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  1. Fulltext All-optical graphene oxide humidity sensors
    Lim WH, Yap YK, Chong WY, Ahmad H
    Sensors (Basel), 2014;14(12):24329-37.
    PMID: 25526358 DOI: 10.3390/s141224329
    The optical characteristics of graphene oxide (GO) were explored to design and fabricate a GO-based optical humidity sensor. GO film was coated onto a SU8 polymer channel waveguide using the drop-casting technique. The proposed sensor shows a high TE-mode absorption at 1550 nm. Due to the dependence of the dielectric properties of the GO film on water content, this high TE-mode absorption decreases when the ambient relative humidity increases. The proposed sensor shows a rapid response (<1 s) to periodically interrupted humid air flow. The transmission of the proposed sensor shows a linear response of 0.553 dB/% RH in the range of 60% to 100% RH.
  2. Biological properties of sodium alkyl methyl ester sulfonate/alkyltrimethylammonium bromide surfactant mixtures
    Wong SP, Lim WH, Cheng SF, Chuah CH
    Colloids Surf B Biointerfaces, 2012 Jan 1;89:48-52.
    PMID: 21937202 DOI: 10.1016/j.colsurfb.2011.08.021
    Quaternary ammonium compounds (QACs) are commonly used as disinfectant in medical care, food industry, detergents and glue industries. This is due to a small concentration of QACs is sufficient to inhibit the growth of various bacteria strains. In this work, the inhibitive power of cationic surfactants, alkyltrimethylammonium bromide (C(n)TAB) in the presence of anionic surfactants, sodium alkyl methyl ester α-sulfonate (C(n)MES) was studied. The growth inhibition test with gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli and Pseudomonas aeruginosa) bacteria were used to determine the toxicity of single and mixed surfactants. Results from this work showed that certain mixed surfactants have lower minimum inhibition concentration (MIC) as compared to the single C(n)TAB surfactants. Besides that, it was also found that alkyl chain length and the mixing ratios of the surfactants play a significant role in determining the mixture inhibitive power.
  3. Fulltext Effect of polyglycerol esters additive on palm oil crystallization using focused beam reflectance measurement and differential scanning calorimetry
    Saw MH, Hishamuddin E, Chong CL, Yeoh CB, Lim WH
    Food Chem, 2017 Jan 1;214:277-84.
    PMID: 27507476 DOI: 10.1016/j.foodchem.2016.07.084
    The effect of 0.1-0.7% (w/w) of polyglycerol esters (PGEmix-8) on palm oil crystallization was studied using focused beam reflectance measurement (FBRM) to analyze the in-line changes of crystal size distribution during the crystallization. FBRM results show that 0.1-0.5% (w/w) of PGEmix-8 did not significantly affect nucleation but slightly retarded crystal growth. The use of 0.7% (w/w) additive showed greater heterogeneous nucleation compared to those with lower dosages of additive. Crystal growth was also greatly reduced when using 0.7% (w/w) dosage. The morphological study indicated that the palm oil crystals were smaller and more even in size than when more additive was added. Isothermal crystallization studies using differential scanning calorimetry (DSC) showed increased inhibitory effects on palm oil crystal growth with increasing concentration of PGEmix-8. These results imply that PGEmix-8 is a nucleation enhancing and crystal growth retarding additive in palm oil crystallization at 0.7% (w/w) dosage.
  4. Spreading profile of evaporative liquid drops in thin porous layer
    Chong WY, Lim KS, Lim WH, Harun SW, Adikan FR, Ahmad H
    Phys Rev E Stat Nonlin Soft Matter Phys, 2012 Jan;85(1 Pt 2):016314.
    PMID: 22400665
    Spreading of evaporative liquid drops in a thin porous layer has been studied. The entire spreading process can be divided into three distinct phases according to the change of the wetted porous region size. The first phase is characterized by the expansion of the wetted porous region and shrinking of the liquid drop. Contact line pinning is observed in the wetted porous region in the second phase even with the liquid drop totally absorbed into the porous layer. The third phase sees the shrinkage of the wetted porous region until it is not observable. Based on these observations, a model is devised to simulate the spreading of a liquid drop under the studied conditions. Partial differential equations are used to describe the relation between liquid drop volume and other important parameters of a fluid flow, including maximum wetted region diameter achieved, time taken to reach each spreading process phase, and evaporation rate. Calculated results are in good agreement with the experimental data.
  5. Note: Fabrication of tapered fibre tip using mechanical polishing method
    Cheong YK, Lim KS, Lim WH, Chong WY, Zakaria R, Ahmad H
    Rev Sci Instrum, 2011 Aug;82(8):086115.
    PMID: 21895293 DOI: 10.1063/1.3627374
    Tapered fibre tips fabricated using mechanical polishing method is studied. The fibre tips are formed by sequential polishing flat-ended single mode fibres with decreasing aluminium oxide polishing film grit size. Based on the proposed technique, tapered fibre tips with cone angle ranging from 30° to 130° are fabricated by controlling the polishing angle. Besides the variety of cone angle, considerable smoothness of the fibre tip surface may assist in good metal coating and hence a well-defined aperture can be obtained. In addition, this paper presents a two-step hybrid fabrication method combining the proposed polishing method with chemical etching method to increase the possible fibre tip cone angles achievable by chemical etching method.
  6. Fulltext Photo-induced reduction of graphene oxide coating on optical waveguide and consequent optical intermodulation
    Chong WY, Lim WH, Yap YK, Lai CK, De La Rue RM, Ahmad H
    Sci Rep, 2016 Apr 01;6:23813.
    PMID: 27034015 DOI: 10.1038/srep23813
    Increased absorption of transverse-magnetic (TM)-polarised light by a graphene-oxide (GO) coated polymer waveguide has been observed in the presence of transverse-electric (TE)-polarised light. The GO-coated waveguide exhibits very strong photo-absorption of TE-polarised light--and acts as a TM-pass waveguide polariser. The absorbed TE-polarised light causes a significant temperature increase in the GO film and induces thermal reduction of the GO, resulting in an increase in optical-frequency conductivity and consequently increased optical propagation loss. This behaviour in a GO-coated waveguide gives the action of an inverted optical switch/modulator. By varying the incident TE-polarised light power, a maximum modulation efficiency of 72% was measured, with application of an incident optical power level of 57 mW. The GO-coated waveguide was able to respond clearly to modulated TE-polarised light with a pulse duration of as little as 100 μs. In addition, no wavelength dependence was observed in the response of either the modulation (TE-polarised light) or the signal (TM-polarised light).
  7. Fulltext Performance investigation of state-of-the-art metaheuristic techniques for parameter extraction of solar cells/module
    Sharma A, Sharma A, Averbukh M, Jately V, Rajput S, Azzopardi B, et al.
    Sci Rep, 2023 Jul 10;13(1):11134.
    PMID: 37429876 DOI: 10.1038/s41598-023-37824-4
    One of the greatest challenges for widespread utilization of solar energy is the low conversion efficiency, motivating the needs of developing more innovative approaches to improve the design of solar energy conversion equipment. Solar cell is the fundamental component of a photovoltaic (PV) system. Solar cell's precise modelling and estimation of its parameters are of paramount importance for the simulation, design, and control of PV system to achieve optimal performances. It is nontrivial to estimate the unknown parameters of solar cell due to the nonlinearity and multimodality of search space. Conventional optimization methods tend to suffer from numerous drawbacks such as a tendency to be trapped in some local optima when solving this challenging problem. This paper aims to investigate the performance of eight state-of-the-art metaheuristic algorithms (MAs) to solve the solar cell parameter estimation problem on four case studies constituting of four different types of PV systems: R.T.C. France solar cell, LSM20 PV module, Solarex MSX-60 PV module, and SS2018P PV module. These four cell/modules are built using different technologies. The simulation results clearly indicate that the Coot-Bird Optimization technique obtains the minimum RMSE values of 1.0264E-05 and 1.8694E-03 for the R.T.C. France solar cell and the LSM20 PV module, respectively, while the wild horse optimizer outperforms in the case of the Solarex MSX-60 and SS2018 PV modules and gives the lowest value of RMSE as 2.6961E-03 and 4.7571E-05, respectively. Furthermore, the performances of all eight selected MAs are assessed by employing two non-parametric tests known as Friedman ranking and Wilcoxon rank-sum test. A full description is also provided, enabling the readers to understand the capability of each selected MA in improving the solar cell modelling that can enhance its energy conversion efficiency. Referring to the results obtained, some thoughts and suggestions for further improvements are provided in the conclusion section.
  8. Fulltext A Systematic Literature Review of 3D Deep Learning Techniques in Computed Tomography Reconstruction
    Rahman H, Khan AR, Sadiq T, Farooqi AH, Khan IU, Lim WH
    Tomography, 2023 Dec 05;9(6):2158-2189.
    PMID: 38133073 DOI: 10.3390/tomography9060169
    Computed tomography (CT) is used in a wide range of medical imaging diagnoses. However, the reconstruction of CT images from raw projection data is inherently complex and is subject to artifacts and noise, which compromises image quality and accuracy. In order to address these challenges, deep learning developments have the potential to improve the reconstruction of computed tomography images. In this regard, our research aim is to determine the techniques that are used for 3D deep learning in CT reconstruction and to identify the training and validation datasets that are accessible. This research was performed on five databases. After a careful assessment of each record based on the objective and scope of the study, we selected 60 research articles for this review. This systematic literature review revealed that convolutional neural networks (CNNs), 3D convolutional neural networks (3D CNNs), and deep learning reconstruction (DLR) were the most suitable deep learning algorithms for CT reconstruction. Additionally, two major datasets appropriate for training and developing deep learning systems were identified: 2016 NIH-AAPM-Mayo and MSCT. These datasets are important resources for the creation and assessment of CT reconstruction models. According to the results, 3D deep learning may increase the effectiveness of CT image reconstruction, boost image quality, and lower radiation exposure. By using these deep learning approaches, CT image reconstruction may be made more precise and effective, improving patient outcomes, diagnostic accuracy, and healthcare system productivity.
  9. Reflection spectra of etched FBGs under the influence of axial contraction and stress-induced index change
    Yang HZ, Lim KS, Qiao XG, Chong WY, Cheong YK, Lim WH, et al.
    Opt Express, 2013 Jun 17;21(12):14808-15.
    PMID: 23787668 DOI: 10.1364/OE.21.014808
    We present a new theoretical model for the broadband reflection spectra of etched FBGs which includes the effects of axial contraction and stress-induced index change. The reflection spectra of the etched FBGs with several different taper profiles are simulated based on the proposed model. In our observation, decaying exponential profile produces a broadband reflection spectrum with good uniformity over the range of 1540-1560 nm. An etched FBG with similar taper profile is fabricated and the experimental result shows good agreement with the theoretical model.
  10. Energy-economy-environment assessments of refrigerants R152a and R134a in a vapor compression refrigeration system using a variable displacement oil-free linear compressor
    Fang X, Chiong MC, Jiang X, Yu LJ, Chen X, Muhieldeen MW, et al.
    Environ Sci Pollut Res Int, 2023 Sep;30(45):101223-101233.
    PMID: 37648923 DOI: 10.1007/s11356-023-29521-6
    In light of the adverse environmental impact of the R134a refrigerant, replacing it with a more environmentally friendly refrigerant has become imperative than ever. This study presents an experimental investigation into the utilization of R152a and R134a refrigerants in a vapor compression refrigeration system employing a variable displacement oil-free linear compressor. The potential for the replacement of R134a with R152a was examined based on energy, environmental, and economic performance analyses. The outcomes indicated that R152a exhibited a higher coefficient of performance (COP) in comparison to R134a under identical operating conditions. Specifically, when the pressure ratio was 2.0 and the piston stroke was 11 mm, R152a's COP was 13.0% higher than R134a. It was also discovered that reducing the operating stroke and increasing the pressure ratio could effectively lower CO2 emissions and total costs. Under the 2.0 pressure ratio and 9-mm piston stroke, R134a produced 1082.4 kg more CO2 emissions than R152a, representing a 209% increase. In addition, the R152a and R134a total cost was reduced by 8.3% with the 2.5 pressure ratio and 11-mm piston stroke. Notably, the results of the current study demonstrated that R152a outperformed R134a in energy consumption, environmental friendliness, and economy in oil-free linear compressor refrigeration systems. R152a used less electric power, generated fewer CO2 emissions, and naturally reduced predicted running costs in order to maintain the same COP.
  11. Fulltext Surveillance for respiratory syncytial virus and parainfluenza virus among patients hospitalized with pneumonia in Sarawak, Malaysia
    Fieldhouse JK, Toh TH, Lim WH, Ting J, Ha SJ, Hii KC, et al.
    PLoS One, 2018;13(8):e0202147.
    PMID: 30110367 DOI: 10.1371/journal.pone.0202147
    BACKGROUND: Respiratory syncytial virus (RSV) and parainfluenza virus (PIV) are frequent causes of pneumonia and death among children at Sibu and Kapit Hospitals in Sarawak, Malaysia.

    OBJECTIVES: To determine the prevalence and risk factors for RSV subtypes A and B and PIV types 1-4 among patients hospitalized with pneumonia.

    METHODS: In a cross-sectional, pilot study nasopharyngeal swabs were studied with real-time reverse transcription polymerase chain reaction assays. Concurrently, we helped Sibu and Kapit Hospitals adapt their first molecular diagnostics for RSV and PIV.

    RESULTS: Of 129 specimens collected (June to July 2017), 39 tested positive for RSV-A (30.2%), two were positive for RSV B (1.6%), one was positive for PIV-3 (0.8%) and one was positive for PIV-4 (0.8%). No samples were positive for PIV-1 or PIV-2. Of the 39 RSV-A positive specimens, 46.2% were collected from children under one year of age and only 5.1% were from patients over the age of 18. A multivariable analysis found the odds of children <1 year of age testing positive for RSV-A were 32.7 (95% CI: 3.9, 276.2) times larger than >18 years of age, and the odds of patients hospitalized at Kapit Hospital testing positive for RSV-A were 3.2 (95% CI: 1.3, 7.8) times larger than patients hospitalized at Sibu Hospital.

    CONCLUSION: This study found an unusually high prevalence of RSV-A among pneumonia patients admitted to the two hospitals. Subsequently, Sibu Hospital adapted the molecular assays with the goal of providing more directed care for such pneumonia patients.

  12. Fulltext An Al-Biruni Earth Radius Optimization-Based Deep Convolutional Neural Network for Classifying Monkeypox Disease
    Khafaga DS, Ibrahim A, El-Kenawy EM, Abdelhamid AA, Karim FK, Mirjalili S, et al.
    Diagnostics (Basel), 2022 Nov 21;12(11).
    PMID: 36428952 DOI: 10.3390/diagnostics12112892
    Human skin diseases have become increasingly prevalent in recent decades, with millions of individuals in developed countries experiencing monkeypox. Such conditions often carry less obvious but no less devastating risks, including increased vulnerability to monkeypox, cancer, and low self-esteem. Due to the low visual resolution of monkeypox disease images, medical specialists with high-level tools are typically required for a proper diagnosis. The manual diagnosis of monkeypox disease is subjective, time-consuming, and labor-intensive. Therefore, it is necessary to create a computer-aided approach for the automated diagnosis of monkeypox disease. Most research articles on monkeypox disease relied on convolutional neural networks (CNNs) and using classical loss functions, allowing them to pick up discriminative elements in monkeypox images. To enhance this, a novel framework using Al-Biruni Earth radius (BER) optimization-based stochastic fractal search (BERSFS) is proposed to fine-tune the deep CNN layers for classifying monkeypox disease from images. As a first step in the proposed approach, we use deep CNN-based models to learn the embedding of input images in Euclidean space. In the second step, we use an optimized classification model based on the triplet loss function to calculate the distance between pairs of images in Euclidean space and learn features that may be used to distinguish between different cases, including monkeypox cases. The proposed approach uses images of human skin diseases obtained from an African hospital. The experimental results of the study demonstrate the proposed framework's efficacy, as it outperforms numerous examples of prior research on skin disease problems. On the other hand, statistical experiments with Wilcoxon and analysis of variance (ANOVA) tests are conducted to evaluate the proposed approach in terms of effectiveness and stability. The recorded results confirm the superiority of the proposed method when compared with other optimization algorithms and machine learning models.
  13. Kidney Transplantation Outcomes From Uncontrolled Donation After Circulatory Death: A Systematic Review and Meta-analysis
    Vijayan K, Schroder HJ, Hameed A, Hitos K, Lo W, Laurence JM, et al.
    Transplantation, 2024 Feb 16.
    PMID: 38361237 DOI: 10.1097/TP.0000000000004937
    BACKGROUND: Uncontrolled donation after circulatory death (uDCD) is a potential additional source of donor kidneys. This study reviewed uDCD kidney transplant outcomes to determine if these are comparable to controlled donation after circulatory death (cDCD).

    METHODS: MEDLINE, Cochrane, and Embase databases were searched. Data on demographic information and transplant outcomes were extracted from included studies. Meta-analyses were performed, and risk ratios (RR) were estimated to compare transplant outcomes from uDCD to cDCD.

    RESULTS: Nine cohort studies were included, from 2178 uDCD kidney transplants. There was a moderate degree of bias, as 4 studies did not account for potential confounding factors. The median incidence of primary nonfunction in uDCD was 12.3% versus 5.7% for cDCD (RR, 1.85; 95% confidence intervals, 1.06-3.23; P = 0.03, I2 = 75). The median rate of delayed graft function was 65.1% for uDCD and 52.0% for cDCD. The median 1-y graft survival for uDCD was 82.7% compared with 87.5% for cDCD (RR, 1.43; 95% confidence intervals, 1.02-2.01; P = 0.04; I2 = 71%). The median 5-y graft survival for uDCD and cDCD was 70% each. Notably, the use of normothermic regional perfusion improved primary nonfunction rates in uDCD grafts.

    CONCLUSIONS: Although uDCD outcomes may be inferior in the short-term, the long-term outcomes are comparable to cDCD.

  14. Fulltext High Prevalence of Viral Infections Among Hospitalized Pneumonia Patients in Equatorial Sarawak, Malaysia
    Toh TH, Hii KC, Fieldhouse JK, Ting J, Berita A, Nguyen TT, et al.
    Open Forum Infect Dis, 2019 Mar;6(3):ofz074.
    PMID: 30949525 DOI: 10.1093/ofid/ofz074
    Background: Although pneumonia is a known cause of morbidity and mortality in Sarawak, Malaysia, the etiology and epidemiology of pneumonia are not well described in this equatorial region. Routine clinical diagnostics for pneumonia etiology at government hospitals in Sarawak had historically involved only bacterial diagnostics. Viral diagnostics were only obtained through outside consultations.

    Methods: From June 15, 2017 to May 14, 2018, we collected nasopharyngeal swabs from 600 patients of all ages older than 1 month hospitalized with pneumonia at Sibu and Kapit Hospitals. Specimens were examined at our collaborating institutions with a panel of molecular assays for viral pathogens including influenza A (IAV), IBV, ICV, and IDV, human adenovirus (AdV), human enterovirus (EV), human coronavirus (CoV), respiratory syncytial virus subtype A (RSV-A) or RSV-B, and parainfluenza virus (PIV) types 1-4.

    Results: Of 599 samples examined, 288 (48%) had molecular evidence of 1 or more respiratory viruses. Overall, the most prevalent virus detected was RSV-A (14.2%) followed by AdV (10.4%) and IAV (10.4%), then RSV-B (6.2%), EV (4.2%), IBV (2.2%), PIV-3 (1.7%), CoV (1.0%), PIV-1 (1.0%), PIV-4 (0.7%), and PIV-2 (0.2%). No specimens were confirmed positive for ICV or IDV.

    Conclusions: The high prevalence of viruses detected in this study suggest that respiratory viruses may be responsible for considerable morbidity in equatorial regions such as Sarawak. Access to viral diagnostics are very necessary for medical staff to determine appropriate pneumonia treatments.

  15. Fulltext Surveillance for respiratory and diarrheal pathogens at the human-pig interface in Sarawak, Malaysia
    Borkenhagen LK, Mallinson KA, Tsao RW, Ha SJ, Lim WH, Toh TH, et al.
    PLoS One, 2018;13(7):e0201295.
    PMID: 30052648 DOI: 10.1371/journal.pone.0201295
    BACKGROUND: The large livestock operations and dense human population of Southeast Asia are considered a hot-spot for emerging viruses.

    OBJECTIVES: To determine if the pathogens adenovirus (ADV), coronavirus (CoV), encephalomyocarditis virus (EMCV), enterovirus (EV), influenza A-D (IAV, IBV, ICV, and IDV), porcine circovirus 2 (PCV2), and porcine rotaviruses A and C (RVA and RVC), are aerosolized at the animal-interface, and if humans working in these environments are carrying these viruses in their nasal airways.

    STUDY: This cross-sectional study took place in Sarawak, Malaysia among 11 pig farms, 2 abattoirs, and 3 animal markets in June and July of 2017. Pig feces, pig oral secretions, bioaerosols, and worker nasal wash samples were collected and analyzed via rPCR and rRT-PCR for respiratory and diarrheal viruses.

    RESULTS: In all, 55 pig fecal, 49 pig oral or water, 45 bioaerosol, and 78 worker nasal wash samples were collected across 16 sites. PCV2 was detected in 21 pig fecal, 43 pig oral or water, 3 bioaerosol, and 4 worker nasal wash samples. In addition, one or more bioaerosol or pig samples were positive for EV, IAV, and RVC, and one or more worker samples were positive for ADV, CoV, IBV, and IDV.

    CONCLUSIONS: This study demonstrates that nucleic acids from a number of targeted viruses were present in pig oral secretions and pig fecal samples, and that several viruses were detected in bioaerosol samples or in the nasal passages of humans with occupational exposure to pigs. These results demonstrate the need for future research in strengthening viral surveillance at the human-animal interface, specifically through expanded bioaerosol sampling efforts and a seroepidemiological study of individuals with exposure to pigs in this region for PCV2 infection.

  16. Donor Diabetes and Steatosis Affects Recipient Survival Following Liver Transplantation Based on Etiology of Liver Cirrhosis
    Lim WH, Ng CH, Tan DJH, Xiao J, Fu CE, Ong C, et al.
    Transplantation, 2024 Feb 01;108(2):473-482.
    PMID: 37439778 DOI: 10.1097/TP.0000000000004718
    BACKGROUND: Liver transplantation (LT) offers patients with decompensated cirrhosis the best chance at long-term survival. With the rising prevalence of diabetes, further clarity is needed on the impact of receiving a liver allograft from a donor with diabetes on post-LT outcomes. This study aims to evaluate the impact of donor diabetes on clinical outcomes after LT.

    METHODS: This is a retrospective analysis of the United Network for Organ Sharing registry data of LT recipients from January 1, 2000, to December 31, 2021. Outcomes analysis was performed using Cox proportional model for all-cause mortality and graft failure. Confounding was reduced by coarsened exact matching causal inference analysis.

    RESULTS: Of 66 960 donors identified, 7178 (10.7%) had diabetes. Trend analysis revealed a longitudinal increase in the prevalence of donor diabetes ( P  

  17. Meta-analysis: Prevalence and impact of alcohol abstinence in alcohol-associated cirrhosis
    Lim WH, Tay P, Ng CH, Tan DJH, Ong C, Koh JH, et al.
    Aliment Pharmacol Ther, 2024 Mar;59(6):730-741.
    PMID: 38303565 DOI: 10.1111/apt.17888
    BACKGROUND: Although alcohol abstinence may be an effective intervention for alcohol-associated cirrhosis, its association with prognosis has not been systematically assessed or quantified.

    AIMS: To determine the prevalence of alcohol abstinence, factors associated with alcohol abstinence and the impact of abstinence on morbidity and overall survival in people with alcohol-associated cirrhosis.

    METHODS: We searched Medline and Embase from inception to 15 April 2023 for prospective and retrospective cohort studies describing alcohol abstinence in people with known alcohol-associated cirrhosis. Meta-analysis of proportions for pooled estimates was performed. The method of inverse variance, employing a random-effects model, was used to pool the hazard ratio (HR) comparing outcomes of abstinent against non-abstinent individuals with alcohol-associated cirrhosis.

    RESULTS: We included 19 studies involving 18,833 people with alcohol-associated cirrhosis. The prevalence of alcohol abstinence was 53.8% (CI: 44.6%-62.7%). Over a mean follow-up duration of 48.6 months, individuals who continued to consume alcohol had significantly lower overall survival compared to those who were abstinent (HR: 0.611, 95% CI: 0.506-0.738). These findings remained consistent in sensitivity/subgroup analysis for the presence of decompensation, study design and studies that assessed abstinence throughout follow-up. Alcohol abstinence was associated with a significantly lower risk of hepatic decompensation (HR: 0.612, 95% CI: 0.473-0.792).

    CONCLUSIONS: Alcohol abstinence is associated with substantial improvement in overall survival in alcohol-associated cirrhosis. However, only half of the individuals with known alcohol-associated cirrhosis are abstinent.

  18. Hepatic, Extra-hepatic Outcomes and Causes of Mortality in NAFLD - An Umbrella Overview of Systematic Review of Meta-Analysis
    Xiao J, Ng CH, Chan KE, Fu C, Tay P, Yong JN, et al.
    J Clin Exp Hepatol, 2023;13(4):656-665.
    PMID: 37440949 DOI: 10.1016/j.jceh.2022.11.006
    BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease globally. While the prevalence, impact, and causes of mortality have been described in various meta-analyses, a systematic all-encompassing umbrella review has yet to be conducted to consolidate the evidence on outcomes associated with NAFLD.

    METHODS: Search was conducted on Medline and Embase for meta-analysis investigating associated complications and causes of mortality in NAFLD patients. Summary estimates were presented with original units, sample size, and I2 for heterogeneity. The Assessment of Multiple Systematic Reviews 2 was employed for article selection.

    RESULTS: 25 meta-analyses were included in the present review. NAFLD increased the risks of systemic complications, including cardiovascular diseases, systemic malignancies, diabetes, and chronic kidney disease. Regarding hepatic outcomes, the incidence of hepatocellular carcinoma in NAFLD was 2.39 per 100 person years (CI: 1.40 to 4.08). Individuals with NAFLD were also found to have an increased likelihood of cholangiocarcinoma (OR: 1.88, CI: 1.25 to 2.83) and gallstone disease (OR: 1.55, CI: 1.31 to 1.82) compared to individuals without NAFLD. NAFLD was associated with a higher risk of fatal and non-fatal CVD events (HR: 1.45, CI: 1.31 to 1.61) compared to individuals without NAFLD. Coronary heart disease and subclinical and clinical coronary heart disease were also significantly elevated in NAFLD individuals compared to individuals without NAFLD. Additionally, NAFLD was associated with an increased risk of all-cause mortality (HR: 1.34, CI: 1.17 to 1.54) and cardiovascular (HR: 1.30, CI: 1.08 to 1.56) but not cancer-related mortality.

    CONCLUSION: The study summarizes high-level evidence from published meta-analyses to provide a much-needed update on the outcomes in patients with NAFLD. The significant systemic burden associated with NAFLD and impending fatty liver epidemic requires prompt action from multidisciplinary providers, policy providers, and stakeholders to reduce the burden of NAFLD.

  19. Fulltext What information and the extent of information research participants need in informed consent forms: a multi-country survey
    Karbwang J, Koonrungsesomboon N, Torres CE, Jimenez EB, Kaur G, Mathur R, et al.
    BMC Med Ethics, 2018 09 15;19(1):79.
    PMID: 30219106 DOI: 10.1186/s12910-018-0318-x
    BACKGROUND: The use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in biomedical research.

    METHODS: This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 (not important) to 5 (very important).

    RESULTS: Of the 2484 questionnaires distributed, 2113 (85.1%) were returned. The majority of respondents considered most elements required in the ICF to be 'moderately important' to 'very important' for their decision making (mean score, ranging from 3.58 to 4.47). Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF (mean score = 4.47, 4.47, and 4.45, respectively).

    CONCLUSIONS: Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF.

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