ABC in context / Dr. Nalini Arumugam … [et al.]

Recognising letters is an essential component of the English language that students should know in order to begin developing basic language skills. However, it is observed that some children at pre-school level have not mastered this basic English language skill and this poses a stumbling block as they enter primary schools. English language educators adopt many approaches to enhance language acquisition, and one way is to create interesting activities to capture children's attention. It is viable to adopt an interactive approach through authentic pictures and letters accompanied with suitable sound. As the children follow the familiar objects, they learn known and unknown accompanying letters. Gradually they internalise these letters and improve their reading progressively. Even if they made mistakes, they are able to reattempt and strive to get answers by engaging in multi-trial opportunities without losing their self-esteem because there is no teacher or peers to evaluate them. This experiential learning enables children to self-assess their level and guides them through till they experience achievement. At the end, learning letters through authentic pictorial guidance as well as trial and error approach encourages children to learn independently to self-regulate their learning. This innovation is expected to have a good commercial value among young learners, teachers and parents

Health promotion activity in Kampung Kukut, Beaufort

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Thiopurine monotherapy is effective in ulcerative colitis but significantly less so in Crohn’s disease: long-term outcomes for 11 928 patients in the UK inflammatory bowel disease bioresource

Objective: Thiopurines are widely used as maintenance therapy in inflammatory bowel disease (IBD) but the evidence base for their use is sparse and their role increasingly questioned. Using the largest series reported to date, we assessed the long-term effectiveness of thiopurines in ulcerative colitis (UC) and Crohn’s disease (CD), including their impact on need for surgery. Design: Outcomes were assessed in 11 928 patients (4968 UC, 6960 CD) in the UK IBD BioResource initiated on thiopurine monotherapy with the intention of maintaining medically induced remission. Effectiveness was assessed retrospectively using patient-level data and a definition that required avoidance of escalation to biological therapy or surgery while on thiopurines. Analyses included overall effectiveness, time-to-event analysis for treatment escalation and comparison of surgery rates in patients tolerant or intolerant of thiopurines. Results: Using 68 132 patient-years of exposure, thiopurine monotherapy appeared effective for the duration of treatment in 2617/4968 (52.7%) patients with UC compared with 2378/6960 (34.2%) patients with CD (p<0.0001). This difference was corroborated in a multivariable analysis: after adjusting for variables including treatment era, thiopurine monotherapy was less effective in CD than UC (OR 0.47, 95% CI 0.43 to 0.51, p<0.0001). Thiopurine intolerance was associated with increased risk of surgery in UC (HR 2.44, p<0.0001); with a more modest impact on need for surgery in CD (HR=1.23, p=0.0015). Conclusion: Thiopurine monotherapy is an effective long-term treatment for UC but significantly less effective in CD

HLA-DQA1*05 carriage associated with development of anti-drug antibodies to infliximab and adalimumab in patients with Crohn's Disease

Anti-tumor necrosis factor (anti-TNF) therapies are the most widely used biologic drugs for treating immune-mediated diseases, but repeated administration can induce the formation of anti-drug antibodies. The ability to identify patients at increased risk for development of anti-drug antibodies would facilitate selection of therapy and use of preventative strategies.This article is freely available via Open Access. Click on Publisher URL to access the full-text

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n1⁄42,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n1⁄43,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombinedo5108) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine–cytokine pathways, for which relevant therapies exist

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Are IT Entrepreneurs More Likely Than Non-IT Ones To Reattempt Entrepreneurship After A Failure?

Internet and mobile devices have made IT ubiquitous and rapid technology evolution has led to diminishing cost of ownership for IT products. Consequently, entrepreneurs who create IT products and services are viewed with broad interest by investors, researchers, governments, and incubators. This research proposes that IT entrepreneurs need to be distinguished from those in other sectors and studied as a unique typology in any entrepreneurship research and investigates whether IT entrepreneurs are more likely to reattempt entrepreneurship due to the influence of five external factors viz., Funding availability, Opportunity cost, Value of knowledge acquired in failure, and Technology evolution and IT and non-IT entrepreneurs view failure differently. The theoretical rationale for bifurcating entrepreneurs as IT and Non-IT for analysis emerged from a) the recent observation that the top five companies in the US by market capitalization are all IT ventures whereas in 2001 when only one constituted the list, b) rapid growth in the application of ML and AI in all sectors, and c) the observed differences between IT and Non-IT entrepreneurs with respect to the five external factors. We theorize that variations in the external factors may differently influence IT and Non-IT entrepreneurs’ decision to reattempt and/or sentiments about failure. The objective of this thesis is to recommend new policies and modifications to existing ones if IT entrepreneurs are observed to have distinct advantages/disadvantages compared to Non-IT ones.Our mixed method approach included an online quantitative survey that measured the influence of the five factors on a scale and qualitative semi-structured interviews to comprehend the sentiments that led to the responses in the survey. To understand the degree of influence of the five external factors quantitatively, hypothesis testing and regression analysis were adopted whereas a thematic analysis was performed on qualitative data.The evidence from our data indicated that non-IT entrepreneurs viewed venture failures more negatively than did IT ones and surprisingly that the sentiments about Funding availability were identical between IT and non-IT entrepreneurs. However the Opportunity cost, the Value of knowledge acquired, the Stigma of failure, and the Technology evolution were higher in their respective measures for IT entrepreneurs than for non-IT ones. Finally it was shown that IT entrepreneurs were more likely to reattempt entrepreneurship after failure than do Non-IT ones.Based on the findings of this study, we recommend that new policies relating to leasing of capital equipment, job opportunities upon failure, public announcement campaigns to mitigate the Stigma of failure, the creation of specific targeted loan/funding mechanisms, and special training and education be formulated to mitigate the disadvantages that are unique to non-IT entrepreneurs.The findings of this study underline how the typology based research can expose certain characteristics of entrepreneurship that may not be evident otherwise. This study may be unique in juxtaposing IT and Non-IT entrepreneurs through the lens of five external factors. Entrepreneurs have been documented to be heterogeneous and this research lays the foundation for further focused research on IT entrepreneurs especially due to the role played by IT in people’s lives.</div