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Background: People with an intellectual disability have a higher risk of developing mental disorders compared to the general population. Available evidence suggests those with an intellectual disability receiving inpatient treatment in general psychiatric wards may have certain unique characteristics. Method: Data gathered from a retrospective review of records of adults with intellectual disability admitted to general psychiatry wards in a tertiary psychiatric hospital in Singapore were analysed. Results: Of 290 adults with intellectual disability, 62.8% were males. The median age was 38 years. The median length of stay was 12 days and over 80% had at least one previous admission. Nearly 80% had a mild intellectual disability and 64.5% had at least one psychiatric comorbidity, the majority having schizophrenia or psychotic disorder. Physical aggression was the most common primary reason for admission. Conclusions: The specific profile of patients identified in the study would be helpful in determining priority areas for the development of specialist psychiatric services for people with intellectual disability.

Low student engagement and motivation in online classes are well-known issues many universities face, especially with distance education during the COVID-19 pandemic. The online environment makes it even harder for teachers to connect with their students through traditional verbal and nonverbal behaviours, further decreasing engagement. Yet, addressing such problems with 24/7 synchronous communication is overly demanding for faculty. This paper details an automated Question-Answering chatbot system trained in synchronous communication and instructor immediacy techniques to determine its suitability and effectiveness in attending to students undergoing an online Chemistry course. The chatbot is part of a new wave of affective focused chatbots that can benefit students' learning process by connecting with them on a relatively more humanlike level. As part of the pilot study in the development of this chatbot, qualitative interviews and self-report data capturing student-chatbot interactions, experiences and opinions have been collected from 12 students in a Singaporean university. Thematic analysis was then employed to consolidate these findings. The results support the chatbot's ability to display several communication immediacy techniques well, on top of responding to students at any time of the day. Having a private conversation with the chatbot also meant that the students could fully focus their attention and ask more questions to aid their learning. Improvements were suggested, in relation to the chatbot's word detection and accuracy, accompanied by a framework to develop communication immediacy mechanics in future chatbots. Our findings support the potential of this chatbot, once modified, to be used in a similar online setting.

While many studies about special education needs (SEN) have discussed inclusive efforts in educational settings, more proximal research examining ways to support students with SEN in-process to achieve is needed. This study discussed proximal data, collected from eye trackers and lesson videos, showing how students with SEN transit between the state of presence, belonging, and engaged participation in an inclusive classroom. Using an eye tracking case study of an inclusive science classroom, with a focus on how science teachers support students with dyslexia to learn science, we unpacked how the teacher supported students through such a transformative experience. We characterised the transitions and examined how these transitions happen and found that the transitions were non-unidirectional and could be prematurely truncated due to a change in the teacher's eye gaze. Some students might not move to the state of engaged participation during a lesson. These transitions were facilitated by the teaching practices. Implications for teachers of inclusive classrooms and research in inclusive classrooms were discussed.

Background: Much has been written about the changes in use and perspectives of telepractice among speech and language therapists (SLTs) during the global COVID-19 pandemic. However, no long-term study has been done to examine whether there is a permanent shift in attitudes towards telepractice as the world adjusts to new norms and endemic COVID-19. Aims: To compare the speech telepractice use and perspectives of SLTs at two time points of the pandemic--during and after the height of the pandemic. Methods & Procedures: Two online surveys were distributed a year apart among SLTs in Singapore. The first survey was disseminated during an initial lockdown period in 2020 and the second survey was done in 2021 when Singapore was starting to reduce strict quarantine and safe-distancing regulations. These surveys were distributed via communication channels of the local speech therapy association. A total of 115 and 71 responses to the survey were collected in 2020 and 2021, respectively. Responses were captured and analysed using descriptive statistics and statistical analysis while qualitative content analysis was used to derive key themes from open-ended questions. Outcomes & Results: Telepractice use across all age groups and client types peaked at the height of the pandemic. Even as lockdown measures were eased, telepractice utilization was still higher than what it was before the pandemic. Dysphagia management was the only area where SLTs reduced their use of telepractice during the stabilization phase. After more experience with telepractice during the height of the pandemic, SLTs acknowledged the benefit of being able to use a wide range of media through telepractice and were less worried about not having the resources or knowledge to set up telepractice. SLTs also reported increased confidence in providing telepractice, which was reflected in their willingness to continue to provide telepractice even after the pandemic ends. Conclusions & Implications: The increase in use of telepractice during this pandemic is likely to be sustained as a majority of respondents believed they would continue to provide this mode of service delivery even after the pandemic ends. However, clinicians will still have to assess for client suitability, as clients with more complex medical or behavioural issues may still require in-person therapy. Additionally, dysphagia management via telepractice will still be limited given that swallow presentations may be more variable. Lastly, although generic resources are helpful for clinicians, the long-term sustainability of telepractice can be boosted by the sharing of resources that are suitable for the local context.

The international movement of teachers is a global phenomenon that has seen an increasing number of teachers moving from one country to another. Although developed countries in the West are traditionally seen as attractive migration destinations for teachers, countries in Asia, such as Singapore, are also proving to be a draw for many foreign teachers. Despite studies of the experiences of foreign teachers, there are few studies investigating the influence of cross-cultural teaching on the development of the professional identity of foreign teachers. Using a narrative inquiry approach, this study examines how the cross-cultural teaching experience of a Chinese beginning teacher in Singapore influenced the development of his professional teacher identity. The story of the participant tells of why the participant became a teacher and how the change of teaching context from China to Singapore influenced his professional identity as a teacher. The study surfaced the large cultural difference between the two countries.

This paper examines the pedagogical practices in three case studies of elementary science lessons that took place in classrooms or laboratories to make connections to the discourse about inclusivity in science teaching. Using the Singapore Teaching Practice as a reference, we analyzed the pedagogical practices enacted during three lessons where specific intervention strategies were undertaken during the lessons to address the needs of students with dyslexia. Using event-oriented inquiry, nine (including one emergent) pedagogical practices were adapted by the science teachers. The findings also suggested differences in the outcomes from enacting the same pedagogical practices in different teaching situations. This study contributes to the literature by offering a situated definition of 'pedagogical practices', a dynamic construct in the existing literature, in the context of inclusive education. Suggestions on ways to adapt the nine pedagogical practices to enhance the reflexivity of teachers in inclusive science teaching are offered.

Many international studies have examined the gross motor skills of children studying in special schools while local studies of such nature are limited. This study investigated the gross motor skills of children with Mild Learning Disabilities (MLD; n = 14, M age = 8.93 years, SD = 0.33) with the Test of Gross Motor Development-2 (TGMD-2, Ulrich, 2000). The TGMD-2 consists of 12 items equally divided into two subtests (locomotor and object control). The locomotor subtest includes run, gallop, hop, leap, horizontal jump and slide while the object control subtest includes strike a stationary ball, stationary dribble, kick, catch, overhand throw and underhand roll. The results revealed significant differences in 8 out of 12 test items: gallop, hop, leap, horizontal jump, slide, strike, dribble and roll at mastery level between children with MLD and TGMD-2 norm population. The authors suggest motor interventions for children with MLD to improve their gross motor skills.

This small-scale pilot study analysed the input of two university teachers regarding their approaches, attitudes and understanding regarding counselling referrals for students in a university setting in Singapore. Data were collected through semi-structured interviews. Using interpretative phenomenological analysis, four main categories of themes were defined from the findings: referral procedures, challenges/difficulties, support and awareness. The academic teaching staff has an important role in the holistic development of students by helping them obtain counselling referrals. The key issues raised are outlined for consideration by policymakers, academic teaching staff and practitioners both within and outside of Singapore. The findings are discussed, including future research possibilities and recommendations to improve the referral process initiated by university staff in higher education.

In this article, we present a case study of six Singaporean elementary school teachers working in a Lesson Study team that prepared them for problem solving instruction. The Lesson Study process included preparing, observing, and critiquing mathematics lessons in the context of solving fractions tasks. By conducting Lesson Study, we anticipated that these teachers would develop greater insight into students' mathematics, which would influence their classroom practices. Through the process of planning, observing and critiquing and by purposefully listening to students' explanations, the teachers began to better understand their students' learning, which in turn could help them develop their students' mathematical knowledge. (Contains 4 tables, 5 figures, and 1 footnote.)

Memories of our schooling and teaching experiences shape our curriculum and pedagogical decision-making process in art education when we become teachers and teacher educators. In this paper, using Hannah Arendt's Actor-Spectator Theory, I engage in retrospective critical introspection of my practices as an art teacher and curriculum developer in Singapore. (Contains 3 endnotes.)

The purpose of this study is to compare the balance control of participants with and without HI and also to investigate the effect of a Balance Programme (BP) on their balance control (HI; n = 2, M age = 7 years old). The BP consisted of six practice sessions of 45 minutes each. The Balance Tasks used to assess balance control were static Balance Tasks: two-leg stand, one-leg stand and dynamic Balance Tasks: in-place jump and in-place hop. Kinetic data such as the Centre of Pressure (COP) and the Ground Reaction Force (GRF) was captured using a force plate. The results revealed differences in Balance Tasks involving static and dynamic balance control between participants with HI and without HI. Improvement in balance control of the participants is observed for some of the Balance Tasks after the introduction of the BP which indicates the inconclusive effectiveness of the BP. The authors suggest that the instructional approach and number of practice sessions may be the contributing factors affecting the effectiveness of the BP. A new BP with an alternative instructional approach together with more practice sessions is warranted to benefit both children with and without HI so as to make inclusion possible. (Contains 4 figures and 3 tables.)

This paper explores 122 secondary school students' perceptions of the choral learning environment. A survey questionnaire was developed taking into consideration the responses of a pilot study in which students were requested to list what they liked and disliked about the choir. The participants rated their degree of agreement on a five-point scale on psychosocial and other perspectives of choral learning. Three research questions were posed: (1) What are Singaporean secondary school students' perceptions of choral learning? (2) Are there any gender differences in their perceptions of choral learning? (3) Are there any across school differences in their perceptions of choral learning? The findings of the study were discussed from the perspective of Singapore's education and learning environment research. (Contains 2 tables.)

This study presents an analysis of alternative conceptions (ACs) on acid--base chemistry harbored by grade 9 students in Singapore. The ACs were obtained by the development and validation of a 4-tier diagnostic instrument. It is among the very few studies in the science education literature that have focused on examining results based also on measures used in the educational psychology literature. The results indicate that the students harbor a range of ACs of varying strengths in relation to the properties of acids and bases, strengths of acids and bases, pH, neutralization, indicators, and sub-microscopic views of acids and bases. The 25-item instrument uncovered 30 ACs. A novel insight from this study is that when students are presented with a test item with all incorrect answer and reason responses but with a blank space for them to fill up their own answer and reason if they disagree with any of these responses, hardly any chose to do so. ACs were also identified from this question. Overall, the results reiterate the utility of the 4-tier format for identifying ACs and getting some indication of their strengths.

Successful transition from preschool to primary school is believed to have long-term positive effects on a child's academic performance and social competence. In this study, data were gathered from preschool teachers, primary schoolteachers and parents through the use of questionnaires and semi-structured interviews, on their perceptions and practices of preparing Kindergarten Two (K2) children for Primary One. Findings from this study revealed that (1) transition practices revolved around discussions about primary school and familiarising preschool children with the primary school environment; (2) awareness of preparing preschool children in non-academic areas of independence, adjustment and social competence seemed apparent and (3) communication and collaboration among preschool teachers, primary schoolteachers and parents to facilitate better continuity between preschool and primary school seemed weak. These findings could be used by parents and teachers to prepare K2 children as well as smoothen their transition from preschool to primary school.

For decades, educators have advocated using history of mathematics in mathematics classrooms. Empirical research on the efficacy of this practice, however, is scarce. A quasi-experiment was used to investigate the effects of using history as a tool to teach mathematics on grade 11 students' mathematics achievement. Effects in three affective domains (attitudes, anxiety, and motivation) were also measured. Four classes from a school in Singapore participated in this quasi-experiment. The experimental group (n?=?51) and control group (n?=?52) were each made up of two classes. Results indicated that using history as a tool to teach mathematics had a significant positive effect on students' mathematics achievement, in an initial posttest and in two retention tests taken 4 months and 1 year, respectively, after the last intervention session. Significant positive effects were also found on two subscales within the affective domain variables (perceived value of mathematics and introjection, a type of extrinsic motivation), but only at a posttest administered midway through the study. These results suggest that using history in mathematics classrooms have both immediate short- and long-term effects on students' achievement, but only short-term positive effects in the affective domains. These results were discussed using qualitative feedback obtained from the participants of this study.

The Academic Motivation Scale (AMS) is a comprehensive and widely used instrument for assessing motivation based on the self-determination theory. Currently, no such comprehensive instrument exists to assess the different domains of motivation (stipulated by the self-determination theory) in mathematics education at the pre-tertiary level (grades 11 and 12) in Asia. This study adapted the ams for this use and assessed the properties of the adapted instrument with 1610 students from Singapore. Exploratory and confirmatory factor analyses indicated a five-factor structure for the modified instrument (the three original ams intrinsic subscales collapsed into a single factor). Additionally, the modified instrument exhibited good internal consistency (mean a?=?0.88), and satisfactory test-retest reliability over a 1-month interval (mean r[subscript xx]?=?0.73). The validity of the modified ams was further demonstrated through correlational analyses among scores on its subscales, and with scores on other instruments measuring mathematics attitudes, anxiety and achievement.

There appears to be a dramatic decline in attitude toward reading between 2006 and 2011 for ten year-olds taking the Progress in International Reading Literacy Study (PIRLS) examination. This "decline", however, is probably not real but is the result of a change in the attitude questionnaire, mentioned only in the fine print in the 2011 PIRLS publication. The scoring of the 2011 version of the questionnaire was profoundly influenced by students' report of outside school reading; the scoring of the 2006 version was not.

Past studies have shown that distinct yet highly correlated sub-constructs of three broad mathematics affective variables: (a) motivation, (b) attitudes and (c) anxiety, have varying degree of correlation with mathematics achievement. The sub-constructs of these three affective constructs are as follows: (a) (i) amotivation, (ii) external regulation, (iii) introjection, (iv) identification, (v) intrinsic motivation; (b) (i) enjoyment of mathematics, (ii) self-confidence in mathematics, (iii) perceived value of mathematics; (c) (i) anxiety with mathematics and (ii) ease with mathematics. This study identifies, both within and across these three affective variables, the key sub-constructs that educators should focus upon when selecting learning process variables for mathematics achievement. Results were analysed using a series of stepwise regression analyses using data from 1018 Grade 12 students enrolled in a top pre-tertiary institution in Singapore, both for concurrent and predictive relationships, and also for both genders. Results of this study showed that after taking into account self-confidence in mathematics and ease with mathematics, all other sub-constructs of mathematics motivation, attitudes and anxiety were not significantly correlated with mathematics achievement. This is true for both concurrent and predictive relationships, and for both genders. Implications of the results of this study are twofold. First, results of this study provide educators with priority affective variables to focus upon in their efforts to enhance performance in mathematics via the affective domain. Second, in situations where administration time is limited, it may be possible to consider only self-confidence and ease with mathematics when investigating relationships between affect and mathematics achievement.

Objective: At the beginning of the coronavirus disease (COVID-19) pandemic in Singapore, the strategy initially involved aggressive ring-fencing of infections, before pivoting towards managing recurrent local interspersed outbreaks of COVID-19. A key feature of Singapore's efforts to preserve health-care capacity was the implementation of the nationwide Home Recovery Programme (HRP), whereby patients were allowed to recover at home as long as they met certain criteria. The programme was centrally coordinated by Singapore's Ministry of Health and was supported by telemedicine providers, primary care physicians and government agencies. This report aims to highlight Singapore's experience in coordinating and implementing the HRP, the challenges faced and the outcomes. Methods: Published and internal data from the Ministry of Health in Singapore, along with policy documents, were reviewed together with a brief literature review of similar programmes conducted globally. Results: Implementation of the HRP led to the majority of patients (98%) recovering from COVID-19 in the outpatient setting, with similar mortality rates to inpatient settings. Hospitalization rates for COVID-19 cases were reduced as compared to previously, alleviating strain on the health-care system. Discussion: The HRP was largely successful at preventing health-care capacities from being overwhelmed, while keeping fatalities to a minimum. Nonetheless, the risks of emergent variants of concern remain present, and heightened vigilance and potential modification of existing protocols based on fluctuations in virulence and infectivity are still needed. [ABSTRACT FROM AUTHOR]

This study investigates attributional beliefs of Singapore secondary students in their English study and how they can be predicted by self-construal, competence and achievement goals. A total of 1,496 students were administered surveys on seven attributions, independent and interdependent self-construals, previous achievement, self-efficacy, mastery approach and avoidance goals and performance approach and avoidance goals. We found that Singapore students attributed academic success mainly to internal regulation (effort, interest and study skills), followed by teachers' help, ability, parents' help and tuition classes. Hierarchical regression analyses showed that three predictors (self-construal, competence and achievement goals) explained 4.2-12.3% of the variances in students' attributional beliefs. In particular, students with interdependent self-construal, high competence or mastery goals tended to attribute academic success to internal regulation (effort, interest and study skills) and support from teachers and parents. Students with low competence, high mastery avoidance goals or high performance goals were more likely to value tuition classes, and those with high performance avoidance goals also tended to ascribe academic success to ability and parent's help. The findings are discussed in relation to the culture of Singapore.

From 2009 to 2011, a team from the Centre for Learning and Life Chances in Knowledge Economies and Societies carried out a mixed-methods study of young people in England and Singapore. With regard to civic attitudes, the study showed that there was a greater sense of political self-efficacy and collective (school) efficacy in Singapore than in England. In addition, the group in Singapore scored higher on future voting relative to the group in England. Further, while both political self-efficacy and collective (school) efficacy were correlated with future voting in England, only the latter was correlated in the case of Singapore. For some, the results may seem counter-intuitive. The article reflects on these results, particularly those relating to democratic outcomes.

Science simulations are popular among educators as such simulations afford for multiple visual representation and interactivity. Despite the popularity and abundance on the internet, our literature review suggested little research has been conducted on the use of simulation in elementary school. Thus, an exploratory pilot case study was conducted to address this research gap. In this study, an open source energy simulation was remixed for use in elementary school targeted at the Grade 4 & 5 students as an after-school enrichment program. We proposed 3 stages: design, customization and implementation, to provide useful insights with the aim to allow other educators to conduct their own remixed simulation lessons. The simulation design principles (e.g., learning outcomes and colour coding) with the corresponding TPACK construct that emerged from the design and customization stages were reported. Such simulation design principles would be useful to interested educators and researchers who wish to adapt and use simulation or teach others how to remix simulation. Data from the multiple sources (e.g., field observations, surveys, design notes and existing simulations) indicated that students enjoyed learning with the remixed energy simulation.

By any measure, Singapore's educational system has generated an extraordinary record of achievement over the past two or three decades. In this article, we report on one key component of a broader three year investigation into why Singapore has done so well, and explore the logic, strength, resilience and limits of the underlying pedagogical model and policy framework that have helped secure this record of achievement. Specifically, we draw on data we collected in 2010 to analyze the pedagogical organization of four theoretically specified "models" of instructional strategy--traditional instruction, direct instruction, teaching for understanding, and co-regulated learning strategies--in Secondary 3 mathematics and English. In the course of our analysis, we develop three arguments. The first is the single-minded performative orientation of instructional practices generally--and instructional strategies specifically--in Singaporean classrooms that rarely deviated from a logic of curriculum coverage, knowledge transmission and assessment. Second, while we found substantial evidence of a pervasive performative orientation to instruction, we also found that teachers in Singapore draw from a variety of instructional perspectives in ways that reflect a pragmatic, instrumental fit-for-purpose approach and broader performative orientation. Third, we found that the national high stakes assessment system, by virtue of its considerable institutional authority, both shaped the pattern of instructional practice at the classroom level and constrained opportunities for instructional improvement. In the conclusion, we review related findings from the research program on the impact of instructional practice on student achievement in Singapore.

Existing instruments designed to measure mathematics attitudes were too long, dated, or assessed with only western samples. To address this issue, a shortened version of the Attitudes Toward Mathematics Inventory (short ATMI) which measures four subscales--;enjoyment of mathematics, motivation to do mathematics, self-confidence in mathematics, and perceived value of mathematics--was created. Its factor structure, reliability, and validity were assessed with 1,601 participants from Singapore. Confirmatory factor analyses supported the original four-factor structure. Within this structure, however, several items were found to correlate highly with others. Their removal either improved or did not impact the properties of the instrument. As a result, these items were removed to produce the short ATMI. Furthermore, a very high correlation (r = 0.96) was found between the enjoyment and motivation subscales. Results of further analysis suggested the removal of the motivation subscale. The short ATMI exhibited strong correlations with the original scale (mean r = 0.96), good overall internal consistencies, both for the full short version (alpha = 0.93) and for the individual subscales (mean alpha = 0.87), and satisfactory test-retest reliability over a 1-month period (mean r[subscript xx] = 0.75). The validity of the short ATMI was further demonstrated through inter-correlations between its subscales, and through correlations with mathematics anxiety and achievement test scores. Participants were able to complete the short ATMI in less than 10 min, making it a viable option when survey administration time is limited. This time would reduce further with the removal of the motivation subscale.

The study set out to examine Quality of Life (QoL), specifically subjective well being in three different addiction populations (260 alcohol-dependent, 282 drug-dependent, and 132 pathological gambling outpatients) at their first visit to treatment, using the Personal Well being Index (PWI). The mean PWI score for all patients was significantly below (i.e., 15 points) Asian norms. Despite reporting a greater addiction severity, alcohol patients scored significantly higher on the PWI compared with drug patients. Despite having demographic characteristics associated with higher functioning, gambling patients did not have the highest QoL; falling in between the alcohol and drug patients. Being married was the only significant predictor of normal personal wellbeing, whilst having debts, a past/current psychiatric morbidity, and a higher addiction severity significantly predicted an abnormal personal wellbeing. Treatment services should pay close attention and target the specific life domains where poor satisfaction is reported by the different addiction populations.

This paper analysed how three teacher-researchers of Singapore's elementary school used online space extensively in Grade 2-Grade 4 classrooms. Such online space, made possible by free and readily available web 2.0 and open source applications, was meant to complement the physical learning space as such space can allow learning activities, which were otherwise not possible in the typical classroom setting, to be carried out. The results revealed that students have positive learning experience but the learning impact was small. Despite such unfaltering results, the teacher-researchers were not daunted due to their strong conviction that technology is vital in their students' learning. (Contains 6 figures and 12 tables.)

The choice of suicide methods varies between countries. Common methods used in Singapore between 2000 and 2004 were jumping (72.4%), hanging (16.6%), and poisoning (5.9%). Those who jumped were more likely to be young, single, female, and to have had a major mental illness. By comparison, those who hung themselves were more likely to be older (OR 2.68), Indian (OR 2.32), and to leave a suicide note (OR 1.53). Those who used poison were more likely to be married (OR 2.33), to be on antidepressants (OR 2.40), to have previously attempted suicide (OR 2.13), and to leave a letter (OR 2.30). The choice was determined by accessibility, acceptability, generational, gender, and racial factors.

Singapore is known for its well-developed public education. Although there have been prolific studies and advancement in pedagogy of different groups of learners, the progress has yet to capture the interest of children in residential care, and their educational needs remain a field lacking in discussion. This study seeks to give these children a voice by answering three main questions: "(1) What have the children experienced in school? (2) How do they feel about these experiences? (3) To what extent are the children's experiences and feelings related to their background?" A mixed-method approach that encompasses both quantitative and qualitative instruments has been employed to find out from the Primary School children in a local Children's Home their perspectives on school experience. The findings reveal that looked after children do encounter greater challenges in school because of their unique background and lack of resources. Most of them would need to rely on the authorities in both the school and the Home for support if better experience and performance in school are to be achieved.

This study investigated pre-service general education teachers' views about including children with special education needs (SEN) into general classrooms in Singapore. While attitudes towards inclusion have been studied widely in other countries, little research in this area has been done in Singapore. In this study, the pre-service general education teachers (N = 114) were asked about their attitudes towards including children with SEN into their classroom. A survey method was used to elicit information on teacher's views towards (a) including children with SEN, (b) the quality or adequacy of their training and (c) the adequacy of resources to educate children with SEN in general classrooms. The teacher candidates in this study would eventually be posted into general schools. The findings of this study point to the overall positive attitudes of the pre-service general education teachers towards including children with SEN into their classrooms. The authors discuss the concerns that the pre-service general education teachers raised in relation to insufficient knowledge and lack of resources for including children with SEN in the general classrooms. (Contains 3 tables.)

This paper analyses how an elementary-level future school in Singapore implements and uses various open-source online platforms, which are easily available online and could be implemented with minimal software cost, for the purpose of teaching and learning. Online platforms have the potential to facilitate students' engagement for independent and collaborative learning, enhance student-teacher interactions, and develop students' technological skills. A framework is constructed to facilitate the conceptualisation of the various pedagogical approaches for learning using such online platforms--learning "from" and "with" technology is proposed. Learning from technology leans itself more towards the didactic and behaviouristic theories whereas learning with technology has its origin from the constructivism and social constructivism paradigms. In addition, both the didactic and constructivist pedagogical approaches are applicable for online learning as they could be used to achieve different outcomes depending on the learning objectives. Implicit in the findings is also the importance of the teachers' commitment and competencies and good infrastructural and technical support in the use of technologies for teaching and learning in an educational setting. (Contains 5 figures and 3 tables.)

Numerous researchers have pointed to the potential benefits of providing students with a relevant historical context when introducing new mathematics concepts. This paper discusses the ways in which this approach may be applied to enhance student learning and attitudes in Singapore mathematics classrooms. While evidence on the efficacy of this approach remains limited, studies to date suggest that students who confront new mathematics concepts within a meaningful historical context will develop more positive attitudes toward the subject matter. Using history in mathematics teaching is likely also to help students recognise interrelationships between the disparate concepts to which they are introduced, and thus develop a more integrated view of the field as a whole. Relevant classroom activities, based on the Singapore junior college mathematics curriculum, are outlined. (Contains 2 footnotes.)

This paper reports on students' errors in performing integration of rational functions, a topic of calculus in the pre-university mathematics classrooms. Generally the errors could be classified as those due to the students' weak algebraic concepts and their lack of understanding of the concept of integration. With the students' inability to link integration to differentiation, these errors could not be detected or rectified. From a deeper perspective, these errors were due to a lack of deep mathematical thinking when the students learnt calculus. This paper also presents the implications of the findings of this study in relation to the classroom teaching of mathematics. It is hoped that the articulation of students' errors and the implications could provide guidance for classroom teachers and prompt further research into students' errors and misconceptions in calculus concepts. (Contains 3 tables and 2 figures.)

Ketamine at sub-anesthetic doses is a potent analgesia. Its use in cancer pain remains equivocal with protocols varying in patient selection, starting dose, titration, duration of use and adjustment of co-analgesics. To study the impact of a standardised Ketamine Step Protocol on cancer pain in a Palliative Care Unit (PCU). This is a prospective cohort study of a standardised Ketamine Step Protocol which was developed in a PCU for use in cancer pain. The subcutaneous ketamine infusion was standardised at a starting dose of 75 mg over 24 hours with Haloperidol 5 mg as prophylaxis against psycho-mimetic side effects. Incremental doses of ketamine followed the daily stepwise protocol. Of the 48 patients analysed, 41 (85.4%) had neuropathic cancer pain. The median Palliative Performance Scale score (PPSv2) was 40%. Mean Numerical Rating Score (NRS) improved from 6.74 to 2.61 (P < 0.0001) with a mean percentage reduction of 58.05%. The final mean daily ketamine dose needed to achieve stable pain control was 137.50 mg/day (±81.54). 31(62.5%) patients achieved pain control by day 3. The mean Morphine Equivalent Daily Dose (MEDD) reduction was from 130.34 mg to 107.33 mg (P < 0.002) with a percentage reduction of 18.85%. More than half of our patients completed the 5 d protocol with mild to moderate side effects not warranting urgent medical intervention nor termination of the ketamine protocol. Use of a standardised Ketamine Step Protocol showed a statistically significant reduction in pain and MEDD in patients with predominantly neuropathic cancer pain. It also demonstrated a safe and effective method for opioid reduction after commencement of parenteral ketamine. Our study shows that: Parenteral ketamine is a potent analgesic which significantly reduced pain in patients with cancer neuropathic pain. This study also demonstrated a safe and effective method for titration of opioids after parenteral ketamine is started. Concurrent use of psychotropics also helps to reduce psycho-mimetic side effects, increasing tolerability to ketamine. [ABSTRACT FROM AUTHOR]

Probation has been in existence in Singapore for more than 70 years. Given its long existence and vested interest in community-based sentencing, this paper calls for an effective measurement of probation officers training and supervision of the offenders measured against recidivism. First the paper focuses on the genesis and evolution of probation coupled with a brief description of programs conducted by probation officers since its introduction till its present iteration, along with its merits. The emphasis lies in the shift from a supervisory program to one which proactively seeks to transform behaviour, hence reaffirming remodelling character of probation. Second, it is recommended that effectiveness of training, supervision of offenders by Probation Officers be measured against the rate of recidivism. To this end, it is proposed that effectiveness of probation can only be measured against recidivism given that probation targets criminogenic needs of offenders. An evaluation of data presented on recidivism suggests that while the recidivism rate is decreasing, it does not maximize the potential role of Probation Officers. Third, training along the lines of Strategic Training Initiative in Community Supervision (STICs) program can be considered to enhance lower recidivism rates. Lastly, it is recommended that Randomized Controlled Trials (RCTs) be conducted for evidence-based policy making in criminal justice system, since RCTs can be useful in assessing the efficacy of probation as a community-based sentencing tool, particularly whether the policy orientation of probation meets the goal of reducing crime. [ABSTRACT FROM AUTHOR]

The Sunda pangolin (Manis javanica) faces threat of extinction due to illegal trafficking of its scales for the purpose of traditional medicine in the Asian region. Ex-situ captive breeding and reintroduction programs have been identified to be a key effort in the conservation of the species. The establishment of blood parameters for captive Sunda pangolins are vital to assess the health in these animals during health assessments. The objective of this study is to establish blood parameters for captive Sunda pangolins and compare the blood parameters with the established blood reference ranges for rescued wild Sunda pangolins in Singapore. Blood parameters for hematology and serum biochemistry were established from 13 clinically normal captive Sunda pangolins. Male captive Sunda pangolins were found to have significantly (P<0.05) higher potassium compared to the female captive Sunda pangolins. Captive Sunda pangolins were found to have significantly (P<0.05) lower white blood cell count (WBC), neutrophil counts, alanine phosphatase (ALP) and phosphorus and significantly (P<0.05) higher PCV, TP, globulin and blood urea nitrogen (BUN) when compared with rescued wild Sunda pangolins from the previous study. [ABSTRACT FROM AUTHOR]

Importance: Return to work after stroke is an important rehabilitation outcome. Vocational rehabilitation may support people with stroke to return to work. Objective: To report the return-to-work rate of people with stroke who completed a local community-based vocational rehabilitation program and to describe the program's impact on their community reintegration. Design: Retrospective database study. Setting: Community-based voluntary welfare organization. Participants: Fifty-eight men and women ages 21 to 55 yr, formally diagnosed with stroke, with no significant cognitive impairment, and fit to undergo rehabilitation. Intervention: A pilot community-based interdisciplinary vocational rehabilitation program implemented between 2014 and 2017. The program included physical rehabilitation, psychosocial support, employment support, and caregiver support services. Outcomes and Measures: Return-to-work rate and community reintegration as measured by the Community Integration Questionnaire (CIQ). Results: Fifty participants completed the program. Their median age was 44 yr, and most were male (n = 37; 74%). Forty-four participants (88%) returned to work after completing the program. Statistically significant differences (p <.001) were found between their CIQ scores at program enrollment and at completion. Conclusions and Relevance: The program appeared to benefit people with stroke in their return-to-work process. Future studies are recommended to determine the effectiveness of such programs and identify features contributing to their success. Potential implications for occupational therapy practice are that vocational rehabilitation interventions can be initiated earlier, comprehensive return-to-work programs can better address the unique needs of people with stroke, and interdisciplinary evaluations are needed to assess suitability for return to work. What This Article Adds: One of occupational therapy's unique goals is to facilitate performance and participation in valued activities such as work. Occupational therapists can play a pivotal role across the continuum of care to support their clients to explore and achieve their vocational goals after stroke. [ABSTRACT FROM AUTHOR]

Congenital diaphragmatic hernia (CDH) is a common birth defect associated with significant mortality and morbidity. There is limited outcome data on CDH in the Southeast Asian region. Rapid accessibility to our CDH Perinatal Center, as a consequence of the small geographic size of our country and efficient land transportation system, has largely eliminated deaths of live outborn babies prior arrival at our center. We selected a study period when extracorporeal membrane oxygenation (ECMO) support was not available at our institution. The data will therefore be relevant in developing management guidelines and antenatal counselling for perinatal centers in this region managing CDH with limited resources, without ECMO facilities. A retrospective study of antenatally or postnatally diagnosed CDH infants born between January 2002 and June 2005 was performed. We selected this study period as ECMO support was not available over this period. We studied the demographics, clinical characteristics, postnatal predictors of mortality and outcomes of CDH infants in a single tertiary institution. A total of 24 patients with CDH were identified. Seventy-nine percent of liveborns with CDH survived to hospital discharge. Antenatal detection rate was 83.3%. Significant postnatal predictors of mortality were preoperative pneumothorax (p = 0.035), high CRIB score (p = 0.007), low one- and five-minute Apgar score (p = 0.011, p = 0.026 respectively) and high pCO2 on initial arterial blood gas (p = 0.007). At one-year follow-up, three patients had delayed gross motor milestones which resolved subsequently. Re-admissions were required for recurrent bronchiolitis (33%) and oesophageal reflux which resolved in all cases. Two (13.3%) infants had surgical complications and needed re-admission for probable adhesive intestinal obstruction; one required adhesiolysis and the other was managed conservatively with good outcome. A single-center CDH outcome in Singapore, without ECMO use, was good. This is a cohort now with long-term survival outcome which will be valuable to the neonatology community. [ABSTRACT FROM AUTHOR]

Parents often express concerns about feeding difficulties in their child. We hypothesized that these parental concerns were associated with adverse growth status in early childhood. We aimed to determine the prevalence of such concerns and whether these concerns were associated with adverse growth status in early childhood. We performed a cross-sectional study among healthy children aged 12–36 months attending three well-baby clinics in three urban areas in Malaysia and Singapore between December 2016 and February 2017. Parents were interviewed for concerns about their child's feeding and presence of behavioral and organic red flags for feeding difficulties. We defined growth faltering as weight-for-age < 3rd centile and short stature as height-for-age < 3rd centile according to World Health Organization Growth Standards. Of the 303 children studied (boys = 160, 52.8%; mean [± SD] chronological age at interview 21.3 [± 4.0] months), 13% (n = 38/292) had growth faltering and 19.5% (n = 50/256) had short stature. Overall, 36.3% (n = 110) of parents expressed concerns about their child's feeding behavior. Sixty-eight percent (n = 206) of parents reported presence of at least one behavioral and 18.5% (n = 56) had at least one organic red flag for feeding difficulties, respectively. 9.9% (n = 30) had both behavioral and organic red flags for feeding difficulties. Growth faltering was significantly associated with parental concern about feeding (odds ratio [OR] 3.049, p < 0.001), food refusal (OR 4.047, p < 0.001) and presence of at least one organic red flag (OR 2.625, p = 0.012). We found that parental concerns about their child's feeding to be common. Presence of parental concern, food refusal in the child and presence of organic red flags for feeding difficulties are associated growth faltering in early childhood. [ABSTRACT FROM AUTHOR]

Current knowledge on the clinical features and natural history of childhood primary sclerosing cholangitis – inflammatory bowel disease in Asia is limited. We described the presenting features and natural history of primary sclerosing cholangitis-inflammatory bowel disease seen in a cohort of Southeast Asian children. We conducted a retrospective review of childhood primary sclerosing cholangitis-inflammatory bowel disease from three tertiary centers in Singapore and Malaysia. Of 24 patients (boys, 58%; median age at diagnosis: 6.3 years) with primary sclerosing cholangitis-inflammatory bowel disease (ulcerative colitis, n = 21; Crohn's disease, n = 1; undifferentiated, n = 2), 63% (n = 15) were diagnosed during follow-up for colitis, and 21% (n = 5) presented with acute or chronic hepatitis, 17% (n = 4) presented simultaneously. Disease phenotype of liver involvement showed 79% had sclerosing cholangitis-autoimmune hepatitis overlap, 54% large duct disease, and 46% small duct disease. All patients received immunosuppression therapy. At final review after a median [±S.D.] duration follow-up of 4.7 [±3.8] years, 12.5% patients had normal liver enzymes, 75% persistent disease, and 12.5% liver failure. The proportion of patients with liver cirrhosis increased from 13% at diagnosis to 29%; 21% had portal hypertension, and 17% had liver dysfunction. One patient required liver transplant. Transplant-free survival was 95%. For colitis, 95% had pancolitis, 27% rectal sparing, and 11% backwash ileitis at initial presentation. At final review, 67% patients had quiescent bowel disease with immunosuppression. One patient who had UC with pancolitis which was diagnosed at 3 years old developed colorectal cancer at 22 years of age. All patients survived. Liver disease in primary sclerosing cholangitis-inflammatory bowel disease in Asian children has variable severity. With immunosuppression, two-thirds of patients have quiescent bowel disease but the majority have persistent cholangitis and progressive liver disease. [ABSTRACT FROM AUTHOR]

The 41-item Comprehensive Needs Assessment Tool for Cancer Caregivers (CNAT-C) is an English language survey for needs assessment developed and validated in South Korean cancer caregivers. The objective of this study was to validate both the English and a translated Chinese version of the CNAT-C in cancer caregivers in Singapore. This was a cross-sectional survey where cancer caregivers completed the CNAT-C and World Health Organisation Quality-of-life BREF (WHOQOL-BREF) in English or Chinese. Cronbach's alpha was used to measure internal consistency. Convergent validity was assessed using Pearson correlation coefficients between CNAT-C scores and WHOQOL-BREF domains. For known groups validity, independent samples t-test was used to compare CNAT-C scores based on Karnofsky performance status. There were 161 cancer caregivers – 80 answered the English version and 81 answered the Chinese version. For the English version, 33.8% were male and the mean age was 46.9 years. For the Chinese version, 27.2% were male and the mean age was 52.6 years. The total CNAT-C score and most domain scores showed good internal consistency, low to moderate convergent validity with WHOQOL-BREF domains and good known groups validity with performance status in both the English and Chinese versions. Domain 1 (health and psychological problems) in the Chinese version did not show convergent validity although there was evidence of known groups validity. Domain 5 (religious/spiritual support) also did not show validity in our study sample. In summary, there was low to moderate convergent validity with the WHOQOL-BREF for both the English and translated Chinese versions. However, both language versions of CNAT-C showed good internal consistency and good known groups validity according to performance status, and both language versions of the CNAT-C can be used to assess the level of unmet needs for cancer caregivers in the Singapore context. [ABSTRACT FROM AUTHOR]

An exploratory descriptive study was conducted to explore the perspectives of patients who had fallen in the hospital; 100 patients were interviewed. An inductive content analysis approach was adopted. Six themes emerged: Apathetic toward falls, self-blame behavior, reluctance to impose on busy nurses, negative feelings toward nurses, overestimating own ability, and poor retention of information. Patients often downplayed the risks of falls and were reluctant to call for help. [ABSTRACT FROM AUTHOR]

Aim: Complex pressure injuries (PI) are a significant worldwide issue for the healthcare system and are prevalent in advanced illness populations. This paper aims to share the holistic management of complex PI in advanced dementia patient to achieve the best outcomes. Method: Mdm T, a 67 years lady with advanced dementia was admitted from a nursing home. She had diabetes mellitus, bullous pemphigoid and multiple pressure injuries. On admission, Mdm T's stage 4 sacral PI measured at 22x14x2cm, undermining 10-1 o'clock 2 cm, bone, ligaments visible with 60% full-thickness necrotic tissue, malodour, and heavy hemopurulent discharge. Scattered of skin erosion over periwound skin. Patient was tachycardia and febrile since one week ago. The goals of wound care manage ongoing infection, malodor, and excessive exudation. Wound bed preparation (TIME concepts) was adopted in wound management after comprehensive wound assessment. The approach of regular wound cleansing with the antimicrobial solution, autolytic debridement, and periodically conservative sharp wound debridement to remove bioburden and non-viable tissue--subsequently, Negative Pressure Wound Therapy initiated for short term to promote cell proliferation and enhance sacral wound contractions. Ciprofloxacin was started after two days on top of Augmentin to treat Pseudomonas infection. Results / Discussion: After 16 days, Mdm T's sacral wound shown vast improvement with 90% of pinkish granulation tissue, nil odour and with wound infection resolved. Mdm T's son feedback that patient shown subjective improvement to be able to interact with him by maintaining eye contact on his visits. Conclusion: It is indeed challenging to manage patient with multiple complex pressure injuries. This case demonstrated with access to specialized wound care nurse in inpatient palliative setting, it helps to improve the wound outcome and QoL for patients. Most importantly, it enhances overall nursing practices on wound management. [ABSTRACT FROM AUTHOR]