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Background: Cancer is one of the critical, challenging problems in a clinical setting among non-infectious diseases and poses a considerable burden to the community for its highest fatalities and associated morbidities. Immunotherapy has paid much attention to curbing cancer and protecting against advanced metastasis. Nutritional sources have been well known for their anticancer properties for centuries, although they exhibited multiple intricated mechanisms to deter this notorious disease. Immune-based therapy is getting popular in modern days to fight against various illnesses, including cancer. In recent years, numerous in vitro and clinical trials have been carried out regarding the potential use of flavonoids in cancer therapy; however, the results and achievements were still controversial and obscure. More research on immune-mediated anticancer therapy has to be done to understand more explicit mechanisms of how plant-derived compounds modulate immune cells and subsequent clinical uses. One of the most commonly tested flavonoid compounds that stimulate immune cells and offer significant immune-mediated anticancer activities is flavonol quercetin. Objectives: This present review summarises an updated overview of quercetin, focusing on its anticancer effects. In addition to its chemistry and sources, quercetin’s immunomodulatory properties and the common signalling mechanisms have also been described and proposed the possible research gap for further investigation and future research. Conclusion: This review would provide a new comparative view regarding quercetin’s immunomodulatory and anticancer activities. Moreover, we conclude that quercetin plays a crucial role in eradicating cancer cells and modulating immune cells’ activity based on the literature. It is worthwhile to extensively investigate quercetin’s anticancer and immunomodulatory effects in clinical settings. Key words: Cancer, flavonol, quercetin, anticancer, immunomodulation

Cancer can be classified as a fourth leading cause of death in Malaysia. There is a continuous effort by scientists in finding alternative cure to cancer due to the known side effects of chemotherapy and radiation therapy as well as recurrences. One of the latest methods to kill cancerous cells is by using immune cells known as natural killer (NK) cells. Flavonoids such as flavone and flavonol are also known for their antioxidant, anti-inflammatory, immunomodulatory and anticancer properties. This study was carried out to determine the role of flavonoid compounds of apigenin, luteolin, and quercetin to facilitate the growth of NK-92 cells. NK-92 cell line was grown in tissue culture flasks containing α- Minimum Essential Medium (MEM) medium enriched with L-glutamine, 12.5% fetal bovine serum, 12.5% horse serum, 0.2 mM myo-inositol, 0.02 mM folic acid, and 100 - 200 U/mL recombinant interleukin 2 (IL-2). The cell viability was determined via trypan blue staining where the cells were manually counted by a haemocytometer. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to determine the cell viability of NK-92 cells after treatment with apigenin, luteolin, and quercetin. Results showed a dose-dependent proliferative effects of apigenin, luteolin, and quercetin on the proliferation of NK-92 cells showing the highest percentage of proliferation at 100 µg/mL for all compounds (*P < 0.05). However, exceeding the dose of 100 µg/mL had resulted in a decline of cell proliferations percentage. Based on these findings, flavonoid compounds comprising apigenin, luteolin and quercetin were able to induce proliferative effects on NK-92 cells.

Background: A new approach involving immune-cell-mediated cancer therapy has been adopted extensively for the sake of lung cancer treatments by utilizing natural killer (NK) cells. NK cell activity can be enhanced with certain agents, and among them are flavonoids. Thus, this study was conducted to investigate the immunomodulatory roles of apigenin, luteolin and quercetin on NK cell activity against lung cancer cells and on the secretions of perforin and granulysin profile. Methods: The NK-92 cells were grown in complete α-Minimum Essential Medium (MEM). NCI-H460 lung cancer cells were cultured in Roswell Park Memorial Institute 1640 media. NK cell activity against lung cancer cells were done using MTT(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. The secretions of perforin and granulysin profiles were then analysed using enzyme-linked immunosorbent assay. Results: Apigenin, luteolin and quercetin significantly increased the NK-cell-mediated cytotoxic activity against lung cancer cells at concentrations 12.5 µg/ml and 25µg/ml ( P < 0.001). The secretion levels of perforin and granulysin from NK cells were also significantly enhanced with apigenin and luteolin treatment but not with quercetin. Conclusions: All three flavonoid compounds possessed some significant immunomodulatory actions on NK cell cytotoxic activity and granule secretion profiles towards lung cancer therapy.

Type 2 diabetes mellitus (DM) is becoming major health threat worldwide and it is extremely common in clinical setting. Malaysia is one of the highest diabetic populations among Asian countries and the new cases are increasing day to day. Early detection of people with high risk of Type 2 DM by using simple, easy and cost-effective assessment tool is the better way to identify and prevent the community from this non-communicable disease. The objectives of the study were to identify those are high risk to become type 2DM among Malaysians by using risk scoring form and to educate them how to prevent it. Total 591 subjects were recruited from the health screening programs carried out by the collaboration of Petaling Jaya Development Council (MBPJ) and Lincoln University College, Malaysia. Modified form of Finnish Type 2 Diabetes Risk Assessment Tool was used to identify people at risk of becoming type 2 DM. Descriptive analysis was performed for all included variables in this study by using SPSS version 21. The study found out that almost half of the participants were found to have family history of DM, 60% of them were overweight and obese and 47% were having above normal waist circumference. We observed that nearly 60 % of participants in the study were having moderate to high risk of becoming type 2 DM in next 10 years. To conclude, the result of our study would be helpful in implementation of cost-effective, convenient Type 2 DM risk assessment tool which has yet to be implemented in Malaysia.

Brain-Derived Neurotrophic Factor (BDNF) is a member of neurotrophins and it plays important role in both peripheral nervous system (PNS) and short-term, as well as long-term plasticity in central nervous system. Physical exercise fosters neurocognitive functions and brain plasticity at all ages. However, there was an interesting finding stated that BDNF concentration was found to be lower in the trained athletes compared to that of control. Platelet BDNF is found to be acquired from the blood circulation rather than the megakaryocyte precursor cells. This review directs attention to the role of BDNF on cognitive function intensified by exercise for future perspectives. Keywords: BDNF, cognitive function, exercise

The Comprehensive Geriatric Assessment (CGA) is recommended to guide treatment choices in older patients with cancer. Patients ≥ 70 years referred to our oncology service with a new cancer diagnosis are screened using the G-8. Patients with a score of ≤14 are eligible to attend the Geriatric Oncology and Liaison (GOAL) Clinic in our institution, with referral based on physician discretion. Referred patients undergo multidimensional assessments at baseline. CGA domains assessed include mobility, nutritional, cognitive, and psychological status. Chemotherapy toxicity risk is estimated using the Cancer Aging and Research Group (CARG) calculator. We undertook a retrospective analysis of patients attending the GOAL clinic over a 30-month period to April 2021. The objective was to determine rates of treatment dose modifications, delays, discontinuation, and unscheduled hospitalizations as surrogates for cytotoxic therapy toxicity in these patients. These data were collected retrospectively. Ninety-four patients received chemotherapy; the median age was 76 (70–87) and 45 were female (48%). Seventy-five (80%) had an ECOG PS of 0–1. Seventy-two (77%) had gastrointestinal cancer, and most had stage III (47%) or IV (40%) disease. Chemotherapy with curative intent was received by 51% (n = 48) and 51% received monotherapy. From the CGA, the median Timed Up and Go was 11 s (7.79–31.6), and 90% reported no falls in the prior 6 months. The median BMI was 26.93 (15.43–39.25), with 70% at risk or frankly malnourished by the Mini Nutritional Assessment. Twenty-seven (29%) patients had impaired cognitive function. Forty-three (46%) had a high risk of toxicity based on the baseline CARG toxicity calculator. Twenty-six (28%) required dose reduction, 55% (n = 52) required a dose delay, and 36% (n = 34) had a hospitalization due to toxicity. Thirty-nine patients (42%) discontinued treatment due to toxicity. Despite intensive assessment, clinical optimization and personalized treatment decisions, older adults with cancer remain at high risk of chemotherapy toxicity.

We report a case of metastatic Non-Small Cell Lung Cancer (NSCLC) with Epidermal Growth Factor Receptor (EGFR) sensitizing mutation – deletion exon 19 – treated with first line chemotherapy using Carboplatin and Pemetrexed. The treatment was then changed to first generation tyrosine kinase inhibitor (TKI), Gefinitib following the detection of EGFR sensitizing mutation. Upon disease progression on Gefitinib, the need for tissue biopsy for resistant point mutation that substitutes methionine for threonine at amino acid position 790 (T790M) was met with diagnostic challenge due to difficulty in sampling tissue from the site of progressive disease. We opted, instead, to perform the non-invasive method using exhaled breath condensate (EBC) and plasma circulating tumour DNA (ctDNA); both of these tests detected the presence of T790M mutation. Third generation TKI, Osimertinib, was commenced based on these non-invasive diagnostic methods, and the patient showed partial response followed by ongoing stable disease after 28 months which exceeded the median progression-free survival (PFS) demonstrated in the AURA3 trial. We believe that a non-invasive method using novel EBC or plasma ctDNA can be used not only as an adjunct test but as an alternative to tissue biopsy where there are diagnostic challenges with invasive procedures.

Obesity is one of the most common, yet among the most neglected, public health problems around the world and it is strongly associated with various non-communicable diseases such as hypertension, diabetes mellitus and coronary artery diseases. Health care personal especially nurses play an important role in educating public to have healthy lifestyle. However, there is an alarming rate of increase in number of obesity among nursing students as well as staff nurses. Therefore, the aim of this study was to determine the anthropometric measurements and its associated risks among post-basic renal care nursing students. Total of 142 post-basic renal care nursing students of five intakes were included in this cross-sectional study. The result of the study showed that 52% of participants were either overweight or obese although most of them were below 40 years of age. Majority of overweight or obese students were Malays and 78% of them being female. We also observed an association of systolic blood pressure (SBP), diastolic blood pressure (DBP) and waist circumference (WC)with increasing body mass index (BMI) (P= 0.001, P= 0.001 and P

Diabetic wounds (DW) are a chronic, non-healing wound on the feet of diabetic patients that pose a serious challenge to world health. Around 84% of diabetic patients undergo lower leg amputations. Though numerous topical and systemic drugs have been used to heal the DW, these drugs have led to the emergence and subsequent rapid overgrowth of resistant bacterial strains, side effects and toxicity. Many herbal plants have very important role in wound healing because they promote the natural repair mechanisms. Moringaoleifera (MO) is an important medicinal plant which has an impressive range of medicinal uses including antimicrobial, anti-inflammatory, antidiabetic, antioxidant and anticancer activities. Recently few researchers reported that MO extracts have effective wound healing property due to the presence of rich flavonoids and vicenin-2. The objective of the present study was to develop hydrogel formulations loaded with Moringaoleifera leaves extract. The prepared hydrogels were evaluated for physical appearance, rheological behavior, skin irritation and wound-healing power in streptozotocin-induced diabetic male wistar albino rats. Results showed that all hydrogel formulations exhibited good and acceptable physical properties. All the animals tolerated the applied gels and no signs of irritations were noticed during the skin irritation study. The in-vivo wound healing studies showed a time dependent increase in percentage of wound, a contraction which is higher than that produced by the control groups. These contractions were statistically significant (P

Objectives: Osteoarthritis (OA) is one of the commonest joint/musculoskeletal disorders, affecting the middle aged and elderly, although younger people may be affected as a result of injury or overuse. The study aimed to analyze the data, evaluate the prescription pattern and rationality of the use of drugs in the treatment of primary OA with due emphasis on the available treatment regimens. Materials and methods: Medical case records of patients suffering from primary OA attending the department of Orthopedics of a tertiary medical centre were the source of data. The study was carried out prospectively for a period of 20 months (from December 2012 to July 2014). Results: 296 case records were collected in which the total number of drugs prescribed were 550. OA was more common in females (51.7%) and was more prevalent in the age group of 30–40 years (39%). Out of 550 drugs prescribed, Aceclofenac was the most frequently prescribed NSAID (29%) followed by Diclofenac (23%). Nimesulide and Paracetamol was the most commonly prescribed fixed dose combination (53). Among gastroprotectives, Ranitidine figured in 66 prescriptions. Glucocorticoids were prescribed orally and intraarticularly in 17 and 14 cases respectively. Dietary supplements like Calcium+Vitamin D (42) and Glucosamine Sulfate + Chondroitin Sulfate complex (19) were also prescribed. Conclusion: The above study highlights the rational use of therapeutic agents for primary OA.

Diabetic foot ulcer (DFU) is the leading cause of lower extremity amputation and is very common in clinical practice. Oxidative stress is important in the pathogenesis of chronic wound and the lipid per oxidation product malondialdehyde (MDA) is toxic molecule which is also associated with pathogenesis of chronic complications of diabetes mellitus. Fibrinogen is a recognized marker in peripheral arterial disease (PAD) and increasing level predict an increased risk of amputation. The aim of this study was to investigate whether the plasma MDA and fibrinogen are associated with severity of DFU. In this study, the plasma MDA and fibrinogen levels were determined in 23 normal subjects, 25 diabetes without ulcer patients, 24 mild DFU patients and 25 severe DFU patients. The results showed that mean plasma MDA levels of normal subjects, diabetes without foot ulcer patients, mild DFU patients and severe DFU patients were 0.98± 0.12 μmol/L, 1.3±0.21 μmol/L, 1.61±0.22 μmol/L and 2.3±0.35 μmol/L respectively. Mean plasma fibrinogen levels of normal subjects, diabetes without foot ulcer patients, mild DFU patients and severe DFU patients were 307± 61.5 mg/dl, 429±63.8 mg/dl, 513.6±77.8 mg/dl and 643.5±71.3 mg/dl respectively. We found out that mean plasma MDA level of severe DFU patients was significantly higher than that of other groups (p

Climate change and extensive groundwater extraction threaten the sustainability of groundwater resources in Myanmar, especially in the Ayeyarwaddy Delta region. Due to the lack of public water supply, an increasing population with extensive agricultural and industrial development has raised the importance of groundwater in many areas of the Ayeyarwaddy Delta. This study revealed the suitability of groundwater quality for drinking and irrigation purposes and the selection of piping materials in the Htantabin township of the delta region, which belongs to the highest group of water consumption from unimproved sources. Seasonal quality changes in groundwater and the influencing factors were also studied. The findings showed that groundwater in some locations in the study area was contaminated by saltwater. Areas within 100 m of the irrigation canal were more likely to experience seawater intrusion. The majority of groundwater samples were not suitable for drinking as the examined parameters exceeded the WHO guideline values. In the summer, only 37.5% of groundwater samples were fitted into categories that were suitable for irrigation; however, a higher percentage (62.5%) became suitable during the rainy season with a reduction in salinity . Contrary to groundwater salinity, the corrosion risk for metal pipes increased during the rainy season.

e24017 Background: Cancer is a disease of aging, however older patients are underrepresented in the clinical trials that determine the standards of care for oncological treatment. We conducted a review to identify whether there have been age-restrictive inclusion criteria in clinical trials over the last twenty five years. We focused on patients with metastatic gastroesophageal cancer. Methods: A search strategy was developed encompassing Embase, Pubmed and The Cochrane Library databases. All completed Phase III randomised controlled trials evaluating systemic anti-cancer therapies in metastatic gastroesophageal malignancies for the period 01.01.95 to 18.11.20 were identified. Reference management software (Covidence; Veritas Health Innovation Ltd) was used to screen for inclusion/exclusion. The following details were extracted from trial protocols: country of study, date of publication, patient number, age inclusion and exclusion criteria. The median age of participants and the percentage of older patients enrolled in each study was collected. A linear probability model was used to estimate the change over time in the proportion of studies using an upper age exclusion. Results: 363 phase III studies were identified. 152 studies were eligible for full text review, 86 were excluded, leaving 66 trials for final analysis. 86% (n = 56) included Gastric, 9% (n = 6) Oesophageal and 5% (n = 3) Oesophagogastric malignancies. Asian studies represented 48% (n = 32) of trials, 29% (n = 19) were worldwide and 23% (n = 15) were European. The median age of trial participants was 62, (range 18-94). No clear trend in the ages of study participants over the time period was identified. 32% (n = 21) of studies specified an upper age limit for inclusion and 57% of these were Asian studies. The median age of exclusion was 75 years (range 65-80). All studies starting before 2003 used an upper age exclusion (n = 12); whereas only 9 of the 52 that started in 2003 or later did (17%). Among these later studies, there was a very modest downward yearly-trend in the proportion of studies using an upper age exclusion (-0.02 per year; 95%CI -0.05 to 0.01; p = 0.31). 52% (n = 34) of studies specified the proportion of their study population who were over 65 years. Older patients represented only 36% of the trial populations in these studies (range 7-60%). Our search of currently enrolling trials on clinicaltrials.gov yielded 11 active studies, none of which specified an upper age limit. Conclusions: Recent years have seen improvements in clinical trial protocols, with many no longer specifying restrictive age criteria. Reasons for poor representation of older patients are complex and ongoing efforts are needed to broaden eligibility criteria and prioritise the inclusion of older adults in clinical trials.

Data extraction pro forma ANC booking study Bhutan. (DOCX 23 kb)

Interview guide for in-depth interviews on the themes around late antenatal booking (DOCX 15 kb)

Myanmar has a high proportion of out-of-pocket (OOP) health care expenditures with limited cost-sharing mechanisms. In Myanmar, there were limited data on the frequency of catastrophic health expenditure (CHE) due to OOP payments, as well as on the factors associated with CHE. This study aimed to investigate health care expenditure, the frequency of CHE, and the factors influencing CHE among households in Magway, Myanmar. A cross-sectional household survey was conducted in 2012 for 700 households (350 in urban areas and 350 in rural areas) in Magway. CHE was defined as a condition wherein the total amount of household health care expenditure was 40% or more of non-food expenditure in the past year. Multiple logistic regression analysis was applied to estimate odds ratios (ORs) and 95% confident intervals (CIs) of CHE. In the previous year, 28.3% of 350 urban households and 51.4% of 350 rural households utilized outpatient services. Households with at least one member admitted to a medical facility were 10.0% and 12.9%, respectively. Those with CHE were 25.2% in the urban areas and 22.7% in the rural areas. The adjusted OR of CHE was 7.79 (95% CI 3.73–16.26) for hospitalization and 1.08 (95% CI 0.36–3.23) for outpatient care, relative to no services used. These findings indicated that nearly one fourth of households in Magway faced CHE due to inpatient care. A safety-net mechanism to protect households from CHE in Myanmar seems essential.

Problem-based learning (PBL) extensively practiced learning approaches in medicine and various higher education settings. Success or failure of PBL depends on student's perception and attitude as well as the facilitators. Understanding student's perception and attitude toward PBL and also the facilitator would work as feedback to upgrade PBL. The purpose of this is study was to determine the students of clinical years and pre-houseman perceptions and attitudes towards the PBL and its facilitators. A questionnaire-based cross-sectional study conducted in a private institution in Malaysia; the questionnaire was prepared using Google docs and distributed to pre-housemen and clinical year students. The results showed 86.2% of participant's positive perception that voiced as the Problem Based Learning encourages them for learning cognitive and soft skills. More than half of the students have consented; that students with dominant leadership benefit more with PBL, and others remain disadvantages in PBL is one of the drawbacks. The majority of the students expressed a positive attitude towards the facilitators; that the guidance and encouragement extended during the PBL session. They also expressed their opinion that the facilitator should debrief at the end of the PBL session. The study concludes that PBL is an appropriate tool to nurture students and enrich them with their soft skills and making better use of cognitive ability. Furthermore, the study conceptualizes that besides some drawbacks in PBL facilitation, it is one of the best methods pave up to the achievements of university objectives. This study results would be beneficial in the facilitation of future PBL sessions not only in Lincoln University College but also in other global universities.

Claudio Sopranzetti, Red Journeys: Inside the Thai Red-Shirt Movement. Chiang Mai, Thailand: Silkworm Books, 2012. 137 pp.Claudio Sopranzetti's Red Journeys: Inside the Thai Red-Shirt Movement is an up-close, vivid, and fast-paced ethnographic account of one and a half frenetic months circulating amongst, conversing with, and feverishly documenting the actions of red-shirt protestors in Bangkok from April 10 to May 20, 2010. While media reports often reductively depict the Red Shirts as a singular rural mass of discontented "Thaksin supporters," Sopranzetti's account documents the movement through encounters with heterogeneous characters with multiple, distinct motives and beliefs. A Ph.D. student in anthropology, Sopranzetti originally traveled to Bangkok to conduct dissertation research on motorcycle taxi drivers. However, the Red Shirts occupied Bangkok in mid-April, placing both Sopranzetti and the drivers he was studying at the center of a national event that began making global headlines. As Sopranzetti puts it, "this side interest took my thesis hostage" (xii), and he shifted his attention to the spectacular story his network of motorbike taxi friends inserted him into. The book documents the view from behind the barricades in raw ethnographic detail, reproducing the blog posts Sopranzetti meticulously recorded during the unfolding protests, and bringing readers into close daily contact with the Red Shirts. It is an innovative ethnography that reproduces the way his field-notes and blogs emerged, and the book is styled to read as if events were playing out in real time. In response to such innovation, we have written this review as a collectively authored wiki which we hope will capture the multifarious reactions of a faculty member, a graduate student, and 11 undergraduate students-two of them from Thailand-who read and discussed the book together in a course on Southeast Asia. The advantage of this approach is that it manages to bring out in one text very different individual readings of the book. For example, some readers noted that the book ignored analyzing top-down power dynamics, while others celebrated the way it carefully avoided forcing a simplifying explanatory narrative onto these events. This collectively written document offers space for both readings, without suppressing either.The immediacy of Sopranzetti's account complicates simplified renderings of the protests as a unified drama with a straightforward plot. This might frustrate readers searching for a full and complete analysis of the convergences and divergences in Thai politics or for the history of the genesis of the Red Shirts. There is, for example, no sustained analysis of the deposed Prime Minister Thaksin Shinawatra or of the man who replaced him, Abhisit Vejjajiva, nor is there much discussion of the allegiances the various groups claimed with the Thai military or the Bangkok police-although there are hints throughout the book of how important the faultlines of allegiance might be. Because the book prioritizes description over analysis, it will work best if readers have some background knowledge of the general conflict and the major players, or at least read it in conjunction with media reports from the period.2 But these basic political details can be found quite readily elsewhere, and Sopranzetti's ethnography exposes something harder to find through an Internet search engine: it highlights the tension between real situations, which took place in Bangkok in late spring of 2010, and how commonly accepted explanations are unable to account for them. Instead of reductionist summaries or explanatory analysis, Red Journeys provides snapshots from the frontlines of the protests.Reading "uncooked" blog posts forces patient readers to engage with the contradictions and complexities of political conflict, which is so frequently painted in simple black and white-or in this case, Red and Yellow-binaries that all too often offer simplifications that are more seductive than accurate. …

論文, Article

Background: There is a rising trend in antibiotic use and misuse which contributes to antibiotic resistance. Objective: This cross-sectional, questionnaire-based study was to assess the knowledge, attitude, and awareness of antibiotic resistance among medical students. Materials and Methods: The study was conducted on medical students of all years (year 1–5) in a private university of Malaysia coincide with the “Antibiotic Awareness Week” of the World Health Organization. Results: Students in the clinical phase of their training had more awareness than the preclinical phase on the consumption of antibiotics over the counter without prescription (P = 0.008). Students of both the phases responded differently when asked whether the newer antibiotics were more effective in treating infection (P = 0.022). Only 43.5% of year 4 and 42.3% of year 5 students were aware (P = 0.036) about Antibiotic Awareness Week. Conclusion: The study concludes that medical students should have in-depth knowledge about antibiotic resistance and its underlying mechanisms to prevent the misuse of antibiotics.

Objective The aims of this study were to assess: (1) concordance between patient preferences stated in advance care plans (ACPs) and hospital care over the subsequent 12 months; (2) change in preferences over time; (3) justifications for discordant care; and (4) effects of ACP completion on hospital utilisation. Methods A retrospective study was conducted of 198 patients with an ACP form registered with an ACP registry and tagged with a hospital unique record number. Data collected from ACP forms and hospital records comprised ACP completion and revisions, care preferences, patient characteristics and hospital care. Instances of care discordant with preferences were analysed as Type A (no ascertainable justification) and Type B (direct patient request or appropriate clinical indications). In a survivor subset, hospital utilisation was compared before and after ACP completion. Results Mean (± s.d.) patient age was 79.5±11.8 years. Patients had a mean (± s.d.) of 5.5±2.5 comorbidities and 90 (46.4%) died within the 12 months after ACP completion. Most ACPs (130; 65.5%) were completed during index hospitalisation and 13 (6.5%) underwent revision, on average, 6.8 months later, all related to rescinding request for cardiopulmonary resuscitation. Hospital care was fully concordant for 154 (77.8%) patients, with 39 (22.2%) receiving 60 instances of discordant care (15 (25%) Type A, 45 (75%) Type B), mostly related to surgical procedures (20; 33%) and intravenous fluids or antibiotics (26; 43%). Patients receiving discordant care had higher mortality (77% vs 45%; P

We conducted a cross-sectional study of the risk behaviours inherent in tobacco smoking, alcohol consumption and premarital sex, among 400 medical students (186 males) from a medical university, Yangon, and 410 community youths (244 males) 15 to 24 years of age from selected townships in Myanmar. As a result, we found that 12.8% smoked, 34.5% consumed alcohol and 10.1% engaged in premarital sex, among medical students, whereas among community youths, the corresponding rates were 28.8%, 32.1% and 11.9%. There was a significant difference in the prevalence of all risk behaviours between male and female respondents. Such risk behaviours were more dominant among males, while being very low among females. Among male respondents, the smoking rate was significantly higher among community youths (46.7%) than among medical students (26.9%); however, student alcohol consumption (58.5%) was greater than that of community youths (47.1%). Premarital sexual experience did not differ significantly between the two groups. These risk behaviours were correlated with one another. Having close friends who engaged in similar behaviours was found to be the major contributing factor for those kinds of risk among both groups. Our results highlighted the fact that, despite their relatively sophisticated knowledge of risks, the prevalence of risky behaviour among the medical students was no less frequent than among community youths. To diminish those risks, evaluations of actual conditions, behaviour modifications and specific preventive measures compatible with existing culture and changing lifestyles should be undertaken. Effective adolescent health programs at schools, colleges and universities should be revised and emphasized.

International audience; A well-preserved fossil talus [National Museum of Myanmar Primates (NMMP) 82] of a large-bodied primate is described from the late middle Eocene Pondaung Formation of central Myanmar. The specimen was collected at Thandaung Kyitchaung, a well-known amphipithecid primate-bearing locality near the village of Mogaung. NMMP 82 adds to a meager but growing sample of postcranial remains documenting the large-bodied primates of the Pondaung Formation. This new talus exhibits a suite of features that resemble conditions found in living and fossil haplorhine primates, notably anthropoids. As such, the phylogenetic signal deriving from the morphology of NMMP 82 conflicts with that provided by NMMP 20, a partial skeleton (including a fragmentary calcaneus) of a second large-bodied Pondaung primate showing undoubted adapiform affinities. Analysis subtalar joint compatibility in a hypothetical NMMP 82/NMMP 20 combination (talus/calcaneus) reveals a substantial degree of functional mismatch between these two tarsal bones. The functional incongruence in subtalar joint morphology between NMMP 20 and NMMP 82 is consistent with the seemingly divergent phylogenetic affinities of these specimens, indicating that two higher level taxa of relatively large-bodied primates are documented in the Pondaung Formation. On the basis of its size and morphology, we refer the NMMP 82 talus to the large-bodied amphipithecid Pondaungia. The occurrence of anthropoid-like tali in the Pondaung Formation obviates the need to invoke homoplasy to explain the shared, derived dental characters that are common to amphipithecids and undoubted anthropoids. Functionally, the NMMP 82 talus appears to have pertained to a primate that is engaged in active quadrupedalism in an arboreal environment along broad and subhorizontal branches. The primate taxon represented by NMMP 82 was capable of climbing and leaping, although it was not particularly specialized for either of these activities.

Recently, radiated electromagnetic interference (EMI) has become a major design issue for high speed circuit designers, and it is likely to become even more severe in the future. With increasing operational speeds of circuits, electronic products may not pass the EMI regulatory standards such as FCC, CISPR, etc. Therefore, it is critical to design an electronic system with Electromagnetic Compatibility (EMC) consideration. Master of Science