Treat-to-target approach in managing modifiable risk factors of patients with coronary heart disease in primary care in Singapore: what are the issues?

<p>Abstract</p> <p>Background</p> <p>The key management strategy for established coronary heart disease (CHD) patients is to control the underlying risk factors. Further complications will be reduced when these risk factors are treated-to-target (TTT) as recommended by clinical practice guidelines. These targets include blood pressure (BP) lower than 130/80 mm Hg and LDL-cholesterol of less than 2.6 mmol/L and for those with type 2 diabetes mellitus (DM), HBA1c less than 7%. This article aimed to explore the issues affecting this approach from both the patients' and primary care physicians' (PCP) perspectives.</p> <p>Methods</p> <p>The study involved triangulation of research methods to determine the findings. Part A: focus group discussions to collect qualitative data from patients with CHD and from PCPs who were managing them in primary care. Part B: A subsequent questionnaire survey to determine the extent of their awareness of treatment targets for modifiable risk factors.</p> <p>Results</p> <p>CHD patients had variable awareness of the modifiable risk factors for CHD due to poor concordance between the PCPs' approach in managing the CHD patients and the latter's reception of information. 46% of participants knew their targets of BP control correctly; 11% of them were correct in stating their target for LDL-cholesterol control. Amongst these participants with DM (n = 146), 27% of them were correct in indicating their target of diabetic control.</p> <p>Conclusions</p> <p>Communication and practice barriers exist which hinder the treat-to-target approach in mitigating the risk factors for CHD patients. Incorporating this approach in routine clinical practice by PCPs has greater potential to achieve treatment targets for patients.</p

Design of Fibril Forming Collagen Mimetic Peptides: Heterotrimers and Nucleation Domains

This paper attempts to design collagen mimetic peptides where the triple-helical region mimics that of human Type I Collagen. With consideration for chain selection and chain register, we utilize the NC2 domain of heterotrimeric Type IX Collagen as a nucleation domain for triple-helix folding

Ensemble candidate classification for the LOTAAS pulsar survey

One of the biggest challenges arising from modern large-scale pulsar surveys is the number of candidates generated. Here, we implemented several improvements to the machine learning (ML) classifier previously used by the LOFAR Tied-Array All-Sky Survey (LOTAAS) to look for new pulsars via filtering the candidates obtained during periodicity searches. To assist the ML algorithm, we have introduced new features which capture the frequency and time evolution of the signal and improved the signal-to-noise calculation accounting for broad profiles. We enhanced the ML classifier by including a third class characterizing RFI instances, allowing candidates arising from RFI to be isolated, reducing the false positive return rate. We also introduced a new training data set used by the ML algorithm that includes a large sample of pulsars misclassified by the previous classifier. Lastly, we developed an ensemble classifier comprised of five different Decision Trees. Taken together these updates improve the pulsar recall rate by 2.5 per cent, while also improving the ability to identify pulsars with wide pulse profiles, often misclassified by the previous classifier. The new ensemble classifier is also able to reduce the percentage of false positive candidates identified from each LOTAAS pointing from 2.5 per cent (∼500 candidates) to 1.1 per cent (∼220 candidates)

An investigation of the cellular uptake and mechanisms of action of MGN-3 on inflammatory processes

The alarming rate at which pathogens are becoming resistant to conventional therapies is a reason for the urgent need to develop alternative strategies to combat bacterial infections. MGN-3 (biobran) was discovered and named after the three scientists: Maeda, Ghoneum and Ninomiya. It is an enzymatically modified rice bran arabinoxylan, which can enhance the host immune system by mediating macrophage function. The aim of this study was to investigate the effect of MGN-3 on the clearance of methicillinresistant Staphylococcus aureus (MRSA) by human U937 macrophages. The uptake of MGN-3 by U937 macrophages was measured by a phloroglucinol colorimetric assay and visualised by confocal microscopy. An in vitro host-pathogen assay (n=24) was performed following exposure of macrophages to MGN-3 (0.5 to 2.0 mg/ml) and/or lipopolysaccharide (LPS) at 1.0 μg/ml or 5.0 μg/ml for 24 hours. The assay was repeated in the presence of receptor inhibitors, to identify potential molecular mechanisms of action. Bacterial internalisation by U937 macrophages was visualised by scanning electron microscopy (SEM). The study demonstrated approximately 29% of total available MGN-3 was taken up by U937 macrophages. There was a significant (P<0.05) dose-dependent increase in clearance of MRSA by U937 macrophages in the presence of MGN-3 compared to the negative control. SEM confirmed internalisation of MRSA by U937 macrophages following MGN-3 treatment. However, MGN-3 inhibited LPS-induced phagocytosis, suggesting both polysaccharides may compete as ligands for the same receptor(s) but that LPS is more potent at inducing phagocytosis. TLR-4 and dectin-1 receptor inhibition reversed the effects of MGN-3 or LPS treatment, suggesting both MGN-3 and LPS mediate phagocytosis at least in part through these receptors. In conclusion, this study established that MGN-3 significantly promotes phagocytosis of MRSA by U937 macrophages in a dose-dependent manner via TLR-4 and dectin-1. Moreover, MGN-3 mediated LPS-induced phagocytosis, suggesting competition for the same receptor(s) and highlighting the potential of MGN-3 to modulate excessive LPSinduced pro-inflammatory responses. Collectively, these findings may ultimately lead to novel potential therapeutic strategies that can be used alongside antibiotic treatments to combat MRSA infection, thereby reducing the over reliance on antibiotic usage

Learning together through international collaboration in teacher education in Malaysia. Report of a project to develop a Bachelor of Education (Honours) in Primary Mathematics

Copyright University of Hertfordshire, School of Education 2011Learning together through international collaboration in teacher education in Malaysia is the report of an enterprising partnership between the University of Hertfordshire, UK, the Ministry of Education Malaysia and two Institutes of Teacher Education in Malaysia. Working collaboratively with colleagues in Malaysia, the University of Hertfordshire School of Education designed, validated, supported and quality assured a Bachelor of Education (Honours) degree programme for initial teacher training for a single cohort of 120 students over four years. All the students graduated in 2010. Learning together through international collaboration in teacher education in Malaysia provides a record of the project itself. It also documents in-depth insights from contributors to the project in two main areas: the collaborative approach to working together and issues relating to learning and teaching, including the Action – Reflection – Modelling (ARM) pedagogical approach, which underpinned the degree programme. Senior managers, teacher educators and lecturers share some of their learning from working together to develop and implement the new degree programme. Student teachers voice some experiences from their school placements. They describe how they used ARM; highlight some of the benefits of the approach and identify some of the challenges associated with introducing a different pedagogy in schools as they were 'learning to teach'. There are glimpses of 'lively and attractive' classes in which 'pupils enjoy and feel comfortable to learn' and 'are eager to answer my questions'. School mentors provide additional insights into the student teachers' learning and teaching practice. The richness of the contributions is reflected in the many quotations included in the report. The successful completion of this project was due to the dedication and expertise of many contributors. The findings documented in this report are relevant for all those engaged in international collaboration and teacher education.Final Published versio

COVID-19 Study Spaces: Supportive Adaptation of Home Learning Environments During the Pandemic

The COVID-19 pandemic has driven considerable changes in how we live, work, and study. How have students adapted space to support remote study? This research project aimed to understand where students were learning, how they were using and adapting the space, and how their decisions might connect to tangible outcomes such as academic success, engagement, connection, and satisfaction with remote learning. An online survey gathered data from 542 college students across 93 majors at two institutions. Results suggest that the bedroom space is the most common study space, and that space adaptation is tied to positive outcomes for student

Single-pulse classifier for the LOFAR Tied-Array All-sky Survey

Searches for millisecond-duration, dispersed single pulses have become a standard tool used during radio pulsar surveys in the last decade. They have enabled the discovery of two new classes of sources: rotating radio transients and fast radio bursts. However, we are now in a regime where the sensitivity to single pulses in radio surveys is often limited more by the strong background of radio frequency interference (RFI, which can greatly increase the false-positive rate) than by the sensitivity of the telescope itself. To mitigate this problem, we introduce the Single-pulse Searcher (SPS). This is a new machine-learning classifier designed to identify astrophysical signals in a strong RFI environment, and optimized to process the large data volumes produced by the new generation of aperture array telescopes. It has been specifically developed for the LOFAR Tied-Array All-Sky Survey (LOTAAS), an ongoing survey for pulsars and fast radio transients in the northern hemisphere. During its development, SPS discovered seven new pulsars and blindly identified ˜80 known sources. The modular design of the software offers the possibility to easily adapt it to other studies with different instruments and characteristics. Indeed, SPS has already been used in other projects, e.g. to identify pulses from the fast radio burst source FRB 121102. The software development is complete and SPS is now being used to re-process all LOTAAS data collected to date

Developing Motivated Learners Through Music

Abstract: &quot;Gymnastic for the body, and music for the mind.&quot; -Plato (Greek Philosopher) Over the last 25 years, many researches and studies have been done to find out how music influences our brain and how we can use music to help our pupils learn faster and more effectively. Our brain is most open and receptive to incoming information when it is in a special state of relaxation. Music is all around us and we agree totally that it plays an integral part in our pupils&apos; overall development. The Singapore government recognizes the importance of music and our school acknowledges each child&apos;s musical experiences as a fundamental aspect of his education journey. However, it is disappointing to find, in the course of our research, that little studies have been done to measure the relationship between motivation and participation in a school&apos;s music programme. Does participation in music education really bring about a high level of motivation, self-discipline and self-esteem? If mere participation in the prescribed school&apos;s music programme brings about all the above mentioned positive influences, why then are we not seeing it in our pupils? Is there a need to enhance our music curriculum by introducing something unique that would cater to their needs and interest and in the process, brings about a high level of motivation, self-discipline and self-esteem? We chanced upon the Ukulele, a fourstringed instrument, which resembles the Banjo, when it was shown to us by one of our aesthetic CCA instructors. Could the uniqueness of the Ukulele be the key to achieving the desired outcomes mentioned earlier? This paper aims to find out if learning to play a special musical instrument will accentuate the level of motivation, self-discipline and self-esteem. 80 pupils went through a 16-hour My Musical Journey with the Ukulele programme in 2005 and another 16-hour of the same programme at the advanced level in year 2006. Statistical data confirmed our hypothesis and showed that there is a positive relationship between the effect of the Ukulele programme and the level of motivation. These pupils appeared more confident and a subsequent qualitative analysis substantiated our findings

1-Tetra­decyl­pyridinium bromide monohydrate

In the title compound, C19H34N+·Br−·H2O, the dihedral angle between the trans-planar alkyl side chain and the pyridinium ring is 52.73 (7)°. In the crystal structure, O—H⋯Br, C—H⋯Br and C—H⋯O hydrogen bonds form a network, while the hydro­phobic alkyl chains inter­digitate, forming bilayers

SELF-CARE PROGRAM FOR OLDER COMMUNITY-DWELLERS: PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL

Abstract Aim: To report a trial protocol to determine if a self-care program enhances quality of life and sense of coherence in community-dwellers aged 65 years or over. Design: A randomized controlled trial with a two-group pretest and posttest will be conducted in a community activity center involving a sample of 64 community-dwellers who are 65 years or over. Methods: The intervention group will receive Resource Enhancement and Activation Program, a structured 12-week self-care program comprising 24 activities based on a salutogenic framework. The control group will receive the routine service. Both outcome and process evaluations will be used. Outcomes will be measured using standardized tools and these include quality of life, sense of coherence, satisfaction with life, activation measure, well-being, depression, loneliness and resilience. Focus group interviews will be conducted to explore participants&apos; views on the program. Conclusion: This study will provide evidence on the feasibility and effectiveness of a self-care program that is based on a salutogenic framework to promote quality of life and sense of coherence among older community-dwellers