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Adherence problems are an inherent issue with any bio-psycho-social-spiritual prescription for any disease or behvaioural entity. It is all the more important in a patient with severe mental illness like Schizophrenia with limited insight. In several countries various interventions have been studied to address adherence problems in psychosis. Such as compliance therapy, family and psycho educational interventions, telephonic prompting and also legislative measures like Community Treatment Orders (CTO) have to date shown inconsistent and only modest benefits. Incentives based interventions have been tested for both preventive measures and also for adherence problems in chronic diseases. The Institute of Mental Health, Singapore has implemented a Pilot Supervision Programme (PSP) that incentivise patient engagement through quarterly vouchers as well as minimising barriers to accessing service by waiving off certain treatment fees whilst also offering them intensive intervention for one year. Our Pilot Programme, that focused on high risk patients with diagnosis of severe mental illness needing involuntary admission with history of either prolonged or repeated admissions, has begun recruiting patients since October 2012. The comparison was done between pre and post intervention phase. Total of 58 patients (95% suffering from schizophrenia or schizoaffective disorder) accepted into the treatment programme and of that nearly half of them have completed 6 months interventions. The results are promising with more than 50% improvemnt in length of stay, number of admissions and psychiatric emergency room visits, making significant impact on our high risk patients with severe mental illness.
Subcutaneous adipose tissue (scAT) and peripheral blood mononuclear cells (PBMC) play a significant role in obesity-associated systemic low-grade inflammation. High-fat diet (HFD) is known to induce inflammatory changes in both scAT and PBMC. However, the time course of the effect of HFD on these systems is still unknown. The aim of the present study was to determine the time course of the effect of HFD on PBMC and scAT. New Zealand white rabbits were fed HFD for 5 or 10 weeks (i.e. HFD-5 and HFD-10) or regular chow (i.e. control (CNT)-5 and CNT-10). Thereafter, metabolic and inflammatory parameters of PBMC and scAT were quantified. HFD induced hyperfattyacidaemia in HFD-5 and HFD-10 groups, with the development of insulin resistance in HFD-10, while no changes were observed in scAT lipid metabolism and inflammatory status. HFD activated the inflammatory pathways in PBMC of HFD-5 group and induced modified autophagy in that of HFD-10. The rate of fat oxidation in PBMC was directly associated with the expression of inflammatory markers and tended to inversely associate with autophagosome formation markers in PBMC. HFD affected systemic substrate metabolism, and the metabolic, inflammatory and autophagy pathways in PBMC in the absence of metabolic and inflammatory changes in scAT. Dietary approaches or interventions to avert HFD-induced changes in PBMC could be essential to prevent metabolic and inflammatory complications of obesity and promote healthier living.
Fracture of crystalline silicon (c-Si) solar cells in photovoltaic modules is a big concern to the photovoltaics (PV) industry. Cell cracks cause performance degradation and warranty issues to the manufacturers. The roots of cell fractures lie in the manufacturing and integration process of the cells and modules as they go through a series of elevated temperature and pressure processes, involving bonding of dissimilar materials, causing residual stresses. Evaluation of the exact physical mechanisms leading to these thermomechanical stresses is highly essential to quantify them and optimize the PV modules to address them. We present a novel synchrotron X-ray microdiffraction based techniques to characterize the stress and fracture in the crystalline silicon PV modules. We show the detailed stress state after soldering and lamination process, using the synchrotron X-ray microdiffraction experiments. We also calculate the maximum tolerable microcrack size in the c-Si cells to sustain the residual stress after lamination. We further demonstrate the effect of these residual stresses on the cell fractures using the widely accepted fracture (4-point bending) tests. These test results show that the soldering and lamination induced localized residual stresses indeed reduce the load-carrying capacity of the c-Si cells.
Method of levels (MOL) is an innovative transdiagnostic cognitive therapy with potential advantages over existing psychological treatments for psychosis.
The Next Level study is a feasibility randomised controlled trial (RCT) of MOL for people experiencing first-episode psychosis. It aims to determine the suitability of MOL for further testing in a definitive trial (trial registration ISRCTN13359355).
The study uses a parallel group non-masked feasibilityRCT design with two conditions: (a) treatment as usual (TAU) and (b) TAU plus MOL. Participants (n = 36) were recruited from early intervention in psychosis services. Outcome measures are completed at baseline, 10 and 14 months. The primary outcomes are recruitment and retention.
Participants’ demographic and clinical characteristics are presented along with baseline data.
Next Level has recruited to target, providing evidence that it is feasible to recruit to a RCT of MOL for first-episode psychosis.
A study conducted as part of the development of the Eleventh International Classification of Mental Disorders for Primary Health Care (ICD-11 PHC) provided an opportunity to test the relationships among depressive, anxious and somatic symptoms in PHC.
Primary care physicians participating in the ICD-11 PHC field studies in five countries selected patients who presented with somatic symptoms not explained by known physical pathology by applying a 29-item screening on somatic complaints that were under study for bodily stress disorder. Patients were interviewed using the Clinical Interview Schedule-Revised and assessed using two five-item scales that measure depressive and anxious symptoms. Structural models of anxious-depressive symptoms and somatic complaints were tested using a bi-factor approach.
A total of 797 patients completed the study procedures. Two bi-factor models fit the data well: Model 1 had all symptoms loaded on a general factor, along with one of three specific depression, anxiety and somatic factors [x2 (627) = 741.016, p < 0.0011, RMSEA = 0.015, CFI = 0.911, TLI = 0.9]. Model 2 had a general factor and two specific anxious depression and somatic factors [x2 (627) = 663.065, p = 0.1543, RMSEA = 0.008, CFI = 0.954, TLI = 0.948].
These data along with those of previous studies suggest that depressive, anxious and somatic symptoms are largely different presentations of a common latent phenomenon. This study provides support for the ICD-11 PHC conceptualization of mood disturbance, especially anxious depression, as central among patients who present multiple somatic symptoms.
Previously known to form only under high pressure synthetic conditions, here we report that the T′-type 214-structure cuprate based on the rare earth atom Tb is stabilized for ambient pressure synthesis through partial substitution of Pd for Cu. The new material is obtained in purest form for mixtures of nominal composition Tb1.96Cu0.8Pd0.2O4. The refined formula, in orthorhombic space group Pbca, with a = 5.5117(1) Å, b = 5.5088(1) Å, and c = 11.8818(1) Å, is Tb2Cu0.83Pd0.17O4. An incommensurate structural modulation is seen along the a axis by electron diffraction and high resolution imaging. Magnetic susceptibility measurements reveal long-range antiferromagnetic ordering at 7.9 K, with a less pronounced feature at 95 K; a magnetic moment reorientation transition is observed to onset at a field of approximately 1.1 T at 3 K. The material is an n-type semiconductor.
Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) is a pest species complex that causes widespread damage to cassava, a staple food crop for millions of households in East Africa. Species in the complex cause direct feeding damage to cassava and are the vectors of multiple plant viruses. Whilst significant work has gone into developing virus-resistant cassava cultivars, there has been little research effort aimed at understanding the ecology of these insect vectors. Here we assess critically the knowledge base relating to factors that may lead to high population densities of sub-Saharan African (SSA) B. tabaci species in cassava production landscapes of East Africa. We focus first on empirical studies that have examined biotic or abiotic factors that may lead to high populations. We then identify knowledge gaps that need to be filled to deliver sustainable management solutions. We found that whilst many hypotheses have been put forward to explain the increases in abundance witnessed since the early 1990s, there are little published data and these tend to have been collected in a piecemeal manner. The most critical knowledge gaps identified were: (i) understanding how cassava cultivars and alternative host plants impact population dynamics and natural enemies; (ii) the impact of natural enemies in terms of reducing the frequency of outbreaks and (iii) the use and management of insecticides to delay the development of resistance. In addition, there are several fundamental methodologies that need to be developed and deployed in East Africa to address some of the more challenging knowledge gaps.
Insulin-like growth factor 1 (IGF1) is a regulator of human growth during infancy and childhood, known to promote bone and muscle growth as well as lipid accumulation. This study aimed to investigate the effects of formula milk with or without IGF1 supplementation (in the form of pure IGF1 or bovine colostrum) on growth and body composition in infant cynomolgus macaques during the first 6 months of life. Three groups of infants were nursery-reared and received formula milk with or without IGF1 or bovine colostrum supplementation for 4 months, and a fourth group consisting of breast-fed infants was included for comparison (n=6 for each group). Ranked-based analysis of covariance was used to detect differences between adjusted means for sex. No differences in weight, height, fat mass, and fat-free mass could be detected between groups. However, bone mineral density (BMD) was significantly different between groups at the end of formula feeding. Infants that received bovine colostrum supplementation displayed higher mean BMD than infants of all other groups, with no differences between the latter three groups. In conclusion, our results suggest that supplementation with bovine colostrum can enhance BMD in formula-fed infants, an effect that apparently does not depend on IGF1. Bovine colostrum supplementation could be beneficial for long-term bone health in infants with suboptimal bone growth.
An outbreak of gastroenteritis affected 453 attendees (attack rate 28·5%) of six separate events held at a hotel in Singapore. Active case detection, case-control studies, hygiene inspections and microbial analysis of food, environmental and stool samples were conducted to determine the aetiology of the outbreak and the modes of transmission. The only commonality was the food, crockery and cutlery provided and/or handled by the hotel's Chinese banquet kitchen. Stool specimens from 34 cases and 15 food handlers were positive for norovirus genogroup II. The putative index case was one of eight norovirus-positive food handlers who had worked while they were symptomatic. Several food samples and remnants tested positive for Escherichia coli or high faecal coliforms, aerobic plate counts and/or total coliforms, indicating poor food hygiene. This large common-source outbreak of norovirus gastroenteritis was caused by the consumption of contaminated food and/or contact with contaminated crockery or cutlery provided or handled by the hotel's Chinese banquet kitchen.
Since the emergence of Middle East respiratory syndrome coronavirus (MERS-CoV), Singapore has enhanced its national surveillance system to detect the potential importation of this novel pathogen. Using the guidelines from the Singapore Ministry of Health, a suspect case was defined as a person with clinical signs and symptoms suggestive of pneumonia or severe respiratory infection with breathlessness, and with an epidemiological link to countries where MERS-CoV cases had been reported within the preceding 14 days. This report describes a retrospective review of 851 suspected MERS-CoV cases assessed at the adult tertiary-care hospital in Singapore between September 2012 and December 2015. In total, 262 patients (31%) were hospitalized. All had MERS-CoV infection ruled out by RT–PCR or clinical assessment. Two hundred and thirty (88%) of the hospitalized patients were also investigated for influenza virus by RT–PCR. Of these, 62 (27%) tested positive for seasonal influenza. None of the patients with positive influenza results had been vaccinated in the year prior to hospital admission. Ninety-three (36%) out of the 262 hospitalized patients had clinical and/or radiological evidence of pneumonia. This study demonstrates the potential benefits of pre-travel vaccination against influenza and pneumococcal disease.
We investigate symbolic and regular powers of monomial ideals. For a square-free monomial ideal I ⊆ 𝕜[x0, … , xn] we show that for all positive integers m, t and r, where e is the big-height of I and . This captures two conjectures (r = 1 and r = e): one of Harbourne and Huneke, and one of Bocci et al. We also introduce the symbolic polyhedron of a monomial ideal and use this to explore symbolic powers of non-square-free monomial ideals.
A number of thin silicon films are prepared through ultra-high-vacuum evaporation on optical quality fused quartz substrates with different growth temperatures. Through an analysis of grazing incidence X-ray diffraction results, a phase transition, from amorphous-to-crystalline, is found corresponding to increases in the growth temperature. The corresponding Raman spectra are also observed to change their form as the films go through this phase transition. Using a Raman peak decomposition process, this phase transition is then quantitatively characterized through the determination of the amount of intermediate-range order and the crystalline volume fraction for the various growth temperatures considered in this analysis. The possible device consequences of these results are then commented upon.
We examine the roles of actuaries in UK life offices, along with trends, challenges to and opportunities for actuaries. We carry out an analysis of senior roles in life offices, a questionnaire survey and interviews with relevant senior personnel. We find that actuaries occupy many important roles in life offices and are regarded as having good industry knowledge and technical skills, especially in financial modelling. There are fewer executive directors and more non-executive directors of life offices who are actuaries compared with the position in 1990. A higher proportion of reserved roles is outsourced to consultants than was the case in 1990. Only a small number of Actuarial Function Holders are directors. Actuaries are more siloed than was the case in the past, although actuaries are well represented in the finance and risk functions of many offices. Although actuarial work in connection with the preparation for Solvency II will decline, there will be important ongoing requirements for actuaries following Solvency II implementation. We also see opportunities for actuaries in four areas: in risk management, in financial analysis and management based on Solvency II and international financial reporting standards, in connection with “big data”, and in product development and the customer proposition. There are implications for the examination syllabus, continuing professional development and research.
The Doba gabbro was collected from an exploration well through the Cretaceous Doba basin of southern Chad. The gabbro is composed mostly of plagioclase, clinopyroxene and Fe–Ti oxide minerals and displays cumulus mineral textures. Whole-rock 40Ar–39Ar step-heating geochronology yielded a Late Permian plateau age of 257 ± 1 Ma. The major and trace elemental geochemistry shows that the gabbro is tholeiitic in composition and has trace element ratios (i.e. La/YbN > 7; Sm/YbPM > 3.4; Nb/Y > 1; Zr/Y > 5) indicative of a basaltic melt derived from a garnet-bearing mantle source. The moderately enriched Sr–Nd isotopes (i.e. ISr = 0.70495 to 0.70839; ɛNd(T) = −1.0 to −1.3) fall within the mantle array (i.e. OIB-like) and are similar to other Late Permian plutonic rocks of North-Central Africa (i.e. ISr = 0.7040 to 0.7070). The enriched isotopic composition of the Doba gabbro contrasts with the more depleted compositions of the spatially associated Neoproterozoic post-Pan-African within-plate granites. The contrasting Nd isotope composition between the older within-plate granites and the younger Doba gabbro indicates that different mantle sources produced the rocks and thus may mark the southern boundary of the Saharan Metacraton.
the maternally inherited MTTL1 A3243G mutation in the mitochondrial genome causes MelaS (Mitochondrial encephalopathy lactic acidosis with Stroke-like episodes), a condition that is multisystemic but affects primarily the nervous system. Significant intra-familial variation in phenotype and severity of disease is well recognized.
retrospective and ongoing study of an extended family carrying the MTTL1 A3243G mutation with multiple symptomatic individuals. tissue heteroplasmy is reviewed based on the clinical presentations, imaging studies, laboratory findings in affected individuals and pathological material obtained at autopsy in two of the family members.
there were seven affected individuals out of thirteen members in this three generation family who each carried the MTTL1 A3243G mutation. the clinical presentations were varied with symptoms ranging from hearing loss, migraines, dementia, seizures, diabetes, visual manifestations, and stroke like episodes. three of the family members are deceased from MelaS or to complications related to MelaS.
the results of the clinical, pathological and radiological findings in this family provide strong support to the current concepts of maternal inheritance, tissue heteroplasmy and molecular pathogenesis in MelaS. neurologists (both adult and paediatric) are the most likely to encounter patients with MelaS in their practice. genetic counselling is complex in view of maternal inheritance and heteroplasmy. newer therapeutic options such as arginine are being used for acute and preventative management of stroke like episodes.
The details of ice interface dynamics in complex systems are critical to a variety of natural and commercial processes. A platform for low temperature environmental transmission electron microscopy is developed and applied to characterization of ice crystallization in colloidal solutions. The platform is utilized for studying the phase evolution in ice during crystallization and the dynamic interactions of Au nanoparticles at the crystallization front. The results indicate that models developed to treat ice–particle interactions at the micron scale extend well to the nanoscale.
We present a case of large, symptomatic lingual thyroid which was successfully and safely removed via a transoral approach, using the da Vinci robotic system, in an academic medical centre in Singapore.
A 17-year-old female adolescent presented with a large lingual thyroid causing upper airway obstruction. She underwent robotic, minimally invasive, transoral resection using the da Vinci system. Post-operative recovery was uneventful; she was able to commence oral feeding almost immediately, and was discharged from hospital on the fourth post-operative day.
It is surgically feasible and safe to undertake transoral robotic resection of a large lingual thyroid. This approach may allow faster recovery and shorter hospitalisation for patients. Surgical safety requires a full understanding of the intralingual neurovascular anatomy.