Asia and digital economy agreements : necessity and uncertainty

As the modern economy becomes increasingly digitalised, countries such as Singapore have recognised the need to focus on incorporating new digital rules and provisions. Specifically, this has led Singapore to formalise Digital Economy Agreements (DEAs) with its trade partners. Essentially, DEAs establish frameworks making digital trade and e-commerce standards and systems interoperable. While Singapore and other like-minded countries have begun forging DEAs with ambitions to expand these networks, the geopolitical aspects of Sino-US competition, especially in the technology field, have brought in a significant level of tension and uncertainty. The effects are particularly acute in regional blocs such as ASEAN, a potential theatre of US-China contestation. This policy brief assesses the need for DEAs and how countries ought to think about developing digital cooperation. It also examines obstacles that may arise from external factors such as great power rivalry, and possible ways countries can navigate these challenges

Estimating patient-specific treatment advantages in the ‘Treatment for Adolescents with Depression Study’

The 'Treatment for Adolescents with Depression Study' (TADS, ClinicalTrials.gov, identifier: NCT00006286) was a cornerstone, randomized controlled trial evaluating the effectiveness of standard treatment options for major depression in adolescents. Whereas previous TADS analyses examined primarily effect modifications of treatment-placebo differences by various patient characteristics, less is known about the modification of inter-treatment differences, and hence, patient characteristics that might guide treatment selection. We sought to fill this gap by estimating patient-specific inter-treatment differences as a function of patients' baseline characteristics. We did so by applying the 'model-based random forest', a recently-introduced machine learning-based method for evaluating effect heterogeneity that allows for the estimation of patient-specific treatment effects as a function of arbitrary baseline characteristics. Treatment conditions were cognitive-behavioural therapy (CBT) alone, fluoxetine (FLX) alone, and the combination of CBT and fluoxetine (COMB). All inter-treatment differences (CBT vs. FLX; CBT vs. COMB; FLX vs. COMB) were evaluated across 23 potential effect modifiers extracted from previous studies. Overall, FLX was superior to CBT, while COMB was superior to both CBT and FLX. Evidence for effect heterogeneity was found for the CBT-FLX difference and the FLX-COMB difference, but not for the CBT-COMB difference. Baseline depression severity modified the CBT-FLX difference; whereas baseline depression severity, patients' treatment expectations, and childhood trauma modified the FLX-COMB difference. All modifications were quantitative rather than qualitative, however, meaning that the differences varied only in magnitude, but not direction. These findings imply that combining CBT with fluoxetine may be superior to either therapy used alone across a broad range of patients

Robustness of an Artificial Intelligence Solution for Diagnosis of Normal Chest X-Rays

Purpose: Artificial intelligence (AI) solutions for medical diagnosis require thorough evaluation to demonstrate that performance is maintained for all patient sub-groups and to ensure that proposed improvements in care will be delivered equitably. This study evaluates the robustness of an AI solution for the diagnosis of normal chest X-rays (CXRs) by comparing performance across multiple patient and environmental subgroups, as well as comparing AI errors with those made by human experts. Methods: A total of 4,060 CXRs were sampled to represent a diverse dataset of NHS patients and care settings. Ground-truth labels were assigned by a 3-radiologist panel. AI performance was evaluated against assigned labels and sub-groups analysis was conducted against patient age and sex, as well as CXR view, modality, device manufacturer and hospital site. Results: The AI solution was able to remove 18.5% of the dataset by classification as High Confidence Normal (HCN). This was associated with a negative predictive value (NPV) of 96.0%, compared to 89.1% for diagnosis of normal scans by radiologists. In all AI false negative (FN) cases, a radiologist was found to have also made the same error when compared to final ground-truth labels. Subgroup analysis showed no statistically significant variations in AI performance, whilst reduced normal classification was observed in data from some hospital sites. Conclusion: We show the AI solution could provide meaningful workload savings by diagnosis of 18.5% of scans as HCN with a superior NPV to human readers. The AI solution is shown to perform well across patient subgroups and error cases were shown to be subjective or subtle in nature

Planar photonic crystals infiltrated with nanoparticle/polymer composites

© 2007 American Institute of Physics. The electronic version of this article is the complete one and can be found at: http://dx.doi.org/10.1063/1.2817964DOI: 10.1063/1.2817964Infiltration of planar two-dimensional silicon photonic crystals with nanocomposites using a simple yet effective melt processing technique is presented. The nanocomposites that were developed by evenly dispersing functionalized TiO₂ nanoparticles into a photoconducting polymer were completely filled into photonic crystals with hole sizes ranging from 90 to 500 nm. The infiltrated devices show tuning of the photonic band gap that is controllable by the adjustment of the nanoparticle loading level. These results may be useful in the development of tunable photonic crystal based devices and hybrid light emitting diodes and solar cells

The impact of metformin with or without lifestyle modification versus placebo on polycystic ovary syndrome : a systematic review and meta-analysis of randomized controlled trials

Objective: Available evidence has shown that metformin improves insulin sensitivity and weight management in polycystic ovary syndrome (PCOS). Nevertheless, key knowledge gaps remain regarding its efficacy and the specific outcomes in this population. This review evaluates the effectiveness of metformin and lifestyle modification compared with placebo in the management of PCOS and will inform the forthcoming, 2023 evidence-based PCOS guidelines. Design: Systematic review and meta-analysis of the literature. Methods: A search was performed in MEDLINE, EMBASE, PsycINFO, All EBM, and CINAHL. The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and included randomized controlled trials published in English through July 2022. Results: Moderate certainty of evidence showed a larger reduction of body mass index (BMI) (mean difference [MD] −0.53, 95% confidence interval [CI] −0.95 to −0.12 kg/m2 ), homeostatic model assessment for insulin resistance (MD −0.50, 95% CI −0.91 to −0.09) (critical outcomes), and fasting glucose (MD −0.13, 95% CI −0.19 to −0.07 mmol/L) with metformin compared to placebo with increased mild gastrointestinal adverse effects (odds ratio [OR] 7.67, 95% CI 2.74–21.46). Low certainty of evidence showed a larger reduction of waist–hip ratio (MD −0.02, 95% CI −0.03 to −0.00), total cholesterol (MD −0.24, 95% CI −0.43 to −0.05 mmol/L), low density lipoprotein (MD −0.16, 95% CI −0.30 to −0.01 mmol/L), and triglycerides (MD −0.11, 95% CI −0.20 to −0.02 mmol/L) with metformin than placebo. Conclusions: Metformin should be considered an efficacious adjunct to lifestyle interventions in adults with PCOS, especially for those with a higher BMI, to improve weight loss, insulin resistance, and lipids

Readmissions, death and its associated predictors in heart failure with preserved versus reduced ejection fraction

BACKGROUND: Data on rehospitalizations for heart failure (HF) in Asia are scarce. We sought to determine the burden and predictors of HF (first and recurrent) rehospitalizations and all‐cause mortality in patients with HF and preserved versus reduced ejection fraction (preserved EF, ≥50%; reduced EF, <40%), in the multinational ASIAN‐HF (Asian Sudden Cardiac Death in Heart Failure) registry. METHODS AND RESULTS: Patients with symptomatic (stage C) chronic HF were followed up for death and recurrent HF hospitalizations for 1 year. Predictors of HF hospitalizations or all‐cause mortality were examined with Cox regression for time to first event and other methods for recurrent events analyses. Among 1666 patients with HF with preserved EF (mean age, 68±12 years; 50% women), and 4479 with HF with reduced EF (mean age, 61±13 years; 22% women), there were 642 and 2302 readmissions, with 28% and 45% attributed to HF, respectively. The 1‐year composite event rate for first HF hospitalization or all‐cause death was 11% and 21%, and for total HF hospitalization and all‐cause death was 17.7 and 38.7 per 100 patient‐years in HF with preserved EF and HF with reduced EF, respectively. In HF with preserved EF, consistent independent predictors of these clinical end points included enrollment as an inpatient, Southeast Asian location, and comorbid chronic kidney disease or atrial fibrillation. The same variables were predictive of outcomes in HF with reduced EF except atrial fibrillation, and also included Northeast Asian location, older age, elevated heart rate, decreased systolic blood pressure, diabetes, smoking, and non‐usage of beta blockers. CONCLUSIONS: One‐year HF rehospitalization and mortality rates were high among Asian patients with HF. Predictors of outcomes identified in this study could aid in risk stratification and timely interventions. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01633398

Synthesis and evaluation of novel dental monomer with branched carboxyl acid group

To enhance the water miscibility and increase the mechanical properties of dentin adhesives, a new glycerol-based monomer with vinyl and carboxylic acid, 4-((1,3-bis(-methacryloyloxy)propan-2-yl)oxy)-2-methylene-4-oxobutanoic acid (BMPMOB), was synthesized and characterized. Dentin adhesive formulations containing 2-hydroxyethyl methacrylate (HEMA), 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]propane (BisGMA), and BMPMOB were characterized with regard to real-time photopolymerization behavior, water sorption, dynamic mechanical analysis, and microscale three-dimensional internal morphologies and compared with HEMA/BisGMA controls. The experimental adhesive copolymers showed higher glass transition temperature and rubbery moduli, as well as improved water miscibility compared to the controls. The enhanced properties of the adhesive copolymers indicated that BMPMOB is a promising comonomer for dental restorative materials

Structural and doping effects in the half-metallic double perovskite A2A_2CrWO6_6

he structural, transport, magnetic and optical properties of the double perovskite $A_2$CrWO$_6$ with $A=\text{Sr, Ba, Ca}$ have been studied. By varying the alkaline earth ion on the $A$ site, the influence of steric effects on the Curie temperature $T_C$ and the saturation magnetization has been determined. A maximum $T_C=458$ K was found for Sr$_2$CrWO$_6$ having an almost undistorted perovskite structure with a tolerance factor $f\simeq 1$. For Ca$_2$CrWO$_6$ and Ba$_2$CrWO$_6$ structural changes result in a strong reduction of $T_C$. Our study strongly suggests that for the double perovskites in general an optimum $T_C$ is achieved only for $f \simeq 1$, that is, for an undistorted perovskite structure. Electron doping in Sr$_2$CrWO$_6$ by a partial substitution of Sr$^{2+}$ by La$^{3+}$ was found to reduce both $T_C$ and the saturation magnetization $M_s$. The reduction of $M_s$ could be attributed both to band structure effects and the Cr/W antisites induced by doping. Band structure calculations for Sr$_2$CrWO$_6$ predict an energy gap in the spin-up band, but a finite density of states for the spin-down band. The predictions of the band structure calculation are consistent with our optical measurements. Our experimental results support the presence of a kinetic energy driven mechanism in $A_2$CrWO$_6$, where ferromagnetism is stabilized by a hybridization of states of the nonmagnetic W-site positioned in between the high spin Cr-sites.Comment: 14 pages, 10 figure