Whole-genome sequencing across multiple samples in a population provides an unprecedented opportunity for comprehensively characterizing the polymorphic variants in the population. Although the 1000 Genomes Project (1KGP) has offered brief insights into the value of population-level sequencing, the low coverage has compromised the ability to confidently detect rare and low-frequency variants. In addition, the composition of populations in the 1KGP is not complete, despite the fact that the study design has been extended to more than 2,500 samples from more than 20 population groups. The Malays are one of the Austronesian groups predominantly present in Southeast Asia and Oceania, and the Singapore Sequencing Malay Project (SSMP) aims to perform deep whole-genome sequencing of 100 healthy Malays. By sequencing at a minimum of 30× coverage, we have illustrated the higher sensitivity at detecting low-frequency and rare variants and the ability to investigate the presence of hotspots of functional mutations. Compared to the low-pass sequencing in the 1KGP, the deeper coverage allows more functional variants to be identified for each person. A comparison of the fidelity of genotype imputation of Malays indicated that a population-specific reference panel, such as the SSMP, outperforms a cosmopolitan panel with larger number of individuals for common SNPs. For lower-frequency (<5%) markers, a larger number of individuals might have to be whole-genome sequenced so that the accuracy currently afforded by the 1KGP can be achieved. The SSMP data are expected to be the benchmark for evaluating the value of deep population-level sequencing versus low-pass sequencing, especially in populations that are poorly represented in population-genetics studies.
A divergent synthesis of skeletally distinct arboridinine and arborisidine was achieved. The central divergent strategy was inspired by the divergent biosynthetic cyclization mode of arboridinine and arborisidine and their hidden topological connection. The branch point was reached through a Michael and Mannich cascade process. A site-selective intramolecular Mannich reaction was developed to construct the tetracyclic core of arboridinine, while a site-selective intramolecular α-amination of ketone was used to access the tetracyclic core of arborisidine. A strategic Peterson olefination through intramolecular nucleophile delivery was able to set up the exocyclic olefin of arboridinine.
Consequent to rapidly declining mortality and birth rates, developing countries, including Malaysia, can expect a rapid increase in the population aged 60 years and above. The health of the elderly is intimately tied up with both biophysical as well as psychosocial factors which include status loss, loneliness, fear of illness and death, poverty, harmful life-styles and deterioration of the quality of life. The effects of these psychosocial factors can manifest as sleep difficulties, worry and anxiety, depression, loss of interest, and a feeling of tiredness. In extreme cases, there may be auditory or visual hallucinations or paranoia. In the present paper, which is based upon a WHO sponsored study of 1001 elderly Malaysians, it is noted that 36% of the elderly have sleep difficulties, 47% "feel tired", 31% have a "loss of interest" and 22% are "worried tense". However 71% of the elderly are able to correctly perform at least 12 of 15 cognitive tests. 20% of elderly men smoke 15 or more cigarettes a day while 44% smoke at least one cigarette a day. 40% of elderly men indicate that their families complain about the amount of alcohol they drink. Undoubtedly primary health care programmes need to be re-oriented to the problems and needs of the elderly in countries such as Malaysia.
The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined.
Unlike much of Peninsular Malaysia, the Baram District of Sarawak remains sparsely populated and underserved, one of the most underserved peoples being the nomadic and semi-nomadic Penans of the Baram. Until quite recently these Penans lived as small nomadic bands of hunter-gatherers. More recently, they have begun to settle in longhouses. However, lacking the necessary skills to live a settled mode of life, these Penans suffer a great deal of hunger, malnutrition, disease and death. Primary health care with its emphasis on the seven essential elements, including food production and nutrition, environmental sanitation, good maternal and child health, knowledge of disease and how it can be prevented as well as the treatment and control of locally endemic diseases, is of critical value in the survival of the semi-nomadic Penans. The specially designed primary health care programme for the Penans of the Baram is outlined briefly in this paper.
Keyword: Baram, Penans, Primary Health Care, Sarawak, Village Health Promoter.
Four areas of differing remoteness were studied to determine the prevalence of goitre in the Keningau Division of Sabah. These areas were Keningau town, the Biah Resettlement Scheme, the Dalit subdistrict and the Pagalunggan subdistrict. The predominant ethnic group in these areas is the Murut. The overall endemicity of goitre for the study population was 76.5% for females aged 15 years and above. There was a significant correlation between the incidence of goitre and the remoteness of an area. The Dalit subdistrict has the highest incidence of goitre (82.6%) followed by the Pagalunggan subdistrict (77.8%), the majority of these goitre cases being classified as grade 2 (visible goitres). These were the two most remote areas in the study. In contrast, Keningau town, the least remote area has the lowest incidence of goitre (62.5%) with most of the goitres being relatively small. With regards to salt usage in the Dalit subdistrict, only 3.0% used iodised salt; 28.0% used fine salt; 3.6% used coarse salt and 65.5% used both fine and coarse salt. In the Pagalunggan subdistrict, all females used uniodised salt with 17.6% using fine salt, 20% using coarse salt and the remainder using both fine and coarse salt. As yet, there is no legislation for the iodisation of salt in Sabah. It is clear that all types of salt need to be iodised and adequately distributed to deprived areas, particularly inland areas.
The lack of efficient hydrogen storage material is one of the bottlenecks for the large-scale implementation of hydrogen energy. Here, a series of new hydrogen storage materials, i.e., anilinide-cyclohexylamide pairs, are proposed via the metallation of an aniline-cyclohexylamine pair. DFT calculations show that the enthalpy change of hydrogen desorption (ΔHd) can be significantly tuned from 60.0 kJ per mol-H2 for the pristine aniline-cyclohexylamine pair to 42.2 kJ per mol-H2 for sodium anilinide-cyclohexylamide and 38.7 kJ per mol-H2 for potassium anilinide-cyclohexylamide, where an interesting correlation between the electronegativity of the metal and the ΔHd was observed. Experimentally, the sodium anilinide-cyclohexylamide pair was successfully synthesised with a theoretical hydrogen capacity of 4.9 wt%, and the hydrogenation and dehydrogenation cycle can be achieved at a relatively low temperature of 150 °C in the presence of commercial catalysts, in clear contrast to the pristine aniline-cyclohexylamine pair which undergoes dehydrogenation at elevated temperatures.
Sodium phenoxide is a potentially promising hydrogen storage material due to its high hydrogen capacity and enhanced thermodynamic properties. Nevertheless, efficient catalysts are still lacking due to the high kinetic barrier for the reversible hydrogen uptake and release of sodium phenoxide. In the current work, a comparative study on the catalytic hydrogenation of sodium phenoxide was conducted. To our delight, a simple yet effective ruthenium-based catalyst was identified to respond aggressively to hydrogen in the solid-state hydrogenation of sodium phenoxide even at room temperature. The activity was enhanced by 6 fold with the as-synthesized 5.0% Ru/TiO2 catalyst as compared to that with commercial 5.0% Ru/Al2O3, respectively, under the same conditions.
We describe a method to obtain point and dispersion estimates for the energies of jets arising from b quarks produced in proton-proton collisions at an energy of s = 13 TeV at the CERN LHC. The algorithm is trained on a large sample of simulated b jets and validated on data recorded by the CMS detector in 2017 corresponding to an integrated luminosity of 41 fb - 1 . A multivariate regression algorithm based on a deep feed-forward neural network employs jet composition and shape information, and the properties of reconstructed secondary vertices associated with the jet. The results of the algorithm are used to improve the sensitivity of analyses that make use of b jets in the final state, such as the observation of Higgs boson decay to b b ¯ .
Pot experiments were conducted to investigate the influence of biochar addition and the mechanisms that alleviate Cd stress in the growth of tobacco plant. Cadmium showed an inhibitory effect on tobacco growth at different post-transplantation times, and this increased with the increase in soil Cd concentration. The growth index decreased by more than 10%, and the photosynthetic pigment and photosynthetic characteristics of the tobacco leaf were significantly reduced, and the antioxidant enzyme activity was enhanced. Application of biochar effectively alleviated the inhibitory effect of Cd on tobacco growth, and the alleviation effect of treatments is more significant to the plants with a higher Cd concentration. The contents of chlorophyll a, chlorophyll b, and carotenoids in the leaves of tobacco plants treated with biochar increased by 9.99%, 12.58%, and 10.32%, respectively, after 60 days of transplantation. The photosynthetic characteristics index of the net photosynthetic rate increased by 11.48%, stomatal conductance increased by 11.44%, and intercellular carbon dioxide concentration decreased to 0.92. Based on the treatments, during the growth period, the antioxidant enzyme activities of tobacco leaves comprising catalase, peroxidase, superoxide dismutase, and malondialdehyde increased by 7.62%, 10.41%, 10.58%, and 12.57%, respectively, after the application of biochar. Our results show that biochar containing functional groups can effectively reduce the effect of Cd stress by intensifying the adsorption or passivation of Cd in the soil, thereby, significantly reducing the Cd content in plant leaves, and providing a theoretical basis and method to alleviate soil Cd pollution and effect soil remediation.
The presence of chloride ion as an environmental pollutant is having a devastating and irreversible effect on aquatic and terrestrial ecosystems. To ensure safe and clean drinking water, it is vital to remove this substance using non-toxic and eco-friendly methods. This study presents a novel and highly efficient Ag NPs-modified bentonite adsorbent for removing chloride ion, a common environmental pollutant, from drinking water using a facile approach. The surface chemical properties and morphology of the pristine Na-bentonite and Ag NPs-Modified bentonite were characterized by field emission scanning electron microscopy (FESEM) and X-ray spectroscopy (EDX), X-Ray diffraction (XRD), Fourier transform infrared (FTIR), and zeta potential (ζ). To achieve maximum chloride ion removal, the effects of experimental parameters, including adsorbent dosage (1-9 g/L), chloride ion concentration (100-900 mg/L), and reaction time (5-25 h), were examined using the Response Surface Methodology (RSM). The chloride ion removal of 90% was obtained at optimum conditions (adsorbent dosage: 7 g/L, chloride ion concentration: 500 mg/L, and reaction time: 20 h). The adsorption isotherm and kinetics results indicated that the Langmuir isotherm model and pseudo-second-order kinetics were found suitable to chloride ion removal. Additionally, the regeneration and reusability of the Ag NPs-modified bentonite were further studied. In the regeneration and reusability study, the Ag NPs-modified bentonite has shown consistently ≥90% and ≥87% chloride ion removal even up to 2 repeated cycles, separately. Thus, the findings in this study provided convincing evidence for using Ag-NPs modified bentonite as a high-efficiency and promising adsorbent to remove chloride ion from drinking water.
Worldwide, some 240 million people have chronic hepatitis B virus (HBV), with the highest rates of infection in Africa and Asia. Our understanding of the natural history of HBV infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous APASL guidelines for management of HBV infection were published in 2012. The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The 2015 guidelines were developed by a panel of Asian experts chosen by the APASL. The clinical practice guidelines are based on evidence from existing publications or, if evidence was unavailable, on the experts' personal experience and opinion after deliberations. Manuscripts and abstracts of important meetings published through January 2015 have been evaluated. This guideline covers the full spectrum of care of patients infected with hepatitis B, including new terminology, natural history, screening, vaccination, counseling, diagnosis, assessment of the stage of liver disease, the indications, timing, choice and duration of single or combination of antiviral drugs, screening for HCC, management in special situations like childhood, pregnancy, coinfections, renal impairment and pre- and post-liver transplant, and policy guidelines. However, areas of uncertainty still exist, and clinicians, patients, and public health authorities must therefore continue to make choices on the basis of the evolving evidence. The final clinical practice guidelines and recommendations are presented here, along with the relevant background information.
The first cooperative study of the Asian Pacific bone marrow transplantation group included 75 patients with early leukemia who received human leukocyte antigen-matched sibling bone marrow transplants and were randomized into granulocyte colony-stimulating factor and control groups. The selected patients were registered from 10 centers in six countries and areas within Asia (Beijing, Taipei, Hong Kong, Japan, Korea, and Malaysia). The incidence of grades II-IV acute graft-vs.-host disease was 22.2%, and the 2-year survival rate was 62.7%. The period of protective isolation (27.1-66.7 days), period of hospitalization (38.6-130.5 days), and medical costs for 4 months (US $10,300-US $80,803) varied considerably. Good cooperation, i.e., low rate of protocol violation or rapid and precise presentation of case reports, was obtained.
The surgical approach for the correction of residual velopharyngeal insufficiency requiring secondary surgery at Chang Gung Memorial Hospital is the modified Furlow palatoplasty with pharyngeal flap (mFP-PF). The aim of this study was to describe the mFP-PF technique and to determine the results obtained with regard to improvements in velopharyngeal function in patients undergoing this surgery. This retrospective analysis included 58 non-syndromic patients treated during the period 1992-2015 who complained of hypernasal speech after primary cleft palate repair and failed postoperative speech therapy. All of them underwent mFP-PF surgery. Preoperative and postoperative perceptual speech assessment results were obtained. The male to female ratio in the study group was 1.2:1, and the mean patient age at the time of surgery was 8.27 years. The patients underwent nasoendoscopic examination and the velar closing ratio was categorized as 0.1-0.4 in 53.4% and 0.5-0.7 in 46.6%. The assessment of speech after mFP-PF showed statistically significant changes for all perceptual speech outcomes. The incidence of repeat surgery was 3.4%. This study revealed that 96.6% of patients did not require second surgery for velopharyngeal insufficiency. Further studies on obstructive sleep apnoea in post-mFP-PF patients and improvements to the surgical technique should be considered.
One hundred and ninety-nine children brought by 181 adults to a child health clinic based in a rural health sub-centre in Peninsular Malaysia are studied. It is noted that the families from which they come are relatively poor, with a large number of children, and that they are fairly highly motivated. Forty-four per cent of children attending the clinic at the time of the study are symptomatic indicating the need to organise the child health clinic on a "preventive-curative" basis. It is also noted that the young child is initially seen in early infancy but is lost to the clinic when he is older making it judicious to formulate immunization schedules that take this into account.
Due to the introduction of newer, more efficacious treatment options, there is a pressing need for policy makers and public health officials to develop or adapt national hepatitis C virus (HCV) control strategies to the changing epidemiological landscape. To do so, detailed, country-specific data are needed to characterize the burden of chronic HCV infection. In this study of 17 countries, a literature review of published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates was conducted, and inputs were validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Hong Kong to 2.4% in Taiwan, while the largest viraemic populations were in Nigeria (2 597 000 cases) and Taiwan (569 000 cases). Diagnosis, treatment and liver transplant rates varied widely across the countries included in this analysis, as did the availability of reliable data. Addressing data gaps will be critical for the development of future strategies to manage and minimize the disease burden of hepatitis C.