Two Decades of Dengue in Malaysia

Dengue is endemic in Malaysia and the first case was documented in 1902. The disease was made notifiable in 1973 and the first outbreak of dengue haemorrhagic fever was reported in 1962. During the decade of 1973-1982, there were 12,077 dengue cases with a case fatality rate of 3.38%. In the following decade of 1983-1992, the number of reported cases increased to 26,361 but the case fatality rate dropped to 0.55%. The increase in incidence could be due to rising economy, rapid industrialization and urban migration. The reduction of case fatality rate could be due to patients seeking early medical treatment and to better case management. Based on 6,970 laboratory confirmed cases since 1983, the male to female ratio was 1.2: 1 and the ratio among the three major ethnic groups (Chinese: Malays: Indians) was 5.1: 2.9: 1. All four dengue serotypes are present in Malaysia but one serotype usually predominates for at least two years. The case fatality rate for dengue 3 outbreak is highest (0.77%), followed by dengue 2 (0.54%) and dengue 1 (0.35%). From our experince in the last two decades, it is possible to predict the severity of dengue outbreaks based on the circulating predominant serotype. The dengue situation in Malaysia during the last two decades has worsened with an ever increasing number of reported cases. Vector control measures have not been successful and it is unlikely that the situation will improve in the next decade. The only solution is through dengue vaccination which hopefully will come about in the not too distant future

The association of types of training and practice settings with doctors’ empathy and patient enablement among patients with chronic illness in Hong Kong

Background: The increase in non-communicable disease (NCD) is becoming a global health problem and there is an increasing need for primary care doctors to look after these patients although whether family doctors are adequately trained and prepared is unknown. Objective: This study aimed to determine if doctors with family medicine (FM) training are associated with enhanced empathy in consultation and enablement for patients with chronic illness as compared to doctors with internal medicine training or without any postgraduate training in different clinic settings. Methods: This was a cross-sectional questionnaire survey using the validated Chinese version of the Consultation and Relational Empathy (CARE) Measure as well as Patient Enablement Instrument (PEI) for evaluation of quality and outcome of care. 14 doctors from hospital specialist clinics (7 with family medicine training, and 7 with internal medicine training) and 13 doctors from primary care clinics (7 with family medicine training, and 6 without specialist training) were recruited. In total, they consulted 823 patients with chronic illness. The CARE Measure and PEI scores were compared amongst doctors in these clinics with different training background: family medicine training, internal medicine training and those without specialist training. Generalized estimation equation (GEE) was used to account for cluster effects of patients nested with doctors. <b>Results</b> Within similar clinic settings, FM trained doctors had higher CARE score than doctors with no FM training. In hospital clinics, the difference of the mean CARE score for doctors who had family medicine training (39.2, SD = 7.04) and internal medicine training (35.5, SD = 8.92) was statistically significant after adjusting for consultation time and gender of the patient. In the community care clinics, the mean CARE score for doctors with family medicine training and those without specialist training were 32.1 (SD = 7.95) and 29.2 (SD = 7.43) respectively, but the difference was not found to be significant. For PEI, patients receiving care from doctors in the hospital clinics scored significantly higher than those in the community clinics, but there was no significant difference in PEI between patients receiving care from doctors with different training backgrounds within similar clinic setting. Conclusion: Family medicine training was associated with higher patient perceived empathy for chronic illness patients in the hospital clinics. Patient enablement appeared to be associated with clinic settings but not doctors’ training background. Training in family medicine and a clinic environment that enables more patient doctor time might help in enhancing doctors’ empathy and enablement for chronic illness patients

Molecular epidemiology of Malaysian dengue 2 viruses isolated over twenty-five years (1968-1993)

The limited sequencing approach was used to study the molecular epidemiology of 24 Malaysian dengue 2 viruses which were isolated between 1968 and 1993. The sequences of a 240-nucleotide-long region across the envelope/non-structural 1 protein (E/NS1) gene junction of the isolates were determined and analysed. Alignment and comparison of the nucleotide and deduced amino acid sequences of the isolates revealed that nucleotide changes occurred mostly at the third position of a particular codon and were of the transition (AG, CU) type. Five nucleotide changes resulted in amino acid substitutions. Pairwise comparisons of the nucleotide sequences gave divergence values ranging from 9 to 9.2. At the amino acid level, the divergence ranged between 0 and 3.8. Based on the 6 divergence as the cut-off point for genotypic classification, the isolates were grouped into two genotypes, I and II. Comparison of the nucleotide sequences of the Malaysian dengue isolates with those of the dengue viruses of other regions of the world revealed that members of genotypes I and II were closely related to viruses from the Indian Ocean and Western Pacific regions, respectively

Effects of bandwidth limitations on the localized state distribution calculated from transient photoconductivity data

The possible effects of experimental bandwidth limitation on the accuracy of the energy distribution of the density of localized states (DOS) calculated from transient photoconductivity data by the Fourier transform method is examined. An argument concerning the size of missing contributions to the numerical Fourier integrals is developed. It is shown that the degree of distortion is not necessarily large even for relatively small experimental bandwidths. The density of states calculated from transient photodecay measurements in amorphous arsenic triselenide is validated by comparing with modulated photocurrent data. It is pointed out that DOS distributions calculated from transient photoconductivity data at a high photoexcitation density are valid under certain conditions. This argument is used to probe the conduction band tail in undoped a-Si:H to energies shallower than 0.1 eV below the mobility edge. It is concluded that there is a deviation in the DOS from exponential at about 0.15 eV below the mobility edge

EDN1 Lys198Asn is Associated with Diabetic Retinopathy in Type 2 Diabetes

Purpose: We tested the hypothesis that genetic variants in vasoactive and angiogenic factors regulating the retina vasculature contribute to the development of diabetic retinopathy (DR). Methods: A case-control study was performed to study the genetic association between DR and polymorphic variants of EDN1 (Lys198Asn), LTA (IVS1–80C>A, IVS1–206G>C, IVS1–252>G), eNOS (Glu298Asp), and ITGA2 (BgI II) in a Chinese population with type 2 diabetes mellitus. A well defined population with type 2 diabetes, consisting of 127 controls and 216 DR patients, was recruited. Results: A higher frequency of the Asn/Asn genotype of EDN1 was found in individuals with at least 10 years of diabetes and no retinopathy (controls) compared with DR patients with any duration of diabetes (DR: 2.3%; control: 11.0%; p=0.0002). The Asn allele was also more frequent in controls than DR patients (DR: 16.4%; control: 29.5%; p=0.007). Multiple logistic regression analysis showed that the Asn/Asn genotype was the factor most significantly associated with reduced risk of DR (odds ratio=0.19; 95% CI: 0.07-0.53; p=0.002) and with late onset of diabetes (Asn/Asn: 59 years; Lys/Lys + Lys/Asn: 53 years; p=0.02). Moreover, the Lys/Lys genotype was more common among patients with nonproliferative (75.7%) than proliferative DR (56.9%; p=0.008). The distributions of Lys198Asn alleles in hypertension did not differ from normotensive subjects. No associations between DR and polymorphisms of LTA, eNOS, or ITGA2 were detected, and there were no detectable gene-gene or gene-environmental interactions among the polymorphisms.Conclusions The Asn/Asn genotype of EDN1 was associated with a reduced risk of DR and with delayed onset of type 2 diabetes

Fractional Branes in Non-compact Type IIA Orientifolds

We study fractional D-branes in the Type-IIA theory on a non-compact orientifold of the orbifold C^3/Z_3 in the boundary state formalism. We find that the fractional D0-branes of the orbifold theory become unstable due to the presence of a tachyon, while there is a stable D-instanton whose tachyon gets projected out. We propose that the D-instanton is obtained after tachyon condensation. We evidence this by calculating the Whitehead group of the Abelian category of objects corresponding to the boundary states as being isomorphic to Z_2.Comment: 29 pages, Latex2e minor corrections. references updated. Version accepted in JHE

Automatic service categorisation through machine learning in emergent middleware

The modern environment of mobile, pervasive, evolving services presents a great challenge to traditional solutions for enabling interoperability. Automated solutions appear to be the only way to achieve interoperability with the needed level of flexibility and scalability. While necessary, the techniques used to determine compatibility, as a precursor to interaction, come at a substantial computational cost, especially when checks are performed between systems in unrelated domains. To overcome this, we apply machine learning to extract high-level functionality information through text categorisation of a system's interface description. This categorisation allows us to restrict the scope of compatibility checks, giving an overall performance gain when conducting matchmaking between systems. We have evaluated our approach on a corpus of web service descriptions, where even with moderate categorisation accuracy, a substantial performance benefit can be found. This in turn improves the applicability of our overall approach for achieving interoperability in the Connect project

News from the Muon (g-2) Experiment at BNL

The magnetic moment anomaly a_mu = (g_mu - 2) / 2 of the positive muon has been measured at the Brookhaven Alternating Gradient Synchrotron with an uncertainty of 0.7 ppm. The new result, based on data taken in 2000, agrees well with previous measurements. Standard Model evaluations currently differ from the experimental result by 1.6 to 3.0 standard deviations.Comment: Talk presented at RADCOR - Loops and Legs 2002, Kloster Banz, Germany, September 8-13 2002, to be published in Nuclear Physics B (Proc. Suppl.); 5 pages, 3 figure