124 research outputs found
Neonatal cholestasis and biliary atresia: perspective from Malaysia
No full textThe liver is an important organ of the human body, playing a major role in the metabolism and storage of nutrients, synthesis of protein and other nutrients, as well as detoxifying many metabolic by-products. The response of the foetal and newborn liver to external insult and injury is limited. This is because the ability of the closely interdependent structures of a developing liver of expressing in the face of a variety of insults is limited as well. Thus most infants with insults to the liver present as cholestatic jaundice with variable degree of pale stools, enlarged liver and conjugated hyperbilirubinaemia. Biliary atresia, an idiopathic condition characterized by progressive fibrosing obliteration of both intra- and extrahepatic bile ducts, is the most important cause of neonatal cholestasis worldwide, including Malaysia. It is also the most important indication for childhood liver transplantation the world over. Challenges facing infants with biliary atresia include a delay in the diagnosis and late surgery, leading to a poor outcome. This often results from a failure to recognise the potential serious nature of an infant with prolonged cholestatic jaundice and pale stools among health care professional
Cost utility, budget impact, and scenario analysis of racecadotril in addition to oral rehydration for acute diarrhea in children in Malaysia
No full textObjective: To perform cost utility (CU) and budget impact (BI) analyses augmented by scenario analyses of critical model structure components to evaluate racecadotril as adjuvant to oral rehydration solution (ORS) for children under 5 years with acute diarrhea in Malaysia. Methods: A CU model was adapted to evaluate racecadotril plus ORS vs ORS alone for acute diarrhea in children younger than 5 years from a Malaysian public payer’s perspective. A bespoke BI analysis was undertaken in addition to detailed scenario analyses with respect to critical model structure components. Results: According to the CU model, the intervention is less costly and more effective than comparator for the base case with a dominant incremental cost-effectiveness ratio of –RM 1,272,833/quality-adjusted life year (USD –312,726/quality-adjusted life year) in favor of the intervention. According to the BI analysis (assuming an increase of 5% market share per year for racecadotril+ORS for 5 years), the total cumulative incremental percentage reduction in health care expenditure for diarrhea in children is 0.136578%, resulting in a total potential cumulative cost savings of –RM 73,193,603 (USD –17,983,595) over a 5-year period. Results hold true across a range of plausible scenarios focused on critical model components. Conclusion: Adjuvant racecadotril vs ORS alone is potentially cost-effective from a Malaysian public payer perspective subject to the assumptions and limitations of the model. BI analysis shows that this translates into potential cost savings for the Malaysian public health care system. Results hold true at evidence-based base case values and over a range of alternate scenarios
Re-engaging with the intimacy of materials through touch
No full textIn today’s retail led world consumers are suffocating through an excess of soulless products. It is time we paused to breathe.
"Touch has a memory" - John Keats. [A1]
It is often assumed that product designers, especially in the fashion industry, will have a deep understanding of the tactile properties of materials that they use. This tacit knowledge is also assumed to be an essential ingredient for intimate engagement with the materials, for touch is about direct contact, close and personal; it is not sensation at a distance in the way of sound and vision. Through this intimacy, the designer can fully understand the potential sensory impact on their customers and can share their knowledge of this intimacy with the customers.
However the rise of fast, offshore manufacture has led to a virtual design approach where cad-cam rules and the first direct contact that the designer has with their material is often when they receive the finished goods. The approach has become embedded in teaching, where virtual-oriented design is cheap and simple as well as effective.
This runs in parallel to what Black [A2] describes as "The Fashion Paradox", i.e. the tension between an industry which has become dependent on the overconsumption of the consumer society made possible by low cost design and manufacture processes with emerging imperatives of environmental and ethical issues. It has become easy to make and sell a lot of goods, but perhaps a new approach is needed before we drown in an ocean of stuff.
We hypothesise that a business strategy to introduce a new intimacy with materials to consumers through goods and experiences that celebrate "the joy of touch" will a) spawn better, higher value goods with cutting-edge appeal and b) provide a positive piece in the jigsaw necessary to address the Fashion Paradox, taking the line described by Fletcher and Early in "5-Ways" [A3, A4] that touch is relevant to the production of "supersatisfiers...which begin to break the chain of consumption and dissatisfaction".
There are always many old voices that decry the lack of materials knowledge in the "designers of today", and we do not wish simply to join them. To avoid this yet to achieve new thinking in the territory we take a tangential approach that does not get stuck into stuff to early.
Accordingly, the method will apply a method of research and teaching based on storytelling in multidisciplinary teams developed by Smith and Sams [A5, A6]. This reflects on the role of designer-storytellers described by Seah [A7] and Erikson [A8]. Thus, perhaps counter-intuitively, we seek to stimulate word-based approaches to a physical effect.
The resultant project vehicle "Touch Stories" is inspired by the observations of experimental psychologist Charles Spence, e.g. [A9], that people have difficulty in detecting and remembering touch, but can be taught touch skills. This builds on earlier design projects "Touch Gourmet" by Torres and Sams [A10]. We provide below a short summary of the science context as well as the more usual design context for the project.
The work described here is our first experiment using this method in the touch context with a fashion student community of young business and design professionals. In recognition, we report in the style of a science experiment - which also reflects the background of the second author.
We are at the very start of a journey which we intend to take well beyond fashion (for the challenge of new materials and "too much stuff" spreads well beyond Fashion and its Paradox), thus to stretch and develop the territory, through the processes described in [A5, A6]. It’s a journey the design world needs to ‘touch on’
Childhood invasive pneumococcal disease: a hospital-based study from Malaysia
No full textAim: New conjugate vaccine for Streptococcus pneumoniae has been introduced in Malaysia recently. Information on infection due to S. pneumoniae in Malaysian children is scarce. We conducted a retrospective chart review of childhood invasive pneumococcal disease (IPD) presented to a single centre in Malaysia. Methods: A retrospective review of 5 years and 4 months of all cases of IPD in children younger than 14 years of age (May 1999-August 2004) seen at the University of Malaya Medical Centre (UMMC), Kuala Lumpur, was conducted. Cases were identified from the record of Department of Medical Microbiology, UMMC. Results: IPD was identified in 50 children (median age 1.1 years, range 2 weeks-14 years) during the study period. Seventy-six per cent of the cases were younger than 2 years of age. Pattern of infections noted include definite pneumonia (n = 8), probable pneumonia (n = 33), meningitis (n = 4), bacteraemia without focus (n = 4) and septic arthritis (n = 1 each). Pre-morbid diseases were present in 28 of all cases. Complications (n = 12, 24) due to IPD were seizures (n = 5), pleural effusion/empyema (n = 4), cerebral palsy (n = 2) and deafness (n = 1). No deaths were attributed to IPD. Sixty-two per cent of the pneumococcal isolates were penicillin non-susceptible and were detected throughout the study period. Conclusions: IPD is associated with high morbidity, particularly among young children. Majority of the isolates were penicillin-non-susceptible strains. Additional information on the serotype of S. pneumoniae isolated is necessary to assess the potential impact of immunisation on preventing pneumococcal infection in Malaysia
Extra-intestinal non-typhoidal Salmonella infections in children
No full textExtra-intestinal non-typhoidal Salmonella (NTS) infections are uncommon in developed countries but common in developing ones. The risk factors, clinical features and outcome of children admitted to the Department of Paediatrics, University of Malaya Medical Center, Kuala Lumpur from 1978 to 1998 with extra-intestinal NTS infections were reviewed. All positive cultures of NTS, blood, cerebrospinal fluid, urine, synovial, pericardial and other body secretions (except stools), were included. Of the 98 cases reviewed, 56 were boys and 42 girls. The mean age was 2.1 years (range: newborn to 14 years). Twenty-seven children were severely immunocompromised and 21 had underlying chronic medical disorders. Bacteraemia was the most commonly detected type of infection and meningitis the commonest focal infection. The overall mortality rate was 15. An immunocompromised stare or underlying chronic medical disorder was associated with increased mortality. The three serotypes most commonly isolated were S. enteritidis, S. paratyphi B and S. typhimurium. Most isolates were sensitive to antibiotics commonly used in salmonellosis
alpha 1-Antitrypsin deficiency is not an important cause of childhood liver diseases in a multi-ethnic Southeast Asian population
No full textAim: We conducted a prospective study to determine the role of alpha 1-antitrypsin (alpha 1AT) deficiency in the pathogenesis of neonatal cholestasis and other childhood liver diseases in a multi-ethnic Southeast Asian population. Methods: Prospective patients with neonatal cholestasis (group 1), other liver diseases (group 2) and children with other medical conditions (group 3) referred to the Paediatric Unit, University of Malaya Medical Centre, Malaysia, from May 2002 to June 2005, were screened for alpha 1AT level and phenotype. alpha 1AT level below 80 mg/dL was considered as low. Results: Of the 114 patients (group 1, n = 53; group 2, n = 42; group 3, n = 19) screened, seven patients (6 of total; group 1, n = 1; group 2, n = 4; group 3, n = 2) had a alpha 1AT level below 80 mg/dL. All had marginally low level (range 57-79 mg/dL), but none had a clinical diagnosis of alpha 1AT deficiency. One patient had PiZ- heterozygous phenotype (alpha 1AT level 217 mg/dL) while another patient had PiMS heterozygous. Conclusions: alpha 1AT deficiency is not an important cause of neonatal cholestasis and childhood liver diseases in Malaysian children. In Malaysian children with neonatal cholestasis or other liver diseases, routine assay for alpha 1AT phenotype is not recommended if there is no family history of neonatal cholestasis of uncertain aetiology, or if alpha 1AT level is above 80 mg/dL
Mitochondrial Hepatopathies: Advances in Genetics, Therapeutic Approaches, and Outcomes
No full text[no abstract available
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