Curating wellness during a pandemic in Singapore: COVID-19, museums, and digital imagination.

OBJECTIVES: The COVID-19 pandemic has caused unexpected disruption to the operation of many museums. However, the disruption also presents an opportunity for local museums to explore new modes of audience engagement that could also help to mitigate the negative health impact of COVID-19 through the imaginative use of technology. This article provides a snapshot of the various digital initiatives that were developed by museums in Singapore during the most challenging time of COVID-19 to exemplify the expanded role of museums as a public health resource. It will also offer a brief reflection on the challenges and benefits of curating wellbeing with digital technologies. STUDY DESIGN: A review of creative responses to COVID-19 by museums in Singapore. METHODS: Scoping search. RESULTS: Several local museums have stepped up efforts to support the wellbeing of people by exploring possibilities with digital virtual platforms. Their swift response to develop online contents following an abrupt closure due to the pandemic exemplifies the caring role of museums in offering people a much-needed respite from social isolation by connecting and interacting with others from a safe distance. Moving forward, it is also important for the museums to be mindful of the barriers that digital virtual platforms might present; since access to technology differs amongst population groups, as do digital competency, and literacy. Museums can benefit from further partnerships with sector experts and organisations to learn about the needs and challenges of different groups in future planning and design. This will help them to gather a holistic overview and help ensure inclusionary strategy and practice. CONCLUSIONS: COVID-19 has challenged museums to adapt their programme and keep the public engaged through virtual programmes on online spaces. Online initiatives have offered opportunities for people to remain socially active and meaningfully engaged despite the stringent measures imposed in response to the viral situation. Postpandemic, we can continue to anticipate a highly connected and inclusive society brought together by virtual technologies.

Healthcare resource use in hospitalized patients with carbapenem-resistant Gram-negative infections.

OBJECTIVES: Antimicrobial resistance (AMR) is a threat to global public health. Infections with resistant organisms are more challenging to treat, often delay patient recovery and can increase morbidity and mortality. Healthcare costs associated with treating patients with AMR organisms are poorly described. In particular, data for specific organisms, such as those harbouring carbapenem resistance, are lacking. METHODS: This was a retrospective, matched (1:1), single-centre, cohort study at a Central London hospital, comparing costs and resource use of 442 adult inpatients infected with either carbapenem-sensitive (CSO) or carbapenem-resistant organisms (CRO) over a two-year period. Resource use and micro-costing data were obtained from the hospital Patient, Education and Research Costing System (PERCS), and included both direct and indirect costs. RESULTS: Overall, the median healthcare-related cost of treating a patient with a CRO was more than double (£49,537 vs £19,299) that of treating a patient with a CSO. There were statistically significant increases in expenditure across 21 of 44 measured parameters including critical care costs, which accounted for the greatest proportion of overall costs in both groups. Infections were predominantly of the respiratory tract (41%) and caused by Pseudomonas aeruginosa (76%). CONCLUSIONS: Infection with CROs increases healthcare expenditure significantly. Many of the costs, including patient support, portering and catering, have been underappreciated in previous work. We additionally note that patients infected with CROs have longer hospital stays, and increased theatre operating times compared with patients infected with CSOs.

QTL mapping identifies a major locus for resistance in wheat to Sunn pest (Eurygaster integriceps) feeding at the vegetative growth stage.

KEY MESSAGE: This research provides the first report of a major locus controlling wheat resistance to Sunn pest. It developed and validated SNP markers that will be useful for marker-assisted selection. Sunn pest (Eurygaster integriceps Puton) is the most destructive insect pest of bread wheat and durum wheat in West and Central Asia and East Europe. Breeding for resistance at the vegetative stage of growth is vital in reducing the damage caused by overwintered adult populations that feed on shoot and leaves of seedlings, and in reducing the next generation of pest populations (nymphs and adults), which can cause damage to grain quality by feeding on spikes. In the present study, two doubled haploid (DH) populations involving resistant landraces from Afghanistan were genotyped with the 90k SNP iSelect assay and candidate gene-based KASP markers. The DH lines and parents were phenotyped for resistance to Sunn pest feeding, using artificial infestation cages at Terbol station, in Lebanon, over three years. Quantitative trait locus (QTL) analysis identified a single major locus on chromosome 4BS in the two populations, with the resistance allele derived from the landrace accessions, IG139431 and IG139883. The QTL explained a maximum of 42 % of the phenotypic variation in the Cham6 × IG139431 and 56 % in the Cham6 × IG139883 populations. SNP markers closest to the QTL showed high similarity to rice genes that putatively encode proteins for defense response to herbivory and wounding. The markers were validated in a large, unrelated population of parental wheat genotypes. All wheat lines carrying the 'C-G' haplotype at the identified SNPs were resistant, suggesting that selection based on a haplotype of favourable alleles would be effective in predicting resistance status of unknown genotypes.

A comparison of the assessment and management of cardiometabolic risk in patients with and without type 2 diabetes mellitus in Canadian primary care.

AIM: To investigate the cardiometabolic risk (CMR) assessment and management patterns for individuals with and without type 2 diabetes mellitus (T2DM) in Canadian primary care practices. METHODS: Between April 2011 and March 2012, physicians from 9 primary care teams and 88 traditional non-team practices completed a practice assessment on the management of 2461 patients >40 years old with no clinical evidence of cardiovascular disease and diagnosed with at least one of the following risk factor-T2DM, dyslipidaemia or hypertension. RESULTS: There were 1304 individuals with T2DM and 1157 without. Pharmacotherapy to manage hyperglycaemia, dyslipidaemia and hypertension was widely prescribed. Fifty-eight percent of individuals with T2DM had a glycated haemoglobin (HbA1c) ≤7.0%. Amongst individuals with dyslipidaemia, median low-density lipoprotein cholesterol (LDL-C) was 1.8 mmol/l for those with T2DM and 2.8 mmol/l for those without. Amongst individuals with hypertension, 30% of those with T2DM achieved the <130/80 mmHg target, whereas 60% of those without met the <140/90 mmHg target. The composite glycaemic, LDL-C and blood pressure (BP) target outcome was achieved by 12% of individuals with T2DM. Only 17% of individuals with T2DM and 11% without were advised to increase their physical activity. Dietary modifications were recommended to 32 and 10% of those with and without T2DM, respectively. CONCLUSIONS: Patients at elevated CMR were suboptimally managed in the primary care practices surveyed. There was low attainment of recommended therapeutic glycaemic, lipid and BP targets. Advice on healthy lifestyle changes was infrequently dispensed, representing a missed opportunity to educate patients on the long-term benefits of lifestyle modification.

An audit of fresh frozen plasma usage in an acute general hospital in Singapore.

BACKGROUND: FFP is often inappropriately used despite existence of guidelines. An audit was conducted with the aim of making recommendations to reduce inappropriate use. MATERIALS AND METHODS: A retrospective review of blood bank and electronic medical records of patients given FFP from October to December 2001 in an acute general hospital was undertaken. The criteria set by the College of American Pathologists in 1994 were used as the standards. RESULTS: Nine hundred and thirty-two units of FFP were used during the study period for 359 transfusion episodes. Only 98 (27%) episodes were deemed appropriate. Percentage of inappropriate requests was similar across specialties. FFP used in the setting of inadequately prolonged coagulation profiles or absence of bleeding or surgical intervention was the commonest reasons for inappropriate use. CONCLUSIONS: Our results showed significant proportion of FFP used outside of established international criteria. There may be many reasons for this and we suggest that a continual system of staff education and administrative intervention may help to reduce the inappropriate usage.

Origin and inheritance of group I introns in 26S rRNA genes of Gaeumannomyces graminis.

Studies of the distribution of the three group I introns (intron A, intron T, and intron AT) in the 26S rDNA of Gaeumannomyces graminis had suggested that they were transferred to a common ancestor of G. graminis var. avenae and var. tritici after it had branched off from var. graminis. Intron AT and intron A exhibited vertical inheritance and coevolved in concert with their hosts. Intron loss could occur after its acquisition. Loss of any one of the three introns could occur in var. tritici whereas only loss of intron T had been found in the majority of var. avenae isolates. The existence of isolates of var. tritici and var. avenae with three introns suggested that intron loss could be reversed by intron acquisition and that the whole process is a dynamic one. This process of intron acquisition and intron loss reached different equilibrium points for different varieties and subgroups, which explained the irregular distribution of these introns in G. graminis. Each of the three group I introns was more closely related to other intron sequences that share the same insertion point in the 26S rDNA than to each other. These introns in distantly related organisms appeared to have a common ancestry. This system had provided a good model for studies on both the lateral transfer and common ancestry of group I introns in the 26S rRNA genes.

Structural rearrangements of the chloroplast genome provide an important phylogenetic link in ferns.

The chloroplast genome of most land plants is highly conserved. In contrast, physical and gene mapping studies have revealed a highly rearranged chloroplast genome in species representing four families of ferns. In all four, there has been a rare duplication of the psbA gene and the order of the psbA, 16S, and 23S rRNA genes has been inverted. Our analysis shows that the described rearrangement results from a minimum of two inversions within the inverted repeat. This chloroplast DNA structure provides unambiguous evidence that phylogenetically links families of ferns once thought to belong to different major evolutionary lineages.

Analysis of Pteridium ribosomal RNA sequences by rapid direct sequencing.

A total of 864 bases from 5 regions interspersed in the 18S and 26S rRNA molecules from various clones of Pteridium covering the general geographical distribution of the genus was analysed using a rapid rRNA sequencing technique. No base difference has been detected amongst the three major lineages, two of which apparently separated before the breakup of the ancient supercontinent, Pangaea. These regions of the rRNA sequences have thus been conserved for at least 160 million years and are here compared with other eukaryotic, especially plant rRNAs.

Aluminum inhibits calpain-mediated proteolysis and induces human neurofilament proteins to form protease-resistant high molecular weight complexes.

We studied the effects of aluminum salts on the degradation of human neurofilament subunits (NF-H, NF-M, and NF-L, the high, middle, and low molecular weight subunits, respectively) and other cytoskeletal proteins using calcium-activated neutral proteinase (calpain) purified from human brain. Calpain-mediated proteolysis of NF-L, tubulin, and glial fibrillary acidic protein (GFAP), three substrates that displayed constant digestion rates in vitro, was inhibited by AlCl3 (IC50 = 200 microM) and by aluminum lactate (IC50 = 400 microM). Aluminum salts inhibited proteolysis principally by affecting the substrates directly. After exposure to 400 microM aluminum lactate and removal of unbound aluminum, human cytoskeletal proteins were degraded two- to threefold more slowly by calpain. When cytoskeleton preparations were exposed to aluminum salt concentrations of 100 microM or higher, proportions of NF-M and NF-H formed urea-insoluble complexes of high apparent molecular mass, which were also resistant to proteolysis by calpain. Complexes of tubulin and of GFAP were not observed under the same conditions. Aluminum salts irreversibly inactivated calpain but only at high aluminum concentrations (IC50 = 1.2 and 2.1 mM for aluminum lactate and AlCl3, respectively), although longer exposure to the ion reduced by twofold the levels required for protease inhibition. These interactions of aluminum with neurofilament proteins and the effects on proteolysis suggest possible mechanisms for the impaired axoplasmic transport of neurofilaments and their accumulation in neuronal perikarya after aluminum administration in vivo.

Chemotherapy-radiotherapy combination in the treatment of carcinoma of the cervix.

Three hundred eligible patients with carcinoma of the cervix out of a total of 560, registered between July 1981 and June 1983 were randomized into receiving either radiotherapy alone or radiotherapy plus weekly injection of bleomycin 15 mg and mitomycin C4 mg. To date (22 Feb. 1985) patients have been evaluated for response to therapy at 3 months and 1 year from completion of treatment. Although both at 3 months and 1 year the combined modality treatment appears to be marginally better (68% and 71% at 3 months, 56% and 63% at 1 year), the long term results remain uncertain at present. Treatment by the addition of chemotherapy to radiation was however well tolerated with a few complications.

Nasopharyngeal carcinoma in Malaysians under the age of 20 years.

A total of 52 cases of NPC were found in a five-year survey from 1978 to 1982 in Malaysia. The annual rate of occurrence was 3.4, 3.0, 2.4 and 1.8 for Chinese, Malays, Kadazans and Sarawakians, respectively. The age-specific incidence rates per 100 000 were highest for Kadazans (2.34 to 7.59) in comparison to the other races (0.11 to 1.24). The proportion of NPC in young Malaysians formed 1.2% in Chinese, 7.2% in Malays and 6.9% for others. A sexual bias was present in Chinese (male:female = 2.2) and Sarawakians (1.7) but not in Kadazans and Malays (0.9). In most Chinese, the primary tumour histologically is of the poorly differentiated characteristic and this type is the predominant tumour in the country. The Kadazans presented with well differentiated primary tumour and the Malays with all three histological types i.e. well-, poorly- and undifferentiated. At first examination enlarged lymph nodes were found in 95.7% of the patients and 65.2% had epistaxis and growth in the postnasal space. Antibodies to IgA anti-VCA were present in half of the 6 patients serologically studied.

Hypopyon--an early sign of leukaemic relapse.

A 5-year-old girl with ALL developed leukaemic hypopyon after 33 months of treatment. Bone marrow and CNS relapse developed 3 months later, which was successfully treated. Local radiotherapy did not prevent an ocular relapse 2 months later, and a second course of irradiation was successfully given. She developed a second bone marrow relapse and died about 9 months after hypopyon was first identified. It is postulated that hypopyon may be an early sign of leukaemic relapse.

Biochemical markers in bronchial carcinoma.

A total of 107 patients with bronchial carcinoma have been studied for the presence of potential circulating tumour markers which might be used as indicators of recurrence after primary treatment. Plasma carcinoembryonic antigen (CEA) levels were estimated in every patient and, after a preliminary hormone screening study, plasma calcitonin (CT) and parathyroid hormone (PTH) levels were assayed in 66 patients. Oat-cell tumours proved to be of particular interest in that CEA levels greater than 40 microgram/l were measured (initially or subsequently) in 40.6 percent and CT levels were elevated in 75 percent. Longitudinal studies point towards the possible use of elevated marker levels as guides to therapy when all other features of recurrent disease are lacking. It is clear that no ideal tumour marker exists for bronchial carcinoma but in an individual case an abnormal level of one or more marker substances may provide a valuable aid to treatment.