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As the world heads into modernisation, English is widely spoken by non-native speakers due to the globally competitive market. Teaching speaking in ESL classrooms has always been a massive problem since many learners are struggling to utter simple sentences despite years of learning English. By introducing the Common European Framework of Reference (CEFR) into the existing curriculum, Communicative Language Teaching (CLT) approach is being prioritised to teach spoken interaction among ESL pupils. This systematic review aims to investigate the implementation of the CLT approach in teaching speaking skills in ESL classrooms. By adopting the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) review methodology, 37 were extracted out of 360 CLT-related articles from Google Scholar and ERIC databases based on the inclusion and exclusion criteria. Based on the selected articles from 2018 to 2022, the findings reveal that teachers and pupils view the CLT approach positively regarding its effectiveness in sustaining speaking skills in ESL classrooms despite the challenges faced. Future research is suggested to fill in the gap of this study by investigating the perceptions of the education stakeholders towards implementing the CLT approach under the ESL context.

An outbreak of Zika virus infection was detected in Singapore in August, 2016. We report the first comprehensive analysis of a national response to an outbreak of Zika virus infection in Asia. In the first phase of the outbreak, patients with suspected Zika virus infection were isolated in two national referral hospitals until their serum tested negative for the virus. Enhanced vector control and community engagement measures were deployed in disease clusters, including stepped-up mosquito larvicide and adulticide use, community participation in source reduction (destruction of mosquito breeding sites), and work with the local media to promote awareness of the outbreak. Clinical and epidemiological data were collected from patients with confirmed Zika virus infection during the first phase. In the second phase, admission into hospitals for isolation was stopped but vector control efforts continued. Mosquitoes were captured from areas with Zika disease clusters to assess which species were present, their breeding numbers, and to test for Zika virus. Mosquito virus strains were compared with human strains through phylogenetic analysis after full genome sequencing. Reproductive numbers and inferred dates of strain diversification were estimated through Bayesian analyses. From Aug 27 to Nov 30, 2016, 455 cases of Zika virus infection were confirmed in Singapore. Of 163 patients with confirmed Zika virus infection who presented to national referral hospitals during the first phase of the outbreak, Zika virus was detected in the blood samples of 97 (60%) patients and the urine samples of 157 (96%) patients. There were 15 disease clusters, 12 of which had high Aedes aegypti breeding percentages. Captured mosquitoes were pooled into 517 pools for Zika virus screening; nine abdomen pools (2%) were positive for Zika virus, of which seven head and thorax pools were Zika-virus positive. In the phylogenetic analysis, all mosquito sequences clustered within the outbreak lineage. The lineage showed little diversity and was distinct from other Asian lineages. The estimated most recent common ancestor of the outbreak lineage was from May, 2016. With the deployment of vector control and community engagement measures, the estimated reproductive number fell from 3·62 (95% CI 3·48–3·77) for July 31 to Sept 1, 2016, to 1·22 (95% CI 1·19–1·24) 4 weeks later (Sept 1 to Nov 24, 2016). The outbreak shows the ease with which Zika virus can be introduced and spread despite good baseline vector control. Disease surveillance, enhanced vector control, and community awareness and engagement helped to quickly curb further spread of the virus. These intensive measures might be useful for other countries facing the same threat. National Medical Research Council Singapore, Centre for Infectious Disease Epidemiology and Research, and A*STAR Biomedical Research Council.

Although existing literature increasingly suggests a positive influence of pet ownership on human physical activity levels, results from many European, American, and Japanese studies have been inconsistent. How pet ownership impacts mental health and atopy is likewise controversial and whether distinct demographic subgroups experience differential effects is unclear. This cross-sectional study surveyed participants ( n  = 823) via a self-administered online questionnaire. Comparisons of outcomes between pet owners and non-pet owners with subgroup analyses were performed within a propensity score-matched subset ( n  = 566) of respondents. There were no differences in physical activity levels or mental health scores between pet owners and non-pet owners. In subgroup analyses, compared to non-pet owners, main pet caregivers reported 14.1 (95% CI 2.79–25.3) and 19.0 (95% CI 4.70–33.3) more minutes per week of moderate- and vigorous-intensity physical activity respectively and higher SF-36 emotional well-being ( β  = 2.7, 95% CI 0.100–5.32) and energy scores ( β  = 3.8, 95% CI 0.410–7.27). Age was a significant effect modifier of the association between pet ownership and emotional well-being, energy and social functioning scores, with greater scores above the ages of 39, 35 and 39 years old respectively (interaction p  = 0.043, 0.044, 0.042). Finally, pet acquisition was associated with worsening of allergic rhinitis, while pet ownership cessation was associated with improvement of allergic rhinitis and eczema symptoms. To our knowledge, this is the first study addressing the public health impact of pet ownership in Southeast Asia and its findings add contextual nuance to suggest potential benefits derived from pet ownership.

The microenvironment for tumor growth and developing metastasis should be essential. This study demonstrated that the hyaluronic acid synthase 3 (HAS3) protein and its enzymatic product hyaluronic acid (HA) encompassed in the subcutaneous extracellular matrix can attenuate the invasion of human breast tumor cells. Decreased HA levels in subcutaneous Has3-KO mouse tissues promoted orthotopic breast cancer (E0771) cell-derived allograft tumor growth. MDA-MB-231 cells premixed with higher concentration HA attenuate tumor growth in xenografted nude mice. Human patient-derived xenotransplantation (PDX) experiments found that HA selected the highly migratory breast cancer cells with CD44 expression accumulated in the tumor/stroma junction. In conclusion, HAS3 and HA were detected in the stroma breast tissues at a high level attenuates effects for induced breast cancer cell death, and inhibit the cancer cells invasion at the initial stage. However, the highly migratory cancer cells were resistant to the HA-mediated effects with unknown mechanisms.

The clinical management of type 2 diabetes mellitus (T2DM) presents a significant challenge due to the constantly evolving clinical practice guidelines and growing array of drug classes available. Evidence suggests that artificial intelligence (AI)-enabled clinical decision support systems (CDSSs) have proven to be effective in assisting clinicians with informed decision-making. Despite the merits of AI-driven CDSSs, a significant research gap exists concerning the early-stage implementation and adoption of AI-enabled CDSSs in T2DM management. This study aimed to explore the perspectives of clinicians on the use and impact of the AI-enabled Prescription Advisory (APA) tool, developed using a multi-institution diabetes registry and implemented in specialist endocrinology clinics, and the challenges to its adoption and application. We conducted focus group discussions using a semistructured interview guide with purposively selected endocrinologists from a tertiary hospital. The focus group discussions were audio-recorded and transcribed verbatim. Data were thematically analyzed. A total of 13 clinicians participated in 4 focus group discussions. Our findings suggest that the APA tool offered several useful features to assist clinicians in effectively managing T2DM. Specifically, clinicians viewed the AI-generated medication alterations as a good knowledge resource in supporting the clinician's decision-making on drug modifications at the point of care, particularly for patients with comorbidities. The complication risk prediction was seen as positively impacting patient care by facilitating early doctor-patient communication and initiating prompt clinical responses. However, the interpretability of the risk scores, concerns about overreliance and automation bias, and issues surrounding accountability and liability hindered the adoption of the APA tool in clinical practice. Although the APA tool holds great potential as a valuable resource for improving patient care, further efforts are required to address clinicians' concerns and improve the tool's acceptance and applicability in relevant contexts.

Neural-Wiskott Aldrich Syndrome Protein (N-WASP) is expressed ubiquitously and regulates actin cytoskeleton remodeling. In order to characterize the role of N-WASP in epidermal homeostasis and cutaneous biology, we generated conditional N-WASP knockout mouse using CK14-cre (cytokeratin 14) to ablate expression of N-WASP in keratinocytes. N-WASP K14KO ( N-WASP fl/fl ; CK14-Cre ) mice were born following Mendelian genetics suggesting that N-WASP expression in keratinocytes is not essential during embryogenesis. N-WASP K14KO mice exhibited stunted growth, alopecia, dry and wrinkled skin. The dry skin in N-WASP K14KO mice is probably due to increased transepidermal water loss (TEWL) caused by barrier function defects as revealed by dye penetration assay. N-WASP K14KO mice developed spontaneous inflammation in the neck and face 10 weeks after birth. Histological staining revealed thickening of the epidermis, abnormal cornified layer and extensive infiltration of immune cells (mast cells, eosinophils and T-lymphocytes) in N-WASP K14KO mice skin compared to control mice. N-WASP K14KO mice had higher serum levels of IL-1α, TNF-α, IL-6 and IL-17 compared to control mice. Thus our results suggest that conditional N-WASP knockout in keratinocytes leads to compromised skin barrier, higher infiltration of immune cells and hyperproliferation of keratinocytes due to increased production of cytokines highlighting the importance of N-WASP in maintaining the skin homeostasis.

Regenerated nanocomposite cellulose membranes embedded with silver nanoparticles (AgNP) and AgNP-graphene oxide (AgGO) were prepared in this study. The as-synthesized AgNP and AgGO were added respectively to a cellulose solution that was prepared by dissolving cellulose in a precooled NaOH/urea (NU) solvent. The solution mixtures were further regenerated into nanocomposite membranes through coagulation in an acidic solution. UV-Vis and TEM results revealed the improved stability of the AgGO compared to that of the AgNP in NU solutions. As revealed by FESEM, the AgGO nanocomposite membrane possessed a more porous structure than a membrane containing AgNP. Antibacterial tests demonstrated that the cellulose membrane of AgGO inhibited the growth of both Staphylococcus aureus and Escherichia coli more effectively than the AgNP nanocomposite membrane, with a lower concentration of AgGO. This work provides a proven and effective method to prepare novel functional cellulose membranes with antibacterial properties, thus broadening the applications of cellulose.

There is a significant increase in plastic consumption with the growing economies of Asia, causing severe environmental issues as a large proportion of the plastic waste is not appropriately disposed due to the underdeveloped collection systems. The situation in Malaysia is particularly worrying as the total plastic waste increased by nearly 30% in 2018, becoming the second-highest of the entire household solid waste. This problem can be addressed by improving the plastic waste management system and increasing the plastic wastes recycling rate. Therefore, this study aims to investigate the current situation of plastic waste generation. Malaysia’s waste management framework is a unique integration of the formal and informal sectors. The lack of uniformity has been the main challenge for the policy implementation in improving plastic waste management. From the plastic material flow analysis, only 41.4% of the plastic wastes were recycled in 2019. The most recycled plastic types in Malaysia are high-density polyethylene (HDPE), polyethylene terephthalate (PET), low-density polyethylene (LDPE), and polypropylene (PP), as they are easier to collect and have higher density. From the identified plastic recycling process flow, the main challenge is low recyclability. Most recyclables are usually contaminated with food waste or non-recyclable plastic, which hinders the sorting process. Informing the public how to recycle plastic waste properly can increase the effectiveness of recyclables collection as well as the sorting process.