PMID: 34780790 DOI: 10.1016/j.envres.2021.112385
    The effluent of textile industries containing synthetic dyes contributed to substantial pollution to water bodies. The biosorption process of Congo Red dye was successfully performed by integrating ultrasonication in the adsorption step with spent brewery yeast as a novel and renewable biosorbent. The adsorption process was hindered when ultrasonication was employed together with the biosorbent, indicating that desorption process had occurred. The adsorption process showed that 4 g/L of biosorbent was the optimum dosage for adsorption of 50 mg/L of Congo Red dye, and that the adsorption equilibrium fitted to the Langmuir model, with kinetics best fitted with pseudo-second order model. The maximum capacity of the adsorption was 52.6 mg/g, showing the potential of spent brewery yeast to aid in removing wastewater pollutants. Maximal Congo Red dye recovery (100%) was achieved in the sonication-assisted desorption studies using 0.01M NaOH as the eluting agent. The ultrasonication effects contributed to the efficient recovery of dye and good conversion of spent brewery yeast to biosorbent can be beneficial for treating pollution from textile wastewater.
  11. Izadi P, Fontmorin JM, Lim SS, Head IM, Yu EH
    Faraday Discuss, 2021 07 16;230(0):344-359.
    PMID: 34259692 DOI: 10.1039/d0fd00132e
    Technologies able to convert CO2 to various feedstocks for fuels and chemicals are emerging due to the urge of reducing greenhouse gas emissions and de-fossilizing chemical production. Microbial electrosynthesis (MES) has been shown a promising technique to synthesize organic products particularly acetate using microorganisms and electrons. However, the efficiency of the system is low. In this study, we demonstrated the simple yet efficient strategy in enhancing the efficiency of MES by applying continuous feeding regime. Compared to the fed-batch system, continuous operational mode provided better control of pH and constant medium refreshment, resulting in higher acetate production rate and more diverse bio-products, when the cathodic potential of -1.0 V Ag/AgCl and dissolved CO2 were provided. It was observed that hydraulic retention time (HRT) had a direct effect on the pattern of production, acetate production rate and coulombic efficiency. At HRT of 3 days, pH was around 5.2 and acetate was the dominant product with the highest production rate of 651.8 ± 214.2 ppm per day and a significant coulombic efficiency of 90%. However at the HRT of 7 days, pH was lower at around 4.5, and lower but stable acetate production rate of 280 ppm per day and a maximum coulombic efficiency of 80% was obtained. In addition, more diverse and longer chain products, such as butyrate, isovalerate and caproate, were detected with low concentrations only at the HRT of 7 days. Although microbial community analysis showed the change in the planktonic cells communities after switching the fed-batch mode to continuous feeding regime, Acetobacterium still remained as the responsible bacteria for CO2 reduction to acetate, dominating the cathodic biofilm.
  12. Khambalia AZ, Lim SS, Gill T, Bulgiba AM
    Food Nutr Bull, 2012 Mar;33(1):31-42.
    PMID: 22624296
    For many developing countries undergoing rapid economic growth and urbanization, trends in nutritional status indicate a decrease in malnutrition with an associated rise in the prevalence of obesity. An understanding of the situation among children in Malaysia is lacking.
  13. Neo YT, Chia WY, Lim SS, Ngan CL, Kurniawan TA, Chew KW
    Food Res Int, 2023 Mar;165:112480.
    PMID: 36869493 DOI: 10.1016/j.foodres.2023.112480
    Production and extraction systems of algal protein and handling process of functional food ingredients need to control several parameters such as temperature, pH, intensity, and turbidity. Many researchers have investigated the Internet of Things (IoT) approach for enhancing the yield of microalgae biomass and machine learning for identifying and classifying microalgae. However, there have been few specific studies on using IoT and artificial intelligence (AI) for production and extraction of algal protein as well as functional food ingredients processing. In order to improve the production of algal protein and functional food ingredients, the implementation of smart system is a must to have real-time monitoring, remote control system, quick response to sudden events, prediction and characterisation. Techniques of IoT and AI are expected to help functional food industries to have a big breakthrough in the future. Manufacturing and implementation of beneficial smart systems are important to provide convenience and to increase the efficiency of work by using the interconnectivity of IoT devices to have good capturing, processing, archiving, analyzing, and automation. This review investigates the possibilities of implementation of IoT and AI in production and extraction of algal protein and processing of functional food ingredients.
  14. Lim SS, Kim BH, Li D, Feng Y, Daud WRW, Scott K, et al.
    Front Chem, 2018;6:318.
    PMID: 30159306 DOI: 10.3389/fchem.2018.00318
    Understanding the mechanism of electron transfer between the cathode and microorganisms in cathode biofilms in microbial electrolysis cells (MECs) for hydrogen production is important. In this study, biocathodes of MECs were successfully re-enriched and subjected to different operating parameters: applied potential, sulfate use and inorganic carbon consumption. It was hypothesized that biocathode catalytic activity would be affected by the applied potentials that initiate electron transfer. While inorganic carbon, in the form of bicarbonate, could be a main carbon source for biocathode growth, sulfate could be a terminal electron acceptor and thus reduced to elemental sulfurs. It was found that potentials more negative than -0.8 V (vs. standard hydrogen electrode) were required for hydrogen production by the biocathode. In additional, a maximum hydrogen production was observed at sulfate and bicarbonate concentrations of 288 and 610 mg/L respectively. Organic carbons were found in the cathode effluents, suggesting that microbial interactions probably happen between acetogens and sulfate reducing bacteria (SRB). The hydrogen-producing biocathode was sulfate-dependent and hydrogen production could be inhibited by excessive sulfate because more energy was directed to reduce sulfate (E°


    SO


    4


    2
    -


    /H2S = -0.35 V) than proton (E° H+/H2 = -0.41 V). This resulted in a restriction to the hydrogen production when sulfate concentration was high. Domestic wastewaters contain low amounts of organic compounds and sulfate would be a better medium to enrich and maintain a hydrogen-producing biocathode dominated by SRB. Besides the risks of limited mass transport and precipitation caused by low potential, methane contamination in the hydrogen-rich environment was inevitable in the biocathode after long term operation due to methanogenic activities.
  15. Ibrahim I, Salehmin MNI, Balachandran K, Hil Me MF, Loh KS, Abu Bakar MH, et al.
    Front Microbiol, 2023;14:1192187.
    PMID: 37520357 DOI: 10.3389/fmicb.2023.1192187
    Microbial electrosynthesis (MES) is an emerging electrochemical technology currently being researched as a CO2 sequestration method to address climate change. MES can convert CO2 from pollution or waste materials into various carbon compounds with low energy requirements using electrogenic microbes as biocatalysts. However, the critical component in this technology, the cathode, still needs to perform more effectively than other conventional CO2 reduction methods because of poor selectivity, complex metabolism pathways of microbes, and high material cost. These characteristics lead to the weak interactions of microbes and cathode electrocatalytic activities. These approaches range from cathode modification using conventional engineering approaches to new fabrication methods. Aside from cathode development, the operating procedure also plays a critical function and strategy to optimize electrosynthesis production in reducing operating costs, such as hybridization and integration of MES. If this technology could be realized, it would offer a new way to utilize excess CO2 from industries and generate profitable commodities in the future to replace fossil fuel-derived products. In recent years, several potential approaches have been tested and studied to boost the capabilities of CO2-reducing bio-cathodes regarding surface morphology, current density, and biocompatibility, which would be further elaborated. This compilation aims to showcase that the achievements of MES have significantly improved and the future direction this is going with some recommendations. Highlights - MES approach in carbon sequestration using the biotic component.- The role of microbes as biocatalysts in MES and their metabolic pathways are discussed.- Methods and materials used to modify biocathode for enhancing CO2 reduction are presented.
  16. Lim SS, Sockalingam JK, Tan PC
    Int J Gynaecol Obstet, 2008 May;101(2):178-83.
    PMID: 18164303 DOI: 10.1016/j.ijgo.2007.10.020
    To compare goserelin and leuprolide given before hysterectomy for symptomatic large fibroid uteri.
  17. Wong SHM, Lim SS, Tiong TJ, Show PL, Zaid HFM, Loh HS
    Int J Mol Sci, 2020 Jul 22;21(15).
    PMID: 32708043 DOI: 10.3390/ijms21155202
    An ideal scaffold should be biocompatible, having appropriate microstructure, excellent mechanical strength yet degrades. Chitosan exhibits most of these exceptional properties, but it is always associated with sub-optimal cytocompatibility. This study aimed to incorporate graphene oxide at wt % of 0, 2, 4, and 6 into chitosan matrix via direct blending of chitosan solution and graphene oxide, freezing, and freeze drying. Cell fixation, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide, alkaline phosphatase colorimetric assays were conducted to assess cell adhesion, proliferation, and early differentiation of MG63 on chitosan-graphene oxide scaffolds respectively. The presence of alkaline phosphatase, an early osteoblast differentiation marker, was further detected in chitosan-graphene oxide scaffolds using western blot. These results strongly supported that chitosan scaffolds loaded with graphene oxide at 2 wt % mediated cell adhesion, proliferation, and early differentiation due to the presence of oxygen-containing functional groups of graphene oxide. Therefore, chitosan scaffolds loaded with graphene oxide at 2 wt % showed the potential to be developed into functional bone scaffolds.
  18. Lim HN, Huang NM, Lim SS, Harrison I, Chia CH
    Int J Nanomedicine, 2011;6:1817-23.
    PMID: 21931479 DOI: 10.2147/IJN.S23392
    Three-dimensional assembly of graphene hydrogel is rapidly attracting the interest of researchers because of its wide range of applications in energy storage, electronics, electrochemistry, and waste water treatment. Information on the use of graphene hydrogel for biological purposes is lacking, so we conducted a preliminary study to determine the suitability of graphene hydrogel as a substrate for cell growth, which could potentially be used as building blocks for biomolecules and tissue engineering applications.
  19. Global Burden of Disease 2016 Injury Collaborators, Naghavi M, Marczak LB, Kutz M, Shackelford KA, Arora M, et al.
    JAMA, 2018 Aug 28;320(8):792-814.
    PMID: 30167700 DOI: 10.1001/jama.2018.10060
    IMPORTANCE: Understanding global variation in firearm mortality rates could guide prevention policies and interventions.

    OBJECTIVE: To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories.

    DESIGN, SETTING, AND PARTICIPANTS: This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths.

    EXPOSURES: Firearm ownership and access.

    MAIN OUTCOMES AND MEASURES: Cause-specific deaths by age, sex, location, and year.

    RESULTS: Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (-0.2% [95% UI, -0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P 

  20. GBD 2019 Lip, Oral, and Pharyngeal Cancer Collaborators, Cunha ARD, Compton K, Xu R, Mishra R, Drangsholt MT, et al.
    JAMA Oncol, 2023 Oct 01;9(10):1401-1416.
    PMID: 37676656 DOI: 10.1001/jamaoncol.2023.2960
    IMPORTANCE: Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning.

    OBJECTIVE: To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates.

    EVIDENCE REVIEW: The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019.

    FINDINGS: In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia.

    CONCLUSIONS AND RELEVANCE: In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts.

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