A review of psychotherapy as add-on treatment to pharmacotherapy for bipolar disorder

Bipolar disorder is a complex illness that makes its treatment challenging. Pharmacotherapy is the foremost remedy, however not all patients benefit from medication alone. Therefore, there are increasing studies to develop various psychotherapy approaches to enhance the treatment outcome. This study presents a systematic review of literatures on the psychotherapy approaches as add-on treatment to pharmacotherapy. Among literatures relevant to psychotherapy for bipolar disorder, four common approaches have been identified as adjunct to pharmacotherapy; namely cognitive-behavioral, family-focused, interpersonal and social rhythm and psychoeducation, literatures that discussed comprehensively and structurally across these approaches with evidence-based studies were tabulated to provide a detailed view of the treatment effects for each approach. The needs for using psychotherapy in treating bipolar disorder are clarified through the factors in medication limitation, functional recovery and models of onset and relapse in the illness. Further, discussion involves treatment effects for each identified approach in every tabulated literature and differences in effectiveness relating to various aspects of the illness and treatment condition. This study concluded positively on the benefits of using the four identified psychotherapy approaches for patients with bipolar disorder. The effectiveness of each approach varies under different contexts for different aspects of the illness. Suggestions are provided for future studies

Development and Clinical Evaluation of a Root Coverage Procedure Using a Collagen Barrier Membrane

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141360/1/jper0770.pd

A review of chemical and physical properties of coconut shell in asphalt mixture

Coconut shell is an agricultural waste which is abundant to the environment and also rise the risk to health as well as environment. Currently, most of the researchers are investigate the use of waste material which can reduce the costof construction and increase the strength. Some of thewaste materials are used in construction for instance palm oil fuel ash, rice husk, fly ash slag, sludge, coconut shell and etc. Hence, coconut shellwas selected for this study. Generally, the chemical and physical properties of coconut shell in road construction was highlighted in this paper and compared with others raw materials. In addition, the chemical and physical characteristics of coconut shell was presented according to X-ray Fluorescence (XRF), Scanning Electron Microscopy (SEM),Fourier Transform Infrared Spectroscopy (FTIR) Analysis and X-ray Diffraction (XRD). A review of using coconut shell in asphalt mixture has better potential than others raw materials to constribute in construction field

Resilient modulus of double layer porous asphalt: application of alkali treated coconut shell and fiber as aggregate replacement

Coconut shell and coconut fiber are the new waste that have been concerned in the highway asphalt pavement industry lately. This paper has studied about the effect of coconut shell and coconut fiber to the resilient modulus of double layer porous asphalt (DLPA). The coconut shell has been substitute to the double layer porous asphalt by 5%, 10% and 15 % of the aggregate with 5 mm size by weight while coconut fiber was added to the asphalt incorporating 0.3% and 0.5% by weight. Before mixing with others aggregate, coconut shell and coconut fiber was treated with 5%wt NaOH to reduce it water absorption ability. The samples were prepared by using Marshall Method. The result shows that DLPA with 10% has better resilient modulus under 25ºC temperature for unaged and aged samples. However, the sample with coconut fiber has lower resilient modulus as the amount of coconut fiber has increased. In general, the substitution of 10% coconut shell provided better resilient modulus among the percentages that have been chosen

A review of utilization of coconut shell and coconut fiber in road construction

This paper provides a review of utilization coconut shell and coconut fiber in road construction. Coconut shell and coconut fiber are new waste materials used in highway industry. Some studies showed that coconut fiber can increase the stability, skid resistance and resilient modulus while coconut shell can improve the indirect tensile strength and static creep behavior of the modified asphalt pavement. In contrast, coconut fiber does not improve the fatigue life of the modified bituminous mixes. In general, the previous research illustrates that coconut shell and coconut fiber significantly improves the engineering properties of asphalt mixtures when mixed with modified bitumen

Two-Year Clinical and Functional Outcomes of an Asian Cohort at Ultra-High Risk of Psychosis

Background: To determine the 2-year clinical and functional outcomes of an Asian cohort at ultra-high risk (UHR) of psychosis.Method: This was a longitudinal study with a follow-up period of 2 years on 255 help-seeking adolescents and young adults at UHR of psychosis managed by a multi-disciplinary mental health team in Singapore. Clients received case management, psychosocial, and pharmacological treatment as appropriate. Data comprising symptom and functional outcomes were collected over the observation period by trained clinicians and psychiatrists.Results: The 2-year psychosis transition rate was 16.9%, with a median time to transition of 168 days. After 2 years, 14.5% of the subjects had persistent at-risk symptoms while 7.5% developed other non-psychotic psychiatric disorders. 38.4% of the cohort had recovered and was discharged from mental health services. The entire cohort's functioning improved as reflected by an increase in the score of the Social and Occupational Functioning Assessment Scale during the follow-up period. Predictors to psychosis transition included low education level, baseline unemployment, a history of violence, and brief limited intermittent psychotic symptoms, while male gender predicted the persistence of UHR state, or the development of non-psychotic disorders.Conclusion: Use of the current UHR criteria allows us to identify individuals who are at imminent risk of developing not just psychosis, but also those who may develop other mental health disorders. Future research should include identifying the needs of those who do not transition to psychosis, while continuing to refine on ways to improve the UHR prediction algorithm for psychosis

Establishment of the nasal microbiota in the first 18 months of life: Correlation with early-onset rhinitis and wheezing.

BACKGROUND: Dynamic establishment of the nasal microbiota in early life influences local mucosal immune responses and susceptibility to childhood respiratory disorders. OBJECTIVE: The aim of this case-control study was to monitor, evaluate, and compare development of the nasal microbiota of infants with rhinitis and wheeze in the first 18 months of life with those of healthy control subjects. METHODS: Anterior nasal swabs of 122 subjects belonging to the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) birth cohort were collected longitudinally over 7 time points in the first 18 months of life. Nasal microbiota signatures were analyzed by using 16S rRNA multiplexed pair-end sequencing from 3 clinical groups: (1) patients with rhinitis alone (n = 28), (2) patients with rhinitis with concomitant wheeze (n = 34), and (3) healthy control subjects (n = 60). RESULTS: Maturation of the nasal microbiome followed distinctive patterns in infants from both rhinitis groups compared with control subjects. Bacterial diversity increased over the period of 18 months of life in control infants, whereas infants with rhinitis showed a decreasing trend (P < .05). An increase in abundance of the Oxalobacteraceae family (Proteobacteria phylum) and Aerococcaceae family (Firmicutes phylum) was associated with rhinitis and concomitant wheeze (adjusted P < .01), whereas the Corynebacteriaceae family (Actinobacteria phylum) and early colonization with the Staphylococcaceae family (Firmicutes phylum; 3 weeks until 9 months) were associated with control subjects (adjusted P < .05). The only difference between the rhinitis and control groups was a reduced abundance of the Corynebacteriaceae family (adjusted P < .05). Determinants of nasal microbiota succession included sex, mode of delivery, presence of siblings, and infant care attendance. CONCLUSION: Our results support the hypothesis that the nasal microbiome is involved in development of early-onset rhinitis and wheeze in infants

The non-coding transcriptome as a dynamic regulator of cancer metastasis.

Since the discovery of microRNAs, non-coding RNAs (NC-RNAs) have increasingly attracted the attention of cancer investigators. Two classes of NC-RNAs are emerging as putative metastasis-related genes: long non-coding RNAs (lncRNAs) and small nucleolar RNAs (snoRNAs). LncRNAs orchestrate metastatic progression through several mechanisms, including the interaction with epigenetic effectors, splicing control and generation of microRNA-like molecules. In contrast, snoRNAs have been long considered "housekeeping" genes with no relevant function in cancer. However, recent evidence challenges this assumption, indicating that some snoRNAs are deregulated in cancer cells and may play a specific role in metastasis. Interestingly, snoRNAs and lncRNAs share several mechanisms of action, and might synergize with protein-coding genes to generate a specific cellular phenotype. This evidence suggests that the current paradigm of metastatic progression is incomplete. We propose that NC-RNAs are organized in complex interactive networks which orchestrate cellular phenotypic plasticity. Since plasticity is critical for cancer cell metastasis, we suggest that a molecular interactome composed by both NC-RNAs and proteins orchestrates cancer metastasis. Interestingly, expression of lncRNAs and snoRNAs can be detected in biological fluids, making them potentially useful biomarkers. NC-RNA expression profiles in human neoplasms have been associated with patients' prognosis. SnoRNA and lncRNA silencing in pre-clinical models leads to cancer cell death and/or metastasis prevention, suggesting they can be investigated as novel therapeutic targets. Based on the literature to date, we critically discuss how the NC-RNA interactome can be explored and manipulated to generate more effective diagnostic, prognostic, and therapeutic strategies for metastatic neoplasms

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all &gt;0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Downscaling of rainfall from global circulation model to station-level data

Due to modernization and rapid industrialization worldwide, burning of fossil fuels to generate enormous amount of energy for usage has become an inevitable process. However, the downside of it is large amount of carbon dioxide is being produced from the burning of fossil fuels. Carbon dioxide is the primary greenhouse gases that contribute to global warming which has a serious impact on the climate these days. Singapore is also affected such that Singapore’s weather has become more unpredictable, irregular and out of the usual norm in the recent years. This year, during the period of January and February 2014, Singapore which experiences rain on most of the days, has suffered its longest dry spell and had little rainfall. While some dry weather is expected at this time of year, the abnormal lack of rain is raising concerns about the pace of climate change in the region. Singapore’s temperature is also getting hotter and rising at a rate of 0.26 °C per decade since 1951. Local government authorities are viewing this climate change issue as one of its main concerns because it will pose serious consequences to the well being of its citizens in the near future. To be able to predict the future precipitate and temperature, preventive measures can be taken in time to handle and deal with the problems caused from climate change. Therefore, this project aims to downscale rainfall and temperature data from Global Circulation Model (GCM) to station level data using Statistical DownScaling Model (SDSM). After assessing the accuracy and performance of SDSM, future prediction of rainfall and temperature can be generated by SDSM and the trends of these future prediction data will be further discussed and analyzed.Bachelor of Engineering (Civil