Inactivating pathogenic bacteria in greywater by biosynthesized Cu/Zn nanoparticles from secondary metabolite of Aspergillus iizukae; optimization, mechanism and techno economic analysis
Authors:
Efaq Noman aff001; Adel Al-Gheethi aff003; Balkis A. Talip aff002; Radin Mohamed aff003; Amir Hashim Kassim aff003
Authors place of work:
Department of Applied Microbiology, Faculty of Applied Sciences, Taiz University, Taiz, Yemen
aff001; Faculty of Applied Sciences and Technology, Universiti Tun Hussein Onn Malaysia (UTHM), KM1, Jalan Panchor, Pagoh, Muar, Johor, Malaysia
aff002; Micro-pollutant Research Centre (MPRC), Department of Water and Environmental Engineering, Faculty of Civil & Environmental Engineering, Universiti Tun Hussein Onn Malaysia, Batu Pahat, Johor, Malaysia
aff003
Published in the journal:
PLoS ONE 14(9)
Category:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0221522
Summary
The inactivation of antibiotic resistant Escherichia coli (Gram negative) and Staphylococcus aureus (Gram positive) seeded in greywater by bimetallic bio-nanoparticles was optimized by using response surface methodology (RSM). The bimetallic nanoparticles (Cu/Zn NPs) were synthesized in secondary metabolite of a novel fungal strain identified as Aspergillus iizukae EAN605 grown in pumpkin medium. Cu/Zn NPs were very effective for inhibiting growth of E. coli and S. aureus. The maximum inactivation was optimized with 0.028 mg mL-1 of Cu/Zn NPs, at pH 6 and after 60 min, at which the reduction of E. coli and S. aureus was 5.6 vs. 5.3 and 5.2 vs. 5.4 log reduction for actual and predicted values, respectively. The inactivation mechanism was described based on the analysis of untreated and treated bacterial cells by Field emission scanning electron microscopy (FESEM), Energy Dispersive X-Ray Spectroscopy (EDS), Atomic Force Microscopy (AFM) revealed a damage in the cell wall structure due to the effect of Cu/Zn NPs. Moreover, the Raman Spectroscopy showed that the Cu/Zn NPs led to degradation of carbohydrates and amino structures on the bacteria cell wall. The Fourier transform infrared spectroscopy (FTIR) analysis confirmed that the destruction take place in the C-C bond of the functional groups available in the bacterial cell wall. The techno economic analysis revealed that the biosynthesis Cu/Zn NPs is economically feasible. These findings demonstrated that Cu/Zn NPs can effectively inhibit pathogenic bacteria in the greywater.
Keywords:
Biology and life sciences – Cell biology – Biochemistry – Organisms – Eukaryota – Engineering and technology – Research and analysis methods – Fungi – Medicine and health sciences – Cellular structures and organelles – Microbiology – Medical microbiology – Microbial pathogens – Bacterial pathogens – Bacteria – Pathology and laboratory medicine – Pathogens – Health care – infectious diseases – Public and occupational health – Preventive medicine – Staphylococcus – Staphylococcus aureus – Cell walls – Biosynthesis – Infectious disease control – Spectrum analysis techniques – Nanotechnology – Nanoparticles – Sanitization – Disinfection – Raman spectroscopy
Introduction
Greywater represents one of the main alternative sources for fresh water especially in Middle East countries with in arid and semi-arid conditions. However, the impact on health due to the presence of microbial diversity becomes its limitation in utilization of greywater. The microbial load of the greywater has been investigated and reported extensively by many authors in the literature [1]. It has been reported that greywater have E. coli, Staphylococcus aureus, Pseudomonas aeruginosa and Salmonella spp. [1]. The techniques used for the disinfection of the greywater are insufficient for elimination of pathogenic bacteria due to occurrence of resistance among the bacterial species against the chemical and physical disinfection methods [2]. The main problem lies in the ability of pathogenic bacteria to survive during/after the treatment process [1]. Greywater composition is quite different for that of blackwater, the high content of pharmaceutical and personal care products in the greywater might increase the bacterial resistance against disinfection by the chlorination, ozonation and the UV irradiation [1,2]. Moreover, the reverse osmosis filtration with high removal efficiency for the pathogenic bacteria is not suitable for disinfection of greywater due to the presence suspension solids which might block the filter pores. Nanotechnology is a promising method for disinfection of pathogenic bacteria in the wastewater. Among several types of the nanoparticles (NPs) the bimetallic nanoparticles have been given considerable an attention due to their unique properties particularly in designing specific and selective chemical reactions [3–5]. The heterozygosity between two metals increases the stimulation processes in various reactions and thus enhance the efficiency of the product type [6]. Several metals have been used for the synthesis of bimetallic nanoparticles. However, the bimetallic nanoparticles with copper metal have exhibited a highly antimicrobial activity against bacterial cells compared to the silver metal, due to the small size and high surface area which giving them high possibility for interacting with the bacterial cell membranes [7]. Hence, the bimetallic nanoparticles with Cu metals have been used in many applications for the inactivation of pathogenic bacteria in the medical instruments and water treatment [8]. The chemical and physical methods which are the most popular for synthesizing of nanoparticles are associated with environmental pollutions. Therefore, there is a need to develop more eco-friendly technologies with less dangerous and inexpensive compared to the traditional methods [9]. Biosynthesis method has high potential to replace the chemical and physical methods. Many microorganisms, including bacteria, fungi, yeast have the ability to produce nanomaterials [10]. The biosynthesis of NPs has become a new trend in the production of bimetallic nanoparticles. The microorganisms produce metallic nanoparticles outside and inside their cell. The production mechanism is relied on the electrostatic reaction between the positive charge of the metal ions and the negative charge of the functional group available on the surface of the cell wall [11]. Moreover, the peptides in the metabolic products play a critical role in the synthesis of nanoparticles, where the self-assembly of metal ions are occurred due to their bonding with peptides [12].
In fungi, the extra-cellular formation of NPs is taking place through the catalytic effect of the extracellular enzyme and metabolite products which have several reducing agents such as naphthoquinones and anthraquinones [13]. The synthesis of NPs by fungi is more beneficial compared to other microorganisms. This is because fungi have simple requirement for their growth and produce significant number of extracellular enzymes compared to bacteria which accelerate the reduction of metal salts to metal NPs [14]. Aspergillus flavus, A. japonicas, Cylindrocladium floridanum, Penicillium oxalicum, Phanerochaete chrysosporium, Rhizopus oryzae, and Trichoderma reesei are the most common fungi which are used for synthesizing NPs [15–20]. However, the biosynthesis of bimetallic Cu/Zn NPs from fungi have not been reported before, while the optimization of Cu/Zn NPs in inactivating pathogenic bacteria has not yet being investigate. However, a study conducted by Mohammadi-Aloucheh et al. [21] had observed the effect of the cell surface against antimicrobial activity using Cu/Zn NPs that biosynthesized from Vaccinium arctostaphylos. Cu/Zn. The optimization of bacterial inactivation by NPs might enhance the antimicrobial activity of NPs against pathogenic bacteria. In addition, an understanding of the inactivation mechanism and the techno economic analysis using NPs might contribute effectively in making this method more applicable in the water and wastewater treatment plants. This study aims to optimize the inactivation of E. coli and S. aureus seeded in greywater by Cu/Zn NPs using response surface methodology (RSM). The inactivation mechanism was investigated, while the economic feasibility for the application of Cu/Zn NPs in a large scale was evaluated based on the techno economic analysis in comparison to the traditional methods.
Materials and methods
Isolation of Aspergillus iizukae EAN605 strain
Aspergillus iizukae EAN605 was isolated from the peat soil sample by culture-based method using standard serial dilution spread plate method on Potato Dextrose Agar medium for enumeration (PDA, Himedia, India) [22]. The fungal strain was purified using single spore isolation technique [23]. The fungal isolate was identified based on the 28 LrDNA. The amplification of DNA was performed using PCR thermal cycler "Veriti 96 Well Thermal Cycler" (Applied Biosystems, USA). The positive and negative sense of primers were amplified the targeted of D1/D2 sequence region (forward primer (F63) 5`GCATATCAATAAGCGGAGGAAAAG3 and reverse primer (LR3) 5`GGTCCGTGTTTCAAGACGG 3`) as described by a study performed by Fell et al. [24]. The sequences were aligned and analysed using NCBI BLAST to identify the species based (http://www.ncbi.nlm.nih.gov/blast) and deposited in gene bank with accession No. MK517570 (https://www.ncbi.nlm.nih.gov/nuccore/MK517570).
Bacterial strains and antibiotic resistance
E. coli and S. aureus were isolated from greywater samples on selective media based on the method described in the previous work [1,25]. The bacterial isolates were purified as accordance to APHA 9225B [22] (S1 Fig). The identification of the bacterial strains were performed based on the morphological, cultural characteristics and biochemical tests (API 20 Staph (Ref. 20 500), API 20NE (Ref 07224 B) and RapiD 20E (Ref 12134 A) (BioMerieux, SA-France) as described by the manufacturers.
Preparation of fungal supernatant
A pure culture of A. iizukae EAN605 was sub-cultured in a sterilized basic mineral medium (Hi Media, India) supplement with 10 g of pumpkin peels as a sole carbon source. The inoculated medium with the fungal strain was incubated at room temperature (25±2°C) for 10 days. The fungal mycelium growth was separated by centrifugation at 13,000 rpm for 10 min at 4°C. The supernatant was collected and kept at 4°C until further uses.
Biosynthesis and characteristics of Cu/Zn nanoparticles
The Cu/Zn NPs were selected to be used in this work after a primary screening for different NPs synthesized with Ag, Cu, Zn, Mn and their combinations (Ag, Cu, Zn, Mn, Ag/Cu, Ag/Mn, Ag/Zn, Cu/Zn, Cu/Mn, Zn/Mn) to choose the most effective NPs which have high antimicrobial activity (Table 1). The Cu/Zn bimetallic NPs were synthesized in 200 mL of distilled water according to the principle described by Ghorbani and Rashidi [26] with modifications. A fixed volume (100 mL) of each metal ions solution in 250 mL of conical flask was mixed, and then 4 mL of the fungal supernatant was added. The flask was left at room temperature (25±2°C) for 24 hrs. In order to check the formation of Cu/Zn NPs, 5 mL of the Cu/Zn solution before and after the mixing with the fungal strain supernatant as well as after 24 hrs post-mixing was scanned for the absorbance using UV-Vis spectrophotometer (DR6000 Hach, USA) with a wavelength ranging from 190 to 1100 nm.
Antimicrobial activity of antibiotics and Cu/Zn NPs biosynthesized from the secondary metabolite of a novel fungal strain Aspergillus iizukae EAN605 grown in pumpkin medium.
The appearance of peak at the wavelength 274 and 280 nm confirmed the formation of Cu/Zn NPs. The Cu/Zn NPs solution was subjected for the centrifugation at 13000 rpm for 10 min (Rotina 420r Benchtop, Germany). The absorbance of participation was carried re-determined in order to check the presence of Cu/Zn NPs, while the final confirmation of Cu/Zn NPs in the participation was confirmed based on Field Emission Scanning Electron Microscopy with Energy Dispersive X-Ray Spectroscopy, FESEM-EDX (Jeol / Japan - Oxford/ USA).
In order to prepare the powder of Cu/Zn NPs, the previously described procedure was repeated for 10 times with 1 L of NPs solution to get a desirable amount of the Cu/Zn NPs. The participation collected from the centrifugation process was washed with 95% ethanol (Sigma Aldrich, UK), dried at 100°C for 24 hrs and then subjected for calcination at 550°C for 3 hrs [27]. The antimicrobial activity of the dried powder was tested against E. coli and S. aureus as detailed in Section 2.5.
In order to study the characteristics of Cu/Zn NPs, one drop from the NPs solution was placed on the upper surface of a small pieces of slide glass (1×1 cm) and left for overnight at room temperature for drying. The slide was used for analysis by FESEM-EDX, Fourier transform infrared spectroscopy (FTIR), atomic force microscopy (AFM) and Raman Spectroscopy (Park System XE-100 / Korea).
Bioassay of Cu/Zn NPs bioactivity against pathogenic bacteria
The antimicrobial activity of Cu/Zn NPs was determined against E. coli and S. aureus grown on Müller-Hinton agar (MHA) using agar diffusion assay. A fixed volume of (0.1 mL, which have 106 cells based on the preparation experiments that were conducted for the inactivation process) E. coli and S. aureus suspension (24 hrs cultures) were sub-cultured on the Mueller Hinton Agar (MHA). A sterile cork borer (0.7 cm) was used to bore a well (7 mm in diameter) in each plate. Three concentrations of each NPs (1, 5 and 10 μL) were put into each well in triplicate. The culture agar plates were incubated for 24 hrs at 35°C. The diameters of the inhibition zones around each well contained nanoparticles without bacterial growth were measured. In order to determine the differences between the antimicrobial activities among the different NPs, the size of the inhibition zone was used to classify the susceptibility of E. coli and S. aureus towards the NPs. For non-clinical application, the bacterial strains were classified as resistant (7 to 10 mm of inhibition zone), moderately resistant (10 to 12 mm), or susceptible (>12 mm) [28]. For comparison, the susceptibility test by disk diffusion test was conducted according to Al-Gheethi et al. [28] and Morse and Jackson [29]. The positive control used including amoxicillin (10 μg L-1), ampicillin (10 μg L-1), ciprofloxacin (5 μg L-1), tetracycline (30 μg L-1), erythromycin (15 μg L-1), penicillin (10 μg L-1), streptomycin (10 μg L-1), and chloramphenicol (30 μg L-1). This reference antibiotics type and concentration were selected due to the inhibitory effect against organisms used in this study [30–31]. The Minimum Inhibition Concentrations (MICs) of antibiotics were selected according to the British Society for Antimicrobial Chemotherapy [32].
Optimization of bacterial inactivation in greywater by Cu/Zn NPs
Preparation of bacterial inoculum
Pure culture of E. coli and S. aureus were sub-cultured in 1 L of the nutrient broth medium and incubated at 37°C for 24 hrs. Both organisms were selected because they have been considered and used as indicators bacteria in greywater by several authors in the literature [33]. The bacterial cells were separated by centrifugation at 10,000 rpm and 4°C for 10 min. The bacterial cells were washed twice with sterilized physiological saline to remove culture media residues and then suspended in 10 mL of saline water [34].
Preparation of greywater samples
The greywater sample (5 L) used in the present study were collected from a village house at Parit Samajan, Johor, Malaysia. The sample was autoclaved at 121˚C for 20 min to inactivate the indigenous microorganism and safe handling. The autoclaved samples were filtrated using membrane filter (Millipore cellulose or Nylon membrane filters; 45 mm diameter, 0.45 mm pore size) according to APHA [22] to remove the suspended solids which might affect negatively on the inactivation process. A fixed volume (500 mL) of autoclaved and filtrated greywater sample was seeded with E. coli (5 mL, 106 cell mL-1), while another sample was seeded with S. aureus (5 mL, 106 cell mL-1). The initial concentrations of E. coli and S. aureus in the samples were confirmed based on serial dilution plating method on nutrient agar. Each seeded greywater sample was divided into 20 fractions according to the total numbers of the experiments runs conducted in the optimization process.
Optimization of bacterial inactivation by Cu/Zn NPs
The inactivation of bacterial cells in the seeded greywater samples by Cu/Zn NPs was optimized using the central composite design CCD (response surface morphology) which was selected to create a significant better model compared to other methods of expert design software program. The CCD requires a smaller number of experiments, where 20 experimental runs were performed in the current work to determine the linear and quadratic effect of Zn/Cu NPs concentration (mg mL-1) (x1) (0.01 to 0.1 mg mL-1), time (x2) (10 to 60 min) and pH (x3) (6 to 8) as well as the interaction between these factors and their effect on the inactivation of pathogenic bacteria in the greywater samples. The inactivation process using Cu/Zn NPs was performed by adding different concentrations of Cu/Zn NPs for each greywater sample, the pH was adjusted using 0.1 M of NaOH (0.1 M) and 0.1 N of HCl according the RSM suggestions. The inoculated samples were mixed by using magnetic stirrer at 200 rpm. The experiments were conducted in triplicate to obtain the accurate evaluation efficiency of Cu/Zn NPs.
Enumeration of bacterial cells in the greywater samples
The inactivation of bacterial cells was evaluated based on their ability to grow in NA medium according to APHA [22]. The greywater sample before and after each treatment process was subjected for the serial dilution and then 0.1 ml of each dilution was transferred on the NA medium. The culture plates were incubated at 37°C for 2–3 days to confirm the inactivation of the bacterial cells and the absence of bacterial regrowth [35]. The counts of viable bacterial cells were enumerated in the plates contains 30 to 300 colonies. The numbers of bacterial cells grown were expressed as log10 CFU mL-1. The log reduction of bacterial cells was calculated according to the Eq (1) as recommended by STAATT [36].
IT is initial numbers of bacterial cells (log10 CFU mL-1) in the greywater sample before the inactivation
RT is the number of bacterial cells (log10 CFU mL-1) recovered from the greywater sample after the inactivated by Cu/Zn NPs.
Mechanism of inactivation process
The bacterial cells morphology before and after the inactivation process was observed using FE-SEM-EDS, FTIT, AFM and Raman Spectroscopy. In brief, 2 mL of bacterial suspension before and after the inactivation process at the optimal conditions (0.028 mg mL-1 of Cu/Zn NPs, pH 6, after 60 min) were subjected for the centrifugation at 2000x g for 10 min. The pellets of bacterial cells were subjected for FESEM-EDS (model JEOL JSM-7600F) analysis. The bacterial cells were coated with gold powder with double side carbon tape using auto fine coater (model JEOL JSM-7600F) at 20 mA for 120s and viewed using SEM. The FTIR spectra analysis for each bacterial strain before and after the inactivation process was obtained on Perkin Elmer spectrum 100. The functional groups on the surface of the bacterial cells before and after the production process was determined at the spectral range of 4000 to 600 cm-1 at a resolution of 4 cm-1, scan number 32 and scan speed of 30 seconds when the pressure gauge is pressed on the sample. The bands were recorded within 30 seconds and used to determine and evaluate the functional groups on the pumpkin peel. The samples for AFM (Park System XE-100/Korea) and Raman Spectroscopy (X-Plora Plus) analysis was prepared by placing the bacterial cells on a surface of a glass slide and then submitted to the AFM analytical laboratory at Minit SCR, UTHM for the analysis.
Statistical analysis
The experimental runs were conducted in triplicate to ensure the accuracy of the results. Design Expert software was used to analyse the data and investigate the first order response surface equations of the model. The significance of the independent variables on the dependent variables was analysed using ANOVA (p<0.05). The R2 adj was used for checking the fit of the linear model. The interactions between the independent factors and their role in the inactivation of bacterial cells was presented using a three-dimensional graphical representation of the system behaviour, called RSM.
Results and discussion
Characterization of biosynthesized Cu/Zn nanoparticles
A previous work had indicated that the Aspergillus iizukae that reported for first time in Malaysia exhibited high efficiency for the decolourization of azo dyes in the wastewater [33]. The results of UV–Vis analysis of Cu/Zn NPs are presented in Fig 1A. The changes in the absorbance of the Cu/Zn solution after 4 mL from the fungal supernatant was added and after the incubation period for 12 and 24 hrs at room temperature (25±2°C) was an indication for forming Cu/Zn NPs. The maximum absorbance at of Cu/Zn NPs after 12 hrs was recorded at 285 nm while was at 284 nm after 24 hrs. The determination of the absorption spectrum is one of the methods used for confirming the formation of NPs [37]. The FESEM analysis revealed that Cu/Zn NPs have a spherical shape with non-uniform distribution and no agglomeration was observed, the size is ranging from 50 to 80 nm (Fig 1B). The EDX detected Cu by 57.73% and Zn by 1.98% of the weight (Fig 1C). The strong intensity and narrow width of Cu/Zn diffraction peaks is an indication for the crystalline shape of the Cu/Zn NPs [38]. The result of FTIR analysis is presented in Fig 1D. It was noted that the peaks are detected at 3571.71, 3488.42, 1646.01, 1105.48 and 1034.74 cm-1 which indicate the presence of intramolecular H bonds, C = C, C–O, while peaks below 1000 cm−1 are belongs to metal oxides due to inter-nuclear vibrations [39]. The peaks at 3571.71 and 3488.42 might be explains as a result for the presence of OH group [40]. The AFM analysis of Cu/Zn NPs showed that the particles surface has tips and scattered nanoparticles. The 3D image displayed that the nanoparticles have sharp tips of nails on the extract surface (Fig 1E). The antimicrobial activity of Cu/Zn NPs is illustrated in Table 1. The results revealed that among different types of the NPs prepared in the current study, Cu/Zn NPs exhibited high antimicrobial activity, the Cu/Zn NPs occurred more antimicrobial activity after calcination at 550°C (S2 Fig). In comparison to the antimicrobial activity of the antibiotics, it was noted that Cu/Zn NPs exhibited stronger activity against E. coli and S. aureus. These results indicated that the NPs has a potential to be used for inactivating pathogenic bacteria in greywater. The concept of non-clinical application or environment used in the present study was used to define the natural antibiotic resistance. The resistant bacteria for one antibiotic might spread their resistance to the other pathogens in the environment. The study of antimicrobial resistance for pathogenic bacteria in the water and wastewater should be conducted based on the concept of non-clinical application [41–42].
Characteristics of Zn/Cu NPs; a) Absorption spectrum; b) FE-SEM photography; c) EDX analysis of Zn/Cu NPs and Weight % of Zn, Cu elements; d) FTIR spectroscopy of Zn/Cu NPs; e) AFM analysis of Zn/Cu NPs.
Optimizing the bacterial cells inactivation in greywater by Cu/Zn NPs
The results for the screening of the bacterial inactivation as a response for Cu/Zn NPs (x1), time (x2) and pH (x3) are illustrated in S1 Table. It can be noted that the maximum inactivation (6 log10) of E. coli was recorded with 0.01 mg mL-1 of NPs, at pH 8 and after 30 and 60 min. The highest inactivation of S. aureus (5.21 Log10) was noted with 0.055 mg mL-1 of NPs, at pH 7 and after 35 min. The different in the responses of E. coli and S. aureus for the action of Cu/Zn NPs might be related to the chemical structure of the cell wall. E. coli is a Gram-negative bacteria with high contents of lipopolysaccharides. S. aureus is a Gram-positive bacteria with thick cell wall due to the high contents of the saccharides and glutamic acid which might protect the bacterial cells from the negative effects of the NPs [1].
The analysis of the regression coefficient and significance of the quadratic model for inactivating E. coli and S. aureus seeded in greywater using bimetallic Cu/Zn NPs showed that both NPs and time was the main independent factors which occurred a significant (P<0.05) inactivation for E. coli and S. aureus (S3 Table). NPs and time exhibited a negative significant synergistic interaction (P<0.09) for the inactivation of E. coli, which does mean that a short time is required for inactivation of E. coli at high concentrations of NPs. In contrast, the time and pH have a negative significant interaction in their effects on S. aureus inactivation. Both NPs and time have quadratic contribution in inactivating of E. coli, but only NPs have the quadratic contribution in inactivating of S. aureus. These findings indicated that the main effective factors for inactivation of pathogenic bacteria are NPs and time, while pH has a secondary effect. It can also note from Fig 2A that the Cu/Zn NPs has more influence on E. coli than time. However, the interaction between them at a constant pH 7, increased the inactivation to 6 log10 with a short time. NPs and time also exhibited more influence than pH (Fig 2B and 2C). Similar findings were also recorded against S. aureus, but the maximum reduction in the concentrations of bacteria was 5.9 log10 (Fig 2D–2F). In the optimization study of E. coli inactivation by Asadi and Moeinpour [43], the results also revealed that high inactivation rate of E. coli within a short time (30 min) was recorded with increasing of silver-coated magnetic nanocomposite concentration from 2 to 10 mg mL-1.
Three-dimensional response surface plot for inactivation of E. coli (A,B,C) and S. aureus (E,F,G) in greywater using Zn/Cu NPs as a response of interaction between independent factors, x1 (Zn/Cu NPs concentration (mg mL-1); x2 (Time, min); x3 (pH),.
Analyses of the variance (ANOVA) of the response surface quadratic model for inactivating E. coli and S. aureus in greywater using bimetallic Cu/Zn NPs is presented in Table 2. It was noted that the independent factors contributed by 95.77 and 87.37% with a significant model (<0.05) in the inactivation of E. coli and S. aureus respectively.
The best operating parameters for inactivation of both E. coli and S. aureus was optimized with 0.028 mg mL-1 of Cu/Zn NPs, at pH 6 and after 60 min. The reduction of E. coli and S. aureus was 5.6 vs. 5.3 and 5.2 vs. 5.4 log reduction for actual and predicted values, respectively (S4 Table). In comparison with a previous study conducted by Mohammadi-Aloucheh et al. [21], Cu/Zn nanocomposites with 0.128 mg mL-1 revealed high anti-bacterial activities against both E. coli and S. aureus. However, this study indicated that a very minimum concentrations of Cu/Zn was required for achieving high inactivation rate. The differences might be related to the nature of inactivation process. Mohammadi-Aloucheh et al. [21] had studied the inactivation in broth medium that contains high nutrients. Instead, this study used the greywater samples for inactivation process.
Analyses of the variance (ANOVA) of the response surface quadratic model for inactivating E. coli and S. aureus in greywater using bimetallic (Cu/Zn) NPs.
The presence of nutrient in the broth medium might protect the bacterial cells for the actions of NPs, hence more concentrations are required for achieving high reduction. The inactivation of E. coli in water by magnetic barium phosphate nanoflakes with embedded iron oxide nanoparticles, achieved 97% within 30 min at 25°C and pH 6 [44]. These findings show that pH 6 is the best for the inactivation of pathogenic bacteria. The high inactivation of bacterial cells at pH 6 might be related to the easy diffusion of NPs through cell membrane and then the high ability to inhibit the metabolic pathway of the bacterial cells. In contrast, at low pH the competition between NPs and proton (H+) is very high. Therefore, the NPs show low affinity to adsorb into the bacterial cell wall and then diffuse into the bacteria cytoplasm [45].
Inactivation mechanism of bacterial cells by Cu/Zn NPs
The results of FESEM imaging showed that E. coli seeded in the greywater samples (untreated) has retaining the rod shape with no NPs attached on the surface and without a critical influence on the bacterial cells under the normal environmental conductions (Fig 3A). In contrast, the results in Fig 3B show NPs adhered to the bacterial surface distributed randomly on the bacterial cell wall surface. Similar findings were also noted for S. aureus (Fig 3C and 3D). These findings are similar as those reported by Mohammadi-Aloucheh et al. [21] which that the Cu/Zn nanocomposite causes obvious cracks in the bacterial membranes. Zhang et al. [46] indicated that the inactivation of bacterial cells by Zn NPs was related to the chemical and physical reactions between Zn and cell membrane components which lead to destruction or blockage the transport channels of the membrane, as well as the direct interaction of Zn NPs with the cell envelope components through electrostatic effect. However, the physical damage caused by the NPs are not detected by FESEM analysis. Therefore, EDS, Raman spectroscopy and FTIR were used to confirm the effect of NPs on the chemical structure of the bacterial cell wall. EDX analysis was used to detect the presence high contents of Zn and Cu as well as Oxygen ions on the surface of E. coli and S. aureus after the inactivation process in comparison to the control (Fig 3E–3H). However, the weight of carbon content has reduced, more significant reduction in the nitrogen was observed, where the nitrogen content decreased from 29.28 to 5.95% in the case of E. coli and from 26.02 to 8.10% in S. aureus. This reduction indicated that the Cu/Zn NPs might be led to denature the protein contents on the surface of bacteria cell membrane. The negative effects of Cu/Zn NPs on the surface of E. coli and S. aureus was confirmed by AFM analysis (Fig 4). The results have revealed the presence of the tips and scattered nanoparticles on the surface of the bacterial cell surface, but it has to mention that AFM was used to confirm the adherence of NPs on the bacterial surface. The AFM shows a rough surface for both bacterial cells after the inactivation process. The FTIR band at 1055.02 and 1058.70 cm-1 in the untreated E. coli and S. aureus is an indication for C-O-C band that reduced after the inactivation as a result of shifts in the formation of the Zn or Cu+—O - C associates in the electrolytes (Fig 5). The band at 1058 is belongs to the carbohydrate region, while the reduction in this band indicated to the adsorption of Cu/Zn NPs onto the functional group of the carbohydrate compounds [47]. These findings confirm the results obtained from EDX analysis which exhibited a reduction for the carbon content in the treated bacterial cells. The reduction in the function groups of -CH = CH2, -CH = CH - and C = CH2 in treated bacteria cells as detected between 600 and 1000 cm-1, indicates the utilization of the group in the adsorption of Cu/Zn NPs. The advanced analysis of the bacterial cell wall using Raman Spectroscopy confirmed the reduction in the amino groups due to the destruction caused by Cu/Zn NPs (Fig 6). Indeed, the inactivation mechanism of bacterial cells by Cu/Zn NPs based on the chemical analysis of the protein and carbohydrates structure of the bacterial cell wall has not been reported before. Therefore, this study showed the understanding of inactivation mechanism of bacterial cells by using Cu/Zn NPs. Although antibacterial mechanisms have not been fully understood, some studies have reported that the mechanism of oxidative and non-oxidative stress induction as well as metal ion release resembles the antibacterial mechanisms. In addition, the multiple simultaneous mechanisms of NPs action against bacterial cells would require multiple simultaneous gene mutations to develop antibacterial resistance. Therefore, the ability of the bacterial cells to resist NPs is weak [48]. Hence, the discharged greywater after the disinfection process by NPs into the environment have not led to increase the antimicrobial resistance against NPs at least on the short term. To date, no similar finding has been reported.
FESEM image and EDX analysis E. coli and S. aureus before and after the inactivation process by Zn/Cu NPs, A, E) E. coli before; B, F) E. coli after; C, G) S. aureus before; D,H) S. aureus after the inactivation process with 0.028 mg mL-1 of Cu/Zn NPs, at pH 6 and after 60 min.
Atomic force micrographs of E. coli and S. aureus cell surface before and after inactivation with 0.028 mg mL-1 of Cu/Zn NPs, at pH 6 and after 60 min; a) untreated E. coli; b) treated E. coli; c) untreated S. aureus; e) treated S. aureus.
Fourier Transform Infrared Spectroscopy (FTIR) spectrum of E. coli, and S. aureus seeded in greywater before after the inactivation process with 0.028 mg mL-1 of Cu/Zn NPs, at pH 6 and after 60 min; a) S. aureus; b) E. coli.
Raman spectroscopy of E. coli and S. aureus in greywater before and after inactivation by bimetallic Zn/Cu nanoparticles; a) E. coli; b) S. aureus.
Techno-economic analysis for Cu/Zn NPs production and application in inactivating pathogenic bacteria in greywater
The flow diagram of Cu/Zn NPs production and application was designed using SuperPro Designer and depicted in Fig 7A. The suggested processes consist of three phases which aim to produce, disinfect and dispose and further applications. The disinfected greywater can reused for irrigation. Meanwhile the fungal biomass can be used as a substrate for biofuel generation and bio-sorbents for further environmental application such as heavy metals or azo dye removal by adsorption process. In Phase A, the fungal strain is sub-cultured in a bioreactor with a production medium to generate the secondary metabolite peptides. The fungal mycelium is separated by using centrifugation and the supernatant is used for bio-synthesis of Cu/Zn NPs. The fungal biomass could be used for the fuel production as proposed by Han et al. [49]. In Phase (B), the greywater with bacteria is stored before disinfection process to remove the suspension solid which may effect during the disinfection process by Cu/Zn NPs. The disinfection process should be conducted under the sunlight to enhance the inactivation of pathogenic bacteria by Zn NPs. However, the Cu/Zn NPs have antimicrobial activity in the absence of the sunlight as determined by the agar diffusion method (as mentioned in Section 3.1). The treated greywater should be subjected for reverse osmosis biomass before the final disposal into the environment.
Zn/Cu NPs a) Flowchart of production and application; b) Internal rate of return.
The annual operating time for production and application of Cu/Zn NPs in inactivating pathogenic bacteria in greywater is 7920 h/year (equivalent for 330 operating days). The total capital investment (TCI) for a proposed plant including the fixed capital estimation (FCE) and working capital cost (WCC) (Eq 4) [50–51].
The FCE include equipment purchase cost, process piping, equipment installation, electrical systems, instrumentation and controls, yard improvements, buildings, and construction as well as the working capital cost (WCC) which might represent 6.5% of FCE as suggested by Han et al. [52]. Therefore, the FCE for design a treatment plant with 1000 m3/day of capacity reach to USD 950,000.00. (Table 3) The additional costs for the treatment process might reach 50% of the equipment cost which was equivalent to USD 475,000.00 [52]. The TCI of the plant could reach to USD 1,425,000.00. WCC regarded to be 6.5% of the FCE (USD 61,750). Therefore, according to Eq (1), the TCI of USD 1,486,750.00 could be calculated. The techno-economic analysis is one of the best methods for determining the effectiveness of any alternative method for treating the environmental pollution. It has been used for estimating the H2 production by fungi from the food wastes and provided very accurate information on the total cost [36,40]. The cost factors associated with the disinfection of greywater in comparison to the physical and chemical treatment process is illustrated in Table 4, which show that the Cu/Zn NPs could be the alternative process for the chemical and physical treatment process.
Fixed capital estimate (FCE) for biosynthesis of Cu/Zn NPs and application in inactivating pathogenic bacteria in greywater.
Cost factors associated with the disinfection of greywater by Cu/Zn NPs in a comparison to the physical and chemical treatment process.
Annual operation cost
The annual operation cost (AOC) for the production and application of Cu/Zn NPs in inactivating pathogenic bacteria include the costs of raw materials (CRM), waste generated from the production process (CWG), utilities (CU) and extra cost (CE) was calculated for annual basis according to Eq (5).
The CRM represent the cost of fungal culture medium which was supplied from the local markets as well as chemicals required for biosynthesis of Cu/Zn NPs, these chemicals were supplied from a local supplier. The CU, which include water and electricity required for the operation process that was estimated based on the price for each unit in the local currency. The CWG represent the final fungal biomass yield generated from the preparation of fungal supernatant. The solid wastes are considered as a biomass yield with high concentrations of carbohydrates and could be used as bio-sorbents for wastewater treatment as well as for fuel production. In the application of the Cu/Zn NPs for the inactivation of pathogenic bacteria in the greywater, the generated greywater might be used for the irrigation.
Table 5 showed the annual operation cost for the production and application of Cu/Zn NPs. The raw materials cost (CRM) estimated at USD 68,287.20/year. The total cost of utilities is estimated to be USD 4600/year as reported in China [47]. This estimation is similarly reported as in Malaysia. The operating labour requires three operators with an average salary of 10,000 USD/year per operator. The maintenance and insurance were estimated as 2% and 1% of the FCE, respectively according to Vlysidis et al. [53] and Ljunggren and Zacchi [26]. It can be concluded that the annual operation cost for the production and application of Cu/Zn NPs in inactivating pathogenic bacteria is estimated at USD 131,387.20/year.
Annual operation cost and profitability for biosynthesis of Cu/Zn NPs and application in inactivating pathogenic bacteria in greywater.
Annual profitability and revenue for Cu/Zn NPs synthesis
The revenue for the production of Cu/Zn NPs is to sell the NPs that have several applications in the environmental treatment industries such as disinfection processes of greywater and wastewater. The current price of Cu/Zn NPs (Spherical with 80–100 nm in the diameter size) is USD 569/kg. According to the mathematical model designed by Han et al. [51], the specific cost of Cu/Zn NPs CZ (kg/USD) is calculated based on the annual costs of capital CC, utilities cost CU, raw material cost CRM and extra cost CE divided by the annual Cu/Zn NPs production (Eq 6).
This study has shown that the best Cu/Zn NPs dosage for inactivating pathogenic bacteria was 0.028 mg mL-1. The total quantity of Cu/Zn NPs required for treating 1000 m3 of greywater is 28 kg. No adjustments for pH are required since the optimal condition for the inactivation process was recorded at pH 6, which is closer to the natural greywater. The required quantity of Cu/Zn NPs for treating 1000 m3 of greywater is 28 kg. This study also indicates that one L of Cu/Zn solution (contain 0.183 g of Zn C4H6O 4 and 0.217 g of C4H10CuO6) with 20 mL of fungal supernatant produces 0.5 g of Cu/Zn NPs, therefore, for producing 28 kg of NPs, 60 m3 of metal solution with 183.48 kg of Zn C4H6O4 and 217.664 kg of C4H10CuO6) and 1.2 m3 of fungal supernatant. The cell culture unit for fungal growth could be designed with 1 m3 of the capacity and with 20 kg of pumpkin peel as a carbon and energy source for fungi in the culture medium for each operation in which 1000 m3 of greywater will be treated. The revenue for each production process is 28 Kg of Cu/Zn NPs which give USD 15932 of the revenue for each process. The production of fungal supernatant requires at least 5 days for the incubation period. Therefore, the total numbers of the production processes per year is estimated to be 52.2 process which is going to produce 1.4616 ton of Cu/Zn NPs. The annual revenue is estimated at USD 831650.4. The local tax in Malaysia estimated to be (15%) (USD 124747.56) and annual operation cost (USD 131,387.20/year). The annual profitability (after the tax) of Cu/Zn NPs is USD 575,515.64/year (Table 5). Based on the Eq 7, the specific cost of Cu/Zn NPs (spherical shape with 51–100 nm in the diameter size) is estimated to be USD 89.8 per kg which is lower than the market laccase enzyme price USD 569/kg.
In this study, Cu/Zn NPs was economically evaluated based on the net present value (NPV), internal rate of return (IRR) and payback period (PBP) for 10 years of the life time. The internal rate of return (IRR), which indicated the efficiency of the investment, was 80% in this study (Fig 7B). According to the above results and analysis, the Cu/Zn NPs biosynthesis is economically feasible.
Conclusion
The current work optimized the inactivation of pathogenic bacteria in greywater by using Cu/Zn NPs. The optimal inactivation rate determined at 0.028 mg mL-1 of Cu/Zn NPs, at pH 6 and after 60 min, at which the reduction of E. coli and S. aureus was 5.6 vs. 5.3 and 5.2 vs. 5.4 log reduction for actual and predicted values, respectively. The advanced analysis by FESEM, FTIR, AFM and Raman Spectroscopy has confirmed the damaging of the bacterial cells due to the adverse effect of Cu/Zn NPs, which led to the damage of protein and carbohydrate structure of the bacterial cell wall. On the other hand, the techno economic analysis for the biosynthesis of Cu/Zn NPs is economically feasible with 80% of the internal rate of return (IRR). It may provide alternative methods for disinfection of greywater. The effect on the characteristic and efficiency of NPs based on the C, N, P content in pumpkin need to be further investigated.
Supporting information
S1 Table [docx]
Coded and un-coded levels of the independent factors investigated in the present work.
S2 Table [docx]
Central composite design arrangement and responses for inactivation of . and . in greywater using bimetallic Zn/Cu NPs.
S3 Table [docx]
Regression coefficient and their significance of the quadratic model for inactivating . and . seeded in greywater using bimetallic (Zn/Cu) NPs.
S4 Table [docx]
The best operating parameters for inactivation of . and . in greywater using bimetallic Zn/Cu NPs.
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- Calculation of the contribution rate of China’s hydraulic science and technology based on a feedforward neural network
- ViraMiner: Deep learning on raw DNA sequences for identifying viral genomes in human samples
- The absence of interleukin 10 affects the morphology, differentiation, granule content and the production of cryptidin-4 in Paneth cells in mice
- Relationship between Helicobacter pylori infection and obesity in Chinese adults: A systematic review with meta-analysis
- Moving model analysis on the transient pressure and slipstream caused by a metro train passing through a tunnel
- The importance of assigning responsibility during evaluation in order to increase student satisfaction from physical education classes: A structural equation model
- Lower dormancy with rapid germination is an important strategy for seeds in an arid zone with unpredictable rainfall
- Gene Cascade Finder: A tool for identification of gene cascades and its application in Caenorhabditis elegans
- Proteomics approach to identify serum biomarkers associated with the progression of diabetes in Korean patients with abdominal obesity
- Malaria vaccine candidates displayed on novel virus-like particles are immunogenic and induce transmission-blocking activity
- Transcriptome analysis of a nematode resistant and susceptible upland cotton line at two critical stages of Meloidogyne incognita infection and development
- Identification of variant HIV envelope proteins with enhanced affinities for precursors to anti-gp41 broadly neutralizing antibodies
- Distinguishing mild cognitive impairment from healthy aging and Alzheimer’s Disease: The contribution of the INECO Frontal Screening (IFS)
- Novel application of amino-acid buffered solution for neuroprotection against ischemia/reperfusion injury
- Are unpopular children more likely to get sick? Longitudinal links between popularity and infectious diseases in early childhood
- Vegetation communities on commercial developments are heterogenous and determined by development and landscaping decisions, not socioeconomics
- Falls among community-dwelling older adults in Ethiopia; A preliminary cross-sectional study
- Retraction: Social success of perfumes
- The effect of ethyl alcohol on the severity of injuries in fatal pedestrian victims of traffic crashes
- Drought stress has transgenerational effects on soybean seed germination and seedling vigor
- Prevalence of benign osseous lesions of the spine and association with spinal pain in the general population in whole body MRI
- Age-related differences of inter-joint coordination in elderly during squat jumping
- Isolation of five Enterobacteriaceae species harbouring blaNDM-1 and mcr-1 plasmids from a single paediatric patient
- Diagnostic performance and image quality of iterative model-based reconstruction of coronary CT angiography using 100 kVp for heavily calcified coronary vessels
- CAC1 knockdown reverses drug resistance through the downregulation of P-gp and MRP-1 expression in colorectal cancer
- Getting your game on: Using virtual reality to improve real table tennis skills
- Microbiological contamination of young children’s hands in rural Bangladesh: Associations with child age and observed hand cleanliness as proxy
- Expansion of the agricultural frontier in the largest South American Dry Forest: Identifying priority conservation areas for snakes before everything is lost
- Utility of lung ultrasound in ANCA-associated vasculitis with lung involvement
- Aerial surveys cause large but ephemeral decreases in bear presence at salmon streams in Kodiak, Alaska
- Exposure to particle debris generated from passenger and truck tires induces different genotoxicity and inflammatory responses in the RAW 264.7 cell line
- Influence of the cultivation medium and pH on the pigmentation of Trichophyton rubrum
- Intra-arterial catheter-directed CT angiography for assessment of endovascular aortic aneurysm repair
- Association of antibiotic exposure with the mortality in metastatic colorectal cancer patients treated with bevacizumab-containing chemotherapy: A hospital-based retrospective cohort study
- The genetic alteration spectrum of the SWI/SNF complex: The oncogenic roles of BRD9 and ACTL6A
- Plasma chemistry in nesting leatherback sea turtles (Dermochelys coriacea) from Florida: Understanding the importance of sample hemolysis effects on blood analytes
- Myotendinous asymmetries derived from the prolonged practice of badminton in professional players
- Computational tools to detect signatures of mutational processes in DNA from tumours: A review and empirical comparison of performance
- Exposure to lipopolysaccharide (LPS) reduces contractile response of small airways from GSTCD-/- mice
- Generation of a protective murine monoclonal antibody against the stem of influenza hemagglutinins from group 1 viruses and identification of resistance mutations against it
- Comparative compositional and functional analyses of Bothrops moojeni specimens reveal several individual variations
- Radiation hardness of cadmium telluride solar cells in proton therapy beam mode
- Bourdieu, networks, and movements: Using the concepts of habitus, field and capital to understand a network analysis of gender differences in undergraduate physics
- A 32-channel parallel transmit system add-on for 7T MRI
- Comparison between Aptima Assays (Hologic) and the Allplex STI Essential Assay (Seegene) for the diagnosis of Sexually transmitted infections
- Knowledge gaps of STIs in Africa; Systematic review
- Correction: Bovine herpesvirus 1 can cross the intact zona pellucida of bovine oocytes after artificial infection
- Distribution of corneal spherical aberration in a Tanzanian population
- Correction: Determinants of physical activity: A path model based on an ecological model of active living
- Wild pollinator activity negatively related to honey bee colony densities in urban context
- Subclinical alterations in left ventricular structure and function according to obesity and metabolic health status
- The epidemiological signature of influenza B virus and its B/Victoria and B/Yamagata lineages in the 21st century
- Identification of bovine CpG SNPs as potential targets for epigenetic regulation via DNA methylation
- Nitric oxide regulates the expression of heme carrier protein-1 via hypoxia inducible factor-1α stabilization
- Development of highly efficient protocols for extraction and amplification of cytomegalovirus DNA from dried blood spots for detection and genotyping of polymorphic immunomodulatory genes
- Construction of pseudomolecule sequences of Brassica rapa ssp. pekinensis inbred line CT001 and analysis of spontaneous mutations derived via sexual propagation
- Effects of flavoring compounds used in electronic cigarette refill liquids on endothelial and vascular function
- Rural pipeline and willingness to work in rural areas: Mixed method study on students in midwifery and obstetric nursing in Mali
- Role of phospholipase A2 receptor 1 antibody level at diagnosis for long-term renal outcome in membranous nephropathy
- Prevalence of anemia in diabetic adult outpatients in Northeast Ethiopia
- Characterization of melanin and optimal conditions for pigment production by an endophytic fungus, Spissiomyces endophytica SDBR-CMU319
- Genetic variability and consequence of Mycobacterium tuberculosis lineage 3 in Kampala-Uganda
- Comparison of in vitro and computational experiments on the relation of inter-beat interval and duration of repolarization in a specific type of human induced pluripotent stem cell-derived cardiomyocytes
- Current and potential contributions of community pharmacy teams to self-harm and suicide prevention: A qualitative interview study
- Prediction of risk scores for colorectal cancer patients from the concentration of proteins involved in mitochondrial apoptotic pathway
- With or without U(K): A pre-Brexit network analysis of the EU ETS
- Graph-theoretical analysis for energy landscape reveals the organization of state transitions in the resting-state human cerebral cortex
- Task-uninformative visual stimuli improve auditory spatial discrimination in humans but not the ideal observer
- Residual stenosis after carotid artery stenting: Effect on periprocedural and long-term outcomes
- gapFinisher: A reliable gap filling pipeline for SSPACE-LongRead scaffolder output
- A plant biostimulant made from the marine brown algae Ascophyllum nodosum and chitosan reduce Fusarium head blight and mycotoxin contamination in wheat
- Monte-Carlo value analysis of High-Throughput Satellites: Value levers, tradeoffs, and implications for operators and investors
- Educational and health outcomes associated with bronchopulmonary dysplasia in 15-year-olds born preterm
- Loss of prostatic acid phosphatase and α-synuclein cause motor circuit degeneration without altering cerebellar patterning
- Neuropathy and neural plasticity in the subcutaneous white adipose depot
- Roles of differential expression of miR-543-5p in GH regulation in rat anterior pituitary cells and GH3 cells
- The enemy’s gaze: Immersive virtual environments enhance peace promoting attitudes and emotions in violent intergroup conflicts
- Protective effect of lactobacillus plantarum on alcoholic liver injury and regulating of keap-Nrf2-ARE signaling pathway in zebrafish larvae
- Koopman Mode Analysis of agent-based models of logistics processes
- Empirical mode decomposition based long short-term memory neural network forecasting model for the short-term metro passenger flow
- Male sexual dysfunction in obesity: The role of sex hormones and small fibre neuropathy
- Multi-agent reinforcement learning with approximate model learning for competitive games
- Identification of olfactory genes and functional analysis of BminCSP and BminOBP21 in Bactrocera minax
- The use of urinary fluoride excretion to facilitate monitoring fluoride intake: A systematic scoping review
- Development of a family caregiver needs-assessment scale for end-of-life care for senility at home (FADE)
- Epidemiology of pneumonia in the pre-pneumococcal conjugate vaccine era in children 2-59 months of age, in Ulaanbaatar, Mongolia, 2015-2016
- H-EM: An algorithm for simultaneous cell diameter and intensity quantification in low-resolution imaging cytometry
- Public expenditure on Non-Communicable Diseases & Injuries in India: A budget-based analysis
- Doxorubicin induces trans-differentiation and MMP1 expression in cardiac fibroblasts via cell death-independent pathways
- uORF-Tools—Workflow for the determination of translation-regulatory upstream open reading frames
- Comparative analysis of postural control and vertical jump performance between three different measurement devices
- Hierarchical multi-view aggregation network for sensor-based human activity recognition
- Clavien–Dindo classification for grading complications after total pharyngolaryngectomy and free jejunum transfer
- Significantly different expression levels of microRNAs associated with vascular invasion in hepatocellular carcinoma and their prognostic significance after surgical resection
- Clinical correlates of workplace injury occurrence and recurrence in adults
- Medicine and the media: Medical experts’ problems and solutions while working with journalists
- Phylogenic classification and virulence genes profiles of uropathogenic E. coli and diarrhegenic E. coli strains isolated from community acquired infections
- Genetic relatedness in carbapenem-resistant isolates from clinical specimens in Ghana using ERIC-PCR technique
- Forest resilience under global environmental change: Do we have the information we need? A systematic review
- Improving the production of podophyllotoxin in hairy roots of Hyptis suaveolens induced from regenerated plantlets
- Controls on planktonic foraminifera apparent calcification depths for the northern equatorial Indian Ocean
- Notch and Delta are required for survival of the germline stem cell lineage in testes of Drosophila melanogaster
- Children with HIV: A scoping review of auditory processing skills
- Correction: Two distinct actin waves correlated with turns-and-runs of crawling microglia
- Expression of Concern: Neurotoxicity Induced by Bupivacaine via T-Type Calcium Channels in SH-SY5Y Cells
- Sex-dependent and -independent transcriptional changes during haploid phase gametogenesis in the sugar kelp Saccharina latissima
- Vehicle modeling for the analysis of the response of detectors based on inductive loops
- New Mycobacteroides abscessus subsp. massiliense strains with recombinant hsp65 gene laterally transferred from Mycobacteroides abscessus subsp. abscessus: Potential for misidentification of M. abscessus strains with the hsp65-based method
- A prognostic Bayesian network that makes personalized predictions of poor prognostic outcome post resection of pancreatic ductal adenocarcinoma
- Impact of care provider network characteristics on patient outcomes: Usage of social network analysis and a multi-scale community detection
- Valid group comparisons can be made with the Patient Health Questionnaire (PHQ-9): A measurement invariance study across groups by demographic characteristics
- Comparison of risk models for mortality and cardiovascular events between machine learning and conventional logistic regression analysis
- Upgraded molecular models of the human KCNQ1 potassium channel
- Mental health and quality of life outcomes in family members of patients with chronic critical illness admitted to the intensive care units of two Brazilian hospitals serving the extremes of the socioeconomic spectrum
- Correction: Secretome profiling of PC3/nKR cells, a novel highly migrating prostate cancer subline derived from PC3 cells
- The extraordinary osteology and functional morphology of the limbs in Palorchestidae, a family of strange extinct marsupial giants
- Primary hyperhidrosis prevalence and characteristics among medical students in Rio de Janeiro
- Implementation of home blood pressure monitoring among French GPs: A long and winding road
- In vitro and molecular chemosensitivity in human cholangiocarcinoma tissues
- Saiga horn user characteristics, motivations, and purchasing behaviour in Singapore
- The health and cost burden of antibiotic resistant and susceptible Escherichia coli bacteraemia in the English hospital setting: A national retrospective cohort study
- Retraction: Comprehensive Comparison of Three Different Immunosuppressive Regimens for Liver Transplant Patients with Hepatocellular Carcinoma: Steroid-Free Immunosuppression, Induction Immunosuppression and Standard Immunosuppression
- Can acute suicidality be predicted by Instagram data? Results from qualitative and quantitative language analyses
- Computational and experimental analysis of the glycophosphatidylinositol-anchored proteome of the human parasitic nematode Brugia malayi
- Antibacterial activity of silver nanoparticles of different particle size against Vibrio Natriegens
- Genetic variations associated with response to dutasteride in the treatment of male subjects with androgenetic alopecia
- To eat or not to eat: Reward delay impulsivity in children with loss of control eating, attention deficit / hyperactivity disorder, a double diagnosis, and healthy children
- Factors associated with newborn care knowledge and practices in the upper Himalayas
- Correction: A more physiological approach to lipid metabolism alterations in cancer: CRC-like organoids assessment
- Correlates of concurrent partnerships and patterns of condom use among men who have sex with men and transgender women in Peru
- Ocular and systemic risk factors associated with recurrent disc hemorrhage in primary open-angle glaucoma
- Development of a denoising convolutional neural network-based algorithm for metal artifact reduction in digital tomosynthesis for arthroplasty: A phantom study
- Low-level sensory processes play a more crucial role than high-level cognitive ones in the size-weight illusion
- The prevalence of asthma and allergic rhinitis in Nigeria: A nationwide survey among children, adolescents and adults
- Retraction: Human Cystathionine-β-Synthase Phosphorylation on Serine227 Modulates Hydrogen Sulfide Production in Human Urothelium
- Which clinical and biochemical predictors should be used to screen for diabetes in patients with serious mental illness receiving antipsychotic medication? A large observational study
- Characteristics of diabetic macular edema patients refractory to anti-VEGF treatments and a dexamethasone implant
- Correction: Effects of dietary n-6: n-3 polyunsaturated fatty acid ratios on meat quality, carcass characteristics, tissue fatty acid profiles, and expression of lipogenic genes in growing goats
- Speckle tracking derived reference values of myocardial deformation and impact of cardiovascular risk factors – Results from the population-based STAAB cohort study
- Impact of pterygium on the ocular surface and meibomian glands
- Lack of association between hypothyroxinemia of prematurity and transient thyroid abnormalities with adverse long term neurodevelopmental outcome in very low birth weight infants
- Transcriptome divergence during leaf development in two contrasting switchgrass (Panicum virgatum L.) cultivars
- Study on Dalfampridine in the treatment of Multiple Sclerosis Mobility Disability: A meta-analysis
- Circulating progenitor cells and the expression of Cxcl12, Cxcr4 and angiopoietin-like 4 during wound healing in the murine ear
- EUSKOR: End-to-end coreference resolution system for Basque
- Inactivating pathogenic bacteria in greywater by biosynthesized Cu/Zn nanoparticles from secondary metabolite of Aspergillus iizukae; optimization, mechanism and techno economic analysis
- Exopolysaccharide producing rhizobacteria and their impact on growth and drought tolerance of wheat grown under rainfed conditions
- Structural equation modeling for hypertension and type 2 diabetes based on multiple SNPs and multiple phenotypes
- Correction: Association between ultraviolet radiation exposure dose and cataract in Han people living in China and Taiwan: A cross-sectional study
- Short-term exercise training improves cardiac function associated to a better antioxidant response and lower type 3 iodothyronine deiodinase activity after myocardial infarction
- Unexpected low genetic variation in the South American hystricognath rodent Lagostomus maximus (Rodentia: Chinchillidae)
- PRC2 activates interferon-stimulated genes indirectly by repressing miRNAs in glioblastoma
- Surgical resection is sufficient for incidentally discovered solitary pulmonary nodule caused by nontuberculous mycobacteria in asymptomatic patients
- “I do all I can but I still fail them”: Health system barriers to providing Option B+ to pregnant and lactating women in Malawi
- Impact of major illnesses and geographic regions on do-not-resuscitate rate and its potential cost savings in Taiwan
- Implementation of intermittent theta burst stimulation compared to conventional repetitive transcranial magnetic stimulation in patients with treatment resistant depression: A cost analysis
- Genome-wide analysis of DNA methylation profile identifies differentially methylated loci associated with human intervertebral disc degeneration
- Correction: Artificial neural networks reveal individual differences in metacognitive monitoring of memory
- Combining fish and environmental PCR for diagnostics of diseased laboratory zebrafish in recirculating systems
- Reading skill modulates the effect of parafoveal distractors on foveal lexical decision in deaf students
- Association between the posterior part of the circle of Willis and the vertebral artery hypoplasia
- Exposure to marital conflict: Gender differences in internalizing and externalizing problems among children
- Ethanol locks for the prevention of catheter-related infection in patients with central venous catheter: A systematic review and meta-analysis of randomized controlled trials
- The effect of age and perturbation time on online control during rapid pointing
- Oilseed rape (Brassica napus) resistance to growth of Leptosphaeria maculans in leaves of young plants contributes to quantitative resistance in stems of adult plants
- Lymphocyte proliferation induced by high-affinity peptides for HLA-B*51:01 in Behçet’s uveitis
- Sensitization of avian pathogenic Escherichia coli to amoxicillin in vitro and in vivo in the presence of surfactin
- Genomic characterization of the complete terpene synthase gene family from Cannabis sativa
- Inhibition of gap junctional intercellular communication by an anti-migraine agent, flunarizine
- Levels of serum eosinophil cationic protein are associated with hookworm infection and intensity in endemic communities in Ghana
- Plant growth promoting rhizobacterium Stenotrophomonas maltophilia BJ01 augments endurance against N2 starvation by modulating physiology and biochemical activities of Arachis hypogea
- Hierarchical integrated and segregated processing in the functional brain default mode network within attention-deficit/hyperactivity disorder
- Rising co-payments coincide with unwanted effects on continuity of healthcare for patients with schizophrenia in the Netherlands
- Analysis of Zobellella denitrificans ZD1 draft genome: Genes and gene clusters responsible for high polyhydroxybutyrate (PHB) production from glycerol under saline conditions and its CRISPR-Cas system
- False-negative errors in next-generation sequencing contribute substantially to inconsistency of mutation databases
- Identification of potassium phosphite responsive miRNAs and their targets in potato
- Quantification of bell-shaped size selectivity in shrimp trawl fisheries using square mesh panels and a sorting cone after a Nordmøre grid
- Deactivation of somatosensory and visual cortices during vestibular stimulation is associated with older age and poorer balance
- Combined immunization with attenuated live influenza vaccine and chimeric pneumococcal recombinant protein improves the outcome of virus-bacterial infection in mice
- Flooding performance evaluation of alkyl aryl sulfonate in various alkaline environments
- An artificial intelligent diagnostic system on mobile Android terminals for cholelithiasis by lightweight convolutional neural network
- Enhanced detection of prion infectivity from blood by preanalytical enrichment with peptoid-conjugated beads
- COI metabarcoding primer choice affects richness and recovery of indicator taxa in freshwater systems
- Retraction: APRIL Induces Tumorigenesis and Metastasis of Colorectal Cancer Cells via Activation of the PI3K/Akt Pathway
- The intake pattern and feed preference of layer hens selected for high or low feed conversion ratio
- Individualized pattern recognition for detecting mind wandering from EEG during live lectures
- Ontogenetic expression of thyroid hormone signaling genes: An in vitro and in vivo species comparison
- Post-activation potentiation effect of eccentric overload and traditional weightlifting exercise on jumping and sprinting performance in male athletes
- Effectiveness of different central venous catheter fixation suture techniques: An in vitro crossover study
- Quantitative detection of ALK fusion breakpoints in plasma cell-free DNA from patients with non-small cell lung cancer using PCR-based target sequencing with a tiling primer set and two-step mapping/alignment
- Nuclei deformation reveals pressure distributions in 3D cell clusters
- Strategies for increasing diagnostic yield of community-onset bacteraemia within the emergency department: A retrospective study
- Rapid evolution of Mexican H7N3 highly pathogenic avian influenza viruses in poultry
- Certified service dogs – A cost-effectiveness analysis appraisal
- Endothelial dysfunction and low-grade inflammation in the transition to renal replacement therapy
- Assessing the impact of a research funder’s recommendation to consider core outcome sets
- Validity of six consumer-level activity monitors for measuring steps in patients with chronic heart failure
- Detection of deceptive motions in rugby from visual motion cues
- The impact of antenatal care on neonatal mortality in sub-Saharan Africa: A systematic review and meta-analysis
- Epidemiological investigation and management of bloody diarrhea among children in India
- Irisin promotes C2C12 myoblast proliferation via ERK-dependent CCL7 upregulation
- Bacteria isolated from Bengal cat (Felis catus × Prionailurus bengalensis) anal sac secretions produce volatile compounds potentially associated with animal signaling
- Petri net–based model of the human DNA base excision repair pathway
- Complexation and conformation of lead ion with poly-γ-glutamic acid in soluble state
- The effects of sympathetic activity induced by ice water on blood flow and brachial artery flow-mediated dilatation response in healthy volunteers
- The Youth-Physical Activity Towards Health (Y-PATH) intervention: Results of a 24 month cluster randomised controlled trial
- The COPD multi-dimensional phenotype: A new classification from the STORICO Italian observational study
- Morphological identification of Amphitetranychus species (Acari: Tetranychidae) with crossbreeding, esterase zymograms and DNA barcode data
- Maintaining hope after a disabling stroke: A longitudinal qualitative study of patients’ experiences, views, information needs and approaches towards making treatment decisions
- Cultural differences in the use of acoustic cues for musical emotion experience
- Effects of a rifampicin pre-treatment on linezolid pharmacokinetics
- High prevalence of multidrug resistant Enterobacteriaceae among residents of long term care facilities in Amsterdam, the Netherlands
- Infection/inflammation-associated preterm delivery within 14 days of presentation with symptoms of preterm labour: A multivariate predictive model
- Prognostic value of preoperative hydronephrosis in patients with bladder cancer undergoing radical cystectomy: A meta-analysis
- Correction: Early life predictors of midlife allostatic load: A prospective cohort study
- PCR-free whole exome sequencing: Cost-effective and efficient in detecting rare mutations
- Epstein-Barr virus genome packaging factors accumulate in BMRF1-cores within viral replication compartments
- Symbiotic incompatibility between soybean and Bradyrhizobium arises from one amino acid determinant in soybean Rj2 protein
- Does anticoagulation needed for distally located incidental pulmonary thromboembolism in patients with active cancer?
- Control of human testis-specific gene expression
- Speaking up culture of medical students within an academic teaching hospital: Need of faculty working in patient safety
- Appraisal on the wound healing potential of Melaleuca alternifolia and Rosmarinus officinalis L. essential oil-loaded chitosan topical preparations
- Understanding parental perspectives on outcomes following paediatric encephalitis: A qualitative study
- Results of scoping review do not support mild traumatic brain injury being associated with a high incidence of chronic cognitive impairment: Commentary on McInnes et al. 2017
- Native seed, soil and atmosphere respond to boreal forest topsoil (LFH) storage
- Development of a quantitative polymerase chain reaction assay and environmental DNA sampling methods for Giant Gartersnake (Thamnophis gigas)
- Genetic diversity and population structure of four Chinese rabbit breeds
- Knowledge, attitude and behaviors towards patients with mental illness: Results from a national Lebanese study
- Correction: An impact evaluation of two rounds of mass drug administration on the prevalence of active trachoma: A clustered cross sectional survey
- Comparative prognostic accuracy of sepsis scores for hospital mortality in adults with suspected infection in non-ICU and ICU at an academic public hospital
- Graph convolutional network approach applied to predict hourly bike-sharing demands considering spatial, temporal, and global effects
- Impact of traffic variability on geographic accessibility to 24/7 emergency healthcare for the urban poor: A GIS study in Dhaka, Bangladesh
- Feeling the heat: Elevated temperature affects male display activity of a lekking grassland bird
- Constructing a comprehensive disaster resilience index: The case of Italy
- Intraocular pressure according to different types of tonometry (non-contact and Goldmann applanation) in patients with different degrees of bilateral tearing
- Prevalent vertebral fracture is dominantly associated with spinal microstructural deterioration rather than bone mineral density in patients with type 2 diabetes mellitus
- Silent volumetric multi-contrast 7 Tesla MRI of ocular tumors using Zero Echo Time imaging
- Nonverbal synchrony in virtual reality
- Do speed cameras reduce road traffic collisions?
- A zero-shot learning approach to the development of brain-computer interfaces for image retrieval
- Use of non-HIV medication among people living with HIV and receiving antiretroviral treatment in Côte d’Ivoire, West Africa: A cross-sectional study
- DNA barcoding of southern African crustaceans reveals a mix of invasive species and potential cryptic diversity
- Development of an international external quality assurance program for HIV-1 incidence using the Limiting Antigen Avidity assay
- Correction: The mean cell volume difference (dMCV) reflects serum hypertonicity in diabetic dogs
- Structural characteristics of lipocalin allergens: Crystal structure of the immunogenic dog allergen Can f 6
- Transport oil product consumption and GHG emission reduction potential in China: An electric vehicle-based scenario analysis
- Ontogenetic shift in the energy allocation strategy and physiological condition of larval plaice (Pleuronectes platessa)
- Increased proliferation and altered cell cycle regulation in pancreatic stem cells derived from patients with congenital hyperinsulinism
- Diagnostic accuracy of Xpert MTB/RIF assay and non-molecular methods for the diagnosis of tuberculosis lymphadenitis
- Assessment of glucose-6-phosphate dehydrogenase activity using CareStart G6PD rapid diagnostic test and associated genetic variants in Plasmodium vivax malaria endemic setting in Mauritania
- Spatial distribution of breast cancer in Sudan 2010-2016
- Human-induced fire regime shifts during 19th century industrialization: A robust fire regime reconstruction using northern Polish lake sediments
- Enhanced effectiveness of oil dispersants in destabilizing water-in-oil emulsions
- Development of UV spectrophotometry methods for concurrent quantification of amlodipine and celecoxib by manipulation of ratio spectra in pure and pharmaceutical formulation
- Iron and manganese co-limit growth of the Southern Ocean diatom Chaetoceros debilis
- Bilateral and unilateral load-velocity profiling in a machine-based, single-joint, lower body exercise
- Veterans Health Administration nurses’ training and beliefs related to care of patients with traumatic brain injury
- Supplementation strategies affect the feed intake and performance of grazing replacement heifers
- Active transcutaneous bone conduction hearing implants: Systematic review and meta-analysis
- Parameterization-induced uncertainties and impacts of crop management harmonization in a global gridded crop model ensemble
- Acidification effects on isolation of extracellular vesicles from bovine milk
- GPR40 full agonism exerts feeding suppression and weight loss through afferent vagal nerve
- Mining version history to predict the class instability
- Humpback whale song occurrence reflects ecosystem variability in feeding and migratory habitat of the northeast Pacific
- A phase 2 study of an oral mTORC1/mTORC2 kinase inhibitor (CC-223) for non-pancreatic neuroendocrine tumors with or without carcinoid symptoms
- Asprosin response in hypoglycemia is not related to hypoglycemia unawareness but rather to insulin resistance in type 1 diabetes
- Muscle oxygenation maintained during repeated-sprints despite inspiratory muscle loading
- Reconstructing systematic persistent impacts of promotional marketing with empirical nonlinear dynamics
- Trans-national conservation and infrastructure development in the Heart of Borneo
- Prediction of cardiovascular disease risk among people with severe mental illness: A cohort study
- Data in question: A survey of European biobank professionals on ethical, legal and societal challenges of biobank research
- Hypertensive APOL1 risk allele carriers demonstrate greater blood pressure reduction with angiotensin receptor blockade compared to low risk carriers
- Reconstructing birth in Australopithecus sediba
- Value of contrast-enhanced ultrasound for preoperative assessment of liver reserve function in patients with liver tumors
- Correction: Identifying obesity/overweight status in children and adolescents; A cross-sectional medical record review of physicians’ weight screening practice in outpatient clinics, Saudi Arabia
- Incidence and risk factors of loss to follow-up among HIV-infected children in an antiretroviral treatment program
- Changes in intracellular folate metabolism during high-dose methotrexate and Leucovorin rescue therapy in children with acute lymphoblastic leukemia
- Functional role and evolutionary contributions of floral gland morphoanatomy in the Paleotropical genus Acridocarpus (Malpighiaceae)
- On the efficiency of HIV transmission: Insights through discrete time HIV models
- Metabolic cost calculations of gait using musculoskeletal energy models, a comparison study
- Comparison of molecular profile in triple-negative inflammatory and non-inflammatory breast cancer not of mesenchymal stem-like subtype
- Evolutionary analysis of six chloroplast genomes from three Persea americana ecological races: Insights into sequence divergences and phylogenetic relationships
- Cultural transmission in a food preparation task: The role of interactivity, innovation and storytelling
- Correction: Effects of affective priming through music on the use of emotion words
- Safety and immunogenicity of investigational seasonal influenza hemagglutinin DNA vaccine followed by trivalent inactivated vaccine administered intradermally or intramuscularly in healthy adults: An open-label randomized phase 1 clinical trial
- Estimation of vaccination coverage from electronic healthcare records; methods performance evaluation – A contribution of the ADVANCE-project
- Dietary phytogenics and galactomannan oligosaccharides in low fish meal and fish oil-based diets for European sea bass (Dicentrarchus labrax) juveniles: Effects on gut health and implications on in vivo gut bacterial translocation
- Suicide by hanging: Results from a national survey in Switzerland and its implications for suicide prevention
- Gene dysregulation in peripheral blood of moyamoya disease and comparison with other vascular disorders
- Genome wide genetic dissection of wheat quality and yield related traits and their relationship with grain shape and size traits in an elite × non-adapted bread wheat cross
- Safety and tolerability of artesunate-amodiaquine, artemether-lumefantrine and quinine plus clindamycin in the treatment of uncomplicated Plasmodium falciparum malaria in Kinshasa, the Democratic Republic of the Congo
- Factors influencing the admission decision for Medical Psychiatry Units: A concept mapping approach
- Comparison of post-traumatic changes in circulating and bone marrow leukocytes between BALB/c and CD-1 mouse strains
- Physiological stress reactivity and recovery related to behavioral traits in dogs (Canis familiaris)
- Associations between birth order with mental wellbeing and psychological distress in midlife: Findings from the 1970 British Cohort Study (BCS70)
- Non-steroidal anti-inflammatory drugs use in older adults decreases risk of Alzheimer’s disease mortality
- The cost-effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis
- Ancient technology and punctuated change: Detecting the emergence of the Edomite Kingdom in the Southern Levant
- Flowers as viral hot spots: Honey bees (Apis mellifera) unevenly deposit viruses across plant species
- Randomized control trial of Tools of the Mind: Marked benefits to kindergarten children and their teachers
- Preserving cultural heritage: Analyzing the antifungal potential of ionic liquids tested in paper restoration
- PNPLA3 rs738409 G allele carriers with genotype 1b HCV cirrhosis have lower viral load but develop liver failure at younger age
- Correction: Unraveling the genetic complexity underlying sorghum response to water availability
- Impact of tear metrics on the reliability of perimetry in patients with dry eye
- Using DNA barcoding to improve invasive pest identification at U.S. ports-of-entry
- Correction: Effects of Lactobacillus plantarum 15-1 and fructooligosaccharides on the response of broilers to pathogenic Escherichia coli O78 challenge
- Physico-chemical characterization and transcriptome analysis of 5-methyltryptophan resistant lines in rice
- Patient factors affecting successful linkage to treatment in a cervical cancer prevention program in Kenya: A prospective cohort study
- Is this a man’s world? The effect of gender diversity and gender equality on firm innovativeness
- Procalcitonin to stop antibiotics after cardiovascular surgery in a pediatric intensive care unit—The PROSACAB study
- Temporal trends, predictors, and outcomes of acute kidney injury and hemodialysis use in acute myocardial infarction-related cardiogenic shock
- Quantitation of free glycation compounds in saliva
- Resolving an 87-year-old taxonomical curiosity with the description of Psylla frodobagginsi sp. nov. (Hemiptera: Sternorrhyncha: Psyllidae), a second distinct Psylla species on the New Zealand endemic plant kōwhai
- The effect of cathodal tDCS on fear extinction: A cross-measures study
- Physiological responses to affiliation during conversation: Comparing neurotypical males and males with Asperger syndrome
- Human cord blood (hCB)-CD34+ humanized mice fail to reject human acute myeloid leukemia cells
- Investigating the dispersal of antibiotic resistance associated genes from manure application to soil and drainage waters in simulated agricultural farmland systems
- Continuous norming of psychometric tests: A simulation study of parametric and semi-parametric approaches
- Phylogenetic microbiota profiling in fecal samples depends on combination of sequencing depth and choice of NGS analysis method
- Cost-effectiveness of apixaban compared to other anticoagulants in patients with atrial fibrillation in the real-world and trial settings
- Biochemical profile and in vitro biological activities of extracts from seven folk medicinal plants growing wild in southern Tunisia
- Low genetic differentiation yet high phenotypic variation in the invasive populations of Spartina alterniflora in Guangxi, China
- A mathematical model for designing networks of C-Reactive Protein point of care testing
- Prevalence of hypochondriac symptoms among health science students in China: A systematic review and meta-analysis
- Femtosecond laser induced step-like structures inside transparent hydrogel due to laser induced threshold reduction
- From In Situ to satellite observations of pelagic Sargassum distribution and aggregation in the Tropical North Atlantic Ocean
- The polyether ionophore salinomycin targets multiple cellular pathways to block proliferative vitreoretinopathy pathology
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- HIV prevalence and risk behavior among male and female adults screened for enrolment into a vaccine preparedness study in Maputo, Mozambique
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- Direct estimation of the parameters of a delayed, intermittent activation feedback model of postural sway during quiet standing
- Occurrence mechanism and coping paths of accidents of highly aggregated tourist crowds based on system dynamics
- Correction: Low Dose Aerosol Fitness at the Innate Phase of Murine Infection Better Predicts Virulence amongst Clinical Strains of Mycobacterium tuberculosis
- Effects of enalapril and paricalcitol treatment on diabetic nephropathy and renal expressions of TNF-α, p53, caspase-3 and Bcl-2 in STZ-induced diabetic rats
- Correction: Public reaction to Chikungunya outbreaks in Italy—Insights from an extensive novel data streams-based structural equation modeling analysis
- Correction: Comparison of neurodegenerative types using different brain MRI analysis metrics in older adults with normal cognition, mild cognitive impairment, and Alzheimer’s dementia
- Intra-individual variability of sleep and nocturnal cardiac autonomic activity in elite female soccer players during an international tournament
- Therapeutic efficacy of equine botulism heptavalent antitoxin against all seven botulinum neurotoxins in symptomatic guinea pigs
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- Scope and efficacy of the broad-spectrum topical antiseptic choline geranate
- Hematological and biochemical parameters for Chinese rhesus macaque
- Veterinary peer study groups as a method of continuous education—A new approach to identify and address factors associated with antimicrobial prescribing
- Correction: The prognosis of heart failure patients: Does sodium level play a significant role?
- Maternal malaria but not schistosomiasis is associated with a higher risk of febrile infection in infant during the first 3 months of life: A mother-child cohort in Benin
- Systematic identification of facility-based stillbirths and neonatal deaths through the piloted use of an adapted RAPID tool in Liberia and Nepal
- Effects of salbutamol and phlorizin on acute pulmonary inflammation and disease severity in experimental sepsis
- Correction: Age, sex and storage time influence hair cortisol levels in a wild mammal population
- Reasons to care: Personal motivation as a key factor in the practice of the professional foster carer in Romania
- Determinants of clinical, functional and personal recovery for people with schizophrenia and other severe mental illnesses: A cross-sectional analysis
- Continuity of care for TB patients at a South African hospital: A qualitative participatory study of the experiences of hospital staff
- EGF receptor stimulation shifts breast cancer cell glucose metabolism toward glycolytic flux through PI3 kinase signaling
- The Better Management of Patients with Osteoarthritis Program: Outcomes after evidence-based education and exercise delivered nationwide in Sweden
- The negative effects of short-term extreme thermal events on the seagrass Posidonia oceanica are exacerbated by ammonium additions
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- Healthcare resource utilization and costs for multiple sclerosis management in the Campania region of Italy: Comparison between centre-based and local service healthcare delivery
- Deconstruction of central line insertion guidelines based on the positive deviance approach—Reducing gaps between guidelines and implementation: A qualitative ethnographic research
- PBMCs transcriptome profiles identified breed-specific transcriptome signatures for PRRSV vaccination in German Landrace and Pietrain pigs
- The impact of admission serum lactate on children with moderate to severe traumatic brain injury
- Hypervirulent Klebsiella pneumoniae serotype K1 clinical isolates form robust biofilms at the air-liquid interface
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- A self-adaptive deep learning method for automated eye laterality detection based on color fundus photography
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- Identification of QTLs for powdery mildew (Podosphaera aphanis; syn. Sphaerotheca macularis f. sp. fragariae) susceptibility in cultivated strawberry (Fragaria ×ananassa)
- Chemical volatiles present in cotton gin trash: A by-product of cotton processing
- PTP1B negatively regulates nitric oxide-mediated Pseudomonas aeruginosa killing by neutrophils
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- Association between regional brain volumes and BMI z-score change over one year in children
- Relationships between Potentially Toxic Elements in intertidal sediments and their bioaccumulation by benthic invertebrates
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- Hospital burden of pulmonary arterial hypertension in France
- Understanding the variability of Australian fire weather between 1973 and 2017
- Photon-counting cine-cardiac CT in the mouse
- Ecophysiological impacts of Esca, a devastating grapevine trunk disease, on Vitis vinifera L.
- Black “Reading the Mind in the Eyes” task: The development of a task assessing mentalizing from black faces
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- Validation of the Rainbow Model of Integrated Care Measurement Tools (RMIC-MTs) in renal care for patient and care providers
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- A randomized controlled trial examining the efficacy of an internet-based cognitive behavioral therapy program for adolescents with anxiety disorders
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- Characteristics of prescription in 29 Level 3 Neonatal Wards over a 2-year period (2017-2018). An inventory for future research
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- Correction: Lkb1 Deficiency Alters Goblet and Paneth Cell Differentiation in the Small Intestine
- Cardiac resynchronization therapy-heart failure (CRT-HF) clinic: A novel model of care
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- Dual-Subpopulation as reciprocal optional external archives for differential evolution
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- Clinical outcomes with neoadjuvant versus adjuvant chemotherapy for triple negative breast cancer: A report from the National Cancer Database
- Identification and characterization of a novel heparan sulfate-binding domain in Activin A longest variants and implications for function
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- Using path signatures to predict a diagnosis of Alzheimer’s disease
- Development and verification of prediction models for preventing cardiovascular diseases
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- Transience effect in capture-recapture studies: The importance of its biological meaning
- Detailed global modelling of soil organic carbon in cropland, grassland and forest soils
- Oral dosing for antenatal corticosteroids in the Rhesus macaque
- Retraction: Modulation of the Pentose Phosphate Pathway Induces Endodermal Differentiation in Embryonic Stem Cells
- An analysis on HBsAg, Anti-HCV, Anti-HIV½ and VDRL test results in blood donors according to gender, age range and years
- Clinical factors associated with bacterial translocation in Japanese patients with type 2 diabetes: A retrospective study
- Meaningful work and resilience among teachers: The mediating role of work engagement and job crafting
- The conditional Fama-French model and endogenous illiquidity: A robust instrumental variables test
- Breast cancers utilize hypoxic glycogen stores via PYGB, the brain isoform of glycogen phosphorylase, to promote metastatic phenotypes
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- Genetic evidence for plural introduction pathways of the invasive weed Paterson’s curse (Echium plantagineum L.) to southern Australia
- Risk of major autoimmune diseases in female breast cancer patients: A nationwide, population-based cohort study
- Real-time three-dimensional MRI for the assessment of dynamic carpal instability
- Interim report on the effective intraperitoneal therapy of insulin-dependent diabetes mellitus in pet dogs using “Neo-Islets,” aggregates of adipose stem and pancreatic islet cells (INAD 012-776)
- The frequency of bowel and bladder problems in multiple sclerosis and its relation to fatigue: A single centre experience
- Retraction: Analysis of Mycobacterium tuberculosis-Specific CD8 T-Cells in Patients with Active Tuberculosis and in Individuals with Latent Infection
- The association between role model presence and self-regulation in early adolescence: A cross-sectional study
- Correction: A controlled-release oral opioid supports S. aureus survival in injection drug preparation equipment and may increase bacteremia and endocarditis risk
- Methamphetamine regulation of activity and topology of ventral midbrain networks
- Evaluation and treatment of latent tuberculosis infection among healthcare workers in Korea: A multicentre cohort analysis
- Occult periprosthetic femoral fractures occur frequently during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA
- TCF4 induces enzalutamide resistance via neuroendocrine differentiation in prostate cancer
- Structural characterization of EGFR exon 19 deletion mutation using molecular dynamics simulation
- Comparing infiltration rates in soils managed with conventional and alternative farming methods: A meta-analysis
- Correction: Permissivity of Primary Human Hepatocytes and Different Hepatoma Cell Lines to Cell Culture Adapted Hepatitis C Virus
- Radiomics features of the primary tumor fail to improve prediction of overall survival in large cohorts of CT- and PET-imaged head and neck cancer patients
- The complete mitochondrial genome of Calyptogena marissinica (Heterodonta: Veneroida: Vesicomyidae): Insight into the deep-sea adaptive evolution of vesicomyids
- Correction: In vitro larval rearing protocol for the stingless bee species Melipona scutellaris for toxicological studies
- Correction: Morphological and molecular identification of the dioecious “African species Volvox rousseletii (Chlorophyceae) in the water column of a Japanese lake based on field-collected and cultured materials
- Upper versus lower airway microbiome and metagenome in children with cystic fibrosis and their correlation with lung inflammation
- “…or else I close my ears” How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study
- Does a spinal implant alter dual energy X-ray absorptiometry body composition measurements?
- Economic and livestock health impacts of birds on dairies: Evidence from a survey of Washington dairy operators
- Repair of subtotal tympanic membrane perforations: A temporal bone study of several tympanoplasty materials
- Shifts in temperature influence how Batrachochytrium dendrobatidis infects amphibian larvae
- Sequential two-step chromatographic purification of infectious poliovirus using ceramic fluoroapatite and ceramic hydroxyapatite columns
- Frequency and distribution of corneal astigmatism and keratometry features in adult life: Methodology and findings of the UK Biobank study
- Differences in the impedance of cochlear implant devices within 24 hours of their implantation
- Suppressive impact of metronomic chemotherapy using UFT and/or cyclophosphamide on mediators of breast cancer dissemination and invasion
- Expression of Concern: miRNA 17 Family Regulates Cisplatin-Resistant and Metastasis by Targeting TGFbetaR2 in NSCLC
- Group leaders establish cooperative norms that persist in subsequent interactions
- Addis Ababa population-based pattern of cancer therapy, Ethiopia
- Agreement between the Cochrane risk of bias tool and Physiotherapy Evidence Database (PEDro) scale: A meta-epidemiological study of randomized controlled trials of physical therapy interventions
- Oxidoreductase disulfide bond proteins DsbA and DsbB form an active redox pair in Chlamydia trachomatis, a bacterium with disulfide dependent infection and development
- DNA barcoding of coastal ray-finned fishes in Vietnam
- Comparison of climbing-specific strength and endurance between lead and boulder climbers
- The performance of different case definitions for severe influenza surveillance among HIV-infected and HIV-uninfected children aged <5 years in South Africa, 2011–2015
- Analgesic drug use in elderly persons: A population-based study in Southern Italy
- RCER: Reliable Cluster-based Energy-aware Routing protocol for heterogeneous Wireless Sensor Networks
- Beta-defensins and analogs in Helicobacter pylori infections: mRNA expression levels, DNA methylation, and antibacterial activity
- Changing educational gradient in long-term care-free life expectancy among German men, 1997-2012
- A non-parametric significance test to compare corpora
- Evaluating the impact of policies recommending PrEP to subpopulations of men and transgender women who have sex with men based on demographic and behavioral risk factors
- Different levels of statistical learning - Hidden potentials of sequence learning tasks
- Dry period heat stress induces microstructural changes in the lactating mammary gland
- Organic resolution function and effects of platinum nanoparticles on bacteria and organic matter
- High levels of fasting glucose and glycosylated hemoglobin values are associated with hyperfiltration in a Spanish prediabetes cohort. The PREDAPS Study
- Genetically distinct Group B Streptococcus strains induce varying macrophage cytokine responses
- Dynamic up- and down-regulation of the default (DMN) and extrinsic (EMN) mode networks during alternating task-on and task-off periods
- ERK1/ATF-2 signaling axis contributes to interleukin-1β-induced MMP-3 expression in dermal fibroblasts
- Cytokine profiles of umbilical cord blood mononuclear cells upon in vitro stimulation with lipopolysaccharides of different vaginal gram-negative bacteria
- Everolimus in de novo kidney transplant recipients participating in the Eurotransplant senior program: Results of a prospective randomized multicenter study (SENATOR)
- Lipopolysaccharide induces mouse translocator protein (18 kDa) expression via the AP-1 complex in the microglial cell line, BV-2
- Does effectiveness in performance appraisal improve with rater training?
- National trends in inpatient endometriosis admissions: Patients, procedures and outcomes, 2006−2015
- Affective and enjoyment responses to 12 weeks of high intensity interval training and moderate continuous training in adults with Crohn’s disease
- Thrombophilic risk factors in hemodialysis: Association with early vascular access occlusion and patient survival in long-term follow-up
- Cabbage stem flea beetle’s (Psylliodes chrysocephala L.) susceptibility to pyrethroids and tolerance to thiacloprid in the Czech Republic
- Implicit learning of artificial grammatical structures after inferior frontal cortex lesions
- Potential survival benefits from optimized chemotherapy implementation in advanced ovarian cancer: Projections from a microsimulation model
- Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia
- Heat stress responses in a large set of winter wheat cultivars (Triticum aestivum L.) depend on the timing and duration of stress
- Mice deficient in NKLAM have attenuated inflammatory cytokine production in a Sendai virus pneumonia model
- Dysregulation of microRNAs and target genes networks in human abdominal aortic aneurysm tissues
- Quality of life and associated factors among patients with breast cancer under chemotherapy at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia
- Evaluation of suitable reference genes in Brassica juncea and its wild relative Camelina sativa for qRT-PCR analysis under various stress conditions
- Time-related immunomodulation by stressors and corticosterone transdermal application in toads
- Machine learning discovery of longitudinal patterns of depression and suicidal ideation
- Multi-scale patterns of tick occupancy and abundance across an agricultural landscape in southern Africa
- A matter of taste: Spatial and ontogenetic variations on the trophic ecology of the tiger shark at the Galapagos Marine Reserve
- Retraction: Adaptive double threshold energy detection based on Markov model for cognitive radio
- Adrenal gland size in obstructive sleep apnea: Morphological assessment of hypothalamic pituitary adrenal axis activity
- Out-of-pocket health spending among Medicare beneficiaries: Which chronic diseases are most costly?
- A large-scale chromosomal inversion is not associated with life history development in rainbow trout from Southeast Alaska
- Deployment, suicide, and overdose among comorbidity phenotypes following mild traumatic brain injury: A retrospective cohort study from the Chronic Effects of Neurotrauma Consortium
- Association between alcohol intake and measures of incident CKD: An analysis of nationwide health screening data
- Exploration of icariin analog structure space reveals key features driving potent inhibition of human phosphodiesterase-5
- A quantitative approach for the analysis of clinician recognition of acute respiratory distress syndrome using electronic health record data
- Morphological, microbiological and ultrastructural aspects of sepsis by Aeromonas hydrophila in Piaractus mesopotamicus
- Recidivism rates in individuals receiving community sentences: A systematic review
- The association of intensive care with utilization and costs of outpatient healthcare services and quality of life
- How well do cancer survivor self-classifications of anxiety, depression and stress agree with a standardised tool? Results of a cross-sectional study
- Comparative nutritional characteristics of the three major Chinese Dendrobium species with different growth years
- Nilotinib, an approved leukemia drug, inhibits smoothened signaling in Hedgehog-dependent medulloblastoma
- Geographic differentiation of agritourism activities in Poland vs. cultural and natural attractiveness of destinations at district level
- Social participation reduces isolation among Japanese older people in urban area: A 3-year longitudinal study
- Explaining age-related decline in theory of mind: Evidence for intact competence but compromised executive function
- Role of GDF15 in methylseleninic acid-mediated inhibition of cell proliferation and induction of apoptosis in prostate cancer cells
- Black people are convicted more for being black than for being poor: The role of social norms and cultural prejudice on biased racial judgments
- Bulked segregant analysis RNA-seq (BSR-Seq) validated a stem resistance locus in Aegilops umbellulata, a wild relative of wheat
- Neurobehavioral dysfunction in non-alcoholic steatohepatitis is associated with hyperammonemia, gut dysbiosis, and metabolic and functional brain regional deficits
- Barriers and enablers to the implementation of a complex quality improvement intervention for acute kidney injury: A qualitative evaluation of stakeholder perceptions of the Tackling AKI study
- Soil and vegetation conditions changes following the different sand dune restoration measures on the Zoige Plateau
- Experimental H1N1pdm09 infection in pigs mimics human seasonal influenza infections
- Emission characteristics of diethylhexyl phthalate (DEHP) from building materials determined using a passive flux sampler and micro-chamber
- Multi-focus microscope with HiLo algorithm for fast 3-D fluorescent imaging
- Pontoscolex corethrurus: A homeless invasive tropical earthworm?
- Modeling reciprocal effects in medical research: Critical discussion on the current practices and potential alternative models
- Does palliative chemotherapy really palliate and are we measuring it correctly? A mixed methods longitudinal study of health related quality of life in advanced soft tissue sarcoma
- Developing cookies formulated with goat cream enriched with conjugated linoleic acid
- The effects of combining focus of attention and autonomy support on shot accuracy in the penalty kick
- Association between hot flashes severity and oxidative stress among Mexican postmenopausal women: A cross-sectional study
- A combined strategy of neuropeptide prediction and tandem mass spectrometry identifies evolutionarily conserved ancient neuropeptides in the sea anemone Nematostella vectensis
- Lipidome profiles of postnatal day 2 vaginal swabs reflect fat composition of gilt’s postnatal diet
- Antitumor activity of a novel dual functional podophyllotoxin derivative involved PI3K/AKT/mTOR pathway
- Genome-wide developed microsatellites reveal a weak population differentiation in the hoverfly Eupeodes corollae (Diptera: Syrphidae) across China
- Prognosis of severe acquired brain injury: Short and long-term outcome determinants and their potential clinical relevance after rehabilitation. A comprehensive approach to analyze cohort studies
- An in silico investigation of menthol metabolism
- Variant analysis pipeline for accurate detection of genomic variants from transcriptome sequencing data
- Identification of candidate flowering and sex genes in white Guinea yam (D. rotundata Poir.) by SuperSAGE transcriptome profiling
- Optimizing the intrinsic parallel diffusivity in NODDI: An extensive empirical evaluation
- The quality of guidelines for diabetic foot ulcers: A critical appraisal using the AGREE II instrument
- Mastitis risk effect on the economic consequences of paratuberculosis control in dairy cattle: A stochastic modeling study
- Confounding by indication of the safety of de-escalation in community-acquired pneumonia: A simulation study embedded in a prospective cohort
- Effects from diet-induced gut microbiota dysbiosis and obesity can be ameliorated by fecal microbiota transplantation: A multiomics approach
- Drivers of HIV-1 transmission: The Portuguese case
- Integration of a FT expression cassette into CRISPR/Cas9 construct enables fast generation and easy identification of transgene-free mutants in Arabidopsis
- A biface production older than 600 ka ago at Notarchirico (Southern Italy) contribution to understanding early Acheulean cognition and skills in Europe
- Mass evacuation and increases in long-term care benefits: Lessons from the Fukushima nuclear disaster
- Circulating levels of free 25(OH)D increase at the onset of rheumatoid arthritis
- The expression of equine keratins K42 and K124 is restricted to the hoof epidermal lamellae of Equus caballus
- Soil respiration from fields under three crop rotation treatments and three straw retention treatments
- Inhibition of polymerase chain reaction: Pathogen-specific controls are better than human gene amplification
- Linkage disequilibrium and haplotype block patterns in popcorn populations
- Downscaling satellite soil moisture using geomorphometry and machine learning
- Choosing efficient actions: Deciding where to walk
- The zooarchaeology and isotopic ecology of the Bahamian hutia (Geocapromys ingrahami): Evidence for pre-Columbian anthropogenic management
- Synergy of the flow behaviour and disperse phase of cellulose nanoparticles in enhancing oil recovery at reservoir condition
- Accuracy of Determine TB-LAM Ag to detect TB in HIV infected patients associated with diagnostic methods used in Brazilian public health units
- Human papillomavirus infection among head and neck squamous cell carcinomas in southern China
- Comparison of feature point detectors for multimodal image registration in plant phenotyping
- Quartet-based inference of cell differentiation trees from ChIP-Seq histone modification data
- Detection and prognostic relevance of circulating tumour cells (CTCs) in Asian breast cancers using a label-free microfluidic platform
- Coralline algal calcification: A morphological and process-based understanding
- Comparing record linkage software programs and algorithms using real-world data
- Antimicrobial resistance and molecular genotyping of Salmonella enterica serovar Enteritidis clinical isolates from Guizhou province of Southwestern China
- Measuring sexual relationship power equity among young women and young men South Africa: Implications for gender-transformative programming
- Effectiveness, safety/tolerability of OBV/PTV/r ± DSV in patients with HCV genotype 1 or 4 with/without HIV-1 co-infection, chronic kidney disease (CKD) stage IIIb-V and dialysis in Spanish clinical practice – Vie-KinD study
- The genome of Alcaligenes aquatilis strain BU33N: Insights into hydrocarbon degradation capacity
- A randomized pilot efficacy and safety trial of diazoxide choline controlled-release in patients with Prader-Willi syndrome
- LMX1A inhibits C-Myc expression through ANGPTL4 to exert tumor suppressive role in gastric cancer
- Lung clearance index to detect the efficacy of Aztreonam lysine inhalation in patients with cystic fibrosis and near normal spirometry – A single-centre feasibility study
- Association of vitamin D nutrition with neuro-developmental outcome of infants of slums in Bangladesh
- Effect of PEPFAR funding policy change on HIV service delivery in a large HIV care and treatment network in Nigeria
- Friends, relatives, sanity, and health: The costs of politics
- European public perceptions of homelessness: A knowledge, attitudes and practices survey
- An overview of the quality assurance programme for HIV rapid testing in South Africa: Outcome of a 2-year phased implementation of quality assurance program
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- Genomic analyses reveal an absence of contemporary introgressive admixture between fin whales and blue whales, despite known hybrids
- Tipping the balance towards long-term retention in the HIV care cascade: A mixed methods study in southern Mozambique
- Diagnosis and classification of pediatric acute appendicitis by artificial intelligence methods: An investigator-independent approach
- Stylistic variation on the Donald Trump Twitter account: A linguistic analysis of tweets posted between 2009 and 2018
- Kinematic determinants of scoring success in the fencing flick: Logistic and linear multiple regression analysis
- Preferences for formal and traditional sources of childbirth and postnatal care among women in rural Africa: A systematic review
- Spectral characteristics of urine specimens from healthy human volunteers analyzed using Raman chemometric urinalysis (Rametrix)
- Associations between industry involvement and study characteristics at the time of trial registration in biomedical research
- A review of the elusive bicolored iris Snouted Treefrogs (Anura: Hylidae:Scinax uruguayus group)
- Development of peptide biosensor for the detection of dengue fever biomarker, nonstructural 1
- The predictive performance of SAPS 2 and SAPS 3 in an intermediate care unit for internal medicine at a German university transplant center; A retrospective analysis
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- Malaria transmission through the mosquito requires the function of the OMD protein
- Small molecule inhibition of lysine-specific demethylase 1 (LSD1) and histone deacetylase (HDAC) alone and in combination in Ewing sarcoma cell lines
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- A spherical falling film gas-liquid equilibrator for rapid and continuous measurements of CO2 and other trace gases
- The role of vitamin D in increasing circulating T regulatory cell numbers and modulating T regulatory cell phenotypes in patients with inflammatory disease or in healthy volunteers: A systematic review
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- Effects of the Best Possible Self intervention: A systematic review and meta-analysis
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- Multiple biomarkers of sepsis identified by novel time-lapse proteomics of patient serum
- PTSD in prison settings: A systematic review and meta-analysis of comorbid mental disorders and problematic behaviours
- The female presence in different organisational positions and performance in secondary schools: Does a woman leader function as mediator?
- Beta power encodes contextual estimates of temporal event probability in the human brain
- Molecular characterization of measles virus strains circulating in Cameroon during the 2013-2016 epidemics
- Using metabolite profiling to construct and validate a metabolite risk score for predicting future weight gain
- Comprehensive analysis of the internal structure and firmness in American cranberry (Vaccinium macrocarpon Ait.) fruit
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- Influence of musculotendon geometry variability in muscle forces and hip bone-on-bone forces during walking
- An international survey of perceptions of the 2014 FIFA World Cup: National levels of corruption as a context for perceptions of institutional corruption
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- Use of high-content analysis and machine learning to characterize complex microbial samples via morphological analysis
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- A mutation in mouse Krüppel-like factor 15 alters the gut microbiome and response to obesogenic diet
- Excellent outcome after desensitization in high immunologic risk kidney transplantation
- Characterization of a new composite membrane for point of need paper-based micro-scale microbial fuel cell analytical devices
- Acute kidney injury during an ultra-distance race
- A mitochondria-targeted fatty acid analogue influences hepatic glucose metabolism and reduces the plasma insulin/glucose ratio in male Wistar rats
- The role of C-reactive protein levels on the association of physical activity with lung function in adults
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- Therapeutic efficacy of neuregulin 1-expressing human adipose-derived mesenchymal stem cells for ischemic stroke
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- Exploring the microbiota of upper respiratory tract during the development of pneumonia in a mouse model
- Improved ICU mortality prediction based on SOFA scores and gastrointestinal parameters
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- Human osteocyte expression of Nerve Growth Factor: The effect of Pentosan Polysulphate Sodium (PPS) and implications for pain associated with knee osteoarthritis
- Prevalence of Epstein-Barr virus, human papillomavirus, cytomegalovirus and herpes simplex virus type 1 in patients with diabetes mellitus type 2 in south-eastern Poland
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- Characterization of Monkeypox virus dissemination in the black-tailed prairie dog (Cynomys ludovicianus) through in vivo bioluminescent imaging
- LPS induces inflammatory chemokines via TLR-4 signalling and enhances the Warburg Effect in THP-1 cells
- How do seabirds modify their search behaviour when encountering fishing boats?
- The diagnostic value of pleural fluid homocysteine in malignant pleural effusion
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- Correction: Recombinant rabbit beta nerve growth factor production and its biological effects on sperm and ovulation in rabbits
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- Retraction: Autophagy in Muscle of Glucose-Infusion Hyperglycemia Rats and Streptozotocin-Induced Hyperglycemia Rats via Selective Activation of m-TOR or FoxO3
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- Correction: Second-line HIV treatment failure in sub-Saharan Africa: A systematic review and meta-analysis
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