Bridging the gap in ageing: Translating policies into practice in Malaysian Primary Care

Population ageing is poised to become a major challenge to the health system as Malaysia progresses to becoming a developed nation by 2020. This article aims to review the various ageing policy frameworks available globally; compare aged care policies and health services in Malaysia with Australia; and discuss various issues and challenges in translating these policies into practice in the Malaysian primary care system. Fundamental solutions identified to bridge the gap include restructuring of the health care system, development of comprehensive benefit packages for older people under the national health financing scheme, training of the primary care workforce, effective use of electronic medical records and clinical guidelines; and empowering older people and their caregivers with knowledge, skills and positive attitudes to ageing and self care. Ultimately, family medicine specialists must become the agents for change to lead multidisciplinary teams and work with various agencies to ensure that better coordination, continuity and quality of care are eventually delivered to older patients across time and settings

The Impact of Lesion In-Painting and Registration Methods on Voxel-Based Morphometry in Detecting Regional Cerebral Gray Matter Atrophy in Multiple Sclerosis

Background and Purpose: VBM has been widely used to study GM atrophy in MS. MS lesions lead to segmentation and registration errors that may affect the reliability of VBM results. Improved segmentation and registration have been demonstrated by WM LI before segmentation. DARTEL appears to improve registration versus the USM. Our aim was to compare the performance of VBM-DARTEL versus VBM-USM and the effect of LI in the regional analysis of GM atrophy in MS. Materials and Methods: 3T T1 MR imaging scans were acquired from 26 patients with RRMS and 28 age-matched NC. LI replaced WM lesions with normal-appearing WM intensities before image segmentation. VBM analysis was performed in SPM8 by using DARTEL and USM with and without LI, allowing the comparison of 4 VBM methods (DARTEL + LI, DARTEL − LI, USM + LI, and USM − LI). Accuracy of VBM was assessed by using NMI, CC, and a simulation analysis. Results: Overall, DARTEL + LI yielded the most accurate GM maps among the 4 methods (highest NMI and CC, P < .001). DARTEL + LI showed significant GM loss in the bilateral thalami and caudate nuclei in patients with RRMS versus NC. The other 3 methods overestimated the number of regions of GM loss in RRMS versus NC. LI improved the accuracy of both VBM methods. Simulated data suggested the accuracy of the results provided from patient MR imaging analysis. Conclusions: We introduce a pipeline that shows promise in limiting segmentation and registration errors in VBM analysis in MS

Death Associated Protein Kinase (DAPK) -mediated neurodegenerative mechanisms in nematode excitotoxicity

Background: Excitotoxicity (the toxic overstimulation of neurons by the excitatory transmitter Glutamate) is a central process in widespread neurodegenerative conditions such as brain ischemia and chronic neurological diseases. Many mechanisms have been suggested to mediate excitotoxicity, but their significance across diverse excitotoxic scenarios remains unclear. Death Associated Protein Kinase (DAPK), a critical molecular switch that controls a range of key signaling and cell death pathways, has been suggested to have an important role in excitotoxicity. However, the molecular mechanism by which DAPK exerts its effect is controversial. A few distinct mechanisms have been suggested by single (sometimes contradicting) studies, and a larger array of potential mechanisms is implicated by the extensive interactome of DAPK. Results: Here we analyze a well-characterized model of excitotoxicity in the nematode C. elegans to show that DAPK is an important mediator of excitotoxic neurodegeneration across a large evolutionary distance. We further show that some proposed mechanisms of DAPK’s action (modulation of synaptic strength, involvement of the DANGER-related protein MAB-21, and autophagy) do not have a major role in nematode excitotoxicity. In contrast, Pin1/PINN-1 (a DAPK interaction-partner and a peptidyl-prolyl isomerase involved in chronic neurodegenerative conditions) suppresses neurodegeneration in our excitotoxicity model. Conclusions: Our studies highlight the prominence of DAPK and Pin1/PINN-1 as conserved mediators of cell death processes in diverse scenarios of neurodegeneration

Tuberculosis in the Western Pacific Region: Estimating the burden of disease and return on investment 2020–2030 in four countries

Background: We aimed to estimate the disease burden of Tuberculosis (TB) and return on investment of TB care in selected high-burden countries of the Western Pacific Region (WPR) until 2030. Methods: We projected the TB epidemic in Viet Nam and Lao People's Democratic Republic (PDR) 2020–2030 using a mathematical model under various scenarios: counterfactual (no TB care); baseline (TB care continues at current levels); and 12 different diagnosis and treatment interventions. We retrieved previous modeling results for China and the Philippines. We pooled the new and existing information on incidence and deaths in the four countries, covering >80% of the TB burden in WPR. We estimated the return on investment of TB care and interventions in Viet Nam and Lao PDR using a Solow model. Findings: In the baseline scenario, TB incidence in the four countries decreased from 97•0/100,000/year (2019) to 90•1/100,000/year (2030), and TB deaths from 83,300/year (2019) to 71,100/year (2030). Active case finding (ACF) strategies (screening people not seeking care for respiratory symptoms) were the most effective single interventions. Return on investment (2020–2030) for TB care in Viet Nam and Lao PDR ranged US$4-US$49/dollar spent; additional interventions brought up to US$2•7/dollar spent. Interpretation: In the modeled countries, TB incidence will only modestly decrease without additional interventions. Interventions that include ACF can reduce TB burden but achieving the End TB incidence and mortality targets will be difficult without new transformational tools (e.g. vaccine, new diagnostic tools, shorter treatment). However, TB care, even at its current level, can bring a multiple-fold return on investment

Estimating the long-term effects of mass screening for latent and active tuberculosis in the Marshall Islands

BACKGROUND: Ambitious population-based screening programmes for latent and active tuberculosis (TB) were implemented in the Republic of the Marshall Islands in 2017 and 2018. METHODS: We used a transmission dynamic model of TB informed by local data to capture the Marshall Islands epidemic's historical dynamics. We then used the model to project the future epidemic trajectory following the active screening interventions, as well as considering a counterfactual scenario with no intervention. We also simulated future scenarios including periodic interventions similar to those previously implemented, to assess their ability to reach the End TB Strategy targets and TB pre-elimination in the Marshall Islands. RESULTS: The screening activities conducted in 2017 and 2018 were estimated to have reduced TB incidence and mortality by around one-third in 2020, and are predicted to achieve the End TB Strategy milestone of 50% incidence reduction by 2025 compared with 2015. Screening interventions had a considerably greater impact when latent TB screening and treatment were included, compared with active case finding alone. Such combined programmes implemented at the national level could achieve TB pre-elimination around 2040 if repeated every 2 years. CONCLUSIONS: Our model suggests that it would be possible to achieve TB pre-elimination by 2040 in the Marshall Islands through frequent repetition of the same interventions as those already implemented in the country. It also highlights the importance of including latent infection testing in active screening activities

Dual‐Sensitivity Multiple Sclerosis Lesion and CSF Segmentation for Multichannel 3T Brain MRI

ABSTRACT BACKGROUND AND PURPOSE A pipeline for fully automated segmentation of 3T brain MRI scans in multiple sclerosis (MS) is presented. This 3T morphometry (3TM) pipeline provides indicators of MS disease progression from multichannel datasets with high‐resolution 3‐dimensional T1‐weighted, T2‐weighted, and fluid‐attenuated inversion‐recovery (FLAIR) contrast. 3TM segments white (WM) and gray matter (GM) and cerebrospinal fluid (CSF) to assess atrophy and provides WM lesion (WML) volume. METHODS To address nonuniform distribution of noise/contrast (eg, posterior fossa in 3D‐FLAIR) of 3T magnetic resonance imaging, the method employs dual sensitivity (different sensitivities for lesion detection in predefined regions). We tested this approach by assigning different sensitivities to supratentorial and infratentorial regions, and validated the segmentation for accuracy against manual delineation, and for precision in scan‐rescans. RESULTS Intraclass correlation coefficients of .95, .91, and .86 were observed for WML and CSF segmentation accuracy and brain parenchymal fraction (BPF). Dual sensitivity significantly reduced infratentorial false‐positive WMLs, affording increases in global sensitivity without decreasing specificity. Scan‐rescan yielded coefficients of variation (COVs) of 8% and .4% for WMLs and BPF and COVs of .8%, 1%, and 2% for GM, WM, and CSF volumes. WML volume difference/precision was .49 ± .72 mL over a range of 0–24 mL. Correlation between BPF and age was r = .62 (P = .0004), and effect size for detecting brain atrophy was Cohen's d = 1.26 (standardized mean difference vs. healthy controls). CONCLUSIONS This pipeline produces probability maps for brain lesions and tissue classes, facilitating expert review/correction and may provide high throughput, efficient characterization of MS in large datasets

Antropologi Budaya Jawa dalam Kitab Tafsir Al-Qur'an Berbahasa Jawa Karya KH. Bisri Mustofa

Penelitian ini memfokuskan diri pada analisa seputar; Pertama, bagaimana model penafsiran Bisyri Musthofa dalam tafsir al-Ibriz?. Kedua, apakah terdapat unsur lokalitas budaya Jawa?. Ketiga, Bagimana pola dialektika al-Qur'an dengan nilai-nilai budaya Jawa dalam tafsir al-Ibriz? Dari hasil analisa dengan menggunakan seperangkat metode, ditemukan beberapa temuan yang menjawab rumusan permasalahan dalam penelitian ini. Pertama, Ada beberapa unsur-unsur lokalitas yang ditemukan dalam tafsîr al-Ibrîz; Kedua, Bisyri Musthofa berusaha merubah tradisi yang bertentangan dengan ajaran agama Islam dan melestarikan budaya yang sesuai dengan Islam; Ketiga, Bisyri Musthofa menafsirkan ayat dengan mengkontekstualisasikannya dengan budaya atau unsur lokal saat beliau menulis tafsirnya. Misalnya persoalan mengundi nasib dengan keris dan batu akik. Keempat, Konteks keindonesiaan tidak luput dari pengamatan Bisyri Musthofa dalam tafsîr al-Ibrîz. Misalnya pakaian yang dipakai wanita-wanita muslimat yang jauh dari ajaran Islam seperti pakaian yukensi (you can see); Kelima, Tradisi lokal Jawa sering dimunculkan dalam tafsîr al-Ibrîz. Misalnya saat Bisyri Musthofa menjelaskan kategori dosa-dosa kecil, salah satunya berjalan dengan berlagak, Bisyri Musthofa mengaitkan sungai dalam sebuah ayat dengan mengambil contoh sungai-sungai yang ada di Jawa, seperti kali Bengawan Solo, kali Berantas, Kali Cintandui, Bisyri Musthofa meramu penafsirannya dengan konteks pengobatan Jaw

Upaya Meningkatkan Hasil Belajar Lari Sprint melalui Pendekatan Bermain pada Siswa Kelas VIII Sekolah Menengah Pertama: Indonesia

Tujuan Penelitian. Untuk mengetahui peningkatan hasil belajar lari sprint melalui pendekatan bermain pada siswa kelas VIII SMP Perguruan Budi Agung Marelan Tahun Ajaran 2019/2020. Metode Penelitian. Penelitian ini berbentuk Penelitian Tindakan Kelas (PTK). Penelitian ini dilakukan dengan menggunakan gaya mengajar bermain sebagai sasaran utama. Pemaparan dalam upaya meningkatkan hasil belajar lari sprint melalui pendekatan bemain pada siswa kelas VIII SMP. jenis penelitian tindakan kelas maka peneliti ini dilakukan dalam dua siklus yang tiap siklusnya terdiri dari 4 tahapan sebagai berikut : 1) Perencanaan (planning), 2) Tindakan (acting), 3) Pengamatan (observing), 4) Refleksi (reflecting). Hasil. Dari pembelajaran lari sprint tindakan untuk memperbaiki di siklus II yaitu dengan menggunakan metode pendekatan bermain dapat kita lihat dari 28 orang siswa hanya 24 orang siswa yang(85,71%) yang telah mencapai nilai ketuntasan, sedangkan 4 orang siswa (14,28%) belum mencapai ketuntasan belajar. Kesimpulan. Berdasarkan hasil penelitian, maka dapat ditarik kesimpulan bahwa Melalui Pendekatan Bermain Dapat Meningkat Hasil Belajar Lari Sprint pada Siswa Kelas VIII SMP Perguruan Budi Agung Marelan Tahun Ajaran 2020/202