Short-term voiding patterns after vaginal hysterectomy and pelvic floor repair

Background: Post-operative transient voiding dysfunction is a known complication of vaginal hysterectomy (VH) with pelvic floor repair (PFR). This study aims to determine the duration of urinary catheterization prior to resumption of normal voiding and hospital length of stay for patients who have undergone VH, PFR with or without concomitant application of transvaginal mesh (TVM) and/or mid-urethral sling (MUS).Methods: This is a retrospective cohort study of women who underwent VH with PFR at a single urogynaecology centre in Singapore between 01 October 2016 and 30 September 2017. Patients’ files were reviewed for data collection and analysis.Results: A total of 238 women with VH with PFR were studied, of whom 68 (28.6%) did not have any implant, 60 (25.2%) had only TVM, 50 (21.0%) had only MUS, and 60 (25.2%) had both TVM and MUS. Overall, 1/68 (1.5%) patients without implants, 16/110 (14.5%) patients with one implant and 13/60 (21.7%) patients with two implants failed at least 1 inpatient voiding trial. Patients undergoing VH PFR without implants had shorter duration of catheterization compared to those with concomitant implants (2.2 versus 5.6 days, p<0.01). Duration of catheterization was shorter in patients with only MUS compared to patients with only TVM (3.5 versus 4.7 days, p<0.01). Patients with single implant had significantly shorter duration of catheterization compared to those with two implants (4.2 versus 5.6 days, p=0.001).Conclusions: One in 68 patients with VH with PFR without implants experienced short term voiding difficulties. This risk increased to 1 in 5 when concomitant implants were inserted

Dominant atmospheric pollutants in malaysia

This Article presents a  Brief of the various types of Pollutants that are contributing to the problem of air pollution in Malaysia, As well as the mention of some episodes in air pollution that have given rise to concern her

Facilitating Mechanical Design with Augmented Reality

By enhancing a real scene with computer generated objects, Augmented Reality (AR), has proven itself as a valuable Human-Computer Interface (HCI) in numerous application areas such as medical, military, entertainment and manufacturing. It enables higher performance of on-site tasks with seamless presentation of up-to-date, task-related information to the users during the operation. AR has potentials in design because the current interface provided by Computer-aided Design (CAD) packages is less intuitive and reports show that the presence of physical objects help design thinking and communication. This research explores the use of AR to improve the efficiency of a design process, specifically in mechanical design.Singapore-MIT Alliance (SMA

Synthesis of trifluoromethylated isoxazoles and their elaboration through inter- and intra-molecular C-H arylation

We report conditions for the preparation of a range of trifluoromethylated isoxazole building blocks through the cycloaddition reaction of trifluoromethyl nitrile oxide. It was found that controlling the rate (and therefore concentration) of the formation of the trifluoromethyl nitrile oxide was Critical for the preferential formation of the desired isoxazole products versus the furoxan dimer. Different conditions were optimised for both aryl- and alkyl-substituted alkynes. In addition, the reactivity at the isoxazole 4-position has been briefly explored for these building blocks. Conditions for intermolecular C–H arylation, lithiation and electrophile quench, and alkoxylation were all identified with brief substrate scoping that signifies useful tolerance to a range of functionalities. Finally, complementary processes for structural diversification through either intramolecular cyclisation or intermolecular cross-coupling were developed

ToyBox Study Malaysia: improving healthy energy balance and obesity-related behaviours among pre-schoolers in Malaysia

The prevalence of childhood overweight and obesity is increasing in Malaysia and currently nearly 10% of children aged between 6 months and 12 years are overweight and almost 12% are obese. Early interventions to prevent excess weight gain are needed. ToyBox Study Malaysia is a feasibility project, funded by the Medical Research Council Newton-Ungku Omar Fund, to assess the practicalities of adapting the existing European ToyBox Study intervention programme to the Malaysian kindergarten setting. The main aims of all ToyBox programmes are related to improving four key energy balance-related behaviours, namely drinking water, eating healthy snacks and meals, reducing sedentary behaviour and increasing physical activity. Using stratified sampling, the ToyBox Study Malaysia intervention will be delivered and compared to usual practice by assessing behaviour, physical activity and health-related outcomes as measured by questionnaires, accelerometry and anthropometry. It is hoped that the evidence-based ToyBox Study Malaysia will help to achieve healthier energy balance-related behaviours in the children and their families and provide lifelong benefits to health. This article provides information on the dietary patterns, physical activity levels and prevalence of overweight and obesity in Malaysian children, and the approach of the ToyBox Study Malaysia

Key Success Factors and Guidance for International Collaborative Design Projects

In the built environment (BE) sector, the co-creation process of design demands understanding of requirements (as viewed by parties involved), mobilisation of tacit knowledge, negotiation, and complex exchange of information. The need to collaborate over distance has further exacerbated the complexity of the process, and, in itself, represents a significant challenge for BE professionals who are increasingly expected to undertake this process within globally distributed virtual teams. The research aims to identify key success factors and develop guidance for international collaborative design projects, via the implementation of collaborative design courses in UK and Canadian universities over three academic years. Questionnaire surveys, focus groups, observation of online meetings, personal reflections provided data for the analysis. The findings reveal the significance of the perceived risk of collaboration and a difference in preferred communication mode between architects and civil/structural engineers. These findings suggest the impact of training in the subject discipline, and that the opportunity for co-located working has helped the development of trust. The guidance is aimed at BE educators who wish to implement this activity in their courses

Process evaluation of a kindergarten-based intervention for obesity prevention in early childhood: the Toybox study Malaysia

BackgroundToybox is a kindergarten-based intervention program that targets sedentary behavior, snacking and drinking habits, as well as promoting physical activity in an effort to improve healthy energy balance-related behaviors among children attending kindergartens in Malaysia. The pilot of this program was conducted as a randomized controlled trial (RCT) involving 837 children from 22 intervention kindergartens and 26 control kindergartens respectively. This paper outlines the process evaluation of this intervention.MethodsWe assessed five process indicators: recruitment, retention, dosage, fidelity, and satisfaction for the Toybox program. Data collection was conducted via teachers’ monthly logbooks, post-intervention feedback through questionnaires, and focus group discussions (FGD) with teachers, parents, and children. Data were analyzed using quantitative and qualitative data analysis methods.ResultsA total of 1072 children were invited. Out of the 1001 children whose parents consented to join, only 837 completed the program (Retention rate: 88.4%). As high as 91% of the 44 teachers and their assistants engaged positively in one or more of the process evaluation data collection methods. In terms of dosage and fidelity, 76% of parents had received newsletters, tip cards, and posters at the appropriate times. All teachers and their assistants felt satisfied with the intervention program. However, they also mentioned some barriers to its implementation, including the lack of suitable indoor environments to conduct activities and the need to make kangaroo stories more interesting to captivate the children’s attention. As for parents, 88% of them were satisfied with the family-based activities and enjoyed them. They also felt that the materials provided were easy to understand and managed to improve their knowledge. Lastly, the children showed positive behaviors in consuming more water, fruits, and vegetables.ConclusionsThe Toybox program was deemed acceptable and feasible to implement by the parents and teachers. However, several factors need to be improved before it can be expanded and embedded as a routine practice across Malaysia

Insights into biofilm dispersal regulation from the crystal structure of the PAS-GGDEF-EAL region of RbdA from Pseudomonas aeruginosa

© 2018 American Society for Microbiology. RbdA is a positive regulator of biofilm dispersal of Pseudomonas aeruginosa. Its cytoplasmic region (cRbdA) comprises an N-terminal Per-ARNT-Sim (PAS) domain followed by a diguanylate cyclase (GGDEF) domain and an EAL domain, whose phosphodiesterase activity is allosterically stimulated by GTP binding to the GGDEF domain. We report crystal structures of cRbdA and of two binary complexes: one with GTP/Mg 2+ bound to the GGDEF active site and one with the EAL domain bound to the c-di-GMP substrate. These structures unveil a 2-fold symmetric dimer stabilized by a closely packed N-terminal PAS domain and a noncanonical EAL dimer. The autoinhibitory switch is formed by an α-helix (S-helix) immediately N-terminal to the GGDEF domain that interacts with the EAL dimerization helix (α6-E) of the other EAL monomer and maintains the protein in a locked conformation. We propose that local conformational changes in cRbdA upon GTP binding lead to a structure with the PAS domain and S-helix shifted away from the GGDEF-EAL domains, as suggested by small-angle X-ray scattering (SAXS) experiments. Domain reorientation should be facilitated by the presence of an α-helical lever (H-helix) that tethers the GGDEF and EAL regions, allowing the EAL domain to rearrange into an active dimeric conformation

Potential use of plasma focus radiation sources in superficial cancer therapy

The new multidisciplinary field of plasma medicine combines plasma physics, electrical engineering, life sciences and clinical medicine. Here we explore potential uses in medicine, most particularly cancer therapy, the plasma source being brought out of the field of industrial applications into the life sciences, the focus being on superficial cancer radiotherapy strategies. Existing radiotherapy practices for such cancers rely on the use of rather large facilities, most popularly the electron linear accelerator and X-ray tube-based devices. Conversely, a compact plasma radiation source can be housed in a relatively small space, there being considerable promise for such devices to produce the fluence requirements of radiotherapy for treatment of skin cancers. The present study of feasibility investigates the plasma focus device, with the emission produced by a single discharge shown to generate an X-ray dose of few tens of mGy. The X-ray dose is the integration of emission in the discharge durations of less than a μs, it is therefore possible using these devices to build up fractional irradiation dose through repetitive operation of the discharge system