National survey of outcomes and practices in acute respiratory distress syndrome in Singapore

The authors acknowledge the following as the total funding sources for this study: 1. SICM NICER grant: logistical, non-monetary, support from the Society of Intensive Care Medicine Singapore. This was in the form of Ngee Ann Polytechnic students (8) who collected the data for the study for one month. 2. NMRC (National medical research council) grant for Dr, Matthew Cove (partial support for this study): This was in the shape of salary support for all his research related activity. (NMRC/TA/0015/2013) (MEC)

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Drug delivery of 5-fluorouracil and biodegradation of injectable polymer-depots

79 p.In this research work, a novel controlled drug delivery system was studied. The system is made up of water insoluble, biodegradable polymers; poly (D,L lactide) (PDLLA) and poly (D,L-lactide-co-glycolide) (PLGA), dissolved in N-methyl-2-pyrrolidone (NMP). Such a polymer solution forms gel depot upon injection into the body fluids and the depot itself gradually degrades with time. A highly potent drug, 5-fluorouracil (5-FU) is incorporated into the depot to achieve the sustainable release profile.Master of Science (Biomedical Engineering

The Association of Dry Eye Symptoms with Socioeconomic Factors and quality of Life

Purpose: Dry eye is a common condition with significant morbidity and socioeconomic burden. The associated demographic factors that worsen utility in dry eye patients were not known. There were many questionnaire instruments advocated for dry eye documentation but none of these have been shown to correlate to quality of life (QoL). We aimed at examining the health related utility values in a group of dry eye patients and their associations.Methods: This was a hospital based prospective cross-sectional study conducted at the dry eye clinic of Singapore National Eye Centre. Patients with dry eye symptoms were randomized to one of the two validated symptom questionnaires, Standard Patient Evaluation of Eye Dryness (SPEED) or Symptom Assessment in Dry Eye (SANDE) questionnaires. All patients underwent an evaluation of socio economic factors and utility was assessed using Time-Trade-Off methodby 4 trained interviewers.Results: We recruited 178 participants with dry eye symptoms (mean age was 56.4 (SD: 14.1) years, 77% female), 85 were assessed with SPEED and 93 with SANDE. The utility values encountered were skewed with only 52% of patients having a reduced utility (median=1.0) with a mean of 0.984 (SD: 0.11). The mean SPEED was 11.7 (5.6), and the mean SANDE was 56.8 (22.6). A higher symptom score was associated with a utility less than 1 with odds ratio 2.75 (95%CI 1.50-5.04). The correlation between SANDE and utility was r=-0.295 (-0.47 to -0.097) and corresponding correlation for SPEED and utility was not significant. To detect a utility less than 1, SPEED had an area under the curve (AUC) of 0.63 (95%CI 0.51-0.75) and the SANDE, 0.67 (0.56-0.77).Conclusions: The health related QoL was relatively good in people with dry eye symptoms in this study. Increased symptoms were associated with decreasing QoL but the association was in general weak. This implied that causes of reduced QoL apart from symptoms, such as costs, treatment inconvenience or adverse effects should be explored.</p

Effect of extended visiting hours on physician distractions in the ICU: a before-and-after study

10.1186/s13054-017-1830-yCritical Care21124

Deep Reinforcement Learning based Joint Spectrum Allocation and Configuration Design for STAR-RIS-Assisted V2X Communications

Vehicle-to-Everything (V2X) communications play a crucial role in ensuring safe and efficient modern transportation systems. However, challenges arise in scenarios with buildings, leading to signal obstruction and coverage limitations. To alleviate these challenges, reconfigurable intelligent surface (RIS) is regarded as an effective solution for communication performance by tuning passive signal reflection. RIS has acquired prominence in 6G networks due to its improved spectral efficiency, simple deployment, and cost-effectiveness. Nevertheless, conventional RIS solutions have coverage limitations. Therefore, researchers have started focusing on the promising concept of simultaneously transmitting and reflecting RIS (STAR-RIS), which provides 360\degree coverage while utilizing the advantages of RIS technology. In this paper, a STAR-RIS-assisted V2X communication system is investigated. An optimization problem is formulated to maximize the achievable data rate for vehicle-to-infrastructure (V2I) users while satisfying the latency and reliability requirements of vehicle-to-vehicle (V2V) pairs by jointly optimizing the spectrum allocation, amplitudes, and phase shifts of STAR-RIS elements, digital beamforming vectors for V2I links, and transmit power for V2V pairs. Since it is challenging to solve in polynomial time, we decompose our problem into two sub-problems. For the first sub-problem, we model the control variables as a Markov Decision Process (MDP) and propose a combined double deep Q-network (DDQN) with an attention mechanism so that the model can potentially focus on relevant inputs. For the latter, a standard optimization-based approach is implemented to provide a real-time solution, reducing computational costs. Extensive numerical analysis is developed to demonstrate the superiority of our proposed algorithm compared to benchmark schemes.Comment: 12 pages, 9 figure

Prevalence and determinants of tobacco use among youth in Myanmar: review of findings from Global Youth Tobacco Survey 2016 Data

Background The study aims to reassess the health, knowledge and practice of students, (9-11 Grades) after the introduction of New National Tobacco Control program for 5 years. This study includes data on prevalence of cigarettes and other tobacco use as well as information on five determinants of tobacco use: access, exposure to secondhand smoke (SHS), cessation, media and advertising, and other indicators. Methods Myanmar GYTS uses a two-stage sample design with schools selected proportional to enrolment size. A total of 3633 eligible students in grades 9-11 completed the survey ,of which 2621 were aged 13-15 years Results Between 2011 and 2016, a reduction in the proportion of students currently use any tobacco products is observed (a fall from overall prevalence among 13-15 year olds of 18.6% to 14%). but currently smoked cigarettes had increased during the period from 6.8% to 8.3%. Currently use any smokeless tobacco products had decreased (9.8% to 5.7%). 74.5% of current smokers tried to stop smoking in the past 12 months.33.2% are exposed to tobacco smoke at home as well as 28.4% are exposed tobacco smoke inside any enclosed public place. 61% of current cigarette smokers bought cigarettes from a store, shop or street vendors. 42.3% of students noticed tobacco advertisements on point of sale. 65% of students thought other people's smoking is harmful to them. Conclusions Myanmar Youth Tobacco program should strengthen in all schools to be 100% tobacco-free and also incorporate training of school personnel on tobacco control, specifically youth-focused programs as joint efforts between Ministry of Health and Sports and Ministry of Education in collaboration with related ministries. Enforcement of the national legislation on tobacco control needs to be strengthened, and the National Tobacco Control Program needs to be more comprehensive incorporating measures to reduce smokeless tobacco use and other non-cigarette tobacco products

Is Oral Health Problems One of the Reasons for Encounters in Medical Primary Care Clinics in Malaysia A Pilot Epidemiological Study Among Selected Three Medical Primary Care Clinics in Kuantan, Malaysia

Introduction: Primary care physicians provide a wide range of care including oral health problems (OHPs). However, epidemiological studies on OHPs in medical primary care clinics (MPCCs) are still limited. The prevalence of patients with OHPs in MPCCs and their epidemiological variables were verified in this study. Methods: A comparative cross-sectional study was conducted among three different MPCCs – university clinic (IIUM), public clinic (Balok) and private clinic (Clinic Ar Razi) in Kuantan from April 2012 to March 2013. Data of patients with OHPs were extracted from patient’ registers and their age, gender, reason for encounter (RFE)and consultation time (day or night) were noted. Interval prevalence was considered for the study. An exploratory analysis between patients’ epidemiological variables and RFE among three different clinics was done. Results: Out of a total of 84,251 patients, 605 patients with OHPs were identified. The prevalence of OHPs in the university, public and private clinic was 9.3, 10.9 and 5.4 per 1000 patients per year, respectively. In the private clinic, 58% of cases were night-calls. The mean (±SD) age of patients from the university, public and private clinic was 22.8(±11.7), 23.1(±17.6) and 17.9(±18.8) years, respectively. The male and female ratio in university, public and private clinic was (36.5% vs. 63.5%), (44.4% vs. 55.6%) and (50.8% vs. 49.2%), respectively. The RFEs were mouth ulcer (50.4%), gingivitis (17.7%), toothache (12.6%), mouth pain (8.9%), hand-foot-mouth-disease (7.8%), gum abscess (1.8%), more than one OHP (0.5%) and teething (0.3%). Although there were no significant differences between age groups and RFEs of patients with OHPs who attended the university clinic, it was significant in the other two clinics (p<0.05). Conclusion: This study highlighted that OHPs was one of RFEs in MPCCs. The epidemiological findings of the study will be valuable for health planners to provide better OH care in MPCCs