Body composition in young female eating-disorder patients with severe weight loss and controls: evidence from the four-component model and evaluation of DXA

BACKGROUND/OBJECTIVES: Whether fat-free mass (FFM) and its components are depleted in eating-disorder (ED) patients is uncertain. Dual energy X-ray absorptiometry (DXA) is widely used to assess body composition in pediatric ED patients; however, its accuracy in underweight populations remains unknown. We aimed (1) to assess body composition of young females with ED involving substantial weight loss, relative to healthy controls using the four-component (4C) model, and (2) to explore the validity of DXA body composition assessment in ED patients. SUBJECTS/METHODS: Body composition of 13 females with ED and 117 controls, aged 10-18 years, was investigated using the 4C model. Accuracy of DXA for estimation of FFM and fat mass (FM) was tested using the approach of Bland and Altman. RESULTS: Adjusting for age, height and pubertal stage, ED patients had significantly lower whole-body FM, FFM, protein mass (PM) and mineral mass (MM) compared with controls. Trunk and limb FM and limb lean soft tissue were significantly lower in ED patients. However, no significant difference in the hydration of FFM was detected. Compared with the 4C model, DXA overestimated FM by 5 +/- 36% and underestimated FFM by 1 +/- 9% in ED patients. CONCLUSION: Our study confirms that ED patients are depleted not only in FM but also in FFM, PM and MM. DXA has limitations for estimating body composition in individual young female ED patients

Pragmatic competence and communication governance in Singapore

This chapter offers a contemporary analysis of communication governance—or the way in which communication is managed or controlled—and electoral outcomes in Singapore. The chapter begins with a brief introduction to Singapore’s media environment and its media economics, and considers how the much-vaunted ideology of pragmatism has been used to shape the way Singaporeans understand the role of the media and their communicative engagement with the government. The chapter applies the linguistic discourse of ‘pragmatic competence’, understood quite simply as the mastery of social language skills we use to cut thought or make sense in our daily interactions and conversations with others, to explain how the People’s Action Party (PAP) was able to experience voters’ backlash at the general election in 2011 (and at the 2012 and 2013 by-elections in Hougang SMC and Punggol East SMC) and claw back strong popular support less than five years later in 2015. As much as elections are typically won (or lost) on policy rationales and responsiveness, the 2011 and 2015 general elections also demonstrated the growing significance of assiduous communication governance and the ability of the PAP government leaders to communicate competently, despite the authoritarian construct of Singapore’s national media system. The chapter then considers the ways in which the regaining of political power can lead to a gradual loss of pragmatic competence, particularly in an authoritarian context like Singapore. Indeed, it looks at how the government has again moved to tighten its media and communitive space by seeking to rein in alternative viewpoints and to regulate ‘fake news’. In this regard, it considers the impact of a well-publicised family dispute between Prime Minister Lee Hsien Loong and his siblings, Lee Wei Ling and Lee Hsien Yang, over the last will of their father, Lee Kuan Yew, in relation to the demolition of the late Lee’s family home that lasted for several weeks from June to July 2017. The exchanges between the siblings—and with a number of senior ministers in the Cabinet—which took place initially on the social media platform of Facebook before the mainstream media reported on it are highly instructive to our understanding of communication governance, not least because the siblings expressly referred to the national press in Singapore as timid and cowed. The media, communication and political landscapes in Singapore point to the ever-growing role of pragmatic competence in communication governance. In fact, it is an aspect of politics that can no longer be ignored as Singapore will continue to face up to urgent social, technological and economic challenges as well as generational leadership changes over the future electoral cycles. The truly competent solution would be to liberalise media and communication spaces and to allow genuine political discourse to be conducted, but the ideological impetus of the PAP is to continue on its trajectory of control—this is considered as the pragmatic thing to do, at least for now

How a 'top-performing' Asian school system formulates and implements policy: the case of Singapore

This article analyses the paradox inherent in the ‘top-performing’ yet tightly controlled Singapore education system. As government controls have increased in complexity, existing policymaking conceptual heuristics in accounting for centre-periphery relationships appear inadequate. It argues that more direct government control is being replaced by ‘steering through paternalism from close proximity’, reflecting a more subtle centre-periphery relationship in an Asian context