Displaying publications 81 - 100 of 342 in total

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  1. Salleh N, Ismail N, Nelli G, Myint K, Khaing SL
    Biotech Histochem, 2022 Jan;97(1):53-66.
    PMID: 33827344 DOI: 10.1080/10520295.2021.1899285
    We investigated changes in the composition of cervical fluid at different phases of the female rat reproductive cycle. Fluid was collected from the cervix of rats by direct cervical flushing and analyzed for changes in Na+ and Cl- content and osmolarity. Following sacrifice, the cervix was harvested and expressions of mRNA and protein for ENaCs, CFTR and AQPs were measured using qPCR and immunohistochemistry, respectively. Cervical fluid Na+ and Cl- content was high during estrus, but osmolarity was high during metestrus and diestrus. Expressions of CFTR, AQP-1 and AQP-2 in the cervix were high during estrus, but low during diestrus. Expression of ENaC (α, β, γ), AQP-5 and AQP-7 was high during metestrus and diestrus and low during estrus. Changes in expression of ion channels in the cervix could explain changes in cervical fluid composition during the estrus cycle phases that could affect female fertility.
  2. Hakimi S, Kari NM, Ismail N, Ismail MN, Ahmad F
    Food Sci Biotechnol, 2022 Jul;31(7):767-785.
    PMID: 35720460 DOI: 10.1007/s10068-022-01097-w
    Enzymatic activity and microbial fermentation play a prominent role in the bioconversion of complex muscle tissue into smaller units of peptides and amino acids, possibly contribute to sensory properties. Thus, this study screens and evaluate anchovy proteins with taste-active peptides and amino acids by the reaction of multiple enzymes using an in silico approach. Information about sensory components was provided based on an in silico analysis using tools available in the BIOPEP-UWM database. Proteins from anchovy, namely myosin heavy chain 6 alpha, myosin light chain 1, cytochrome B, and NADH ubiquinone oxidoreductase, were subjected to in silico digestion with the combination of 23 enzymes. This led to the release of taste-active peptides and amino acids, including umami, sweet, salty, sour, and bitter sensory properties. The combination of multiple enzymes released a more significant number of taste-active peptides and amino acids for both myosins compared to other proteins.
  3. Ismail N, Myint K, Khaing SL, Giribabu N, Salleh N
    Mol Biol Rep, 2023 Aug;50(8):6729-6737.
    PMID: 37382776 DOI: 10.1007/s11033-023-08555-6
    BACKGROUND: Unexplained infertility could arise from a defect in the cervix. However, the contribution of abnormal cervical fluid microenvironment to this problem still needs to be identified. Therefore, this study identifies the changes in the cervical fluid microenvironment, i.e., pH, electrolytes and osmolarity as well as expression of ion transporters in the cervix including ENaC, CFTR and AQP in fertile women and in women suffering from primary unexplained infertility.

    METHODS: Fertile women and women with unexplained infertility but having regular 28-day menstrual cycles were chosen in this study, Day-22 serum progesterone levels were determined. In the meantime, serum FSH and LH levels were determined on day 2 while, cervical flushing was performed at day 14 to analyse changes in the cervical fluid pH, osmolarity, Na+ and Cl- levels. Meanwhile, cells retrieved from cervical fluid were subjected to mRNA expression and protein distribution analysis for CFTR, AQP and ENaC by qPCR and immunofluorescence, respectively.

    RESULTS: No significant changes in serum progesterone, FSH and LH levels were observed between the two groups. However, cervical fluid pH, osmolarity, Na+ and Cl- levels were significantly lower in primary unexplained infertile group when compared to fertile group. Expression of CFTR and AQP (AQP 1, AQP 2, AQP 5 and AQP 7) in endocervical cells was lower and expression of β-ENaC was higher in primary unexplained infertile women (p 

  4. Ahmad H, Ramli R, Ismail NN, Aidit SN, Yusoff N, Samion MZ
    Sci Rep, 2021 Jun 02;11(1):11652.
    PMID: 34078979 DOI: 10.1038/s41598-021-90978-x
    As a result of the emergence of two-dimensional (2D) materials for various opto-electronics applications, a new class of materials named MXenes have been attracting interests due to their outstanding nonlinear properties. In this work, an MXene niobium carbide (Nb2C) was proposed and demonstrated as a saturable absorber to induce mode-locking in thulium- and thulium/holmium-doped fiber lasers. The Nb2C solution was first prepared using the liquid exfoliation technique, and then deposited onto a microfiber for integration into the laser cavity. Stable mode-locking operation was observed in both laser cavities, where the center wavelengths of the laser were recorded at 1944 nm for the TDFL and 1950 nm for the THDFL. The generated pulses in the TDFL and THDFL had repetition rates of 9.35 and 11.76 MHz respectively, while their corresponding pulse widths were 1.67 and 1.34 ps. Both of the lasers were highly stable, having SNR values of more than 52 dB and showed no major fluctuations when tested for their long-term stabilities. The results demonstrate an excellent performance of the Nb2C as a saturable absorber, offering opportunities to further explore MXenes for future photonics devices.
  5. He B, Ismail N, Leng KKK, Chen G
    Heliyon, 2023 Dec;9(12):e22828.
    PMID: 38125459 DOI: 10.1016/j.heliyon.2023.e22828
    This research demonstrates the application of novel optimization methods in the realm of renewable energy and contributes to the development of environmentally friendly electricity generation and consumption. In this study, an improved version of the Al-Biruni algorithm has been proposed for Hybrid Renewable Energy Systems (HRES) optimization, which includes fuel cells, photovoltaic cells, and windmills. The algorithm considers supply, demand, and energy storage constraints and seeks the best combination of energy sources to meet load demand while reducing total system cost. Inspired by ancient Iranian philosopher Abu Biruni, the proposed method includes modifications to explore solution space efficiently and improve answer value. The proposed HRES model is applied to a case study from Dunhuang City, China, and its findings are validated by comparing it with other optimization approaches. The Modified Al-Biruni Earth Radius (MBER) algorithm is found to be the most efficient and reliable system, costing 4.23 million units of currency. Compared to other optimization approaches, MBER exhibited a total cost of 4.1 million US dollars, 0.009, 3.7, 3.7, LPSP, and 356 h per year. The overall cost is 5.26 million units of currency with a 0.5% Loss of Power Supply Probability (LPSP), which directly impacts system performance and dependability. The improved Al-Biruni algorithm can efficiently optimize the system, reduce costs, and increase load supply, contributing to the growth of renewable energy sources and the application of advanced meta-heuristic techniques in complex energy systems.
  6. Ismail N, Isa KAM, Hamzah SH, Mokhtar IW
    J Int Soc Prev Community Dent, 2023;13(6):500-508.
    PMID: 38304538 DOI: 10.4103/jispcd.JISPCD_52_23
    AIM: To compare caregivers' acceptance, consent, and concern toward utilization of a combination of basic behavior guidance technique (CBBGT) and Papoose Board (PB) for their special needs children and to evaluate the impact of PB usage on the caregiver's attitude and the association between their education level, monthly household income, and previous dental experience.

    MATERIALS AND METHODS: This cross-over study incorporated 90 special needs children who were recruited to receive dental treatment with two ways of behavior guidance exposures consecutively in the order of A-B/B-A design. Exposure A is CBBGT (distraction, tell-show-do, and positive reinforcement), while Exposure B is PB. The dental procedures were either dental prophylaxis or restoration with a handpiece. Caregivers need to answer a paper-based questionnaire before and after exposure. The Wilcoxon sign rank test and logistic regression were utilized in order to establish the comparability, impacts, and association.

    RESULT: About 88 caregivers of special needs children aged between 2 and 15 years completed the sequence. Overall, 98.9% of the children presented with neurodevelopmental disorders. Twenty-seven caregivers were significantly concerned when the combination of basic BGT was applied to their children, and 14 caregivers felt the same for PB. However, the Wilcoxon sign rank test revealed insignificant caregiver scores on acceptance and consent for both methods but significantly improved attitudes towards the use of PB after observing the placement of their children.

    CONCLUSION: The studied caregiver demonstrated equivalent acceptance, consent, and concern toward the use of PB and a combination of basic BGT with improved attitudes after comprehensive explanation and real-time observation of PB usage during their children's dental treatment.

  7. Mohd Faizal MN, Ismail N, M S Eldeen I, Mariam T
    Pak J Biol Sci, 2021 Jan;24(5):579-587.
    PMID: 34486333 DOI: 10.3923/pjbs.2021.579.587
    <b>Background and Objective:</b> Horseshoe crabs are widely used in both traditional and modern pharmaceutical applications. Most of the previous studies on horseshoe crabs focused on their blood which contains hemolymph and amoebocyte lysate. This study aimed to determine the potential antibacterial and antifouling properties of different extracts from the carapace and the book gills of <i>Carcinoscorpius rotundicauda</i>. <b>Materials and Methods:</b> The crude extracts were subjected to the bioactivity tests using the disc-diffusion and the inhibition of biofilm-formation measurement assays, for both the antibacterial and antifouling activities respectively. <b>Results:</b> The results obtained indicated that the carapace extracts had stronger antibacterial and antifouling effects compared to the book gills extracts. Extracts obtained from the male displayed more activity compared to the extracts from the female with a few exceptions. Methanol and acetone carapace crude extracts showed the best overall performance. A sterol compound was isolated from the carapace acetone extracts of the male of <i>C. rotundicauda</i>. However, the compound did not display strong activity compared to the crude extract. The compound might be contributing to the observed activity with other components through a synergistic effect. <b>Conclusion:</b> The presence of antibacterial and antifouling activities in the carapace and book gills extracts could be added to the complexity of the defence mechanisms of horseshoe crabs. The results of this study, therefore, may contribute to the knowledge of the defence mechanisms of <i>C. rotundicauda</i>. Further research is needed to determine the bioactivities of other parts of the animal and to explore their potential applications.
  8. He B, Chen Y, Ismail N, Chen G, Ni L
    Heliyon, 2024 Jan 15;10(1):e23812.
    PMID: 38223717 DOI: 10.1016/j.heliyon.2023.e23812
    Based on the framework theory of industrial digitization, digital industrialization, digital governance and digital value-added in a sustainable environment, this paper systematically studies the relevant elements of governance and value distribution in the sustainable environment of global trade, and its impact on the development path of human beings. This paper explores the way to embed digital technology into the global value chain to realize digital empowerment, measures the competitiveness index of Keqiao's textile industry in the global value chain, analyzes the technical and environmental challenges faced by China's textile industry in the digital age, and proposes the corresponding countermeasures to deal with the impact of global value chain participation and to improve the international competitiveness of China's textile industry.
  9. Ismail N, Nishida Y, Ohtsuka S, Boxshall G, Bernot JP
    Biodivers Data J, 2024;12:e116598.
    PMID: 38420188 DOI: 10.3897/BDJ.12.e116598
    BACKGROUND: In total, 14 species of Caligus have been reported from Malaysia. Amongst them, four species are reported from lutjanid fishes.

    NEW INFORMATION: Caligusdussumieri Rangnekar, 1957 is reported from Malabar snapper, Lutjanusmalabaricus, purchased from a local wet market in Terengganu, Peninsular Malaysia. This is the first record of this species in Malaysia and it is only the second species assigned to the bonito-group of the genus Caligus to be reported from Malaysia. A key to species of the bonito-group is presented herein. The list of caligids infecting lutjanid fishes and the geographical distributions plus the known hosts of members of the bonito-group of Caligus are discussed.

  10. Ohtsuka S, Piasecki W, Ismail N, Kamarudin AS
    Parasite, 2020;27:40.
    PMID: 32463013 DOI: 10.1051/parasite/2020038
    Both sexes of Brachiella malayensis n. sp. are described on the basis of specimens found in the nostrils of narrow-barred Spanish mackerel Scomberomorus commerson (Lacepède) collected off Besut, Malaysia. The female of this species closely resembles those of B. magna Kabata, 1968 and B. cybii Pillai, Prabha et Balaraman, 1982 but is distinguishable mainly by the body size and the proportions of the cephalosome, posterior processes and caudal rami. While examining the male, we noticed a systematic inconsistency in some lernaeopodid genera. The genus Brachiella Cuvier, 1830, represented by its type-species Brachiella thynni Cuvier, 1830, and two monotypic genera Charopinopsis Yamaguti, 1963 and Eobrachiella Ho et Do, 1984, represented by Charopinopsis quaternia (Wilson, 1935) and Eobrachiella elegans (Richiardi, 1880), respectively, share distinct synapomorphies in the embracing (vs. pinching) elongate male maxilliped and the female trunk with a pair of long, cylindrical ventroposterior processes (in addition to a pair of modified caudal rami), both of which are involved in their unique reproductive strategy. The latter two genera are herewith relegated to junior synonyms of Brachiella.
  11. Hamid SBA, Denil NM, Ismail NA, Mauludyani AVR
    Med J Malaysia, 2024 Mar;79(Suppl 1):53-58.
    PMID: 38555886
    INTRODUCTION: Food insecurity is often link with nutritional status. An increased rate of food insecurity can have a severe impact on children's growth. During the COVID-19 outbreak, little is known regarding its effect on food security and nutritional status, especially concerning vulnerable groups such as children. The purpose of this study was to assess household food security status, children's nutritional status along with their association, and the determinants of food insecurity during the COVID-19 pandemic.

    MATERIALS AND METHODS: This cross-sectional study was conducted from May to July 2022 in urban areas in Selangor among children aged less than two years old from B40 households using purposive sampling through both online surveys and face-to-face interviews. There were 112 children aged < 2 years old from B40 households participating in this study. The data obtained on maternal sociodemographic, Household Food Insecurity Scale (HFIAS), and children's anthropometric measurements were analysed by using the WHO Anthro Survey, descriptive analysis, Person's Chisquare test and Fischer's exact test.

    RESULTS: The prevalence of food insecurity was more significant than the prevalence of food secured, at 55.4% and 44.6% respectively. The stunting among the children rated at 34.8%, followed by 7.2% of the sample found underweight, 7.8% (BAZ) and 16.1% (BAZ) of them were wasted, and overweight & obese, proportionately. This study discovered that household size was the sole determinant of household food security status. This finding suggested that size of a household influenced the odds of a household being food insecure.

    CONCLUSION: The findings of this study provide insights into how the COVID-19 pandemic have an impact on children's nutritional status especially those from low-income and bigger size households. Therefore, more thorough and effective interventions should be designed particularly targeting this urban poor community to enhance their nutritional status and health.

  12. Chukwuma OB, Rafatullah M, Tajarudin HA, Ismail N
    Int J Environ Res Public Health, 2021 Jun 03;18(11).
    PMID: 34204975 DOI: 10.3390/ijerph18116001
    Discovering novel bacterial strains might be the link to unlocking the value in lignocellulosic bio-refinery as we strive to find alternative and cleaner sources of energy. Bacteria display promise in lignocellulolytic breakdown because of their innate ability to adapt and grow under both optimum and extreme conditions. This versatility of bacterial strains is being harnessed, with qualities like adapting to various temperature, aero tolerance, and nutrient availability driving the use of bacteria in bio-refinery studies. Their flexible nature holds exciting promise in biotechnology, but despite recent pointers to a greener edge in the pretreatment of lignocellulose biomass and lignocellulose-driven bioconversion to value-added products, the cost of adoption and subsequent scaling up industrially still pose challenges to their adoption. However, recent studies have seen the use of co-culture, co-digestion, and bioengineering to overcome identified setbacks to using bacterial strains to breakdown lignocellulose into its major polymers and then to useful products ranging from ethanol, enzymes, biodiesel, bioflocculants, and many others. In this review, research on bacteria involved in lignocellulose breakdown is reviewed and summarized to provide background for further research. Future perspectives are explored as bacteria have a role to play in the adoption of greener energy alternatives using lignocellulosic biomass.
  13. Chukwuma OB, Rafatullah M, Tajarudin HA, Ismail N
    Life (Basel), 2021 May 28;11(6).
    PMID: 34071172 DOI: 10.3390/life11060493
    Omics have given rise to research on sparsely studied microbial communities such as the landfill, lignocellulolytic microorganisms and enzymes. The bacterial diversity of Municipal Solid Waste sediments was determined using the illumina MiSeq system after DNA extraction and Polymerase chain reactions. Data analysis was used to determine the community's richness, diversity, and correlation with environmental factors. Physicochemical studies revealed sites with mesophilic and thermophilic temperature ranges and a mixture of acidic and alkaline pH values. Temperature and moisture content showed the highest correlation with the bacteria community. The bacterial analysis of the community DNA revealed 357,030 effective sequences and 1891 operational taxonomic units (OTUs) assigned. Forty phyla were found, with the dominant phyla Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidota, while Aerococcus, Stenotrophomonas, and Sporosarcina were the dominant species. PICRUSt provided insight on community's metabolic function, which was narrowed down to search for lignocellulolytic enzymes' function. Cellulase, xylanase, esterase, and peroxidase were gene functions inferred from the data. This article reports on the first phylogenetic analysis of the Pulau Burung landfill bacterial community. These results will help to improve the understanding of organisms dominant in the landfill and the corresponding enzymes that contribute to lignocellulose breakdown.
  14. Jasni N, Wee CL, Ismail N, Yaacob NS, Othman N
    Sci Rep, 2024 Feb 17;14(1):3968.
    PMID: 38368470 DOI: 10.1038/s41598-024-54279-3
    Horseshoe crabs are among the most studied invertebrates due to their unique, innate immune system and biological processes. The metabolomics study was conducted on lipopolysaccharide (LPS)-stimulated and non-stimulated hemocytes isolated from the Malaysian Tachypleus gigas and Carcinoscorpius rotundicauda. LC-TOF-MS, multivariate analyses, principal component analysis (PCA), and partial least squares-discriminant analysis (PLS-DA) were included in this study to profile the metabolites. A total of 37 metabolites were identified to be differentially abundant and were selected based on VIP > 1. However, of the 37 putative metabolites, only 23 were found to be significant with ANOVA at p 
  15. Imam MU, Azmi NH, Bhanger MI, Ismail N, Ismail M
    PMID: 23304216 DOI: 10.1155/2012/816501
    Diet is an important variable in the course of type 2 diabetes, which has generated interest in dietary options like germinated brown rice (GBR) for effective management of the disease among rice-consuming populations. In vitro data and animal experiments show that GBR has potentials as a functional diet for managing this disease, and short-term clinical studies indicate encouraging results. Mechanisms for antidiabetic effects of GBR due to bioactive compounds like γ-aminobutyric acid (GABA), γ-oryzanol, dietary fibre, phenolics, vitamins, acylated steryl β-glucoside, and minerals include antihyperglycemia, low insulin index, antioxidative effect, antithrombosis, antihypertensive effect, hypocholesterolemia, and neuroprotective effects. The evidence so far suggests that there may be enormous benefits for diabetics in rice-consuming populations if white rice is replaced with GBR. However, long-term clinical studies are still needed to verify these findings on antidiabetic effects of GBR. Thus, we present a review on the antidiabetic properties of GBR from relevant preclinical and clinical studies, in order to provide detailed information on this subject for researchers to review the potential of GBR in combating this disease.
  16. Gopinath VK, Ling KT, Haziani KN, Ismail NM
    J Clin Pediatr Dent, 2008;33(1):39-42.
    PMID: 19093650
    This study reports on the predisposing factors and prevalence of fractured anterior teeth among 12 and 16 years-old school children in Kubang Kerian, Kelantan, West Malaysia.
  17. Ismail N, Mohd Yusof MYP, Wan Mokhtar I
    J Clin Pediatr Dent, 2024 May;48(3):6-14.
    PMID: 38755976 DOI: 10.22514/jocpd.2024.053
    Exploring parental opinions regarding the use of passive immobilisation during dental treatment is critical when identifying behaviour guidance application priorities. Instead of being dismissed as an inappropriate and less favourable option, this article aims to systematically evaluate factors affecting parental acceptance toward the use of passive immobilisation as behaviour guidance among children during dental treatment in various populations and regions. This research follows Arksey and O'Malley framework and updated by Joanna Briggs Institute Framework for Scoping Reviews methodology to summarise 40 research papers from 1984 to 2022 in PubMed, Web of Science, Science Direct, EBSCO Host, Scopus, grey literature and Google search outlining the research trend of parental acceptance toward passive immobilisation as behaviour guidance. Factors influencing parental acceptance toward the use of passive immobilisation were classified into parental socio-economic and demographic characteristics, exposure method of the devices to the parents, type of dental procedures, and children's cooperation and cognitive level. In conclusion, the current explorative review of the parental perspective toward passive immobilisation proposed a recommendation and facilitate the dentist to consider this technique as an alternative option for behaviour guidance in paediatric dentistry.
  18. Ismail N, Zam Z, Hassan SA, Rahman ZA
    Malays J Med Sci, 2017 Mar;24(2):21-27.
    PMID: 28894400 DOI: 10.21315/mjms2017.24.2.3
    BACKGROUND: Stenotrophomonas maltophilia has emerged as an important nosocomial pathogen, capable of causing a wide spectrum of infections. Treatment is difficult because it is resistant to many antimicrobial agents, thus reducing the treatment options. The aims of this study were to describe the antimicrobial susceptibility patterns and synergistic effect of selected antimicrobial combinations against S. maltophilia isolates.

    METHODS: This was a descriptive cross-sectional study undertaken in the Hospital Universiti Sains Malaysia from April 2011 to March 2012. S. maltophilia isolated from various clinical specimens were included in the study. Antimicrobial susceptibility testing was done using the epsilometer test (E-test) and interpreted according to the guidelines of the Clinical and Laboratory Standards Institute. In the synergy test, the isolates were tested against six different antimicrobial combinations.

    RESULTS: In total, 84 S. maltophilia isolates were collected and analysed. According to the E-test, the antimicrobial susceptibility of trimethoprim-sulfamethoxazole (TMP-SMX), tigecycline, and ciprofloxacin was 100%, 91.1%, and 88.9% respectively. The antimicrobial combination of TMP-SMX and ceftazidime showed the highest synergistic effect.

    CONCLUSION: TMP-SMX remains the antimicrobial of choice to treat S. maltophilia infection. TMP-SMX and ceftazidime was the most effective combination in vitro.

  19. Jamalluddin NA, Ismail N, Mutalib SRA, Sikin AM
    Bioresour Bioprocess, 2022 Mar 12;9(1):21.
    PMID: 38647764 DOI: 10.1186/s40643-022-00509-3
    Supercritical carbon dioxide (Sc-CO2) is an alternative tool to extract lipid for the production of fish oil and enzyme from fish by-products (FBPs). In the application of Sc-CO2, this review covers sample preparation, lipid extraction operation, and characterization of fish oil and enzyme as final products. Generally, the fish samples with moisture content less than 20% and particle size less than 5 mm are considered before lipid extraction with Sc-CO2. Sc-CO2 parameters, such as pressure (P), temperature (T), extraction time (text), and flow rate (F), for simultaneous recovery of fish oil, protein, and enzyme were found to be less severe (P: 10.3-25 MPa; T: 25-45 °C, text: 20-150 min; F: 3-50 g/min) than the extraction of fish oil alone (P: 10-40 Mpa; T: 35-80 °C; text: 30-360 min; F: 1-3000 g/min). The enzyme from the Sc-CO2 defatted sample showed higher activity up to 45 U/mg due to lower denaturation of protein as compared to the organic solvent treated sample albeit both samples having similar pH (6-10) and temperature stability (20-60 °C). Overall, mild extraction of lipid from FBPs using Sc-CO2 is effective for the production of enzymes suitable in various industrial applications. Also, fish oil as a result of extraction can be produced as a health product with high polyunsaturated fatty acids (PUFAs) and low contamination of heavy metals.
  20. Abd Rani AY, Ismail N, Zakaria Y, Isa MR
    Med J Malaysia, 2024 Jul;79(4):470-476.
    PMID: 39086346
    INTRODUCTION: Tuberculosis (TB) is a global public health issue. The Southeast Asian region grapples with numerous challenges in TB management, with loss to follow-up (LTFU) emerging as a critical barrier to effective control of the disease. This review synthesised published articles to identify socioeconomic factors contributing to the burden of TB losses for follow-up in Southeast Asia.

    MATERIALS AND METHODS: This scoping review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework developed by the Joanna Briggs Institute (JBI). A total of 10 studies were identified as eligible from the title and abstract review. The mixed method quality appraisal tool (MMAT) version 2018 was used to assess the quality of the included quantitative studies.

    RESULTS: The results showed that poverty, unemployment, low education levels, migrant status, community support, male gender, substance abuse, and regional disparities significantly impact the occurrence of TB LTFU in Southeast Asia.

    CONCLUSION: The findings have significant implications for public health in Southeast Asia. Addressing these socioeconomic barriers through community-based strategies, educational initiatives, and policy reforms is vital for improving treatment outcomes and overall public health.

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