Browsing by Author "Liu, Chang"
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Item Open Access Community-Based Long-Term Care Services: If We Build It, Will They Come?(Journal of aging and health, 2016-03) Liu, Chang; Eom, Kirsten; Matchar, David B; Chong, Wayne F; Chan, Angelique WMObjective
This study examines the relationship between caregivers' perception of community-based long-term care (CBLTC) services and the service use.Method
We used first two waves of the longitudinal data set of 1,416 dyads of care recipients and their caregivers in Singapore. Four perceived attributes of LTC services--service quality, convenience, social connectedness, and affordability--were measured on a 5-point scale.Results
Among the four perceived attributes, perceived affordability was significantly associated with future utilization for all types of CBLTC services. Perceived service quality and convenience was significantly associated with center-based LTC services use.Discussion
Caregivers are critically involved in the decision of using CBLTC services, and their perception of service characteristics is significantly associated with the uptake of CBLTC services. It is important to incorporate both care recipients' and caregivers' needs and preferences when designing and promoting integrated health care delivery models.Item Open Access Detecting Germline PTEN Mutations Among At-Risk Patients With Cancer: An Age- and Sex-Specific Cost-Effectiveness Analysis.(Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-08) Ngeow, Joanne; Liu, Chang; Zhou, Ke; Frick, Kevin D; Matchar, David B; Eng, CharisPurpose
Cowden syndrome (CS) is an autosomal dominant disorder characterized by benign and malignant tumors. One-quarter of patients who are diagnosed with CS have pathogenic germline PTEN mutations, which increase the risk of the development of breast, thyroid, uterine, renal, and other cancers. PTEN testing and regular, intensive cancer surveillance allow for early detection and treatment of these cancers for mutation-positive patients and their relatives. Individual CS-related features, however, occur commonly in the general population, making it challenging for clinicians to identify CS-like patients to offer PTEN testing.Patients and methods
We calculated the cost per mutation detected and analyzed the cost-effectiveness of performing selected PTEN testing among CS-like patients using a semi-quantitative score (the PTEN Cleveland Clinic [CC] score) compared with existing diagnostic criteria. In our model, first-degree relatives of the patients with detected PTEN mutations are offered PTEN testing. All individuals with detected PTEN mutations are offered cancer surveillance.Results
CC score at a threshold of 15 (CC15) costs from $3,720 to $4,573 to detect one PTEN mutation, which is the most inexpensive among the different strategies. At base-case, CC10 is the most cost-effective strategy for female patients who are younger than 40 years, and CC15 is the most cost-effective strategy for female patients who are between 40 and 60 years of age and male patients of all ages. In sensitivity analyses, CC15 is robustly the most cost-effective strategy for probands who are younger than 60 years.Conclusion
Use of the CC score as a clinical risk calculator is a cost-effective prescreening method to identify CS-like patients for PTEN germline testing.Item Open Access From Hospital to Home: Impact of Transitional Care on Cost, Hospitalisation and Mortality.(Annals of the Academy of Medicine, Singapore, 2019-10) Ang, Yan Hoon; Ginting, Mimaika Luluina; Wong, Chek Hooi; Tew, Chee Wee; Liu, Chang; Sivapragasam, Nirmali Ruth; Matchar, David BruceItem Open Access Genome-wide analysis identifies novel susceptibility loci for myocardial infarction.(European heart journal, 2021-03) Hartiala, Jaana A; Han, Yi; Jia, Qiong; Hilser, James R; Huang, Pin; Gukasyan, Janet; Schwartzman, William S; Cai, Zhiheng; Biswas, Subarna; Trégouët, David-Alexandre; Smith, Nicholas L; INVENT Consortium; CHARGE Consortium Hemostasis Working Group; GENIUS-CHD Consortium; Seldin, Marcus; Pan, Calvin; Mehrabian, Margarete; Lusis, Aldons J; Bazeley, Peter; Sun, Yan V; Liu, Chang; Quyyumi, Arshed A; Scholz, Markus; Thiery, Joachim; Delgado, Graciela E; Kleber, Marcus E; März, Winfried; Howe, Laurence J; Asselbergs, Folkert W; van Vugt, Marion; Vlachojannis, Georgios J; Patel, Riyaz S; Lyytikäinen, Leo-Pekka; Kähönen, Mika; Lehtimäki, Terho; Nieminen, Tuomo VM; Kuukasjärvi, Pekka; Laurikka, Jari O; Chang, Xuling; Heng, Chew-Kiat; Jiang, Rong; Kraus, William E; Hauser, Elizabeth R; Ferguson, Jane F; Reilly, Muredach P; Ito, Kaoru; Koyama, Satoshi; Kamatani, Yoichiro; Komuro, Issei; Biobank Japan; Stolze, Lindsey K; Romanoski, Casey E; Khan, Mohammad Daud; Turner, Adam W; Miller, Clint L; Aherrahrou, Redouane; Civelek, Mete; Ma, Lijiang; Björkegren, Johan LM; Kumar, S Ram; Tang, WH Wilson; Hazen, Stanley L; Allayee, HoomanAims
While most patients with myocardial infarction (MI) have underlying coronary atherosclerosis, not all patients with coronary artery disease (CAD) develop MI. We sought to address the hypothesis that some of the genetic factors which establish atherosclerosis may be distinct from those that predispose to vulnerable plaques and thrombus formation.Methods and results
We carried out a genome-wide association study for MI in the UK Biobank (n∼472 000), followed by a meta-analysis with summary statistics from the CARDIoGRAMplusC4D Consortium (n∼167 000). Multiple independent replication analyses and functional approaches were used to prioritize loci and evaluate positional candidate genes. Eight novel regions were identified for MI at the genome wide significance level, of which effect sizes at six loci were more robust for MI than for CAD without the presence of MI. Confirmatory evidence for association of a locus on chromosome 1p21.3 harbouring choline-like transporter 3 (SLC44A3) with MI in the context of CAD, but not with coronary atherosclerosis itself, was obtained in Biobank Japan (n∼165 000) and 16 independent angiography-based cohorts (n∼27 000). Follow-up analyses did not reveal association of the SLC44A3 locus with CAD risk factors, biomarkers of coagulation, other thrombotic diseases, or plasma levels of a broad array of metabolites, including choline, trimethylamine N-oxide, and betaine. However, aortic expression of SLC44A3 was increased in carriers of the MI risk allele at chromosome 1p21.3, increased in ischaemic (vs. non-diseased) coronary arteries, up-regulated in human aortic endothelial cells treated with interleukin-1β (vs. vehicle), and associated with smooth muscle cell migration in vitro.Conclusions
A large-scale analysis comprising ∼831 000 subjects revealed novel genetic determinants of MI and implicated SLC44A3 in the pathophysiology of vulnerable plaques.Item Open Access Projecting the effects of long-term care policy on the labor market participation of primary informal family caregivers of elderly with disability: insights from a dynamic simulation model.(BMC geriatrics, 2016-03-23) Ansah, John P; Matchar, David B; Malhotra, Rahul; Love, Sean R; Liu, Chang; Do, YoungBackground
Using Singapore as a case study, this paper aims to understand the effects of the current long-term care policy and various alternative policy options on the labor market participation of primary informal family caregivers of elderly with disability.Methods
A model of the long-term care system in Singapore was developed using System Dynamics methodology.Results
Under the current long-term care policy, by 2030, 6.9 percent of primary informal family caregivers (0.34 percent of the domestic labor supply) are expected to withdraw from the labor market. Alternative policy options reduce primary informal family caregiver labor market withdrawal; however, the number of workers required to scale up long-term care services is greater than the number of caregivers who can be expected to return to the labor market.Conclusions
Policymakers may face a dilemma between admitting more foreign workers to provide long-term care services and depending on primary informal family caregivers.Item Open Access The Alife Bestiary: An AR Object Recognition Project on the Archivolt of Alife(2019) Liu, ChangThe archivolt of Alife being exhibited as a part of the Brummer Collect in the Nasher Museum of Art at Duke University is an enigmatic artifact with many unknown elements. Specifically, the iconography, one of the aspects of the archivolt that has not been explored by many scholars, has several possible interpretations to each of the animals depicted. Despite the amount of information that can be presented as interesting knowledge, scholarly discourse and research involving an artifact is generally not presented to the public due to the complexity of the information. Therefore, by using augmented reality and object recognition technology, this thesis aims to present the multiple iconographic theories regarding the key animals on the archivolt of Alife in a dynamic manner, giving users insight on how to view the iconography by making scholarly information more accessible. The digital component of this thesis uses the newest object recognition algorithm provided by ARKit to build an interactive app that allows the viewers to see “info cards” directly overlaid on top of the iconography. Although the current state of AR technology still has limitations regarding buildability and malleability, the usable prototype of this application was successfully produced and is subject to future expansions and experiments.