Experience In Southeast Asia Research Articles

Investigating the Clinical Appropriateness of Short Synacthen Testing and Utility of Pretest Cortisol to Predict Short Synacthen Testing Outcomes: A Tertiary Center Experience in Southeast Asia

ObjectiveNo studies have investigated the predictors of an adequate cortisol response to the short synacthen test (SST) and the appropriateness of patient selection for SST in the Southeast Asian population. The aim of our study is to investigate the predictors and indications of SSTs and concondance of SSTs conducted with outcomes. MethodsThis is a retrospective study investigating all SSTs performed over a year in a tertiary center. Clinical data of patients with SSTs between February 2022 and February 2023 were extracted. We determined the appropriateness of SST testing. Binary logistic regression was used to assess the parameters that predict adequate cortisol response on SST. The proportion of individuals with biochemical “pass” or “fail” on SST was compared with the Χ2 test. Baseline cortisol levels that predicted SST pass were determined using area under receiving operating characteristics curves. ResultsOf the 781 SSTs, 83.9% of SSTs showed an adequate cortisol response. Postural hypotension (26.9%) and exogenous glucocorticoid administration (14.2%) were common indications for SST. In our cohort, 50.2% of the SSTs were inappropriately indicated. Pretest serum cortisol and albumin predict biochemical pass on SST. A pretest cortisol level of 300 nmol/L predicted SST response with 93% sensitivity and a cortisol level of <100 nmol/L confirmed adrenal insufficiency (AI) with 97.3% specificity. Using these cortisol thresholds could avoid 302 (38.5%) of SSTs. ConclusionOur analysis showed that clinical features of AI do not reliably predict SST outcomes. We advocate careful assessment of the pretest probability of AI in patients referred for SST. A pretest cortisol level can reduce the number of SSTs, with cost savings implications.

Quantifying the internal and external drivers of Southeast Asian rainfall extremes on decadal timescales

Rainfall over mainland Southeast Asia experiences variability on seasonal to decadal timescales in response to a multitude of climate phenomena. Historical records and paleoclimate archives that span the last millennium reveal extreme multi-year rainfall variations that significantly affected the societies of mainland Southeast Asia. Here we utilize the Community Earth System Model Last Millennium Ensemble (CESM-LME) to quantify the contributions of internal and external drivers to decadal-scale rainfall extremes in the Southeast Asia region. We find that internal variability was dominant in driving both Southeast Asian drought and pluvial extremes on decadal timescales although external forcing impacts are also detectable. Specifically, rainfall extremes are more sensitive to Pacific Ocean internal variability than the state of the Indian Ocean. This discrepancy is greater for droughts than pluvials which we suggest is attributable to external forcing impacts that counteract the forced Indian Ocean teleconnections to Southeast Asia. Volcanic aerosols, the most effective radiative forcing during the last millennium, contributed to both the Ming Dynasty Drought (1637–1643) and the Strange Parallels Drought (1756–1768). From the Medieval Climate Anomaly to the Little Ice Age, we observe a shift in Indo-Pacific teleconnection strength to Southeast Asia consistent with enhanced volcanism during the latter interval. This work not only highlights asymmetries in the drivers of rainfall extremes but also presents a framework for quantifying multivariate drivers of decadal-scale variability and hydroclimatic extremes.

Comparing the Causes and Consequences of the Asian and Global Financial Crises on Southeast Asia

The arrival of the global financial crisis (GFC) just a decade after the Asian financial crisis (AFC) may have settled for now the argument about whether the world had learned enough so that economic crises are no longer possible. But it has not settled the argument of whether lessons were learned. This paper deals with this question by focusing on the experience of Southeast Asia, which has borne the full impact of both crises. For this region, these crises emerged through a combination of factors that were as different as they were similar between one crisis and another. The lessons that were learned or not learned in interpreting those factors with respect to each crisis determined each country’s response to that crisis, with politics being an important part of the calculus. Indicators just before the onset of the GFC and of its impact showed that some, but not all, lessons from the AFC were indeed learned. Whatever the lessons learned, however, Southeast Asian stock markets were decimated but which quickly rebounded. Nor would learning lessons guarantee insulation from future crises because the external environment facing Southeast Asia has changed and will continue to change.

Speleothem records from western Thailand indicate an early rapid shift of the Indian summer monsoon during the Younger Dryas termination

Mainland Southeast Asia experiences complex and variable hydroclimatic conditions, mainly due to its location at the intersection of Asian monsoon subsystems. Predicting future changes requires an in-depth understanding of paleoclimatic conditions that is currently hindered by a paucity of records in some regions. In this paper, we present the first speleothem stable isotope records from western Thailand detailing the Bølling-Allerød interstadial, Younger Dryas termination, and early- to mid-Holocene period. We find evidence of higher precipitation during the Bølling-Allerød (14,321–12,824 years before present (1950: BP)) compared to a Younger Dryas termination that starts 11,702–11,674 BP, has a rapid shift centered on 11,660–11,641 BP, and ends 11,603–11,589 BP. In addition, our records show Holocene monsoon intensity peaking at 8250 BP or before, a multi-millennia delay from the Northern Hemisphere summer insolation peak, followed by a trend to drier conditions until at least 750 BP. Assessment of the timing of the Younger Dryas termination in paleoclimate records across Southeast Asia reveals an earlier shift of the Indian Summer Monsoon to global climate shifts when compared to East Asian Summer Monsoon records. The causes of this are currently unknown. Some potentially important aspects include: an Indian Summer Monsoon influence on East Asian Summer Monsoon strength via the Indian Ocean Dipole climate pattern, the role of the Tibetan Plateau in monsoon dynamics, and exposure of the Sundaland shoreline. More high-resolution paleoclimate records, especially on the pathway of Indian Summer Monsoon to East Asian Summer Monsoon, are required for further discussion on the mechanisms controlling the differences between climate regimes.

Emerging patterns of genetic diversity in the critically endangered Malayan tiger (Panthera tigris jacksoni)

Southeast Asia experiences some of the highest deforestation in the world. Loss of tropical forest typically leads to widespread habitat fragmentation, with detrimental effects on dispersal ability and gene flow—particularly for large carnivores. We conducted mtDNA and microsatellite analysis to assess—for the first time—contemporary patterns of genetic diversity in the Malayan tiger. We collected 295 suspected carnivore samples in Peninsular Malaysia, from which we identified 26 as originating from tiger using 16 polymorphic microsatellite loci, comprising 22 individual tigers. Despite limitations of the study, our findings suggest tiger subpopulations in the north of the peninsula maintain some genetic connectivity and migration between two putative geographic subpopulations in the Main Range and Greater Taman Negara, with negligible population segregation due to dispersal barriers such as road infrastructure. We identified consistently lower levels of genetic diversity in tigers in the Greater Taman Negara region compared to tigers in the Main Range and small but emerging differences in nuclear and mitochondrial genetic diversity. Our mtDNA haplotype and nuclear DNA analyses suggest the levels of genetic diversity in Malayan tigers may be amongst some of the lowest of the surviving tiger subspecies, though the study is limited both in scale and genomic loci. Our findings are consistent with an expected lag between the rapid decline of tigers in Peninsular Malaysia by over 95% in the last 70 years and observed differences in their levels of genetic diversity.

Pengaruh Pemberian Sari Kacang Hijau Terhadap Peningkatan Kadar Hemoglobin pada Ibu Hamil Anemia

Anemia is a condition where the number and size of red blood cells or hemoglobin concentration is below the normal limit value. It is estimated that 52.5% of women in Southeast Asia experience anemia. Iron content. Green beans are a source of vegetable protein, vitamins (A, B1, C and E), as well as several other substances that are very beneficial for the human body. The aim of this research was to see the effect of giving green bean juice on increasing hemoglobin levels of anemic pregnant women in the Lubuk Buaya Padang Health Center work area. The research design used quantitative quasi-experimental methods, one group pretest-posttest design. The sample size was 15 pregnant women. Research results The average hemoglobin levels of pregnant women before and after being given green bean juice in the treatment group were 10.5 gr/dL and 11.4 gr/dl. In these results there was an increase in hemoglobin levels. There is an effect of giving green bean juice on increasing hemoglobin levels in pregnant women with anemia, the result is p value = 0.000 and the significance value is greater than 5% (p=0.000&lt;0.05 for the variable Hb level (0.000). This means that giving green bean juice can increase Hb levels of pregnant women. This study concluded that there was an effect of giving green bean juice on increasing the value of hemoglobin levels in pregnant women.

Sustainable thin shell analysis on structural foundation subjected to seismic loads

Shell structures are recognized for their exceptional performance in withstanding compression forces, often utilized as roof components. However, Southeast Asia experiences significant annual losses due to floods, with inadequate structural mitigation despite high population concentrations in seismic risk areas. Previous research explored thin shell structures as elevated foundations to mitigate flood effects on buildings. Unfortunately, the proposed shell design exceeded the material’s strength limit of 40N/mm2, limiting its feasibility. To address this, our study proposes a modified thin shell with a 600mm thickness. Finite Element analysis using LUSAS software evaluated the new design’s structural behavior under dynamic loads from earthquakes and flood-induced waves. Results demonstrate a substantial reduction of up to 99% in equivalent stress compared to the previous model [Model P]. The revised model [Model C] proves feasible in withstanding intense building loads, ensuring maximum stress remains below the concrete material’s strength limit. Implementation of these findings offers valuable structural mitigation, reducing flood impacts and enhancing both structural resilience and human safety.

ASEAN and Biosecurity Law: Experience of Southeast Asia

ASEAN and Biosecurity Law: Experience of Southeast Asia

Failure of PPP mechanism: A cross-country analysis of these unique issues associated with the road sector in Southeast Asian markets

To meet financial requirement for infrastructure development, the Public–Private Partnership (PPP) mechanism has been applied in a range of nations as a promising solution. However, unpredicted collapses that are linked to PPP applications have been experienced worldwide despite scientific protocols and concentrated efforts from engaged sectors. Numerous academic works have attempted to minimize PPP failures by exploring the area of risk management. However, there are limited efforts focusing on Southeast Asia. Previous studies in these markets have mainly identified risks, rather than in-depth analysis of root causes of failure, or proposing practical solution. This paper, by carrying out an evidence-based analysis of the Southeast Asia experience with an intensive focus on emerging markets, analyzes critical reasons and their underlying connections that result in PPP failure. Research outcomes also suggest using constructive strategies promoting a regulatory framework to diminish collapses that affect drivers and so enable the restoration of PPPs.

A quest for agency in the Anthropocene: Law and environmental movements in Southeast Asia

AbstractThe Anthropocene questions the very foundation of environmental law. Many legal scholars have proposed directions on how environmental law should be transformed to respond to complex challenges in the new geological epoch. However, they tend to avoid questions about which social actors should be regarded as the agents of change to bring about such a transformation. This article addresses the question of agency by considering the experience of Southeast Asia. By employing a comparative perspective, this article reveals that environmental movements are a major agent of change in the Anthropocene because they have been playing a pivotal role in progressing environmental law in the region. However, despite their importance in the region, environmental movements have persistently been confronted by intimidation, repression and even murder.

The influence of land use and land cover change on landslide susceptibility in the Lower Mekong River Basin

The Lower Mekong River Basin in Southeast Asia experiences frequent rainfall-triggered landslides especially during the monsoon season. In this study, the influence of land use and land cover change and other causative factors on landslide susceptibility is evaluated in the Lower Mekong Basin. Frequency ratio analysis is performed to quantify the relationship between LULC change and susceptibility. Detailed landslide inventory maps are used for analysis with yearly LULC maps. The LULC change is used as a contributing variable in a logistic regression-based susceptibility model with other variables including distance to roads, slope, aspect, forest loss, and soil properties. The Receiver Operating Characteristic (ROC) curve and Area Under the Curve are estimated for the model trained by each landslide inventory. The models show good performance, with AUC values ranging from 0.697 to 0.958 and an average AUC equal to 0.820. Both the Frequency Ratio analysis and the Logistic Regression models indicate LULC change from agricultural land to forest has a positive correlation with landslide occurrence. The most significant factors in the models are found to be distance to roads, slope, and aspect. A better understanding of the effects of LULC on landslide susceptibility can be useful for local land and disaster management and for the implementation of LULC as a factor in future susceptibility models. Using datasets that are unique to the Lower Mekong region, this study provides additional insights into the relationship between causative factors and landslide activity to better inform regional and global landslide susceptibility modeling.

Performance and 12 month outcomes of a wire free fractional flow reserve system for assessment of coronary artery disease, first experience in south east asia

Abstract Funding Acknowledgements Type of funding sources: None. Background Fractional flow reserve (FFR) using an invasive pressure wire has a Class 1A recommendation for guiding coronary revascularization in stable coronary artery disease (CAD). Angiography based ‘wire free’ FFR is an emerging technique which determines the physiological significance of a coronary lesion without requirement of a pressure wire or induction of hyperemia. It also eliminates potential complications associated with introduction of wires into the coronary arteries. Objective To assess the 12-month clinical outcomes of PCI deferral, guided by an angiography based fractional flow reserve (CAFFR) system. The primary end point was a composite of death from any cause, myocardial infarction (MI) or target vessel revascularization (TVR) Methods This was a prospective, single center study involving 69 patients (93 vessels) with angiographic stenosis of 30%-90%. Patients with CAFFR of &amp;lt;0.80 or poor image quality were excluded leaving 29 patients (31 vessels) for analysis. All recruited patients had a CAFFR &amp;gt;0.80 and thus, PCI deferral. Wired FFR was done for comparison on 14 patients (48%) at the operator’s discretion. Results The mean age was 59 ± 12.6 years old. Majority of patients (83%) were male. 12 (42%) patients were diabetic, 18 (62%) were hypertensive, 17 (59%) had dyslipidemia and 18 (62%) had a smoking history. The mean LVEF was 52+/-11.4%. 72% of the patients had a recent acute coronary syndrome. We assessed the LAD artery in 15 (52%) vessels. The mean CAFFR and FFR was 0.87 ± 0.04 and 0.89 ± 0.05 respectively. The values showed agreement with each other with no statistically significant proportional bias on the Bland Altman plot (linear regression t test: t=-1.19, p = 0.257). CAFFR values &amp;gt;0.80 showed 100% correspondence to negative FFR values (&amp;gt;0.80). There were zero procedural complications from CAFFR measurement. At 12 months, all 29 patients were alive. Only 1 patient (3.4%) met the primary end point (TVR for angina). 89.6% (26) patients remained in CCS class 1 on follow up. Conclusion CAFFR shows good agreement with wired FFR. The 12-month outcome data shows that CAFFR guided PCI deferral is safe and comparable to the gold standard of wired FFR guided PCI deferral. Further analysis with a larger patient pool and longer follow-up is warranted. Abstract Figure. Bland-Altman plot of FFR and CAFFR

Performance and 12-month outcomes of a wire-free fractional flow reserve system for assessment of coronary artery disease – first experience in South East Asia

Fractional flow reserve (FFR) using an invasive pressure wire has a Class 1A recommendation for guiding coronary revascularisation in stable coronary artery disease (CAD). Angiography based ‘wire free’ FFR is an emerging technique which determines the physiological significance of a coronary lesion without requirement of a pressure wire or induction of hyperaemia. It also eliminates potential complications associated with introduction of wires into the coronary arteries.

S3300 Is it Necessary to Transfuse FFP and Platelets Before Esophageal Variceal Band Ligation in Acute Variceal Bleeding Patients? Southeast Asia Experience. RIP FFP and Platelets Transfusion!

S3300 Is it Necessary to Transfuse FFP and Platelets Before Esophageal Variceal Band Ligation in Acute Variceal Bleeding Patients? Southeast Asia Experience. RIP FFP and Platelets Transfusion!

National Information Literacy Programs: the Experience of Southeast Asia and Ukraine

National Information Literacy Programs: the Experience of Southeast Asia and Ukraine

An evaluation of a medical student international service-learning experience in Southeast Asia.

International service-learning trips (ISLTs) are structured experiences in a different country where students interact and engage in cross-cultural dialog with others. Month-long ISLTs originating from North American or European medical schools enhance clinical acumen, cultural awareness, and global health familiarity. The impact of experiences shorter than 1 month or those that originate from Asia is unknown. We aimed to determine the impact of a short-term ISLT on medical students' clinical and cultural competence. At Duke-National University Singapore, we developed an ISLT incorporating peer-assisted learning and a 1-week on-site experience delivering supervised primary care, health screening, and health education in an underserved Southeast Asian community. Using a prospective controlled design, we assessed its impact on medical students' clinical and cultural competency using validated surveys. We compared medical students who participated in the ISTL (intervention group) to a control group of students before and after the ISTL experience. We analyzed responses using univariate analysis and the Kruskal-Wallis test. : Sixty-six students responded to the survey (100%). After the ISTL, the intervention group (n = 32) showed an increase in their ratings of clinical competency (preexperience mean = 3.39, postexperience mean = 3.81, P < 0.01) as well as an increase in their cultural competency domains (preexperience mean = 3.61, postexperience mean = 4.12, P < 0.01). Post the ISTL, students in the intervention group rated their clinical and cultural competency higher than the control group (n = 34) (clinical: intervention postexperience mean = 3.81, control postexperience mean = 3.30, P < 0.01; cultural: intervention postexperience mean = 4.12, control postexperience mean = 3.50, P < 0.01). After the ISTL, the intervention group reported increased ratings of self-efficacy (pre mean = 3.99, post mean = 4.29, P = 0.021), which were higher than the control group (pre mean = 4.29, post mean = 3.57, P < 0.01). : This short-term ISLT in an Asian medical school improved students' clinical and cultural competency and self-efficacy. Our findings suggest a positive impact of short-term ISLTs if designed and implemented with a student learning focus.

Co-editors' notes

Co-editors' notes

Transfemoral transcatheter tricuspid valve replacement of a degenerated tricuspid bioprosthesis: Initial experience in Southeast Asia with three-year follow-up.

Transfemoral transcatheter tricuspid valve replacement of a degenerated tricuspid bioprosthesis: Initial experience in Southeast Asia with three-year follow-up.

Erratum to: Percutaneous transfemoral transcatheter mitral valve replacement of a degenerated mitral bioprosthesis: initial experience in Southeast Asia with nine-month follow-up.

Erratum to: Percutaneous transfemoral transcatheter mitral valve replacement of a degenerated mitral bioprosthesis: initial experience in Southeast Asia with nine-month follow-up.

The Nanyang Revolution: The Comintern and Chinese Networks in Southeast Asia, 1890–1957. By Anna Belogurova (New York, Cambridge University Press, 2019) 276 pp. $99.99

The Nanyang Revolution provides a fascinating analysis of the overlapping nationalist and internationalist movements of Southeast Asia, primarily during the 1920s and 1930s. Belogurova pays particular attention to the Malaya Communist Party (mcp) and its role in the revolutionary activities of the period. Yet while the mcp may have the starring role in Belogurova’s story, several other organizations make important contributions, including the Comintern, Chinese immigrant associations (huiguan), the Nationalists (Guomindang), the Chinese Communist Party (ccp), the League Against Imperialism (lai), and even global Christianity. Chronicling the fascinating interactions between all of these, Belogurova argues that “the revolutionary international organizations active in Southeast Asia connecting the various peoples living in the area to the rest of the world makes the case that local developments—whether in Singapore or Shanghai or Manila—cannot be understood without a basic understanding of global interactions. Moreover, it demonstrates how Chinese practices were intertwined with global tendencies that produced the embeddedness of nations in global discourses, which are often mistaken for national discourses” (233).To understand the relationship between global and national discourses, Belogurova investigates the multiple and, at times, conflicting meanings of the Chinese term minzu. Leaders from the Guomindang, the ccp, the Comintern, and the mcp all used the term minzu, though each used it differently in different contexts. Sometimes it meant nation or nationality; other times it meant ethnic group, race, or simply people. As Belogurova writes, “These multiple meanings resulted in a semantic slippage,” allowing two groups to use the same words to refer to seemingly divergent trends (54). “As a result of different understandings of the word minzu by the ccp and the Comintern, a communist organization that was built according to people became the basis of a countrywide communist party of a nonexistent nation…. By promoting a national (i.e., Malayan) party and a Malayan Revolution, the Comintern conformed to the nascent idea of a national Malayan identity among Chinese immigrant communists and their jurisdiction over both the Nanyang and Malaya” (56).Belogurova’s fascinating work builds upon the previous scholarship of Benton, Kuhn, Ong, Nonini, and several other notable scholars to provide a complex vision of nationalism and internationalism in Southeast Asia.1 She also borrows the ideas of Tan Liok Ee, whose research on the terms bangsa and minzu provides a critical piece of Belogurova’s interpretive framework.2 She has conducted exhaustive research for The Nanyang Revolution, and her footnotes represent a treasure trove of information.Belogurova organizes her work into eight non-narrative chapters of approximately thirty pages each. Although her title suggests an analysis of the period from 1890 to 1957, the vast majority of the text focuses on the 1920s and 1930s. In her prologue, Belogurova establishes the durian as a metaphor for the Chinese experience in Southeast Asia. Tradition held that any Chinese immigrant who developed a liking for the smelly fruit was destined to remain in the region. Others argued that the fruit was “a symbol of the stink of the Nanyang’s capitalist society” (4). Intriguing as this metaphor is, it would have been helpful if Belogurova had used the prologue to lay out an organizing rationale for the remaining seven chapters.Belogurova’s ongoing work will certainly have a meaningful impact on the field of overseas Chinese history. Research libraries and graduate students will want to acquire The Nanyang Revolution. It not only sheds important light on the mcp in Southeast Asia but also adds to our understanding of such larger themes as migration, nationalism, globalism, and revolution. Belogurova has deftly helped to untangle these complex strands within colonial Southeast Asia.