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Background: Using the lived experience as their expertise, peer support specialists (PSS) focus on the empowerment of individuals with mental health conditions. Despite its value, peer support services in Singapore are relatively uncommon. Perspectives from mental health workers may provide insights on targeted strategies to address the organisational changes needed for the continued growth of the lived experience workforce., Aims: The study aims to explore the attitudes and perceptions of mental health workers regarding the benefits, challenges, and potential strategies in the implementation of peer support services across mental health settings in Singapore., Methods: A total of 59 responses were gathered for an online survey via convenience sampling. Descriptive statistics were generated for quantitative data, while an inductive thematic analytic method was utilised for qualitative inputs. The coding and refinement of themes were discussed between both authors., Results: The majority of the respondents were willing to accept PSS as a healthcare profession (72.9%), willing to work with PSS (89.8%) and perceived there should be PSS where they worked (64.4%). Key themes identified highlighted a supportive and inclusive workplace environment, the power of the lived experience, and recovery-oriented contribution as the underlying benefits and potential challenges in implementing PSS in Singapore., Implications: Policymakers could consider funding initiatives and regulatory standards to support the implementation of PSS across mental health settings in Singapore, while organisations could implement training programmes and supervision targeted at enhancing the practice of recovery-oriented care amongst its staff., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: The heterogeneity of depressive and anxiety disorders complicates clinical management as it may account for differences in trajectory and treatment response. Self-schemas, which can be determined by Self-Referential Judgements (SRJs), are heterogeneous yet stable. SRJs have been used to characterize personality in the general population and shown to be prognostic in depressive and anxiety disorders., Methods: In this study, we used SRJs from a Self-Referential Encoding Task (SRET) to identify clusters from a clinical sample of 119 patients recruited from the Institute of Mental Health presenting with depressive or anxiety symptoms and a non-clinical sample of 115 healthy adults. The generated clusters were examined in terms of most endorsed words, cross-sample correspondence, association with depressive symptoms and the Depressive Experiences Questionnaire and diagnostic category., Results: We identify a 5-cluster solution in each sample and a 7-cluster solution in the combined sample. When perturbed, metrics such as optimum cluster number, criterion value, likelihood, DBI and CHI remained stable and cluster centers appeared stable when using BIC or ICL as criteria. Top endorsed words in clusters were meaningful across theoretical frameworks from personality, psychodynamic concepts of relatedness and self-definition, and valence in self-referential processing. The clinical clusters were labeled "Neurotic" (C1), "Extraverted" (C2), "Anxious to please" (C3), "Self-critical" (C4), "Conscientious" (C5). The non-clinical clusters were labeled "Self-confident" (N1), "Low endorsement" (N2), "Non-neurotic" (N3), "Neurotic" (N4), "High endorsement" (N5). The combined clusters were labeled "Self-confident" (NC1), "Externalising" (NC2), "Neurotic" (NC3), "Secure" (NC4), "Low endorsement" (NC5), "High endorsement" (NC6), "Self-critical" (NC7). Cluster differences were observed in endorsement of positive and negative words, latency biases, recall biases, depressive symptoms, frequency of depressive disorders and self-criticism., Discussion: Overall, clusters endorsing more negative words tended to endorse fewer positive words, showed more negative biases in reaction time and negative recall bias, reported more severe depressive symptoms and a higher frequency of depressive disorders and more self-criticism in the clinical population. SRJ-based clustering represents a novel transdiagnostic framework for subgrouping patients with depressive and anxiety symptoms that may support the future translation of the science of self-referential processing, personality and psychodynamic concepts of self-definition to clinical applications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Tan, Wang, Tan, Ong, Ooi, Lee, Rane, Tey, Chua, Goh, Lam, Chakraborty, Yew, Ong, Kee, Lim, Hashim, Lu, Meany, Tolomeo, Lee, Tan and Keppo.)

Objective: Caregivers of children with Autism Spectrum Disorder (ASD) often experience emotional and psychological distress, as well as disruptions to family life and employment due to the challenges of caring for children with ASD. This study examines the relationship between problem behaviours and caregiver burden among children with ASD., Method: A cross-sectional study using convenience sampling recruited 230 caregivers of children with ASD aged 4 to 18 years from selected autism centres in Kuching, Sarawak. The caregivers completed the Aberrant Behaviour Checklist-2 and the Zarit Burden Interview., Results: Univariate analysis revealed a significant difference in caregiver burden for children with ASD receiving medications ( p  = 0.013), registered with the Social Welfare Department ( p  = 0.036), and having siblings with ASD ( p  = 0.046). About 40% of the children exhibited at least one domain of problem behaviour. More than half of the caregivers (53.9%) experienced burden, with the majority experiencing mild burden. Positive associations were seen between irritability ( r  = 0.458, p  < 0.01), social withdrawal ( r  = 0.439, p  < 0.01), stereotypic behaviour ( r  = 0.392, p  < 0.01), hyperactivity/non-compliance ( r  = 0.467, p  < 0.01), and caregiver burden. Child factors, including the duration of problem behaviour ( r  = 0.182, p  = 0.007), medication use (eta = 0.187, p  = 0.005), Social Welfare Department registration (eta = 0.138, p  = 0.036), and the presence of siblings with ASD (eta = 0.130, p  = 0.046) were associated with caregiver burden. Multiple linear regression showed that hyperactivity/noncompliance significantly predicted caregiver burden., Conclusion: Specific problem behaviours in children with ASD were associated with caregiver burden. These results highlight the need for interventions for the child with ASD and their caregivers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Chua, Abd Rahman and Ratnasingam.)

Tuberculosis (TB) is a public health challenge globally, and molecular testing is recommended to expedite diagnosis. Concerns that Xpert MTB/RIF assay (Xpert) may be less sensitive when testing paucibacillary samples led to the development of the Xpert MTB/RIF Ultra assay (Ultra). We evaluated the performance of Ultra against Xpert on clinical samples sent to the national reference laboratory in Singapore. In total, 149 samples collected between January 2019 and November 2020 were analysed. Mycobacterium tuberculosis complex (MTBC) was isolated from 55 cultures. Using culture as the reference standard, Ultra demonstrated higher sensitivity (96.4% vs 85.5%) and marginally lower specificity (88.3% vs 89.4%) compared to Xpert in the full cohort. When considering only paucibacillary specimens such as extrapulmonary and smear-negative samples, similar results were obtained. Reclassifying Ultra trace results (low levels of MTB are detected but no rifampicin resistant result is detected) as negative in the full cohort led to a decrease in sensitivity by 10.9% and a marginal increase in specificity by 1.1%. In instances of low bacillary load, Ultra also identified rifampicin resistance more accurately than Xpert, when corroborated against other methods such as broth microdilution, line probe assay and whole genome sequencing (WGS). One isolate tested rifampicin-resistant using Xpert and Ultra, but was phenotypically susceptible and WGS demonstrated the presence of the silent mutation Thr444Thr. Ultra is more sensitive than Xpert in the detection of MTBC and rifampicin resistance in our local setting. Nevertheless, the results of molecular testing should still be correlated with phenotypic studies., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: The aims of this study were to investigate associations between attachment and the presence of persistent pain in women following treatment for breast cancer and to investigate the relationship between attachment, pain, and quality of life (QOL) in women with persistent pain., Methods: Women (N = 335) previously diagnosed with primary non-metastatic breast cancer completed an online survey with measures of attachment, pain, QOL, demographics, and medical history. Variables were compared between women with (N = 128) and without (N = 207) persistent pain. For those reporting pain, regression analyses were conducted to investigate relationships between attachment, pain, and QOL., Results: Higher attachment anxiety, but not attachment avoidance, was related to the presence of persistent pain. Among women with persistent pain, associations between attachment anxiety and avoidance and greater pain intensity were lost when pain catastrophizing was considered in analysis. Significant associations between attachment and diminished QOL and perceived effectiveness of pain management were identified in multivariate analysis., Conclusions: These findings extend the available literature regarding associations between pain and attachment insecurity. In women with pain after breast cancer treatment, attachment anxiety and avoidance were associated with negative pain and QOL outcomes. Further attention regarding the use of attachment-informed approaches in supporting women following breast cancer treatment is indicated., (© 2018 John Wiley & Sons, Ltd.)

Background: To investigate the relationship between dietary intakes at six, nine and 12 months and risk of myopia in three-year-old children in a birth cohort., Methods: Three hundred and seventeen children from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study were included. Dietary intake at six, nine and 12 months of age was ascertained using either 24-hour recalls or three-day food diaries completed by parents. Cycloplegia was achieved with three drops of one per cent cycloplentolate instilled at five minute intervals. Cycloplegic autorefraction and axial length (AL) were measured at three years of age with a table-mounted autorefractor and optical biometer, respectively. Myopia was defined as spherical equivalent (SE) of ≤ -0.50 D. Associations of dietary intake with SE, AL and myopia were examined by single dietary factor models using two multivariable regression models. Model 1 included adjusting for age, gender and total energy intake. Model 2 included additional adjustments for ethnicity, time spent outdoors, maternal education and parental myopia., Results: In the single dietary factor adjusted models, dietary intakes at six, nine and 12 months were not associated with SE, AL and myopia. In model 1, protein, fat and carbohydrate intakes were not associated with SE, AL and myopia at any of the three time points (p > 0.05). In model 2, protein, fat and carbohydrate intakes were not associated with SE, AL and myopia at any of the three time points (p > 0.05)., Conclusions: In this study, there was no evidence that diet at ages six, nine and 12 months was related to SE, AL or myopia at age three years. Further prospective studies with larger sample sizes are needed to understand the influence of diet on eye development in young children., (© 2018 Optometry Australia.)

Laser sensing has been applied in various underwater applications, ranging from underwater detection to laser underwater communications. However, there are several great challenges when profiling underwater turbulence effects. Underwater detection is greatly affected by the turbulence effect, where the acquired image suffers excessive noise, blurring, and deformation. In this paper, we propose a novel underwater turbulence detection method based on a gated wavefront sensing technique. First, we elaborate on the operating principle of gated wavefront sensing and wavefront reconstruction. We then setup an experimental system in order to validate the feasibility of our proposed method. The effect of underwater turbulence on detection is examined at different distances, and under different turbulence levels. The experimental results obtained from our gated wavefront sensing system indicate that underwater turbulence can be detected and analyzed. The proposed gated wavefront sensing system has the advantage of a simple structure and high detection efficiency for underwater environments., Competing Interests: The authors declare no conflict of interest.

Accuracy is an important measure of system performance and remains a challenge in 3D range gated reconstruction despite the advancement in laser and sensor technology. The weighted average model that is commonly used for range estimation is heavily influenced by the intensity variation due to various factors. Accuracy improvement in term of range estimation is therefore important to fully optimise the system performance. In this paper, a 3D range gated reconstruction model is derived based on the operating principles of range gated imaging and time slicing reconstruction, fundamental of radiant energy, Laser Detection And Ranging (LADAR), and Bidirectional Reflection Distribution Function (BRDF). Accordingly, a new range estimation model is proposed to alleviate the effects induced by distance, target reflection, and range distortion. From the experimental results, the proposed model outperforms the conventional weighted average model to improve the range estimation for better 3D reconstruction. The outcome demonstrated is of interest to various laser ranging applications and can be a reference for future works., Competing Interests: The authors declare no conflict of interest.

The range gated technique is a promising laser ranging method that is widely used in different fields such as surveillance, industry, and military. In a range gated system, a reflected laser pulse returned from the target scene contains key information for range reconstruction, which directly affects the system performance. Therefore, it is necessary to study the characteristics and effects of the target reflection factor. In this paper, theoretical and experimental analyses are performed to investigate the influence of target reflection on three-dimensional (3D) range gated reconstruction. Based on laser detection and ranging (LADAR) and bidirectional reflection distribution function (BRDF) theory, a 3D range gated reconstruction model is derived and the effect on range accuracy is analyzed from the perspectives of target surface reflectivity and angle of laser incidence. Our theoretical and experimental study shows that the range accuracy is proportional to the target surface reflectivity, but it decreases when the angle of incidence increases to adhere to the BRDF model. The presented findings establish a comprehensive understanding of target reflection in 3D range gated reconstruction, which is of interest to various applications such as target recognition and object modeling. This paper provides a reference for future improvement to perform accurate range compensation or correction.

Purpose: To investigate the effect of age of myopia onset on the severity of myopia later in life among myopic children., Methods: In this prospective study, school children aged 7-9 years from the Singapore Cohort Of the Risk factors for Myopia (SCORM) were followed up till 11 years (n = 928). Age of myopia onset was defined either through questionnaire at baseline (age 7-9 years) or subsequent annual follow-up visits. Age of onset of myopia was a surrogate indicator of duration of myopia progression till age 11 years. Cycloplegic refraction and axial length were measured at every annual eye examination. High myopia was defined as spherical equivalent of ≤-5.0 D. A questionnaire determined the other risk factors., Results: In multivariable regression models, younger age of myopia onset (per year decrease) or longer duration of myopia progression was associated with high myopia (odds ratio (OR) = 2.86; 95% CI: 2.39 to 3.43), more myopic spherical equivalent (regression coefficient (β) = -0.86 D; 95% CI: -0.93 to -0.80) and longer axial length (β = 0.28 mm; 95% CI: 0.24 to 0.32) at aged 11 years, after adjusting for gender, race, school, books per week and parental myopia. In Receiver Operating Curve (ROC) analyses, age of myopia onset alone predicted high myopia by 85% (area under the curve = 0.85), while the addition of other factors including gender, race, school, books per week and parental myopia only marginally improved this prediction (area under the curve = 0.87)., Conclusions: Age of myopia onset or duration of myopia progression was the most important predictor of high myopia in later childhood in myopic children. Future trials to retard the progression of myopia to high myopia could focus on children with younger age of myopia onset or with longer duration of myopia progression., (© 2016 The Authors Ophthalmic & Physiological Optics © 2016 The College of Optometrists.)

Purpose: To investigate the association of passive tobacco smoke exposure with early-onset myopia among three-year-old children in Singapore., Methods: Pregnant mothers who attended their first trimester clinic at two major maternity units were recruited into the GUSTO birth cohort. The current analysis comprised 572 three-year-old children, who underwent cycloplegic autorefraction and axial length (AL) measurements. Myopia was defined as spherical equivalent (SE) of ≤-0.50 dioptres (D). Either parent completed questionnaires describing their child's exposure to passive smoke at six months, one and two years of age., Results: There were 197 children (36.2%) who were exposed to passive smoke from birth to before six months. Compared to non-exposed children, children exposed to any passive smoke from birth to before six months experienced greater myopia prevalence (adjusted OR = 2.79; 95% CI: 1.24-6.29; p = 0.01). The odds of myopia in a child was greater if a smoker smokes at home, in the family car, or in the presence of the child (adjusted OR = 3.95; 95% CI: 1.41-11.09; p < 0.01) compared to non-exposed child. In contrast to myopia, childhood exposure to passive smoke did not systematically shift mean values for SE or AL., Conclusions: In this prospective birth cohort study, we found that childhood exposure to passive smoke from birth to before six months slightly increased the risk of early-onset myopia. This may indicate a delayed response to passive smoke exposure before six months and the development of myopia at three years of age. Our study is limited by the small number of myopic children at this young age. Thus, larger prospective studies using more objective cotinine level measures are required to fully establish and understand the influence of tobacco smoke on refractive development in older children., (© 2016 The Authors Ophthalmic & Physiological Optics © 2016 The College of Optometrists.)

Purpose: This study investigated the association of axial length (AL) to corneal radius of curvature (CRC) ratio with spherical equivalent (SE) in a 3-year old Asian cohort., Methods: Three-hundred forty-nine 3-year old Asian children from The Growing Up in Singapore towards Healthy Outcomes (GUSTO) birth cohort study underwent AL and CRC measurements with a noncontact ocular biometer and cycloplegic refraction using an autorefractor. The ratio of AL to CRC (AL/CRC) was calculated for all the participants, and subsequently AL, CRC, and AL/CRC were analyzed in relationship to SE., Results: The SE showed better correlation with AL/CRC (Spearman's correlation coefficient, ρ = -0.53; 95% confidence interval [CI]: -0.66; -0.49; P < 0.001) compared to either AL or CRC alone ([ρ = -0.36; 95% CI: -0.51 to 0.51; P = 0.01] and [ρ = 0.05; 95% CI: -0.04 to 0.17; P = 0.34], respectively). Mean AL/CRC was 2.91 ± 0.06 among myopes and decreased to 2.79 ± 0.06 among hyperopes. Axial length to corneal radius of curvature was strongly correlated with SE in myopes (ρ = -0.78; 95% CI: -3.76; -0.79; P = < 0.001), but not in emmetropes and hyperopes ([ρ = -0.39; 95% CI: -10.73; -0.57; P = 0.01] and [ρ = -0.18; 95% CI: -17.28; 12.42; P = 0.38], respectively). Linear regression adjusted for gender and ethnicity showed a 0.74-diopter shift in SE towards myopia with every 0.1 increase in AL/CRC ratio ( P < 0.001, r 2 = 0.33)., Conclusion: The correlation between SE and AL/CRC is stronger than that between AL or CRC alone. This suggests that in a research setting, when cycloplegic refraction is difficult to perform on 3-year-old children, AL/CRC may be the next best reference for refractive error., Translational Relevance: In the research setting, AL/CRC may be the next best reference for refractive error over AL alone when cycloplegic refraction is unavailable in 3-year old children.

Range determination has crucial dependency of intensity over distance due to the fact that output of a range gated system is the reflectivity and range information expressed in term of intensity. From our experimental study, the analyzed trend line of reflected intensity versus range agrees with the theoretical model where it underlies an inverse range-squared dependency. Considering the energy attenuation factor for a better three-dimensional (3D) solution, a range compensation model is derived based on time slicing technique to compensate the effect imposed by distance beyond an optimum range. A range gated imaging system with pulse profile feedback is proposed in order to apply the range compensation model. Experimental results show noticeable improvement as compared to the conventional weighted average method for reflected laser pulse data across different ranges and 3D surface reconstruction using the proposed range compensation model.

Purpose: To investigate the associations of near work, outdoor activity, and anthropometric risk factors with early-onset myopia in Singaporean preschool children., Methods: Pregnant women who attended their first-trimester clinic at two major maternity units were recruited for the GUSTO birth cohort (n = 1236). Cycloplegic autorefraction and axial length (AL) were obtained in 3-year-old children (n = 572). Parents completed detailed questionnaires on parental myopia, near work, and outdoor activities when the child was 2 years of age. Height and weight were measured in the children at various time points from birth to 3 years of age., Results: Among the cohort of 572 children, 35 children (6.1%) had early-onset myopia. In multivariable regression models, compared to children whose parents were not myopic, those with two myopic parents were more likely to have a more myopic spherical equivalent (SE) (regression coefficient: -0.36; 95% confidence interval [CI]: -0.61 to -0.11) and longer AL (regression coefficient: 0.24; 95% CI: 0.10-0.39) and more likely to have myopia (odds ratio [OR] = 4.8; 95% CI: 1.4-16.6). Neither near work nor outdoor activity was associated with SE, AL, and myopia. Taller children were found to have longer AL at birth and at 12, 24, and 36 months, but there were no associations with SE., Conclusions: Genetic factors may have a greater contribution to early development of refractive error compared to environmental factors.

Myopia is a significant public health problem worldwide, particularly in East Asian countries. The increasing prevalence of myopia poses a huge socio-economic burden and progressive high myopia can lead to sight-threatening ocular complications. Hence, the prevention of early-onset myopia progressing to pathological high myopia is important. Recent epidemiological studies suggest that increased outdoor time is an important modifiable environmental factor that protects young children from myopia. This protective effect may be due to high light intensity outdoors, the chromaticity of daylight or increased vitamin D levels. This review summarises the possible underlying biological mechanisms for the protective association between time outdoors and myopia, including the potential role of nicotinic acetylcholine receptors in refractive error development. Recent evidence for the role of other environmental risk factors such as near work, birth seasons, parental smoking and birth order are also summarised., (© 2015 Optometry Australia.)

Background: Essential genes are critical for the development of all organisms and are associated with many human diseases. These genes have been a difficult category to study prior to the availability of balanced lethal strains. Despite the power of targeted mutagenesis, there are limitations in identifying mutations in essential genes. In this paper, we describe the identification of coding regions for essential genes mutated using forward genetic screens in Caenorhabditis elegans. The lethal mutations described here were isolated and maintained by a wild-type allele on a rescuing duplication., Results: We applied whole genome sequencing to identify the causative molecular lesion resulting in lethality in existing C. elegans mutant strains. These strains are balanced and can be easily maintained for subsequent characterization. Our method can be effectively used to analyze mutations in a large number of essential genes. We describe here the identification of 64 essential genes in a region of chromosome I covered by the duplication sDp2. Of these, 42 are nonsense mutations, six are splice signal mutations, one deletion, and 15 are non-synonymous mutations. Many of the essential genes in this region function in cell cycle, transcriptional regulation, and RNA processing., Conclusions: The essential genes identified here are represented by mutant strains, many of which have more than one mutant allele. The genetic resource can be utilized to further our understanding of essential gene function and will be applicable to the study of C. elegans development, conserved cellular function, and ultimately lead to improved human health.

Objectives: To establish (1) the intrarater and interrater reliability of Four Square Step Test (FSST) times in persons with chronic stroke; (2) the concurrent validity of FSST times with standing balance and functional mobility measures; and (3) the FSST cutoff score for distinguishing the differences in dynamic balance performance of persons with chronic stroke from healthy control adults., Design: Cross-sectional study., Setting: University-based rehabilitation center., Participants: Convenience sample of subjects (N=30) consisting of community-dwelling persons with chronic stroke (n=15) and healthy control adults (n=15)., Interventions: Not applicable., Main Outcome Measures: FSST scores; balance and functional mobility measured using Berg Balance Scale (BBS) scores; Timed Up & Go (TUG) test scores; and limits of stability (LOS) measured by dynamic posturography., Results: FSST times showed good intrarater reliability, with intraclass correlation coefficients ranging from .82 to .83 and an interrater reliability >.99. An FSST cutoff score of 11 seconds was able to discriminate between healthy adults older than 50 years and persons with stroke (sensitivity, 73.3%; specificity, 93.3%). FSST times were correlated with LOS scores for directional control in the backward direction (r=.64; P=.01). FSST was approaching a significant correlation with TUG scores (r=.59; P=.02) and LOS scores for endpoint excursion in the forward direction (r=-.58; P=.02). However, there was no correlation with BBS scores., Conclusion: FSST is an easy-to-administer clinical test with good intrarater and interrater reliability in persons with chronic stroke to assess dynamic standing balance. FSST times of 11 seconds are able to differentiate between persons with chronic stroke and healthy adults older than 50 years. The correlation of FSST times with standing balance and functional mobility measures requires further research with a larger sample size., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Curation of a high-quality gene set is the critical first step in genome research, enabling subsequent analyses such as ortholog assignment, cis-regulatory element finding, and synteny detection. In this project, we have reannotated the genome of Caenorhabditis briggsae, the best studied sister species of the model organism Caenorhabditis elegans. First, we applied a homology-based gene predictor genBlastG to annotate the C. briggsae genome. We then validated and further improved the C. briggsae gene annotation through RNA-seq analysis of the C. briggsae transcriptome, which resulted in the first validated C. briggsae gene set (23,159 genes), among which 7347 genes (33.9% of all genes with introns) have all of their introns confirmed. Most genes (14,812, or 68.3%) have at least one intron validated, compared with only 3.9% in the most recent WormBase release (WS228). Of all introns in the revised gene set (103,083), 61,503 (60.1%) have been confirmed. Additionally, we have identified numerous trans-splicing leaders (SL1 and SL2 variants) in C. briggsae, leading to the first genome-wide annotation of operons in C. briggsae (1105 operons). The majority of the annotated operons (564, or 51.0%) are perfectly conserved in C. elegans, with an additional 345 operons (or 31.2%) somewhat divergent. Additionally, RNA-seq analysis revealed over 10 thousand small-size assembly errors in the current C. briggsae reference genome that can be readily corrected. The revised C. briggsae genome annotation represents a solid platform for comparative genomics analysis and evolutionary studies of Caenorhabditis species.

Objectives: To establish (1) the intrarater and interrater reliabilities of step test (ST) scores in subjects with chronic stroke, (2) the ST's known-groups validity and cutoff scores for distinguishing subjects with chronic stroke from healthy adults older than 50 years, and (3) the convergent validity of ST scores with lower-limb muscle strength, coordination, balance performance, and walking speed., Design: Cross-sectional study., Setting: University-based rehabilitation center., Participants: Convenience sample of subjects (N=30): community-dwelling subjects with chronic stroke (n=15) and healthy adults older than 50 years (n=15)., Interventions: Not applicable., Main Outcome Measures: ST scores; handheld dynamometer measurements of bilateral lower-limb muscle strength; lower-extremity motor coordination test (LEMOCOT) scores; Berg Balance Scale scores; walking speed as measured by a 5-meter walk test., Results: ST scores showed excellent intrarater reliability, with intraclass correlation coefficients ranging from .981 to .995 and interrater reliability ranging from .996 to .999. A cutoff score of 13 on the paretic side was found to distinguish the healthy adults older than 50 years from subjects with stroke at a sensitivity of 87% and a specificity of 87%. A cutoff score of 11 on the nonparetic side was found to distinguish the healthy adults from subjects with stroke at a sensitivity of 100% and a specificity of 67%. ST scores of the paretic limb demonstrated a significant correlation with muscle strength, the LEMOCOT scores of the paretic leg, and walking speed. ST scores of the nonparetic limb demonstrated a significant correlation with muscle strength and the LEMOCOT scores of the paretic leg., Conclusions: The ST is a reliable measurement tool when the number of steps is counted by either experienced or inexperienced examiners by viewing videotapes. ST scores with both the paretic limb and the nonparetic limb are sensitive in distinguishing subjects with chronic stroke from healthy adults older than 50 years., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

The Ataxia-telangiectasia-mutated (ATM) gene in humans was identified as the basis of a rare autosomal disorder leading to cancer susceptibility and is now well known as an important signal transducer in response to DNA damage. An approach to understanding the conserved functions of this gene is provided by the model system, Caenorhabditis elegans. In this paper we describe the structure and loss of function phenotype of the ortholog atm-1. Using bioinformatic and molecular analysis we show that the atm-1 gene was previously misannotated. We find that the transcript is in fact a product of three gene predictions, Y48G1BL.2 (atm-1), K10E9.1, and F56C11.4 that together make up the complete coding region of ATM-1. We also characterize animals that are mutant for two available knockout alleles, gk186 and tm5027. As expected, atm-1 mutant animals are sensitive to ionizing radiation. In addition, however, atm-1 mutants also display phenotypes associated with genomic instability, including low brood size, reduced viability and sterility. We document several chromosomal fusions arising from atm-1 mutant animals. This is the first time a mutator phenotype has been described for atm-1 in C. elegans. Finally we demonstrate the use of a balancer system to screen for and capture atm-1-derived mutational events. Our study establishes C. elegans as a model for the study of ATM as a mutator potentially leading to the development of screens to identify therapeutic targets in humans.

The issue of heterozygosity continues to be a challenge in the analysis of genome sequences. In this article, we describe the use of allele ratios to distinguish biologically significant single-nucleotide variants from background noise. An application of this approach is the identification of lethal mutations in Caenorhabditis elegans essential genes, which must be maintained by the presence of a wild-type allele on a balancer. The h448 allele of let-504 is rescued by the duplication balancer sDp2. We readily identified the extent of the duplication when the percentage of read support for the lesion was between 70 and 80%. Examination of the EMS-induced changes throughout the genome revealed that these mutations exist in contiguous blocks. During early embryonic division in self-fertilizing C. elegans, alkylated guanines pair with thymines. As a result, EMS-induced changes become fixed as either G→A or C→T changes along the length of the chromosome. Thus, examination of the distribution of EMS-induced changes revealed the mutational and recombinational history of the chromosome, even generations later. We identified the mutational change responsible for the h448 mutation and sequenced PCR products for an additional four alleles, correlating let-504 with the DNA-coding region for an ortholog of a NFκB-activating protein, NKAP. Our results confirm that whole-genome sequencing is an efficient and inexpensive way of identifying nucleotide alterations responsible for lethal phenotypes and can be applied on a large scale to identify the molecular basis of essential genes.

Purpose: Our aim was to present our experience with the management of six women with uterine scar pregnancies in KK Women's and Children's Hospital, Singapore., Methods: The medical records of women with a pregnancy in previous uterine scar that had been diagnosed in our department during 2004-2008 were reviewed., Results: Out of six women, one woman presented in mid-trimester, at 16 weeks with severe abdominal pain and persistent vomiting. She underwent a hysterectomy complicated with massive haemorrhage. The other five women presented in first trimester. Two women had excision of the scar with the sac, two had ultrasound-guided injection of methotrexate in the sac and one had systemic methotrexate. In all cases, maternal recovery was complete. Uterine scar pregnancy was diagnosed by ultrasonography., Conclusion: Women at a risk appear to be those with multiple Caesarean sections, termination of pregnancy and myomectomy. Operative as well as medical treatments have been reported for scar pregnancy. Surgical treatment includes excision of trophoblastic tissues by laparotomy or laparoscopy whilst medical treatment includes local and/or systemically administered methotrexate. Although many interventions have been described, optimal treatment is still not known and they remain a challenge.

Study Type:  Reliability study Introduction:  Cervical spondylotic myelopathy (CSM) is the most common spinal cord disorder in persons more than 55 years old. Despite multiple neuroimaging approaches proposed to quantify the spinal cord compromise in CSM patients, magnetic resonance imaging (MRI) remains the procedure of choice by providing helpful information for clinical decision making, determining optimal subpopulations for treatment, and selecting the optimal treatment strategies. However, the validity, reliability, and accuracy of the MRI quantitative measurements have not yet been addressed., Objective:  To assess the intra- and inter-observer reliability of MRI quantitative measurements of the spinal cord compromise in CSM patients., Methods:  Seventeen CSM patients (13 male) of mean age 54.5 years old were selected from the AOSpine North America database. The patients had different combinations of stenotic levels (1-4 levels) and the clinical severity (range mJOA baseline: 8-18). Asymptomatic or previous surgically treated CSM, active infection, neoplastic disease, rheumatoid arthritis, ankylosing spondylitis, trauma, or concomitant lumbar stenosis were excluded. The patients underwent preoperative MRI using 1.5T (15 patients) and 3T (two patients) scanner, including mid-sagittal T1-weighted, axial and mid-sagittal T2-weighted series. MRI data were analyzed (Mango 2.0 software; Multi-Image Analysis GUI) by four blind raters in three different sessions. Four measurements were analysed: transverse area (TA) (Figure 1), compression ratio (CR) (Figure 2), maximal canal compromise (MCC), and maximal spinal cord compression (MSCC) (Figure 3). The differences for each measurement were evaluated using mixed-effect ANOVA models (ratter, session, ratter x session). The intra- and inter-rater reliability was evaluated with intraclass correlation coefficients (ICC) (Figure 4). Figure 1 Transverse area (TA)Figure 2 Compression ratio (CR = AP/W)Figure 3 Maximal canal compromise (MCC), and maximal spinal cord compression (MSCC). MCC(%) = 1-[Dx/(Da+Db)/2] × 100%; MSCC(%) = 1-[dx/(da+db)/2] × 100%Figure 4 Intraclass correlation coefficients (ICC) Results:  The principal findings were: (i) for TA (71.48 ± 12.99mm2), the intra-rater agreement was 0.97 (95% CI, range 0.94-0.99) and the inter-rater agreement was 0.76 (95% CI, range 0.49-0.90); (ii) for CR (0.35 ± 0.04%), 0.94 (95% CI, range 0.88-0.98), and 0.79 (95% CI, range 0.57-0.91) respectively; (iii) for MCC (83.21 ± 2.08%), 0.95 (95% CI, range 0.89-0.98), and 0.64 (95% CI, range 0.28-0.85) respectively; and (iv) for MSCC (82.87 ± 1.52%), 0.93 (95% CI, range 0.86-0.97), and 0.84 (95% CI, range 0.65-0.93) respectively., Conclusions:  Our data suggest that three out of four measurements (TA, CR and MSCC) have acceptable intra- and interreliability coefficients (ICC > 0.75). However, for the maximal canal compromise measure, although the intrareliability was acceptable, the inter-rater reliability was not acceptable (0.64). Based on this study, we recommend that three MRI measures: transverse area, compression ratio and maximal spinal cord compression should be used in the imaging assessment of the spinal cord in CSM patients.

Genomic rearrangements are widely used in Caenorhabditis elegans research but many remain incompletely characterized at the physical level. We have used oligo-array comparative genomic analysis to assess the physical structure of 20 deficiencies and a single duplication of chromosome V. We find that while deletions internal to the chromosome appear simple in structure, terminal deletions are complex, containing duplications in addition to the deletion. Additionally, we confirm that transposon-induced deficiencies contain breakpoints that initiate at Tc1 elements. Finally, 13 of these deficiencies are known to suppress recombination far beyond the extent of the deletion. These deficiencies fall into two classes: strong and weak suppressors of adjacent recombination. Analysis of the deleted regions in these deficiencies reveals no common physical sites to explain the observed differences in recombination suppression. However, we find a strong correlation between the size of the rearranged chromosome and the severity of recombination suppression. Rearranged chromosomes that have a minor effect on recombination fall within 2% of normal chromosome size. Our observations highlight the use of array-based approaches for the analysis of rearranged genomes, revealing previously unidentified deficiency characteristics and addressing biologically relevant questions.

Unilateral rupture of the quadriceps tendon is not uncommon, but bilateral spontaneous quadriceps tendon rupture is a rare occurrence and is usually associated with some underlying predisposing condition. We describe a case of a previously healthy patient who presents with bilateral spontaneous rupture of both quadriceps tendon. Investigations revealed that he had underlying alkaptonuria which was previously undiagnosed. Alkaptonuria is a rare inborn metabolic disease, which results in the derangement of homogentisic acid metabolism. Excessive accumulation of homogentisic acid is known to affect multiple organ systems, resulting in tendinopathy and arthropathy in the muscoskeletal system.

Hereditary neuropathy with liability to pressure palsies (HNPP) is a disease that presents with recurrent reversible episodes of neurapraxia that occur typically after trivial trauma. It is an autosomal dominant, demyelinating neuropathy. A 20-year-old man presented with left ulnar nerve palsy after a fall. He had reduced two-point discrimination over his left ulnar nerve distribution, with mild clawing of the ring and little fingers, and accompanying weakness of the first dorsal interrosseus and abductor digiti minimi of grade four power. His Froment's sign was also positive. Careful clinical examination and appropriate tests, including electromyography and genetic testing, confirmed the diagnosis of HNPP. This case report is presented to promote awareness and recognition of this disease in the local and regional context.