Prospects for Inter-Regional Cooperation

There is a growing tendency to compare regionalism in Europe and Asia. Such analysis often uses the EU as the basis for comparison in analyzing ASEAN’s promotion of Asian regional cooperation. However, given the significant differences between the two regions, the European experience is not directly transferable. Rather than imposing one region’s processes and experience onto the other, it is more important to cultivate inter-regional cooperation that will enable Europe and Asia to learn and benefit from each other. Despite mutual acknowledgment of the need for deeper and broader inter-regional cooperation, interaction between the EU and ASEAN has so far been limited. However, the long-term prospects for inter-regional cooperation are promising, with the EU and ASEAN facing both internal challenges in their integration processes and common economic and security threats in their respective regions

Leader-driven Change from Aquino to Duterte: Towards a Redirection or Restructuring in Philippine Foreign Policy?

The global perceptions of leaders have significant influence in a state’s foreign policy. In the Philippines’ case, the striking contrast between Presidents Benigno Aquino III, who possesses a moralist and liberalist views, and Duterte, who holds a legalist and realist global perceptions, led to significant changes in their foreign policies. These are evident in their conflicting stance on two cases involving the death penalty of a Filipino worker in Indonesia in 2013; and the country’s maritime arbitration case with China filed in 2013 and eventually won in 2016. Their divergence caused important leader-driven changes, which may result in either a redirection or a restructuring in the country’s foreign policy

Clinical Pharmacist-Led Intervention to Improve Statin Metric for Secondary Prevention at Providence Medical Group – Southern Oregon Region

Clinical Pharmacist-Led Intervention to Improve Statin Metric for Secondary Prevention at Providence Medical Group – Southern Oregon Region Chloe Nguyen, PharmD, Judy Wong, PharmD, BCACP, and Karen White, PharmD, BCACP Background: Currently, there is a gap in meeting the statin metric at Providence Medical Group in Southern Oregon Region. The purpose of this project is to identify intervention strategies to improve statin metric for secondary prevention among patients with clinical atherosclerotic cardiovascular disease (ASCVD). Methods: This quality improvement project was approved by the system’s Institutional Review Board. Patients at least 18 years of age with diagnosis of clinical ASCVD not prescribed statin therapy or prescribed sub-optimal statin therapy were included. Different strategies were implemented at Central Point Family Medicine Clinic. A presentation was delivered to the providers in late December to address barriers with statin prescribing. Pre- and post-surveys were collected to assess the effectiveness of the presentation and knowledge of providers regarding statin prescribing in patients with clinical ASCVD. Chart reviews were performed in January on identified patients to provide recommendation to providers. The primary outcomes were to assess impact of academic detailing intervention on perceived barriers on statin initiation or optimization via pre- and post-surveys and to calculate the percentage of approved recommendation from providers. The secondary outcome was the percentage of statins prescribed per each intervention strategy: refer to clinical pharmacist for management, discuss statin therapy during the next appointment with provider, or update problem list and medication list. Results: Prior to the intervention, a majority of providers believed that statins caused myopathy, liver injury, and rhabdomyolysis which can influence their decision when prescribing statin therapies and discussing statin treatment with patients. Post-survey results showed a slight decrease in belief that statins cause myopathy, liver injury, incidental diabetes, cognitive impairment and rhabdomyolysis. In addition, providers were more likely to retry a different statin or at a lower dose if patient had a documented intolerance to previous statin therapy following education. In a sample of 35 chart reviews, 5 patients were receiving sub-optimal statin therapies, 7 had documented reason for statin intolerance, and 3 were not candidates to receive high intensity statin. A majority of recommendations were approved by providers. The most common intervention chosen by providers (51.4%) was to discuss statin options with patient in next office visit. However, no changes were observed from this intervention. Out of the 10 patients who were referred to clinical pharmacy services for management, 5 declined statin and 4 were unable to reach. Only one patient was successfully started on high intensity statin. Conclusions: Beliefs and approaches to statin discussions are varied among PCPs and can be contributing factors for statin initiation or optimization. These results highlight the complexity of finding interventions that would be most successful for improving statin metric for secondary prevention among patients with clinical ASCVD. Nonetheless, we can be vigilant about working with providers to provide recommendations for the remaining patients with clinical ASCVD and create appropriate follow-up plans for those who were unable to be reached and those who do not have upcoming appointment with providers.https://digitalcommons.psjhealth.org/pharmacy_PGY2/1003/thumbnail.jp

Leader-driven Change from Aquino to Duterte: Towards a Redirection or Restructuring in Philippine Foreign Policy?

The global perceptions of leaders have significant influence in a state’s foreign policy. In the Philippines’ case, the striking contrast between Presidents Benigno Aquino III, who possesses a moralist and liberalist views, and Duterte, who holds a legalist and realist global perceptions, led to significant changes in their foreign policies. These are evident in their conflicting stance on two cases involving the death penalty of a Filipino worker in Indonesia in 2013; and the country’s maritime arbitration case with China filed in 2013 and eventually won in 2016. Their divergence caused important leader-driven changes, which may result in either a redirection or a restructuring in the country’s foreign policy

Integrated genetic and methylomic analyses identify shared biology between autism and autistic traits

Abstract: Previous studies have identified differences in DNA methylation in autistic individuals compared to neurotypical individuals. Yet, it is unclear if this extends to autistic traits—subclinical manifestation of autism features in the general population. Here, we investigate the association between DNA methylation at birth (cord blood), and scores on the Social and Communication Disorders Checklist (SCDC), a measure of autistic traits, in 701 8-year-olds, by conducting a methylome-wide association study (MWAS). We did not identify significant CpGs associated with SCDC. The most significant CpG site was cg14379490, on chromosome 9 (MWAS beta = − 1.78 ± 0.35, p value = 5.34 × 10−7). Using methylation data for autism in peripheral tissues, we did not identify a significant concordance in effect direction of CpGs with p value 0.5). In contrast, using methylation data for autism from post-mortem brain tissues, we identify a significant concordance in effect direction of CpGs with a p value < 10−4 in the SCDC MWAS (binomial sign test, p value = 0.004). Supporting this, we observe an enrichment for genes that are dysregulated in the post-mortem autism brain (one-sided Wilcoxon rank-sum test, p value = 6.22 × 10−5). Finally, integrating genome-wide association study (GWAS) data for autism (n = 46,350) with mQTL maps from cord-blood (n = 771), we demonstrate that mQTLs of CpGs associated with SCDC scores at p value thresholds of 0.01 and 0.005 are significantly shifted toward lower p values in the GWAS for autism (p < 5 × 10−3). We provide additional support for this using a GWAS of SCDC, and demonstrate a lack of enrichment in a GWAS of Alzheimer’s disease. Our results highlight the shared cross-tissue methylation architecture of autism and autistic traits, and demonstrate that mQTLs associated with differences in DNA methylation associated with childhood autistic traits are enriched for common genetic variants associated with autism and autistic traits

Paediatric/young versus adult patients with long QT syndrome

Introduction Long QT syndrome (LQTS) is a less prevalent cardiac ion channelopathy than Brugada syndrome in Asia. The present study compared the outcomes between paediatric/young and adult LQTS patients. Methods This was a population-based retrospective cohort study of consecutive patients diagnosed with LQTS attending public hospitals in Hong Kong. The primary outcome was spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF). Results A total of 142 LQTS (mean onset age=27±23 years old) were included. Arrhythmias other than VT/VF (HR 4.67, 95% CI (1.53 to 14.3), p=0.007), initial VT/VF (HR=3.25 (95% CI 1.29 to 8.16), p=0.012) and Schwartz score (HR=1.90 (95% CI 1.11 to 3.26), p=0.020) were predictive of the primary outcome for the overall cohort, while arrhythmias other than VT/VF (HR=5.41 (95% CI 1.36 to 21.4), p=0.016) and Schwartz score (HR=4.67 (95% CI 1.48 to 14.7), p=0.009) were predictive for the adult subgroup (>25 years old; n=58). A random survival forest model identified initial VT/VF, Schwartz score, initial QTc interval, family history of LQTS, initially asymptomatic and arrhythmias other than VT/VF as the most important variables for risk prediction. Conclusion Clinical and ECG presentation varies between the paediatric/young and adult LQTS population. Machine learning models achieved more accurate VT/VF prediction

Integrated genetic and methylomic analyses identify shared biology between autism and autistic traits.

Previous studies have identified differences in DNA methylation in autistic individuals compared to neurotypical individuals. Yet, it is unclear if this extends to autistic traits-subclinical manifestation of autism features in the general population. Here, we investigate the association between DNA methylation at birth (cord blood), and scores on the Social and Communication Disorders Checklist (SCDC), a measure of autistic traits, in 701 8-year-olds, by conducting a methylome-wide association study (MWAS). We did not identify significant CpGs associated with SCDC. The most significant CpG site was cg14379490, on chromosome 9 (MWAS beta = - 1.78 ± 0.35, p value = 5.34 × 10 -7 ). Using methylation data for autism in peripheral tissues, we did not identify a significant concordance in effect direction of CpGs with p value  0.5). In contrast, using methylation data for autism from post-mortem brain tissues, we identify a significant concordance in effect direction of CpGs with a p value < 10-4 in the SCDC MWAS (binomial sign test, p value = 0.004). Supporting this, we observe an enrichment for genes that are dysregulated in the post-mortem autism brain (one-sided Wilcoxon rank-sum test, p value = 6.22 × 10-5). Finally, integrating genome-wide association study (GWAS) data for autism (n = 46,350) with mQTL maps from cord-blood (n = 771), we demonstrate that mQTLs of CpGs associated with SCDC scores at p value thresholds of 0.01 and 0.005 are significantly shifted toward lower p values in the GWAS for autism (p < 5 × 10-3). We provide additional support for this using a GWAS of SCDC, and demonstrate a lack of enrichment in a GWAS of Alzheimer's disease. Our results highlight the shared cross-tissue methylation architecture of autism and autistic traits, and demonstrate that mQTLs associated with differences in DNA methylation associated with childhood autistic traits are enriched for common genetic variants associated with autism and autistic traits.This study was funded by grants from the Medical Research Council, the Wellcome Trust, the Autism Research Trust, and the Templeton World Charity Foundation. The research was conducted in association with the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust. The UK Medical Research Council and Wellcome (grant ref: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. This study was supported by grant HD073978 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Environmental Health Sciences, and National Institute of Neurological Disorders and Stroke; and by the Beatrice and Samuel A. Seaver Foundation. We acknowledge iPSYCH and The Lundbeck Foundation for providing samples and funding for the MINERvA dataset. The iPSYCH (The Lundbeck Foundation Initiative for Integrative Psychiatric Research) team acknowledges funding from The Lundbeck Foundation (grant numbers R102-A9118 and R155–2014-1724), the Stanley Medical Research Institute, the European Research Council (project number 294838), the Novo Nordisk Foundation for supporting the Danish National Biobank resource, and grants from Aarhus and Copenhagen Universities and University Hospitals, including support to the iSEQ Center, the GenomeDK HPC facility, and the CIRRAU Center. This research has been conducted using the Danish National Biobank resource, supported by the Novo Nordisk Foundation. The SEED study was supported by Centers for Disease Control and Prevention (CDC) Cooperative Agreements announced under the RFAs 01086, 02199, DD11–002, DD06–003, DD04–001, and DD09–002 and the SEED DNA methylation measurements were supported by Autism Speaks Award #7659 to MDF. The SSC was supported by Simons Foundation (SFARI) award and NIH grant MH089606. The project leading to this application has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 777394. The JU receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI

Epigenomic and transcriptomic signatures of a Klinefelter syndrome (47,XXY) karyotype in the brain

Klinefelter syndrome (KS) is the most common sex-chromosome aneuploidy in humans. Most affected individuals carry one extra X-chromosome (47,XXY karyotype) and the condition presents with a heterogeneous mix of reproductive, physical and psychiatric phenotypes. Although the mechanism(s) by which the supernumerary X-chromosome determines these features of KS are poorly understood, skewed X-chromosome inactivation (XCI), gene-dosage dysregulation, and the parental origin of the extra X-chromosome have all been implicated, suggesting an important role for epigenetic processes. We assessed genomic, methylomic and transcriptomic variation in matched prefrontal cortex and cerebellum samples identifying an individual with a 47,XXY karyotype who was comorbid for schizophrenia and had a notably reduced cerebellum mass compared with other individuals in the study (n = 49). We examined methylomic and transcriptomic differences in this individual relative to female and male samples with 46,XX or 46,XY karyotypes, respectively, and identified numerous locus-specific differences in DNA methylation and gene expression, with many differences being autosomal and tissue-specific. Furthermore, global DNA methylation, assessed via the interrogation of LINE-1 and Alu repetitive elements, was significantly altered in the 47,XXY patient in a tissue-specific manner with extreme hypomethylation detected in the prefrontal cortex and extreme hypermethylation in the cerebellum. This study provides the first detailed molecular characterization of the prefrontal cortex and cerebellum from an individual with a 47,XXY karyotype, identifying widespread tissue-specific epigenomic and transcriptomic alterations in the brain. © 2014 Landes Bioscience

Mainland and international S-L as an excellent model for developing global citizen

In the age of internationalization, global citizenship education has become an important concept, particularly in regards to worldwide curriculum reform. Different institutions around the world have been promoting the concept of global citizenship education by diversifying programs and curricula so as to prepare students with potent skills and knowledge for future challenges. International Service-Learning (ISL) is unique in itself in that it integrates community services and academic learning on a global platform. In recent years, many scholars have brought attention to ISL in higher education and provided insight on conducting research on this kind of learning experience. These scholars agree that ISL is a strong and effective model for responding to and promoting internationalization. Compared to other forms of experiential learning models, such as study or volunteer abroad experiences, ISL serves as an ideal pedagogy: one best suited to prepare students and college graduates to be active global citizens in the 21st century. With this in mind, Lingnan University (LU) has structured a development strategy in order to enhance the internationalization and global civic engagement of students. The Mainland and International Service -Learning Program (MISLP) is one of the main braches of programs offered by the Office of Service-Learning (OSL) in LU. Each summer, over 70 students from both Lingnan and partner universities serve and learn through projects all around the world. With the integration of Global Citizenship Education, the MISLP gives students\u27 exposure to global issues. After the program, all participants become global citizens, gaining a greater sense of civic engagement and social responsibility. The presentation will include different scholars’ ideas on ISL, the uniqueness and practice of the MISLP in LU, and the successful design of the MISLP, which leads to a transformative learning process for students. The MISLP provides a platform for students to develop their global citizenship and enhance their academic development in a Service-Learning setting

Ventricular tachyarrhythmia risk in paediatric/young vs. adult Brugada syndrome patients: a territory-wide study

Introduction: Brugada syndrome (BrS) is a cardiac ion channelopathy with a higher prevalence in Asia compared to the Western populations. The present study compared the differences in clinical and electrocardiographic (ECG) presentation between paediatric/young (≤25 years old) and adult (>25 years) BrS patients. Method: This was a territory-wide retrospective cohort study of consecutive BrS patients presenting to public hospitals in Hong Kong. The primary outcome was spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF). Results: The cohort consists of 550 consecutive patients (median age of initial presentation = 51 ± 23 years; female = 7.3%; follow-up period = 83 ± 80 months), divided into adult (n = 505, mean age of initial presentation = 52 ± 19 years; female = 6.7%; mean follow-up period = 83 ± 80 months) and paediatric/young subgroups (n = 45, mean age of initial presentation = 21 ± 5 years, female = 13.3%, mean follow-up period = 73 ± 83 months). The mean annual VT/VF incidence rate were 17 and 25 cases per 1,000 patient-year, respectively. Multivariate analysis showed that initial presentation of type 1 pattern (HR = 1.80, 95% CI = [1.02, 3.15], p = 0.041), initial asymptomatic presentation (HR = 0.26, 95% CI = [0.07, 0.94], p = 0.040) and increased P-wave axis (HR = 0.98, 95% CI = [0.96, 1.00], p = 0.036) were significant predictors of VT/VF for the adult subgroup. Only initial presentation of VT/VF was predictive (HR = 29.30, 95% CI = [1.75, 492.00], p = 0.019) in the paediatric/young subgroup. Conclusion: Clinical and ECG presentation of BrS vary between the paediatric/young and adult population in BrS. Risk stratification and management strategies for younger patients should take into consideration and adopt an individualised approach