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Parent education programs are important avenues through which parents of children with developmental delays can learn new skills to help them with child-rearing challenges. However, those in economic hardship often face problems with applying these skills at home where the child's learning and/or behavioral problems commonly occur. In this exploratory qualitative study, we adopted a positive deviance (PD) lens to explore strategies six economically disadvantaged parents used to support their children who were attending special and mainstream preschools concurrently. The PD perspective was first used in public health research with low-resource communities where a few individuals have been observed to adopt uncommon practices and behaviors that enable them to find better ways to prevent social or health problems than their neighbors facing similar constraints and risks. We identified adaptive parental behaviors, thoughts and feelings that helped them navigate daily hassles faced with "dual schooling" their children in Singapore. The study highlights important implications in the development and refinement of future parent training programs.

In Singapore, preschool children with developmental disabilities receive developmental interventions by multidisciplinary teams of providers across various settings. Cessation of in-person sessions during the early stages of the COVID-19 pandemic necessitated providers to pivot rapidly and use virtual platforms to continue delivering interventions. This cross-sectional study assessed the effects of this challenging experience on providers' psychological wellbeing, including resilience, depression, stress, and anxiety. Ninety-five providers anonymously completed (i) an online questionnaire which included questions on their perceptions of the provision of virtual services and stress; (ii) the Connor-Davidson Resilience Scale (CD-RISC); and (iii) the Depression, Anxiety and Stress Scale (DASS). Among participants who used virtual platforms to continue providing interventions, 83.3% reported difficulties during sessions. Over half (57.9%; n = 55) reported increased stress compared to pre-COVID-19. The mean CD-RISC score (62.7; range: 36-88) was lower than that of general population samples, indicating reduced resilience. Lack of flexibility to work from home, difficulties providing interventions online, higher self-reported stress, and a non-hospital setting were significantly associated with lower resilience. Prevalence rates of depression, anxiety, and stress were 13.7% (n = 13), 42.1% (n = 40), and 56.8% (n = 54), respectively, with school-based settings significantly associated with a positive screen for depression. The results reveal the often-invisible psychological ill-effects in providers of children with developmental disabilities and underscore the need for targeted support to improve their resilience and overall mental wellbeing so that they can continue to effectively provide the crucial interventions needed by the children under their care.

Screening for autism in childhood has been advocated as a part of standard care. Challenges exist with screening implementation and performance of screening tools in clinical practice. This study aimed to examine the validity and feasibility of using the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) for screening of autism in Singapore. Caregivers completed the M-CHAT-R/F as a part of the routine 18-month well-child visit in seven primary care clinics. Screening and follow-up interviews were administered by trained nursing staff. Children screened positive and a subset of those screened negative underwent diagnostic assessments for autism, which included an Autism Diagnostic Observation Schedule, Second Edition. Participants were 5336 multiethnic children (mean age 18.6 ± 0.9 months, 51.3% male gender). In total, 113 (2.1%) were screened positive, of which 54 (1.0%) were classified to have autism after their diagnostic assessment. Sensitivity of the M-CHAT-R/F was 88.6%, specificity 71.4%, and positive predictive value 90.7% for an autism diagnosis. The majority of respondents rated the screening process as feasible within the clinic setting. The M-CHAT-R/F had acceptable psychometric properties and high feasibility when used in primary care settings in Singapore. Recommendations for implementation of systematic screening and future research are presented.

Previous literature has shown that family structure affects language development. Here, factors relating to older siblings (their presence in the house, sex, and age gap), mothers (maternal stress), and household size and residential crowding were assessed to systematically examine the different roles of these factors. Data from mother-child dyads in a Singaporean birth cohort, (677-855 dyads; 52% males; 58% to 61% Chinese, 20% to 24% Malay, 17% to 19% Indian) collected when children were 24, 48, and 54 months old, were analyzed. There was a negative effect of having an older sibling, moderated by the siblings' age gap, but not by the older sibling's sex, nor household size or residential crowding. Maternal stress affected language outcomes in some analyses but not others. Implications for understanding the possible effects of family structure on language development are discussed.

Early childhood teachers face many challenges as they interact with children, their parents, fellow teachers and the early childhood community. The responsibility to meet the needs of a diverse group of people is critical to the teacher's development as a professional. This paper discusses the quantitative findings of a survey that examined the perceptions of the professional self of early childhood teachers. The population sample comprised of 88 early childhood teachers in a part-time undergraduate early childhood education programme with at least 2 years of teaching experience. Factor analysis was applied to identify and explore six factors of early childhood teachers' sense of professional self. The study found that participants rated themselves significantly lower in the latent variable of Professional Self with EC Communities and that the more experienced early childhood teachers rated themselves significantly higher.

Introduction: The Advancing Research To Eliminate Mental Illness Stigma (ARTEMIS) study evaluated the impact of an intervention developed and implemented in Singapore on attitudes towards depression in university students. We aimed to assess the likelihood of university students intervening when their peers suffer from depression, before and after the ARTEMIS intervention. Methods: 390 students were recruited from a university in Singapore. The ARTEMIS intervention comprised a lecture by a trained mental health professional, a sharing session by a person with lived experience of depression, and a question-and-answer segment with a panel. The Bystander Intervention Scale for Depression (BISD) was administered at baseline, post-intervention, and 3-month follow-up. BISD assessed four factors: acceptance of responsibility to intervene, knowledge on how to intervene, awareness of depression among peers, and vigilance towards possible symptoms of depression. Linear mixed models were conducted to investigate associations. Sociodemographic correlates were also examined. Results: A favourable shift in all factors was observed at post-intervention, which weakened at 3-month follow-up. Having past experience in the mental health field (b=1.50) and older age (b=0.18) were significantly associated with knowledge on how to intervene. Having social contact with mental illness (SCMI) and past experience in the mental health field (PEMHF) were significantly associated with awareness of depression among peers (SCMIb=0.89, PEMHF b=0.43) and vigilance towards possible symptoms of depression (SCMI b=0.39, PEMHF b=0.61). Discussion: The short-term results of the intervention appeared promising across all BISD factors; however, these results were not sustained after 3 months. Future research should include the impact of 'booster' interventions over time. Sociodemographic factors that were identified to be significant correlates should also be considered when planning for future interventions. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to share how an Asian university enhanced students' global competence through international business study missions (BSMs). More specifically, it focuses on how the design of these BSMs enabled "deep" learning beyond industry tourism and how 21st-century competencies such as "global competence" can be acquired through participation in short-term, faculty-led study missions. Design/methodology/approach: Using the case study approach, it critically analyzes the learning goals and objectives, design decisions, implementation details and learning outcomes underlying three BSMs led by three instructors from the same university to the USA (New York), Germany (Berlin and Stuttgart) and South Korea (Seoul). Findings: The study shows that students gained global competencies related to specific fields of study such as the creative industries, urban sustainability and entrepreneurship. It shows how design choices such as destination, range of organizations, length of individual visits, range of pedagogical techniques, intensity of preparation and quality of management contribute to students' acquisition of global competencies. Research limitations/implications: This research presents a subset of case studies that may limit the generalization of the findings; the bias that results from an unrepresentative, opportunistic sample (selection bias); and lack of quantitative causality in a qualitative evaluation. Practical implications: The course design described here provides practical information for designing study abroad "deep" learning goals, objectives and outcomes focusing on global competence. Originality/value: The detailed case studies of three instructors from different disciplines to achieve the country's education vision of globally competent students.

This Singapore study involved a sample of 3776 secondary school students to examine the role of educational hope in moderating the relationships between teacher-student relationship dimensions (instrumental help, emotional support, relationship satisfaction, relationship conflict) and student engagement dimensions (perceived importance of schooling, school belonging, and effort expenditure). Besides its main associations with the student engagement dimensions, educational hope was found to be a significant moderator in the relationships (a) between perceived teacher instrumental help and perceived importance of schooling, and (b) between perceived teacher emotional support and effort expenditure, such that students high on perceived instrumental help or teacher emotional support and educational hope were also those high on the perceived importance of schooling or effort expenditure. This study demonstrates that the constructs, though theorised in Western contexts, have empirical utility and relevance for understanding the engagement of students in the Singapore context. Implications arising from this study are discussed.

Using a grounded theory research design, this paper examined the collaborative learning experiences of secondary school students in Singapore. The core phenomenon that emerged was the need for social interactions in collaborative learning, both in classroom and online settings. Educators often take for granted that effective collaborative learning will occur naturally once students are assigned to work in groups. In examining students' dissatisfaction when working in groups, this study highlighted the importance of surfacing these hidden assumptions for careful scrutiny. The key factors identified were centered on the need to address social challenges within collaborative learning. These included a pragmatic, results-oriented approach with limited interpersonal engagement used by students that can compromise collaborative learning outcomes. Having a deeper understanding of the challenges that resulted from limited social interactions provides educators with insights when designing classroom and online learning activities. This paper contributes to the understanding of groups' active learning to inform pedagogical practices for educators engaged in designing better collaborative learning experiences. Educators and curriculum designers need to be aware of the social drawbacks in collaborative learning in order to design a more socially engaging learning environment.

Summary: Differences in demographic and environmental niches facilitate plant species coexistence in tropical forests. However, the adaptations that enable species to achieve higher demographic rates (e.g. growth or survival) or occupy unique environmental niches (e.g. waterlogged conditions) remain poorly understood. Anatomical traits may better predict plant environmental and demographic strategies because they are direct measurements of structures involved in these adaptations.We collected 18 leaf and twig traits from 29 tree species in a tropical freshwater swamp forest in Singapore. We estimated demographic parameters of the 29 species from growth and survival models, and degree of association toward swamp habitats. We examined pairwise trait–trait, trait–demography and trait–environment links while controlling for phylogeny.Leaf and twig anatomical traits were better predictors of all demographic parameters than other commonly measured leaf and wood traits. Plants with wider vessels had faster growth rates but lower survival rates. Leaf and spongy mesophyll thickness predicted swamp association.These findings demonstrate the utility of anatomical traits as indicators of plant hydraulic strategies and their links to growth–mortality trade‐offs and waterlogging stress tolerance that underlie species coexistence mechanisms in tropical forest trees. [ABSTRACT FROM AUTHOR]

The increase in alcohol consumption, and the greater consequences of chronic alcohol use among females, as well as the convergence of the gender gap warrants investigation. This paper aims to uncover gender differences in individuals with alcohol use disorder (AUD) in Singapore. The SMHS 2016 was a population-based, cross-sectional, epidemiological study. Recruitment spanned from August 2016 to March 2018, where 6126 respondents were recruited. Similarly to global estimates, lifetime prevalence and 12-month prevalence for AUD were higher in males than females. However, females had a higher prevalence of obsessive–compulsive disorder (OCD) co-morbidity than males. Women also had an earlier onset and age of recovery of AUD than men. Alarmingly, male (94.14%) and female (100%) respondents reported low help-seeking for their AUD. Gender differences in individuals with AUD were identified in Singapore population. Future research should direct its effort to identify barriers to help-seeking for individuals with alcohol use disorder. [ABSTRACT FROM AUTHOR]

Schools devote considerable attention in identifying and implementing evidence-based prevention programmes to enhance student development and functioning. A major challenge faced is with organising the theory, research and practice of the implementation and dissemination process. This poses even greater challenges to schools because these are complex systems and rarely implement programmes singly to meet the varied needs of their students. Beyond establishing efficacy, there is little documentation about how these programmes have been adapted for diverse student populations. We utilised the Prevention System Support component of Wandersman et al.'s (Am J Community Psychol 41:171-181, 2008) Interactive Systems Framework for Dissemination and Implementation to systematically elicit key general and programme-specific capacity builders that promote the implementation of school prevention programmes in Singapore schools. SWOT analysis completed by 308 school programme leaders yielded five organisational-level general capacity builders and two programme-specific factors related to teacher training and technical support. Fewer opportunities and threats present as challenges to strengthening school capacity to deliver programmes effectively. Implications arising from the analysis were discussed.

This study used three previously validated instruments, namely Science Academic Hardiness (SAH), Students' Conceptions of Learning Science (COLS) and Science Learning Self-Efficacy (SLSE) on 431 Singaporean students. Using structural equation modeling, results showed that the SAH commitment dimension a positive predictor explaining both the reproductive (e.g. science learning as memorizing or testing) and constructivist (e.g. science learning as understanding or seeing in a new way) conceptions of science learning as well as all dimensions of students' self-efficacy among high school students. It was also found that the SAH control dimension is a positive predictor for explaining the SLSE science communication dimension but is a negative predictor for explaining reproductive COLS. Finally, only students with constructivist COLS had significant associations with all SLSE dimensions. These findings suggest that students' personal commitment to learning science is an important aspect to cultivate since it has the ability to predict conceptions of science learning and self-efficacy. Further, creating opportunities for students to be engaged in learning through constructivist ways--such as designing tasks to help students understand and see phenomena in new ways and occasions for students to apply their science knowledge to solve science problems--is likely to lead to positive self-efficacy in practical science work, science communication, and everyday applications of scientific knowledge. Additionally, students' engagement in reproductive ways of learning science--such as memorization, testing, and calculating and practicing--could be reduced since these do not contribute to building students' science learning self-efficacy.

Parent education programs are important avenues through which parents of children with developmental delays can learn new skills to help them with child-rearing challenges. However, those in economic hardship often face problems with applying these skills at home where the child's learning and/or behavioral problems commonly occur. In this exploratory qualitative study, we adopted a positive deviance (PD) lens to explore strategies six economically disadvantaged parents used to support their children who were attending special and mainstream preschools concurrently. The PD perspective was first used in public health research with low-resource communities where a few individuals have been observed to adopt uncommon practices and behaviors that enable them to find better ways to prevent social or health problems than their neighbors facing similar constraints and risks. We identified adaptive parental behaviors, thoughts and feelings that helped them navigate daily hassles faced with "dual schooling" their children in Singapore. The study highlights important implications in the development and refinement of future parent training programs. [ABSTRACT FROM AUTHOR]

This scoping review examines the landscape of educational evaluation research in Asia over the past decade, uncovering the methodologies, themes, and unique regional challenges within this domain. By delving into 62 articles from evaluation-centric journals, the study reveals a predominant focus on learning, teaching, and assessment, highlighting the importance of pedagogical methods and learning outcomes. The review also notes a significant emphasis on institutional-level evaluation, with China leading in contributions. Despite the rich insights offered, this review points to gaps in leadership and evaluation tools, suggesting areas for future exploration. Ultimately, this review aims to enrich global discussions on educational evaluation, emphasizing the need for a comprehensive understanding of Asia's diverse and evolving educational evaluation practices. [ABSTRACT FROM AUTHOR]

Low consumer acceptance emerges as one important barrier to the introduction of cultivated meat, a novel food which offers an opportunity for more sustainable and ethical meat production. Due to the motives for impression management and self‐esteem, one factor that could contribute to people's acceptance of cultivated meat is their perceptions of other individuals who consume cultivated meat. In the current research, two online survey studies with 393 Singaporean undergraduate students and 401 American adults were conducted to explore the perceptions of cultivated meat eaters. In both studies, participants were randomly assigned to read one of three profiles that described a cultivated meat eater, a conventional meat eater, and a vegetarian. Then they rated the target on a list of traits. In Study 1, cultivated meat eaters were evaluated as more eco‐friendly than conventional meat eaters, and less pure than vegetarians. In Study 2, cultivated meat eaters were perceived as more eco‐friendly than conventional meat eaters, and less healthy than vegetarians; further, the participants tended to believe that others' general perception of cultivated meat eaters is slightly negative, and their belief about others' perception was strongly correlated with their acceptance of cultivated meat. Practical implications and future directions were discussed. [ABSTRACT FROM AUTHOR]

Including children with learning difficulties and disabilities in regular classrooms continues to be a challenge for teachers. This study investigated the perceptions of kindergarten teachers and learning support educators (LSEd) towards including children with developmental needs and or learning difficulties in pre-schools in Singapore. A total of 50 participants responded to a survey questionnaire and a group interview session. The study concluded that that the teachers were positive towards including children with developmental learning needs into regular kindergartens. This paper provides insights into the concerns of pre-school teachers about training and support that at the time of conducting the research was much needed in the pre-school sector.

Universities are inundated with detailed applicant and enrolment data from a variety of sources. However, for these data to be useful there is a need to convert them into strategic knowledge and information for decision-making processes. This study uses predictive modelling to identify at-risk adult learners in their first semester at SIM University, a Singapore University that caters mainly to adult learners. Fourteen variables from the enrolment database were considered as possible factors for the predictive model. To classify the at-risk students, various algorithms were used such as a neural network and classification tree. The performances of the different models were compared for sensitivity, specificity and accuracy indices. The model chosen is a classification tree model that may be used to inform policy. The implications of these results for identification of individuals in need of early intervention are discussed.

Background: It is known that many surgeons encounter intraoperative adverse events which can result in Second Victim Syndrome (SVS), with significant detriment to their emotional and physical health. There is, however, a paucity of Asian studies in this space. The present study thus aimed to explore the degree to which the experience of an adverse event is common among surgeons in Singapore, as well as its impact, and factors affecting their responses and perceived support systems. Methods: A self-administered survey was sent to surgeons at four large tertiary hospitals. The 42-item questionnaire used a systematic closed and open approach, to assess: Personal experience with intraoperative adverse events, emotional, psychological and physical impact of these events and perceived support systems. Results: The response rate was 57.5% (n = 196). Most respondents were male (54.8%), between 35 and 44 years old, and holding the senior consultant position. In the past 12 months alone, 68.9% recalled an adverse event. The emotional impact was significant, including sadness (63.1%), guilt (53.1%) and anxiety (45.4%). Speaking to colleagues was the most helpful support source (66.7%) and almost all surgeons did not receive counselling (93.3%), with the majority deeming it unnecessary (72.2%). Notably, 68.1% of the surgeons had positive takeaways, gaining new insight and improving vigilance towards errors. Both gender and surgeon experience did not affect the likelihood of errors and emotional impact, but more experienced surgeons were less likely to have positive takeaways (p = 0.035). Individuals may become advocates for patient safety, while simultaneously championing the cause of psychological support for others. Conclusions: Intraoperative adverse events are prevalent and its emotional impact is significant, regardless of the surgeon's experience or gender. While colleagues and peer discussions are a pillar of support, healthcare institutions should do more to address the impact and ensuing consequences. [ABSTRACT FROM AUTHOR]

Possessing strong communication skills is essential in contributing to effective teaching. This paper investigates graduating student teachers' English language proficiency, as measured by IELTS tests scores, of graduating EL student teachers. The paper considers what teachers need to know about the English language given that English has been the medium of instruction (MoI) for Singapore schools since 1987. Given such a context, English language proficiency is an important consideration in the preparation of pre-service teachers in Singapore. Implications for additional training and preparation in language skills are also proposed.

Background: Little is known about the prevalence of dermatoses in "skin-well" geriatric Singaporeans. We aim to identify the prevalence of dermatoses and their associations within the geriatric population in Singapore, and to understand the distribution of dermatological encounters presenting to primary care physicians, and the resultant referral behaviour. Methods: A joint quantitative-qualitative study was performed across 8 months. Patients aged 65 years and above who visited a local polyclinic for management of non-dermatological chronic diseases were recruited. They were administered questionnaires, and underwent full skin examinations. Online surveys were disseminated to polyclinic physicians under the same healthcare cluster. Results: 201 patients and 53 physicians were recruited. The most common dermatoses identified in patients were benign tumours and cysts (97.5%), and asteatosis (81.6%). For every 1-year increase in age, the odds of having asteatosis increased by 13.5% (95% CI 3.4–24.7%, p = 0.008), and urticarial disorders by 14.6% (95% CI 0.3–30.9%, p = 0.045). Patients who used any form of topical preparations on a daily basis had higher odds of having eczema and inflammatory dermatoses (OR 2.51, 95% CI 1.38 to 4.56, p = 0.003). Physicians reported dermatological conditions involving 20% of all clinical encounters. Eczema represented the most commonly reported dermatosis within the first visit. 50% of dermatology referrals were done solely at the patient's own request. Conclusion: The prevalence of dermatoses in the elderly in Singapore is high, especially asteatosis. Prompt recognition by the primary healthcare provider potentially prevents future morbidity. Outreach education for both primary care physicians and the general public will be key. Ethics approval: National Healthcare group (NHG) Domain Specific Review Board (DSRB), Singapore, under Trial Registration Number 2020/00239, dated 11 August 2020. [ABSTRACT FROM AUTHOR]

Aim: Patients with metabolic dysfunction‐associated steatotic liver disease (MASLD) are at increased risk of incident cardiovascular disease. However, the clinical characteristics and prognostic importance of MASLD in patients presenting with acute myocardial infarction (AMI) have yet to be examined. Methods: This study compared the characteristics and outcomes of patients with and without MASLD presenting with AMI at a tertiary centre in Singapore. MASLD was defined as hepatic steatosis, with at least one of five metabolic criteria. Hepatic steatosis was determined using the Hepatic Steatosis Index. Propensity score matching was performed to adjust for age and sex. The Kaplan‐Meier curve was constructed for long‐term all‐cause mortality. Cox regression analysis was used to investigate independent predictors of long‐term all‐cause mortality. Results: In this study of 4446 patients with AMI, 2223 patients with MASLD were matched with patients without MASLD using propensity scores. The mean follow‐up duration was 3.4 ± 2.4 years. The MASLD group had higher rates of obesity, diabetes and chronic kidney disease than their counterparts. Patients with MASLD had early excess all‐cause mortality (6.8% vs. 3.6%, p <.001) at 30 days, with unfavourable mortality rates sustained in the long‐term (18.3% vs. 14.5%, p =.001) compared with those without MASLD. After adjustment, MASLD remained independently associated with higher long‐term all‐cause mortality (hazard ratio 1.330, 95% confidence interval 1.106‐1.598, p =.002). Conclusion: MASLD embodies a higher burden of metabolic dysfunction and is an independent predictor of long‐term mortality in the AMI population. Its early identification may be beneficial for risk stratification and provide therapeutic targets for secondary preventive strategies in AMI. [ABSTRACT FROM AUTHOR]

Introduction: Given that mental illness stigma is a common occurrence amongst people with mental illness and caregivers (CGs) can be a potential victim of stigma themselves, there is a need to examine caregivers' perspective on the phenomenon. This study is part of a larger study which aims to qualitatively examine the concept of mental illness stigma amongst different stakeholders in Singapore. Methods: Focus group discussions (FGDs) were conducted amongst 21 informal caregivers to explore the experience of stigma encountered by them and their care recipients, and how it may implicate their caregiving experience. Both inductive and deductive thematic analyses were employed to analyze the data. Results: Three overarching themes of stigma encounters that may have implication on caregiving experience were identified: 1) Stigma within the family; 2) Structural stigma; and 3) Stigma by association. Experience of stigma within family (e.g., social exclusion and lack of understanding) limits the caregiving supports available to CGs. CGs also took up a mediating role between their care recipients and other family who may hold stigmatizing views. Witnessing their care recipients being subjected to structural disadvantages (e.g., employment, school, and mandatory conscription) can induce emotional stresses amongst CGs and motivate them to protest and seek redress on their behalf. Furthermore, encounters of stigma themselves (e.g., being judged or blamed for their loved one's condition) also led to feelings of guilt and self-blame amongst the CGs. Discussion: These findings can aid the formulation of interventions in informing CGs on what to expect on their caregiving journey and supporting them in dealing with issues relating to stigma and highlight the importance of anti-stigma efforts in organizational settings such as schools, corporations, and government agencies. [ABSTRACT FROM AUTHOR]

BACKGROUND: The administration of intravenous cangrelor at reperfusion achieves faster onset of platelet P2Y12 inhibition than oral ticagrelor and has been shown to reduce myocardial infarction (MI) size in the preclinical setting. We hypothesized that the administration of cangrelor at reperfusion will reduce MI size and prevent microvascular obstruction in patients with ST-segment–elevation MI undergoing primary percutaneous coronary intervention. METHODS: This was a phase 2, multicenter, randomized, double-blind, placebo-controlled clinical trial conducted between November 2017 to November 2021 in 6 cardiac centers in Singapore. Patients were randomized to receive either cangrelor or placebo initiated before the primary percutaneous coronary intervention procedure on top of oral ticagrelor. The key exclusion criteria included presenting <6 hours of symptom onset; previous MI and stroke or transient ischemic attack; on concomitant oral anticoagulants; and a contraindication for cardiovascular magnetic resonance. The primary efficacy end point was acute MI size by cardiovascular magnetic resonance within the first week expressed as percentage of the left ventricle mass (%LVmass). Microvascular obstruction was identified as areas of dark core of hypoenhancement within areas of late gadolinium enhancement. The primary safety end point was Bleeding Academic Research Consortium–defined major bleeding in the first 48 hours. Continuous variables were compared by Mann-Whitney U test (reported as median [first quartile–third quartile]), and categorical variables were compared by Fisher exact test. A 2-sided P <0.05 was considered statistically significant. RESULTS: Of 209 recruited patients, 164 patients (78%) completed the acute cardiovascular magnetic resonance scan. There were no significant differences in acute MI size (placebo, 14.9% [7.3–22.6] %LVmass versus cangrelor, 16.3 [9.9–24.4] %LVmass; P =0.40) or the incidence (placebo, 48% versus cangrelor, 47%; P =0.99) and extent of microvascular obstruction (placebo, 1.63 [0.60–4.65] %LVmass versus cangrelor, 1.18 [0.53–3.37] %LVmass; P =0.46) between placebo and cangrelor despite a 2-fold decrease in platelet reactivity with cangrelor. There were no Bleeding Academic Research Consortium–defined major bleeding events in either group in the first 48 hours. CONCLUSIONS: Cangrelor administered at the time of primary percutaneous coronary intervention did not reduce acute MI size or prevent microvascular obstruction in patients with ST-segment–elevation MI given oral ticagrelor despite a significant reduction of platelet reactivity during the percutaneous coronary intervention procedure. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03102723. [ABSTRACT FROM AUTHOR]

This study examines the impact of message length and audience's perceived information overload on the effectiveness of a fact-check in reducing belief in fake news within the COVID-19 vaccination context. Through an online experiment (N = 374) conducted in Singapore, we found an interaction effect between one's level of information overload and the type of fact-check that was being shown (short, medium, or long). The findings from this study help to extend the literature on the effectiveness of fact-checks in reducing general public's belief in fake news. [ABSTRACT FROM AUTHOR]

Background: Postpartum depression (PPD) is highly prevalent and plagues a significant proportion of parents. Postpartum depression also exerts various negative consequences on infant development and parent-infant relationships. Social support is identified as an important factor influencing many parental predictors, and may affect the development of PPD. Objective: This study aimed to investigate how perceived social support can indirectly influence PPD symptoms in parents at 6 months postpartum by influencing postpartum anxiety, parental satisfaction, and parental self-efficacy (PSE). Methods: A secondary analysis of data from a randomized controlled trial was used with a cross-sectional exploratory design. A total of 400 Singaporean parents (200 couples) were included, and structural equation modeling was used to analyze the relationships between PPD and potential predictors. Results: Findings revealed a less adequate fit between the hypothesized model and the data collected. Social support was found to be a significant predictor of postpartum anxiety, PSE, and parental satisfaction. Postpartum anxiety was a significant predictor of PPD, but PSE and parental satisfaction were not. Conclusion: This study provides an overview of how different parental predictors may be associated with PPD among Asian parents. Postpartum anxiety significantly predicted PPD, but social support had negative effects on postpartum anxiety, parenting satisfaction, and PSE. The findings provide further insight into how parents at risk of PPD can be identified and demonstrated how social support might negatively impact parental outcomes. More qualitative research with Asian parents is needed to further explain these findings and inform the development of future interventions. [ABSTRACT FROM AUTHOR]

Screening for autism in childhood has been advocated as a part of standard care. Challenges exist with screening implementation and performance of screening tools in clinical practice. This study aimed to examine the validity and feasibility of using the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) for screening of autism in Singapore. Caregivers completed the M-CHAT-R/F as a part of the routine 18-month well-child visit in seven primary care clinics. Screening and follow-up interviews were administered by trained nursing staff. Children screened positive and a subset of those screened negative underwent diagnostic assessments for autism, which included an Autism Diagnostic Observation Schedule, Second Edition. Participants were 5336 multiethnic children (mean age 18.6 ± 0.9 months, 51.3% male gender). In total, 113 (2.1%) were screened positive, of which 54 (1.0%) were classified to have autism after their diagnostic assessment. Sensitivity of the M-CHAT-R/F was 88.6%, specificity 71.4%, and positive predictive value 90.7% for an autism diagnosis. The majority of respondents rated the screening process as feasible within the clinic setting. The M-CHAT-R/F had acceptable psychometric properties and high feasibility when used in primary care settings in Singapore. Recommendations for implementation of systematic screening and future research are presented. Systematic screening for autism in early childhood has been suggested to improve eventual outcomes by facilitating earlier diagnosis and access to intervention. However, clinical implementation of screening has to take into account effectiveness and feasibility of use within a healthcare setting for accurate diagnosis of autism. In Singapore, autism screening using a structured screening tool is not currently employed as a part of routine well-child visits for children in primary care clinics. In this study, 5336 children (aged 17–20 months) were screened for autism using the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) during their 18-month well-child visit in seven primary care clinics. Screening and follow-up interviews were administered by nursing staff at each clinic. Children screened positive and a portion of those screened negative then underwent diagnostic assessments to determine whether they met the diagnostic criteria for autism. In total, 113 (2.1%) were screened positive, of which 54 (1.0%) met the criteria for autism. Children who screened positive and received a diagnosis accessed autism-specific intervention at an average age of 22 months. Nurses and physicians rated the acceptability and practicality of the M-CHAT-R/F highly. Therefore, the M-CHAT-R/F questionnaire was an effective and feasible tool for autism screening among 18-month-old children in this study. Future studies will be designed to determine the optimal age of screening and role of repeated screening in Singapore, as well as to better understand any potential improved outcomes nationwide compared with pre-implementation of autism screening. [ABSTRACT FROM AUTHOR]

Purpose: The aim of PRISTINE was to evaluate the 6 and 12 months safety and efficacy of the Selution Sustained Limus Release (SLR)™ sirolimus-coated balloon for treatment of complex lower limb occlusive lesions (TASC II C & D) in patients with chronic limb threatening ischemia (CLTI) from Singapore. Methods: PRISTINE was a prospective, non-randomized, single arm, observational, multi-investigator, single-center clinical study. Complication-free survival at 30 days was the safety clinical endpoint. Immediate technical success (ability to cross and dilate the lesion and achieve residual angiographic stenosis < 30%), 6-month primary vessel patency, limb salvage, clinically driven target lesion revascularization (TLR) and amputation free survival (AFS) were the efficacy endpoints of interest. Results: Seventy five patients were included. There were 50 (68.0%) males; mean age, 69.0 ± 10.7 years. CLTI severity was based on the Rutherford Scale (R5 = 51; R6 = 17). Significant co-morbidities included diabetes mellitus (n = 68; 91.0%) and end-stage renal failure (n = 28; 37.0%). 112 atherosclerotic lesions were treated (TASC II D = 58 (52%); 76 (67%) de novo). There was 100% technical success. Mean lesion length treated was 22.4 ± 13.9 cm. Primary vessel patencies at 6 and 12 months were 64/86 (74%) and 43/74 (58%) and freedom from clinically driven TLR were 72/86 (84%) and 55/74 (74%) respectively. AFS was 61/73 (84.0%; five deaths and seven major lower extremity amputation) at 6-months. Mean Rutherford score improved from 5.1 ± 0.55 at baseline to 1.1 ± 2.05 (p < 0.05) at one year and there was a wound healing rate of 38/48 (79%) at the same timepoint. Conclusions: The Selution SLR™ drug eluting balloon is safe and efficacious in treating highly complex infra-inguinal atherosclerotic lesions in an otherwise challenging frail population of CLTI patients with a high incidence of diabetes and end-stage renal failure. It is associated with highly satisfactory acute technical and clinical success, 12-month target lesion patency and AFS. Level of Evidence: Level 2b, Individual Cohort Study. [ABSTRACT FROM AUTHOR]

Background: This trial is a parallel, two-arm, non-blinded cluster randomised controlled trial that is under way in Singapore, with the aim of measuring the efficacy of male Wolbachia-infected Aedes aegypti deployments in reducing dengue incidence in an endemic setting with all four dengue serotypes in circulation. The trial commenced in July 2022 and is expected to conclude in September 2024. The original study protocol was published in December 2022. Here, we describe amendments that have been made to the study protocol since commencement of the trial. Methods: The key protocol amendments are (1) addition of an explicit definition of Wolbachia exposure for residents residing in intervention sites based on the duration of Wolbachia exposure at point of testing, (2) incorporation of a high-dimensional set of anthropogenic and environmental characteristics in the analysis plan to adjust for baseline risk factors of dengue transmission, and (3) addition of alternative statistical analyses for endpoints to control for post hoc imbalance in cluster-based environmental and anthropogenic characteristics. Discussion: The findings from this study will provide the first experimental evidence for the efficacy of releasing male-Wolbachia infected mosquitoes to reduce dengue incidence in a cluster-randomised controlled trial. The trial will conclude in 2024 and results will be reported shortly thereafter. Trial registration: ClinicalTrials.gov, identifier: NCT05505682. Registered on 16 August 2022. Retrospectively registered. Last updated 11 November 2023. [ABSTRACT FROM AUTHOR]

Background: Emerging diagnostic modalities suggest that miRNA profiles within extracellular vesicles (EVs) isolated from peripheral blood specimens may provide a non-invasive diagnostic alternative for dementia and neurodegenerative disorders. Given that EVs confer a protective environment against miRNA enzymatic degradation, the miRNAs enriched in the EV fraction of blood samples could serve as more stable and clinically relevant biomarkers compared to those obtained from serum. Objective: To compare miRNAs isolated from EVs versus serum in blood taken from Alzheimer's disease (AD) dementia patients and control cohorts. Methods: We compared 25 AD patients to 34 individuals who exhibited no cognitive impairments (NCI). Subjects were Singapore residents with Chinese heritage. miRNAs purified from serum versus blood-derived EVs were analyzed for associations with AD dementia and medial temporal atrophy detected by magnetic resonance imaging. Results: Compared to serum-miRNAs, we identified almost twice as many EV-miRNAs associated with AD dementia, and they also correlated more significantly with medial temporal atrophy, a neuroimaging marker of AD-brain pathology. We further developed combination panels of serum-miRNAs and EV-miRNAs with improved performance in identifying AD dementia. Dominant in both panels was miRNA-1290. Conclusions: This data indicates that miRNA profiling from EVs offers diagnostic superiority. This underscores the role of EVs as vectors harboring prognostic biomarkers for neurodegenerative disorders and suggests their potential in yielding novel biomarkers for AD diagnosis. [ABSTRACT FROM AUTHOR]

This paper describes how Singapore achieved skin allograft self-sufficiency in 2017 by adopting 5 key strategies in 2012. Singapore General Hospital (SGH) established its own allograft recovery programme in 1998 but was still dependent on overseas allograft procurement. 1. Expanding the donor pool: a. increasing coverage to all hospitals, b. adopting mobile recovery sets and c. increasing skin donor upper age limit from 75 to 90. 2. Reducing allograft usage by utilising Biobrane as part of SGH Burns protocol. 3. Extending allograft shelf-life by adopting cryopreservation. 4. Tapping on the existing national organ and tissue donation network. 5. Expanding public outreach efforts. The allograft recovery programme expanded from 4 to all 20 institutions. Donor referrals increased by 42.9% from 35 in 2014 to over 50 currently. Donor numbers increased by 210%, rising from 4.5 per year before 2015 to an average of 14 per year from 2015 to 2022. The total allografts recovered increased by 223%, climbing from 13,000 to 42,000 annually. Cryopreservation was adopted, extending shelf life to 5.5 years and doubling storage capacity to more than 140,000 cm2 in 2022. Singapore achieved skin allograft self-sufficiency with no overseas procurement since 2017. ● 5 key strategies were used to achieve skin allograft self-sufficiency. ● Donor pool was expanded. ● Allograft shelf-life was extended with cryopreservation. ● Allograft usage was reduced by adopting Biobrane as part of burns protocol. ● Donor referrals, donor numbers and total allografts recovered increased substantially. [ABSTRACT FROM AUTHOR]

Objective: Tonic tensor tympani syndrome is found in a subset of tinnitus patients who experience intra-aural and peri-aural symptoms, in addition to their tinnitus, in the absence of clinically detectable pathology. As the syndrome has not been widely reported, this study aims to determine its prevalence and evaluate the effectiveness of current management. Methods: The tinnitus management clinic records of patients over the past six years were assessed to identify tonic tensor tympani syndrome patients and track their progress based on patient-reported Tinnitus Handicap Index scores. Patients with reversible ear pathology and temporomandibular joint disorder were excluded. Results: It was found that 13 per cent of the tinnitus management patients fulfilled the criteria for tonic tensor tympani syndrome and 94 per cent of those who returned for follow up showed an improvement in their Tinnitus Handicap Index grades. Conclusion: This study suggests that tonic tensor tympani syndrome is a significant problem among tinnitus patients and current tinnitus management strategies contribute effectively to helping such patients habituate to their symptoms. [ABSTRACT FROM AUTHOR]

Oral health of the older population has long been overlooked in global healthcare agenda. Limited access to oral healthcare for dependent older adults results in poor oral health, negatively impacting their quality of life, nutrition and overall well‐being. Especially for nations experiencing rapid ageing population, efforts must be urgently made to integrate oral healthcare services into the current healthcare system and policy. Singapore stands out as one of the most rapidly ageing nations in Southeast Asia, achieving remarkable progress in the healthcare field, as well as advancements in social modernization and economic growth. It now faces the growing burden of the dependent older population and is required to respond to the complex challenges associated with providing holistic eldercare services and ensuring the well‐being of its ageing population. This narrative review offers an overview of Singapore's current healthcare policy and system development for the older population, with a specific focus on oral healthcare. The goal is to shed light on this underexplored area, highlighting the challenges that need to be tackled to improve the accessibility of oral health services for dependent older adults. [ABSTRACT FROM AUTHOR]

Introduction: Paroxysmal nocturnal haemoglobinuria (PNH) is a rare haematologic disease characterised by intravascular haemolysis, thrombophilia and bone marrow failure. There is a lack of established clinical guidance on the screening, diagnosis and management of PNH in Singapore. A relatively low level of awareness among healthcare professionals regarding PNH manifestations further contributes to diagnostic delays. Additionally, limited access to complement inhibitors, like eculizumab, may delay treatment and impact patient outcomes. Method: Nine haematologists from different institutions in Singapore convened to formulate evidence- based consensus recommendations for optimising the diagnosis and management of patients with PNH and improving access to novel treatments. The experts reviewed the existing literature and international guidelines published from January 2010 to July 2023, focusing on 7 clinical questions spanning PNH screening, diagnostic criteria, investigations, treatment and monitoring of subclinical and classic disease, PNH with underlying bone marrow disorders, and PNH in pregnancy. A total of 181 papers were reviewed to formulate the statements. All experts voted on the statements via 2 rounds of Delphi and convened for an expert panel discussion to finetune the recommendations. Results: Sixteen statements have been formulated for optimising the screening, diagnosis and management of PNH. Upon confirmation of PNH diagnosis, individuals with active haemolysis and/or thrombosis should be considered for anti-complement therapy, with eculizumab being the only approved drug in Singapore. Conclusion: The current recommendations aim to guide the clinicians in optimising the screening, diagnosis and management of PNH in Singapore. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to investigate the beginning teachers' perceptions of pedagogical knowledge and skills in teaching in Singapore. Data was collected from the beginning teachers at three time points: the exit point of the teacher education programme, the end of their first year and third year of teaching. In this three year study, the focus is to examine the beginning teachers' perceptions of their development in the following teaching related factors: lesson planning, classroom management and instructional strategies. The results showed that beginning teachers' pedagogical knowledge and skills increased significantly, but at different rates, in all three factors at the end of their third year of teaching. It suggested that learning to teach is an on-going process that begins from the pre-service teacher education programme and continues into the initial three years of teaching. (Contains 5 tables.)

Background: Maternal vitamin status preconception and during pregnancy has important consequences for pregnancy outcome and offspring development. Changes in vitamin status from preconception through early and late pregnancy and postpartum have been inferred from cross-sectional data, but longitudinal data on vitamin status from preconception throughout pregnancy and postdelivery are sparse. As such, the influence of vitamin supplementation on vitamin status during pregnancy remains uncertain. This study presents one prespecified outcome from the randomized controlled NiPPeR trial, aiming to identify longitudinal patterns of maternal vitamin status from preconception, through early and late pregnancy, to 6 months postdelivery, and determine the influence of vitamin supplementation. Methods and findings: In the NiPPeR trial, 1,729 women (from the United Kingdom, Singapore, and New Zealand) aged 18 to 38 years and planning conception were randomized to receive a standard vitamin supplement (control; n = 859) or an enhanced vitamin supplement (intervention; n = 870) starting in preconception and continued throughout pregnancy, with blinding of participants and research staff. Supplement components common to both treatment groups included folic acid, β-carotene, iron, calcium, and iodine; components additionally included in the intervention group were riboflavin, vitamins B6, B12, and D (in amounts available in over-the-counter supplements), myo-inositol, probiotics, and zinc. The primary outcome of the study was glucose tolerance at 28 weeks' gestation, measured by oral glucose tolerance test. The secondary outcome reported in this study was the reduction in maternal micronutrient insufficiency in riboflavin, vitamin B6, vitamin B12, and vitamin D, before and during pregnancy. We measured maternal plasma concentrations of B-vitamins, vitamin D, and markers of insufficiency/deficiency (homocysteine, hydroxykynurenine-ratio, methylmalonic acid) at recruitment, 1 month after commencing intervention preconception, in early pregnancy (7 to 11 weeks' gestation) and late pregnancy (around 28 weeks' gestation), and postdelivery (6 months after supplement discontinuation). We derived standard deviation scores (SDS) to characterize longitudinal changes among participants in the control group and measured differences between the 2 groups. At recruitment, the proportion of patients with marginal or low plasma status was 29.2% for folate (<13.6 nmol/L), 7.5% and 82.0% for riboflavin (<5 nmol/L and ≤26.5 nmol/L, respectively), 9.1% for vitamin B12 (<221 pmol/L), and 48.7% for vitamin D (<50 nmol/L); these proportions were balanced between the groups. Over 90% of all participants had low or marginal status for one or more of these vitamins at recruitment. Among participants in the control group, plasma concentrations of riboflavin declined through early and late pregnancy, whereas concentrations of 25-hydroxyvitamin D were unchanged in early pregnancy, and concentrations of vitamin B6 and B12 declined throughout pregnancy, becoming >1 SDS lower than baseline by 28 weeks gestation. In the control group, 54.2% of participants developed low late-pregnancy vitamin B6 concentrations (pyridoxal 5-phosphate <20 nmol/L). After 1 month of supplementation, plasma concentrations of supplement components were substantially higher among participants in the intervention group than those in the control group: riboflavin by 0.77 SDS (95% CI 0.68 to 0.87, p < 0.0001), vitamin B6 by 1.07 SDS (0.99 to 1.14, p < 0.0001), vitamin B12 by 0.55 SDS (0.46 to 0.64, p < 0.0001), and vitamin D by 0.51 SDS (0.43 to 0.60, p < 0.0001), with higher levels in the intervention group maintained during pregnancy. Markers of vitamin insufficiency/deficiency were reduced in the intervention group, and the proportion of participants with vitamin D insufficiency (<50 nmol/L) during late pregnancy was lower in the intervention group (35.1% versus 8.5%; p < 0.0001). Plasma vitamin B12 remained higher in the intervention group than in the control group 6 months postdelivery (by 0.30 SDS (0.14, 0.46), p = 0.0003). The main limitation is that generalizability to the global population is limited by the high-resource settings and the lack of African and Amerindian women in particular. Conclusions: Over 90% of the trial participants had marginal or low concentrations of one or more of folate, riboflavin, vitamin B12, or vitamin D during preconception, and many developed markers of vitamin B6 deficiency in late pregnancy. Preconception/pregnancy supplementation in amounts available in over-the-counter supplements substantially reduces the prevalence of vitamin deficiency and depletion markers before and during pregnancy, with higher maternal plasma vitamin B12 maintained during the recommended lactational period. Trial registration: ClinicalTrials.govNCT02509988; U1111-1171-8056. In this pre-specified secondary analysis of the NiPPeR double-blind randomized controlled trial, Keith M Godfrey and colleagues investigate maternal B-vitamin and vitamin D status before, during and after pregnancy, and the influence of supplementation preconception and during pregnancy Author summary: Why was this study done?: A mother's vitamin status preconception and during pregnancy are important for healthy pregnancy outcomes and offspring development. Truly longitudinal data on changes in vitamin status from preconception to early and late pregnancy and postpartum are sparse, with changes generally inferred from cross-sectional data and lower pregnancy concentrations often ascribed to plasma volume expansion. Few studies have evaluated the influence of vitamin supplementation preconception and during pregnancy. What did the researchers do and find?: As prespecified secondary outcomes of a randomized trial, this study characterized longitudinal patterns of maternal vitamin status from preconception, through early and late pregnancy, to 6 months postdelivery, and determined the influence of supplementation. Significant proportions of preconception women living in high-income countries had marginal or low status of folate, riboflavin, vitamin B12, and vitamin D, and many developed markers of vitamin B6 deficiency in late pregnancy. In the absence of intervention supplementation, maternal plasma concentrations of different vitamins showed differing longitudinal patterns from preconception to early and late pregnancy, and markers of functional B6 and B12 insufficiency increased during pregnancy. Our trial indicates that preconception and pregnancy supplementation in amounts available in over-the-counter supplements substantially reduced the prevalence of deficiency/depletion markers before and during pregnancy, with a higher maternal plasma vitamin B12 maintained during the recommended lactational period. What do these findings mean?: The study findings are inconsistent with plasma volume expansion wholly accounting for lower gestational vitamin concentrations. In the setting of advocacy for more sustainable diets that are likely to be less nutrient dense, the findings suggest a need to reappraise dietary recommendations for preconception and pregnancy and to consider further the role of multiple micronutrient supplements in women living in higher-income countries. [ABSTRACT FROM AUTHOR]

Previous research has shown that while pre-service teachers' formation of their professional identity is shaped by their own teaching and learning experiences, pre-service programmes can make a difference. Our study examines pre-service teachers' professional identity development at the point of entry and exit of their 4-year undergraduate initial teacher preparation programme. Our study aims to establish a baseline understanding of their perceptions about teaching before they embark on the initial teacher preparation programme and to explore the changes in their perceptions (if any) at the point of graduation from the programme. The implications of the findings are discussed in terms of informing admission criteria into the programmes, how initial teacher preparation programmes can be enhanced and key areas of focus for beginning teacher induction programmes.

Background: Singapore is experiencing great demographic change. These demographic trends show fewer young people and declining birth rates, greater longevity for ageing generations and an increase in the number of non-Singaporean residents. Statistics also show that more than half of the total population increase in the last decades was contributed by non-resident (non-Singaporeans). These demographic trends have far-reaching implications for schools and educators. Aims: The paper looks at how key demographic trends will reshape Singapore's schools. The paper focuses on three key factors-mortality, fertility and migration-and their impact on schools. Method: The analyses are based on existing demographic data and trends. The data is taken from Singapore Department of Statistics, 2008. Results: The first two factors, namely ageing population and declining birth rates, lead to the need to develop lifelong learning skills. The third factor of immigration leads towards multiculturalism in education for hybrid identities to work, think, and play across cultural boundaries. Conclusion: It is necessary to ensure that the school structures are responsive to changing needs, so that it can evolve in a timely manner to prepare the learners meaningfully. Schools in Singapore have to incorporate a wider range of activities that can help to develop 21st century skills without compromising the rigor and quality of the original school and curriculum structure which has served the needs of the students in Singapore well. (Contains 2 tables.)

Current research on children's autistic traits in the general population relies predominantly on caregiver-report, yet the extent to which individual, caregiver or demographic characteristics are associated with informants' ratings has not been sufficiently explored. In this study, caregivers of 396 Singaporean two-year-olds from a birth cohort study completed the Quantitative Checklist for Autism in Toddlers. Children's gender, cognitive functioning and birth order, maternal age, and ethnic group membership were not significant predictors of caregiver-reported autistic traits. Poorer child language development and higher maternal depressive symptoms significantly predicted more social-communicative autistic traits, while lower maternal education predicted more behavioural autistic traits. Children's language and informants' educational level and depressive symptomatology may need to be considered in caregiver-reports of autistic traits.

This article explores pre-service music teachers' professional identities during pre-service training. Its focus is a student cohort whose studies are funded by the Singaporean Ministry of Education in return for a commitment--a teaching bond or contract--to work as teachers in schools. An overview of pre-service teacher education and the challenges of attraction and retention in Singapore is followed by discussion of the literature relating to identity formation, with a focus on music teacher and musician identities. Next, analysis and discussion of the findings highlight that participants' teacher identities did not align with their level of performance proficiency. Teacher identity did, however, align with participants' intentions to remain in teaching; participants who defined themselves first and foremost as music teachers were more likely than their peers to plan long-term teaching careers. The article considers the influence of teaching bonds, or contracts, signed by students in advance of their post-secondary studies. It concludes by considering the implications for recruitment and for developing professional identity among pre-service music teachers.

The purpose of this study was to investigate if there were differences in the levels of pedagogical knowledge and skills as perceived by the student teachers who were enrolled in the Primary and the Secondary Post Graduate Diploma in Education programme at the National Institute of Education in Singapore. 170 Primary and 426 Secondary student teachers participated in the study. The results showed that there were no significant differences at the beginning of the programme between the two cohorts. However, there were significant differences between the two groups at the end of programme, with the Primary student teachers tending to perceive themselves as gaining more pedagogical knowledge and skills by the end of their initial teacher preparation programme than the Secondary student teachers.