Biogas upgrading and membrane anti-fouling mechanisms in electrochemical anaerobic membrane bioreactor (EC-AnMBR): Focusing on spatio-temporal distribution of metabolic functionality of microorganisms.

Electrochemical anaerobic membrane bioreactor (EC-AnMBR) by integrating a composite anodic membrane (CAM), represents an effective method for promoting methanogenic performance and mitigating membrane fouling. However, the development and formation of electroactive biofilm on CAM, and the spatio-temporal distribution of key functional microorganisms, especially the degradation mechanism of organic pollutants in metabolic pathways were not well documented. In this work, two AnMBR systems (EC-AnMBR and traditional AnMBR) were constructed and operated to identify the role of CAM in metabolic pathway on biogas upgrading and mitigation of membrane fouling. The methane yield of EC-AnMBR at HRT of 20 days was 217.1 ± 25.6 mL-CH4/g COD, about 32.1 % higher compared to the traditional AnMBR. The 16S rRNA analysis revealed that the EC-AnMBR significantly promoted the growth of hydrolysis bacteria (Lactobacillus and SJA-15) and methanogenic archaea (Methanosaeta and Methanobacterium). Metagenomic analysis revealed that the EC-AnMBR promotes the upregulation of functional genes involved in carbohydrate metabolism (gap and kor) and methane metabolism (mtr, mcr, and hdr), improving the degradation of soluble microbial products (SMPs)/extracellular polymeric substances (EPS) on the CAM and enhancing the methanogens activity on the cathode. Moreover, CAM biofilm exhibits heterogeneity in the degradation of organic pollutants along its vertical depth. The bacteria with high hydrolyzing ability accumulated in the upper part, driving the feedstock degradation for higher starch, sucrose and galactose metabolism. A three-dimensional mesh-like cake structure with larger pores was formed as a biofilter in the middle and lower part of CAM, where the electroactive Geobacter sulfurreducens had high capabilities to directly store and transfer electrons for the degradation of organic pollutants. This outcome will further contribute to the comprehension of the metabolic mechanisms of CAM module on membrane fouling control and organic solid waste treatment and disposal.

Identification of extracellular polymeric substances layer barrier in chloroquine phosphate-disturbed anammox consortia and mechanism dissection on cytotoxic behavior by computational chemistry.

The over-dosing use of chloroquine phosphate (CQ) poses severe threats to human beings and ecosystem due to the high persistence and biotoxicity. The discharge of CQ into wastewater would affect the biomass activity and process stability during the biological processes, e.g., anammox. However, the response mechanism of anammox consortia to CQ remain unknown. In this study, the accurate role of extracellular polymeric substances barrier in attenuating the negative effects of CQ, and the mechanism on cytotoxic behavior were dissected by molecular spectroscopy and computational chemistry. Low concentrations (≤6.0 mg/L) of CQ hardly affected the nitrogen removal performance due to the adaptive evolution of EPS barrier and anammox bacteria. Compact protein of EPS barrier can bind more CQ (0.24 mg) by hydrogen bond and van der Waals force, among which O-H and amide II region respond CQ binding preferentially. Importantly, EPS contributes to the microbiota reshape with selectively enriching Candidatus_Kuenenia for self-protection. Furthermore, the macroscopical cytotoxic behavior was dissected at a molecular level by CQ fate/distribution and computational chemistry, suggesting that the toxicity was ascribed to attack of CQ on functional proteins of anammox bacteria with atom N17 (f-=0.1209) and C2 (f+=0.1034) as the most active electrophilic and nucleophilic sites. This work would shed the light on the fate and risk of non-antibiotics in anammox process.

Simultaneous removal of antibiotic resistance genes and improved dewatering ability of waste activated sludge by Fe(II)-activated persulfate oxidation.

Waste activated sludge properties vary widely with different regions due to the difference in living standards and geographical distribution, making a big challenge to developing a universally effective sludge dewatering technique. The Fe(II)-activated persulfate (S2O82-) oxidation process shows excellent ability to disrupt sludge cells and extracellular polymeric substances (EPS), and release bound water from sludge flocs. In this study, the discrepancies in the physicochemical characteristics of sludge samples from seven representative cities in China (e.g., dewaterability, EPS composition, surface charge, microbial community, relative abundance of antibiotic resistance genes (ARGs), etc.) were investigated, and the role of Fe(II)-S2O82- oxidation in enhancing removal of antibiotic resistance genes and dewatering ability were explored. The results showed significant differences between the EPS distribution and chemical composition of sludge samples due to different treatment processes, effluent sources, and regions. The Fe(II)-S2O82- oxidation pretreatment had a good enhancement of sludge dewatering capacity (up to 76 %). Microbial analysis showed that the microbial community in each sludge varied significantly depending on the types of wastewater, the wastewater treatment processes, and the regions, but Fe(II)-S2O82- oxidation was able to attack and rupture the sludge zoogloea indiscriminately. Genetic analysis further showed that a considerable number of ARGs were detected in all of these sludge samples and that Fe(II)-S2O82- oxidation was effective in removing ARGs by higher than 90 %. The highly active radicals (e.g., SO4-·, ·OH) produced in this process caused drastic damage to sludge microbial cells and DNA stability while liberating the EPS/cell-bound water. Co-occurrence network analysis highlighted a positive correlation between population distribution and ARGs abundance, while variations in microbial communities were linked to regional differences in living standards and level of economic development. Despite these variations, the Fe(II)-S2O82- oxidation consistently achieved excellent performance in both ARGs removal and sludge dewatering. The significant modularity of associations between different microbial communities also confirms its ability to reduce horizontal gene transfer (HGT) by scavenging microbes.

Novel ADAMTS13 mutations in a patient with congenital thrombotic thrombocytopenic purpura.

Congenital thrombotic thrombocytopenic purpura (TTP) is a rare autosomal recessive genetic disorder caused by mutations in the ADAMTS13 gene. Approximately 200 mutations of the ADAMTS-13 gene have been identified, although only a few have been characterized through in vitro expression studies. We conducted an investigation on a male congenital TTP patient with reduced plasma levels of ADAMTS13 activity. DNA sequence analysis revealed two mutations on chromosome 9 (1.9q34.2) in the patient's ADAMTS13 gene. One mutation was a non-synonymous mutation (exon 5: c.A530G: p.Y177C), while the other was a nonsense mutation (exon 21: c.G2651A: p.W884X). Both mutations were found to be heterozygous. The patient's parents had no history of thrombocytopenia or neurological symptoms. DNA sequence analysis showed the patient's father was a heterozygote for the nonsense mutation of the ADAMTS13 gene (exon 21: c.G2651A: p.W884X), while the mother was a heterozygote for the non-synonymous mutation of the ADAMTS13 gene (exon 5: c.A530G: p.Y177C). To investigate the mechanism behind ADAMTS13 deficiency in this patient, wild type (WT), ADAMTS13 p.Y177C, and ADAMTS13 p.W884X were transiently expressed in 293-6E cells. Expression studies revealed a significant reduction in enzyme activity and secretion, although the protease was detected within the cells. The 3D structures of the natural and mutated ADAMTS-13 proteins were partially reconstructed using the Phyre2 web server. The mutation that replaces the tyrosine residue at amino acid position 177 with cysteine may result in decreased steric hindrance and a looser structure. This mutation affects the binding of calcium ions and the secretion of the enzyme from intracellular to extracellular compartments.

Self-assembled electrochemically active biofilms doped with carbon nanotubes: Electron exchange efficiency and cytotoxicity evaluation.

Thick electrochemically active biofilms (EABs) will lead to insufficient extracellular electron transfer (EET) rate because of the limitation of both substrate diffusion and electron exchange. Herein, carbon nanotubes (CNTs)-doped EABs are developed through self-assembly. The highly conductive biofilms (internal resistance of ∼211 Ω) are efficiently enriched at CNTs dosage of 1 g L-1, with the stable power output of 0.568 W m-2 over three months. The embedded CNTs can act as electron tunnel to accelerate the EET rate in thick biofilm. Self-charging/discharging experiments and Nernst-Monod model stimulation demonstrate a higher net charge storage capacity (0.15 C m-2) and more negative half-saturation potential (-0.401 V) for the hybrid biofilms than that of the control (0.09 C m-2, and -0.378 V). Enzyme activity tests and the observation of confocal laser scanning microscopy by live/dead staining show a nearly negligible cytotoxicity of CNTs, and non-targeted metabonomics analysis reveals fourteen differential metabolites that do not play key roles in microbial central metabolic pathways according to KEGG compound database. The abundance of typical exoelectrogens Geobacter sp. is 2-fold of the control, resulting in a better bioelectrocatalytic activity. These finding provide a possible approach to prolong electron exchange and power output by developing a hybrid EABs doped with conductive material.

Bioelectrochemical anaerobic membrane bioreactor enables high methane production from methanolic wastewater: Roles of microbial ecology and microstructural integrity of anaerobic biomass.

The disintegration of anaerobic sludge and blockage of membrane pores has impeded the practical application of anaerobic membrane bioreactor (AnMBR) in treating methanolic wastewater. In this study, bioelectrochemical system (BES) was integrated into AnMBR to alleviate sludge dispersion and membrane fouling as well as enhance bioconversion of methanol. Bioelectrochemical regulation effect induced by BES enhanced methane production rate from 4.94 ± 0.52 to 5.39 ± 0.37 L/Lreactor/d by accelerating the enrichment of electroactive microorganisms and the agglomeration of anaerobic sludge via the adhesive and chemical bonding force. 16 S rRNA gene high-throughput sequencing demonstrated that bioelectrochemical stimulation had modified the metabolic pathways by regulating the key functional microbial communities. Methanogenesis via the common methylotrophic Methanomethylovorans was partially substituted by the hydrogenotrophic Candidatus_Methanofastidiosum, etc. The metabolic behaviors of methanol are bioelectrochemistry-dependent, and controlling external voltage is thus an effective strategy for ensuring robust electron transfer, low membrane fouling, and long-term process stability.

Associations between composite dietary antioxidant index and estimated 10-year atherosclerotic cardiovascular disease risk among U.S. adults.

Background: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death and disability both in U.S. and worldwide. Antioxidants have been proved critical in mitigating the development of atherosclerosis. This study aimed to investigate the associations between composite dietary antioxidant index (CDAI) and estimated 10-year ASCVD risk among U.S. adults. Methods: Data extracted from the National Health and Nutrition Examination Survey were analyzed. A total of 10,984 adults aged 18 years and above were included in this study. CDAI was calculated based on the dietary intake reported in their 24-h recall interviews. The estimated 10-year ASCVD risk was calculated via Pooled Cohort Equations (PCE). Results: After adjusting potential confounders, it was indicated that CDAI score was negatively correlated with 10-year ASCVD risk (OR 0.97, 95% CI 0.95-0.99). Stratify CDAI score by quartile, results showed that participants in the second, third, and fourth quartiles had lower ASCVD odds ratio (Q2: OR 0.87, 95% CI 0.69-1.09; Q3: OR 0.78, 95% CI 0.62-0.98; Q4: OR 0.74, 95% CI 0.59-0.94) than those in the first quartile (Q1, lowest CDAI score group), which was confirmed by the trend test as well (p < 0.05). Subgroup analyses stratified by sex, age, race/ethnicity, and smoking status did not show significant effect modification. Conclusion: Higher dietary antioxidants intake is associated with lower ASCVD risk among U.S. adults, for which policymakers and healthcare professionals may consider increasing the consumption of antioxidant-rich foods as a preventive strategy for ASCVD.

[Functional analysis of functional membrane microdomains in the biosynthesis of menaquinone-7].

Functional membrane microdomains (FMMs) that are mainly composed of scaffold proteins and polyisoprenoids play important roles in diverse cellular physiological processes in bacteria. The aim of this study was to identify the correlation between MK-7 and FMMs and then regulate the MK-7 biosynthesis through FMMs. Firstly, the relationship between FMMs and MK-7 on the cell membrane was determined by fluorescent labeling. Secondly, we demonstrated that MK-7 is a key polyisoprenoid component of FMMs by analyzing the changes in the content of MK-7 on cell membrane and the changes in the membrane order before and after destroying the integrity of FMMs. Subsequently, the subcellular localization of some key enzymes in MK-7 synthesis was explored by visual analysis, and the intracellular free pathway enzymes Fni, IspA, HepT and YuxO were localized to FMMs through FloA to achieve the compartmentalization of MK-7 synthesis pathway. Finally, a high MK-7 production strain BS3AT was successfully obtained. The production of MK-7 reached 300.3 mg/L in shake flask and 464.2 mg/L in 3 L fermenter.

[Development of biosensors highly responsive to N-acetylneuraminic acid in Bacillus subtilis].

Bacillus subtilis is recognized as a generally-regarded-as-safe strain, and has been widely used in the biosynthesis of high value-added products, including N-acetylneuraminic acid (NeuAc) which is widely used as a nutraceutical and a pharmaceutical intermediate. Biosensors responding to target products are widely used in dynamic regulation and high-throughput screening in metabolic engineering to improve the efficiency of biosynthesis. However, B. subtilis lacks biosensors that can efficiently respond to NeuAc. This study first tested and optimized the transport capacity of NeuAc transporters, and obtained a series of strains with different transport capacities for testing NeuAc-responsive biosensors. Subsequently, the binding site sequence of Bbr_NanR responding to NeuAc was inserted into different sites of the constitutive promoter of B. subtilis, and active hybrid promoters were obtained. Next, by introducing and optimizing the expression of Bbr_NanR in B. subtilis with NeuAc transport capacity, we obtained an NeuAc-responsive biosensor with wide dynamic range and higher activation fold. Among them, P535-N2 can sensitively respond to changes in intracellular NeuAc concentration, with the largest dynamic range (180-20 245) AU/OD. P566-N2 shows a 122-fold of activation, which is 2 times of the reported NeuAc-responsive biosensor in B. subtilis. The NeuAc-responsive biosensor developed in this study can be used to screen enzyme mutants and B. subtilis strains with high NeuAc production efficiency, providing an efficient and sensitive analysis and regulation tool for biosynthesis of NeuAc in B. subtilis.

Impact of sandwich-type composite anodic membrane on membrane fouling and methane recovery from sewage sludge and food waste via electrochemical anaerobic membrane bioreactor.

Membrane fouling presents a big challenge for the real-world implementation of anaerobic membrane bioreactors (AnMBRs) in digesting high-solid biowastes. In this study, an electrochemical anaerobic membrane bioreactor (EC-AnMBR) with a novel sandwich-type composite anodic membrane was designed and constructed for controlling membrane fouling whilst improving the energy recovery. The results showed that EC-AnMBR produced a higher methane yield of 358.5 ± 74.8 mL/d, rising by 12.8% compared to the AnMBR without applied voltage. Integration of composite anodic membrane induced a stable membrane flux and low transmembrane pressure through forming an anodic biofilm while total coliforms removal reached 97.9%. The microbial community analysis further provided compelling evidence that EC-AnMBR enriched the relative abundance of hydrolyzing (Chryseobacterium 2.6%) bacteria and methane-producing (Methanobacterium 32.8%) archaea. These findings offered new insights into anti-biofouling performance and provided significant implications for municipal organic waste treatment and energy recovery in the new EC-AnMBR.

Insights into biodegradation behaviors of methanolic wastewater in up-flow anaerobic sludge bed (UASB) reactor coupled with in-situ bioelectrocatalysis.

Granular sludge disintegration and washing out pose a challenge to up-flow anaerobic sludge bed (UASB) reactor treating methanolic wastewater. Herein, in-situ bioelectrocatalysis (BE) was integrated into UASB (BE-UASB) reactor to alter microbial metabolic behaviors and enhance the re-granulation process. BE-UASB reactor exhibited the highest methane (CH4) production rate of 388.0 mL/Lreactor/d and chemical oxygen demand (COD) removal of 89.6 % at 0.8 V. Sludge re-granulation was strengthened with particle size over 300 µm of up to 22.4%. Bioelectrocatalysis stimulated extracellular polymeric substances (EPS) secretion and formation of granules with rigid [-EPS-cell-EPS-] matrix by enhancing the proliferation of key functional microorganisms (Acetobacterium, Methanobacterium, and Methanomethylovorans) and diversifying metabolic pathways. Particularly, a high Methanobacterium richness (10.8%) drove the electroreduction of CO2 into CH4 and reduced its emissions (52.8%). This study provides a novel bioelectrocatalytic strategy for controlling granular sludge disintegration, which will facilitate the practical application of UASB in methanolic wastewater treatment.

Enhanced co-digestion of sewage sludge and food waste using novel electrochemical anaerobic membrane bioreactor (EC-AnMBR).

Membrane fouling remains a big challenge hindering the wide-application of anaerobic membrane bioreactor (AnMBR) technology. In this study, an electrochemical anaerobic membrane bioreactor (EC-AnMBR) was developed by coupling electrochemical regulation to enhance co-digestion of sewage sludge and food waste and mitigate membrane fouling. The highest methane production (0.12 ± 0.02 L/Lreactor/day) and net energy recovery (31.82 kJ/day) were achieved under the optimum conditions of 0.8 V, hydraulic retention time of 10 days and solids retention time of 50 days. Electrochemical regulation accelerated the mineralization of high-molecular-weight organics and reinforced the membrane antifouling ability by inducing electrostatic repulsive force and electrochemical oxidation. Besides, symbiotic relationships among functional microorganisms (Spirochaetes, Methanolinea, etc.) were enhanced, improving the hydrolysis and methanogenesis processes of complex organics and the long-term stability. This study confirms the technical feasibility of EC-AnMBR in treating high-solid biowastes, and provides the fundamental data to support its application in real-world scenarios.

Effects of combined remediation of pre-ozonation and bioaugmentation on degradation of benzo[a]pyrene and microbial community structure in soils.

The combination technique of pre-ozonation and bioaugmentation is promising for remediating benzo[a]pyrene (BaP)-contaminated soil. However, little is known about the effect of coupling remediation on the soil biotoxicity, soil respiration, enzyme activity, microbial community structure, and microbial in the process of remediation. This study developed two coupling remediation strategies (pre-ozonation coupled with bioaugmentation by addition of polycyclic aromatic hydrocarbons (PAHs) specific degrading bacteria or activated sludge), compared with sole ozonation and sole bioaugmentation, to improve degradation of BaP and recovery of soil microbial activity and community structure. Results showed that the higher removal efficiency of BaP (92.69-93.19%) was found in coupling remediation, compared with sole bioaugmentation (17.71-23.28%). Meanwhile, coupling remediation significantly reduced the soil biological toxicity, promoted the rebound of microbial counts and activity, and recovered the species numbers and microbial community diversity, compared with sole ozonation and sole bioaugmentation. Besides, it was feasible to replace microbial screening with activated sludge, and coupling remediation by addition of activated sludge was more conducive to the recovery of soil microbial communities and diversity. This work provides a strategy of pre-ozonation coupled with bioaugmentation to further degrade BaP in soil by promoting the rebound of microbial counts and activity, as well as the recovery of species numbers and microbial community diversity.

Effective multipurpose sewage sludge and food waste reduction strategies: A focus on recent advances and future perspectives.

Energy crisis and increasing rigorous management standards pose significant challenges for solid waste management worldwide. Several emerging diseases such as COVID-19 aggravated the already complex solid waste management crisis, especially sewage sludge and food waste streams, because of the increasingly large production year by year. As mature waste disposal technologies, landfills, incineration, composting, and some other methods are widespread for solid wastes management. This paper reviews recent advances in key sewage sludge disposal technologies. These include incineration, anaerobic digestion, and valuable products oriented-conversion. Food waste disposal technologies comprised of thermal treatment, fermentation, value-added product conversion, and composting have also been described. The hot topic and dominant research foci of each area are summarized, simultaneously compared with conventional technologies in terms of organic matter degradation or conversion performance, energy generation, and renewable resources production. Future perspectives of each technology that include issues not well understood and predicted challenges are discussed with a positive effect on the full-scale implementation of the discussed disposal methods.

Prospects for humic acids treatment and recovery in wastewater: A review.

Clean water shortages require the reuse of wastewater. The presence of organic substances such as humic acids in wastewater makes the water treatment process more difficult. Humic acids can significantly affect the removal of heavy metals and other such toxins. Humic acids is formed by the decomposition and transformation of animal and plant remains by microorganisms, and naturally exists in soil and water. It is necessary to degrade and remove humic acids from wastewater. As it seriously human health, effective technologies for removing humic acids from wastewater have attracted great interest over the past decades. This study compared existing techniques for removing humic acids from wastewater, as well as their limitations. Physicochemical treatments including filtration and oxidation are basic and key approaches to removing humic acids. Biological treatments including enzyme and fungi-mediated humic acids degradation are economically feasible but require some scalability. In conclusion, the integrated treatment processes are more significant options for the effective removal of humic acids from wastewater. In addition, humic acids have rich utilization values. It can improve the soil, increase crop yields, and promote the removal of pollutants.

Long-term performance, microbial evolution and spatial microstructural characteristics of anammox granules in an upflow blanket filter (UBF) treating high-strength nitrogen wastewater.

Granule formation, microstructure and microbial spatial distribution are crucial to granule stability and nitrogen removal. Here, an upflow blanket filter (UBF) reactor with porous fixed cylinder carriers was fabricated and operated for 234 days to investigate overall performance and the formation mechanism of anammox granules. Results showed that the UBF performed the highest nitrogen removal efficiency of 93.19 ± 3.39% under nitrogen loading rate of 3.6 kg-N/m3/d and HRT of 2 h. The tryptophan-like proteins as the key component in EPS were vital for granules formation. Further 16 s rRNA analysis indicated that SBR1031 with a relative abundance of 40.5% played an important role in cell aggregation. Thus, anammox granules were developed successfully with a two-layered spatial structure where outer-layer was ammonia oxidizing bacteria and inner-core was anaerobic ammonia oxidizing bacteria. Together, introduction of porous fixed cylinder carriers is a valid method to avoid biomass loss and floatation.

At-home disposal practices of used insulin needles among patients with diabetes in China: A single-center, cross-sectional study.

Background: Most insulin injections for people with diabetes are administered at home, thus generating many used needles. Unsafe disposal of these at-home needles can lead to needle stick injuries, blood-borne disease transmission, and environmental contamination. Previous studies have shown varying results on the prevalence of and factors associated with safe sharps disposal practices of people with diabetes. Objective: To assess the prevalence of and the factors associated with the safe disposal of used insulin needles among patients with diabetes. Methods: We collected data from 271 insulin-using patients at a tertiary care hospital in China. A self-designed instrument was used to assess sociodemographic data, disease- and treatment-related characteristics, sharps disposal practices, education on diabetes self-management and sharps disposal, and awareness of the potential risks associated with unsafe sharps disposal. Multivariate logistic regression analysis was used to explore factors associated with safe sharps disposal practices. Results: Only 10.3% (28/271) of participants disposed of used at-home insulin needles in a safe manner, and 14.8% (45/271) of participants had received previous instruction on sharps disposal. Previous sharps disposal instruction (AOR = 4.143, 95% CI = 1.642-10.450) and awareness of the risk of blood-borne pathogen transmission (AOR = 3.064, 95% CI = 1.332-7.046) were associated with safe disposal of used insulin needles. Conclusion: In our study, the prevalence of safe sharps disposal practices was low, and a minority of respondents had received previous instruction on sharps disposal. Participants who had previously received instruction and were aware of the risk of blood-borne pathogen transmission were more likely to handle sharps safely. Our study findings suggest that health care professionals should pay attention to sharps disposal practices of patients with diabetes and conduct diabetes education programs that include information on safe sharps disposal methods and potential hazards of unsafe sharps disposal.

Nitrogen removal and microbial mechanisms in a novel tubular bioreactor-enhanced floating treatment wetland for the treatment of high nitrate river water.

A novel tubular bioreactor-enhanced floating treatment wetland (TB-EFTW) was developed for the in situ treatment of high nitrate river water. When compared with the enhanced floating treatment wetland (EFTW), the TB-EFTW system achieved 30% higher total nitrogen removal efficiency. Further, the average TN level of the TB-EFTW effluent was below the Grade IV requirement (1.5 mg/L) specified in Chinese standard (GB3838-2002). Microbial analysis revealed that both aerobic and anoxic denitrifying bacteria coexisted in the new system. The relative abundance of aerobic and anoxic denitrifiers were 42.69% and 22% at the middle and end of the tubular bioreactor (TB), respectively. It is reasonable to assume that effective nitrogen removal can mainly be attributed to the addition of solid carbon source and the spatial difference in DO distribution (oxic-anoxic areas in sequence) inside the TB. The initial investment cost and operating costs associated with the TB-EFTW system are approximately 14,000 and 3500 yuan per 1000 m3 river water, respectively. Considering its low cost, minimal maintenance requirements, and effective nitrogen removal, this newly developed system can be regarded as a promising technology for treating high nitrate river water. PRACTITIONER POINTS: A novel TB-EFTW system was developed to upgrade traditional in situ treatment techniques. The TB-EFTW could achieve 30% higher nitrogen removal efficiency than EFTWs. Both aerobic and anoxic denitrifying bacteria coexisted in the system. The system shows better technical and economic performance compared with routine techniques.

Online health management continuance and the moderating effect of service type and age difference: A meta-analysis.

Numerous empirical studies have been carried out to explore factors of online health management continuance. However, results were not unified. We thus conducted a meta-analysis to identify influential factors and potential moderators. A systematic literature search was performed in nine databases (PubMed, Web of Science, the Cochrane Library, Ovid of JBI, CINAHL, Embase, CNKI, VIP, and CBM) published up to December 2020 in the English or Chinese language. Meta-analysis of combined effect size, heterogeneity, moderator analysis, publication bias assessment, and inter-rater reliability was conducted. Totally 41 studies and 12 pairwise relationships were identified. Confirmation, perceived usefulness, satisfaction, information quality, service quality, perceived ease of use, and trust were all critical predictors. Service type and age difference showed their moderating effects respectively. The perceived usefulness was more noteworthy in medical service than health and fitness service. The trust was more noteworthy in young adults. The results confirmed the validity and robustness of the Expectation Confirmation Model, Information Systems Success Model, and trust theory in online health management continuance. Moderators included but are not limited to age difference and service type. The elderly research in the healthcare context and other analytical methods such as qualitative comparative analysis should be applied in the future.

Gender differences in factors associated with the health literacy of hospitalized older patients with chronic diseases: A cross-sectional study.

Background: To identify gender differences in factors associated with the health literacy of hospitalized older patients with chronic diseases. Methods: A total of 471 hospitalized older patients with chronic diseases in four hospitals were investigated from May 2019 to June 2020. The self-developed demographic information questionnaire, the "Health Literacy Scale for Patients with Chronic Diseases" and the "Self-Efficacy for Managing Chronic Diseases 6-item Scale" were applied in this study. Multiple linear regression was used to assess the factors influencing health literacy among older patients with chronic diseases by gender. Results: The factors influencing health literacy differed by gender. Male health literacy was related to education background, number of children, monthly income, duration of chronic disease and chronic disease self-efficacy. For females, health literacy was associated with age, education background, monthly income, duration of chronic disease and chronic disease treatment. Conclusion: Healthcare providers should focus on the above-mentioned factors that could help identify those with low health literacy differ base on gender. Gender-specific strategies should be developed to improve the health literacy of older patients with chronic diseases and strengthen their chronic disease management.